Knowledge of and Attitudes Toward Hearing Loss Among Primary Care Physicians in the Public Health Sector of Mauritius.

Introduction Primary care physicians are essential first points of contact for patients with hearing loss. Thus, knowledge of hearing loss and related aspects is essential to ensure the optimal management of individuals with suspected hearing loss. Objective This study aimed to determine the knowledge of and attitudes toward hearing loss among primary care physicians in the public health sector in Mauritius. Methods In this cross-sectional descriptive cohort study, 320 primary care physicians completed an online questionnaire adapted from previous questionnaires on knowledge of and attitudes toward hearing loss. Responses were analyzed using descriptive statistics and cross-sectional analyses. Results Primary care physicians showed limited knowledge of hearing loss in areas such as early identification and intervention, professionals responsible for hearing assessments, and hearing tests used for assessing hearing sensitivity. However, the responses also showed positive attitudes toward hearing loss. Significant associations between knowledge of and attitudes toward hearing loss were obtained regarding the type of physician, length of practice, and department posted in. Ear, nose, and throat specialists, as well as pediatricians, demonstrated significantly higher scores for both knowledge of and positive attitudes toward hearing loss. Conclusions The findings highlight a strong need for ongoing medical education to spread awareness about hearing loss among primary care physicians in the public health sector of Mauritius.

Evaluation of outstanding theories in outsourcing with practices in the public health sector: The case of Türkiye.

Outsourcing is an essential tool in supply management. This study examines the current outsourcing application areas of the public health sector in Türkiye. Application examples are presented, together with the prominent theories in outsourcing (Transaction Cost Economics Theory (TCE), Core Competencies Theory (CCT), Agency Theory (AT), Resource-Based View Theory (RBVT), Relational Theory (RT), and Social Change Theory (SCT), Turkish public procurement legislation, Ministry of Health outsourcing practices, and public hospitals are discussed for review and example. The examination shows that foreign dependency on the public health sector is increasing, and more than one theory is applied in some procurement processes. As a result of this study, examining and comparing which theories come to the fore in outsourcing in other countries is recommended.

Assessing public health sector performance in Bangladesh: Implications for health systems strengthening and universal health coverage - A secondary data analysis.

The Ministry of Health and Family Welfare has established a health systems strengthening initiative for measuring the performance of public sector health facilities in Bangladesh. The objective of the performance management initiative is to establish routine systems for measuring and scoring health facility performance and promote best practices in public health service management. The performance initiative includes a set of assessments conducted across the four tiers of the public health sector. The findings of assessments demonstrate improvements in the quality of health services and a sharp increase in the utilisation of services across all tiers during the period 2017-2019. The performance management initiative has also identified areas for improvement in the supply-side health system readiness, including ensuring an adequate supply of human resources, essential medicines, and functioning medical equipment and technologies. This initiative outlines the need to systematically address the issue of high health workforce vacancy rates through effective human resource planning and management strategies. The reporting of these ongoing health systems successes and challenges through the performance management initiative in Bangladesh provides an opportunity to develop evidence-based policy reforms for strengthening supply-side health systems. The initiative results, particularly in the context of growing public demand for services, also justifies a monitoring and evaluation mechanism focusing on the quality and coverage of frontline health facilities and the development of more integrated health systems. The performance management initiative will facilitate the maintenance of essential health services while addressing emergency health needs and tracking progress towards achieving the Universal Health Coverage goal.

Inequality in health care services in urban and rural settings in South Africa.

In low- and middle-income countries, urban and rural settings are distinct communities with the latter being more likely to have limited resources, particularly in health care services. We assessed the inequality in health care services in urban and rural settings in South Africa, highlighting the disparities between public and private health services, given that the latter are located mainly in urban settings. Rural settings suffer the highest inequality in the availability of drugs and supplies, overcrowding of health care facilities, delays in transporting patients, inadequate emergency medical services, and lack of experienced health care professionals. Rural settings also preferentially have a shortage of various levels of health care services, and increased security threats by criminals. In addition to specific remedies, the overarching key to solving these challenges is socio-economic growth, as well as visionary and compassionate leadership with integrity and accountability, which ensures policy development, implementation, monitoring, and evaluation.

Clinical learning environments across two different healthcare settings using the undergraduate clinical education environment measure.

