Spatial and Socioeconomic Inequalities in Cesarean Section Deliveries in Urban Settings in Dakar, Senegal.

As part of an initiative aimed at reducing maternal and child mortality, Senegal implemented a policy of free Cesarean section (C-section) since 2005. Despite the implementation, C-section rates have remained low and significant large disparities in access, particularly in major cities such as Dakar. This paper aims to assess C-section rates and examines socioeconomic inequalities in C-section use in the Dakar region between 2005 and 2019. This study incorporates data from various sources, including the health routine data within District Health Information Software 2 (DHIS2) platform, government statistics on slum areas, and data from Demographic and Health Surveys (DHS). A geospatial analysis was conducted to identify locations of Comprehensive emergency obstetric and Newborn Care (CEmONC) services using the Direction des Travaux Géographiques et Cartographiques (DTGC) databases and satellite imagery from the Google Earth platform. The analytical approach encompassed univariate, bivariate, and multivariate analyses. The C-section rate fluctuated over the years, increasing from 11.1% in 2005 to 16.4% in 2011, declined to 9.8% in 2014, and then raised to 13.3% in 2019. The wealth tertile demonstrated a positive correlation with C-sections in urban areas of the Dakar region. Geospatial analyses revealed that women residing in slum areas were less likely to undergo C-section deliveries. These findings underscore the importance of public health policies extending beyond merely providing free C-section delivery services. Strategies that improve equitable access to C-section delivery services for women across all socioeconomic strata are needed, particularly targeting the poor women and those in urban slums.

Not Lost in Translation: The Use of Standardized Patients Technology among Health Professional Students in Tanzania.

Health professionals in Tanzania report a perceived need for sexual and reproductive health communication training to meet patient needs and reduce disparities. Simulation optimizes clinical performance and public entrustment. The study describes the development, feasibility, and acceptability measures of evidence-based, Afrocentric, standardized patient scenarios to train nursing, medical, and midwifery students in sexual and reproductive health in Tanzania. Standardized patient simulation cases with embedded cultural, language, gender, age, sexuality, and legal complexity issues were identified by stakeholders in Dar es Salaam centering on;1) adolescent health, 2) women's health, and 3) male health cases. Twenty-four health professional students evenly split across nursing, midwifery, and medicine were recruited and enrolled to participate in a pilot trial of the standardized patient simulations conducted in Kiswahili and the results recorded. Videos were evaluated by trained bilingual research staff using standardized behavioral checklists. Descriptive statistics and bivariate analyses were used to assess the pilot data. The study found that seventy-five percent (N =18) of baseline participants (N=24) returned for the 3-month follow-up simulation assessment. While not powered for statistical significance, students showed improvement in all cases and a significant improvement in the male erectile dysfunction concerns case for both interpersonal communication (t (17) = -3.445, p < .005) and medical history taking checklist (t(17)= -3.259, p < .005). Further, most students found the opportunity to practice using the simulations helpful or very helpful in their sexual and reproductive health education. It was therefore concluded that preliminary sexual and reproductive health simulation data using standardized patients demonstrated feasibility and acceptability among student participants.

Integrating private health facilities in government-led health systems: a case study of the public-private mix approach in Ethiopia.

BACKGROUND: Private health care facilities working in partnership with the public health sector is one option to create sustainable health systems and ensure health and well-being for all in low-income countries. As the second-most populous country in Africa with a rapidly growing economy, demand for health services in Ethiopia is increasing and one-quarter of its health facilities are privately owned. The Private Health Sector Program (PHSP), funded by the United States Agency for International Development, implemented a series of public-private partnership in health projects from 2004 to 2020 to address several public health priorities, including tuberculosis, malaria, HIV/AIDS, and family planning. We assessed PHSP's performance in leadership and governance, access to medicines, health management information systems, human resources, service provision, and finance. METHODS: The World Health Organization's health systems strengthening framework, which is organized around six health system building blocks, guided the assessment. We conducted 50 key informant interviews and a health facility assessment at 106 private health facilities supported by the PHSP to evaluate its performance. RESULTS: All six building blocks were addressed by the program and key informants shared that several policy and strategic changes were conducive to supporting the functioning of private health facilities. The provision of free medicines from the public pharmaceutical logistics system, relaxation of strict regulatory policies that restricted service provision through the private sector, training of private providers, and public-private mix guidelines developed for tuberculosis, malaria, and reproductive, maternal, newborn, child, and adolescent health helped increase the use of services at health facilities. CONCLUSIONS: Some challenges and threats to sustainability remain, including fragile partnerships between public and private bodies, resource constraints, mistrust between the public and private sectors, limited incentives for the private sector, and oversight of the quality of services. To continue with gains in the policy environment, service accessibility, and other aspects of the health system, the government and international communities must work collaboratively to address public-private partnerships in health areas that can be strengthened. Future efforts should emphasize a mechanism to ensure that the private sector is capable, incentivized, and supervised to deliver continuous, high-quality and equitable services.