BACKGROUND: The clinical placements of our medical students are almost equally distributed across private and public sectors. This study aims to assess medical students' perceptions of their Clinical learning Environment (CLE) across these two different healthcare settings, using the Undergraduate Clinical Education Environment Measure (UCEEM). METHODS: 76 undergraduate medical students (Year 5 and 6), were invited to participate. Data were collected using an online UCEEM with additional questions related to demographics and case load exposure. The UCEEM consists of two overarching domains of experiential learning and social participation, with four subdomains of learning opportunities, preparedness, workplace interaction, and inclusion. RESULTS: 38 questionnaires were received. Of 225 responses to the individual UCEEM items, 51 (22.6%) scored a mean of ≥ 4 (range 4-4.5, representing strong areas), 31 (13.7%) scored a mean of ≤ 3 (range 2.1-3, needing attention) and 143 (63.6%) scored a mean of 3.1-3.9 (areas that could be improved). The majority (63%) of the case load exposure responses scored a mean of ≥ 4 (range 4-4.5). Compared to the private sittings, there is a significant reduction in total UCEEM (p = 0.008), preparedness for student entry (p = 0.003), and overarching dimension of social participation (p = 0.000) scores for the public sector. Similarly, both workplace interaction patterns and student inclusion and equal treatment scored significantly lower for the public sector (p = 0.000 and p = 0.011 respectively). Two out of three case load exposure items scored significantly higher for the public sector (p = 0.000). DISCUSSION: The students' CLE perceptions were generally positive. The lower UCEEM ratings in the public sector items were related to student entry preparedness, workplace interactions, student inclusiveness and workforce equity of treatment. In contrast the students were exposed to more variety and larger number of patients in the public sector. These differences indicated some significantly different learning environments between the two sectors.

Covid-19 corruption in the public health sector-emerging evidence from Bangladesh.

This paper explores Covid-19-related corruption in Bangladesh. Specifically, we analyse the issue of Covid-19-related corruption in the health sector of Bangladesh. We also explore how denial strategies adapted by government officials have worsened the problem. Using Cohen's notion of denial strategies (Cohen 2001. States of Denial. Cambridge: Polity), we analyse media reports during the pandemic that highlighted Covid-19-related corruption occurring in the Bangladeshi health sector. Our analyses reveal that the Covid-19 pandemic has given rise to a new wave of corruption, particularly in the procurement of testing kits and personal protective equipment (PPE), as well as the issuance of false Covid-19 certificates. We call for an in-depth investigation of Covid-19-related corruption in Bangladesh and other developing countries that follows similar social, contextual and cultural values via interviews with policymakers and health professionals. Our paper extends the ongoing debate on Covid-19-related corruption and its impacts on public health sectors.

A challenging work environment: The lived experiences of Eswatini diagnostic radiographers in the public health sector.

BACKGROUND: Diagnostic radiographers play a vital role in healthcare so it is important for senior management to understand radiographer's duties and work experiences. There has been a number of studies conducted on the experiences of radiographers in other countries like the United Kingdom and South Africa. From these studies a number of work place challenges were identified. In the Eswatini healthcare context, there has been no research conducted on the daily experiences of diagnostic radiographers working in Eswatini. The country's leadership aims to attain its Vision 2022 which focusses on the attainment of the millennium development goals. This vision affects all healthcare professions so for it to be successful, it is imperative to understand what it means to be a diagnostic radiographer working in the country of Eswatini. This paper aims to address this gap in literature. AIM: The aim of this paper is to explore and describe the lived experiences of Eswatini diagnostic radiographers working in the public health sector. METHODS: A qualitative, exploratory, descriptive and phenomenological design was utilised. Participants were purposively sampled within the public health sector. Diagnostic radiographers participated voluntarily and willingly consented to participate in focus group interviews (n = 18). RESULTS: A challenging work environment emerged as a principal theme from the participants narratives with 6 sub-themes namely: Lack of resources and consumables, Shortage of radiographers, Absence of radiologists, Lack of proper radiation monitoring and safety, Poor remuneration, Stagnant professional growth. CONCLUSIONS: The findings of this study provided new insights into what Eswatini radiographers are experiencing in the public health sector. It is evident that there are a number of challenges which need to be addressed by the Eswatini management in order to successfully implement Vision 2022. Based on this study, there is the potential for a future study on the development of a professional identity for radiographers in Eswatini.

Rehabilitation Capacity in South Africa-A Situational Analysis.

Rehabilitation in South Africa (SA) operates independently of major health services and reforms, despite the increasing rehabilitation need. With the introduction of National Health Insurance (NHI), SA is facing another major health reform. Evidence is needed on the current SA rehabilitation situation, regarding shortcomings, opportunities, and priority strategic strengthening actions. We aimed to describe the current rehabilitation capacity in the SA public health sector, which serves the majority and most vulnerable South Africans. A cross-sectional survey was conducted in five provinces, using the World Health Organisation's Template for Rehabilitation Information Collection (TRIC). Participants were purposively selected for their insights and experiences of rehabilitation in specific government departments, health sectors, organisations, and/or services. TRIC responses were analysed descriptively. Participants explained how timely and effective rehabilitation produced long-term health, social, and economic benefits. Positive initiatives were reported for rehabilitation data collection, service design, and innovation. Challenges included inadequacies in human resources, the integration of rehabilitation at primary care, guidelines, and specialised long-term care facilities. The continuity of care across levels of care was sub-optimal due to inefficient referral systems. Promoting and improving rehabilitation nationally requires concerted, innovative, collaborative, and integrated efforts from multiple stakeholders within, and outside, the health system.

Generation Y medical doctors' experiences of a positive psychology 2.0 intervention for burnout in a South African public hospital.

The aim of the research was to explore experiences of a Positive Psychology 2.0 (PP2.0) intervention for burnout among Generation Y medical doctors working in a South African public hospital. The emphasis was on the potential benefits and recommended intervention amendments in a specific cultural context of South Africa. A phenomenological approach was followed in the collective case study. The Maslach Burnout Inventory was administered in phases I and III to quantify the level of burnout. This study offers findings that could be incorporated into a bigger burnout intervention strategy in the South African public hospital, involving all stakeholders to ensure that burnout is combatted on a long-term basis. Furthermore, the findings emphasized certain culture-specific structural issues and the impact that the neglection of burnout has on newly qualified medical doctors working in a South African public hospital and patients in their care. Certain recommendations were made for the South African public hospital for future research in PP2.0 interventions and for facilitators working with burnout among newly qualified medical doctors.

Expert opinions on knowledge-translation interventions for occupational therapists working with neonates in South Africa: A Delphi study.

Background: There is a paucity of literature on knowledge translation (KT) interventions for occupational therapists (OTs) in assessing and caring for the neonate and at-risk infant. Care at this stage of life is paramount, requiring a shift from the survival of the neonate, to the quality of survival. Consequently, clinicians working with neonates have a crucial role in ensuring optimal development and preventing long-term adverse developmental outcomes. Aim: This study aimed to explore experts' opinions on KT interventions for OTs working with neonates and at-risk infants in South Africa. Setting: This study was located in South Africa. Due to the virtual nature of data collection, no geographical limitations within the country were imposed. Method: A two-round Delphi study with a multidisciplinary expert panel (n = 20; n = 18) was conducted. The round one survey was developed based on a literature review, findings from a preceding focus group, and a pilot study. The subsequent round was based on the data and comments generated from the first round. Results were pooled and presented to participants following both rounds. Results: Consensus on 127 items out of 130 was achieved. These included consensus on the definition of KT in neonatal care, the knowledge that OTs should possess, professional competencies, skills required, professional values, and characteristics. Further agreement was reached on the KT process, the usefulness of KT modalities, recommended courses in neonatal care, barriers to KT, best-practice and requirements for undergraduate training. Conclusion: Knowledge translation required for OTs working with neonates and at-risk infants were established in this study. Contribution: This study may be useful for consideration in contextually relevant KT interventions for clinicians working in neonatal care.

The impact of public health sector stockouts on private sector prices and access to healthcare: Evidence from the anti-malarial drug market.

In developing countries, public sector health facilities frequently run out of essential medicines ("stockouts"). I test whether anti-malarial drug stockouts affect prices, quality, and overall access to anti-malarial drugs in private sector outlets in Uganda. I combine data from four sources: 1) standardized patient drug purchases; 2) vendor surveys; 3) real customer surveys; 4) public sector supply delivery dates. Using a difference-in-differences approach, I find that stockouts increase private-sector antimalarial drug prices by $0.68, or 35 percent. I find few changes in quality. Real customer characteristics change, suggesting that stockouts lead less educated and poorer customers to drop out of the market. Analysis using the 2016 Demographic and Health Survey additionally shows stockouts reduce treatment at public sector facilities and reduce the likelihood that children receive medicine. My results suggest that stockouts increase prices in the private sector and lead to less equitable health outcomes.

Public sector primary care services in Sri Lanka and the specialist family physician: A qualitative study.

Introduction: In the background of a rising burden of non-communicable disease (NCD) Sri Lanka has prioritised reorganising primary care based on a family medicine approach. Aims: This study explored the integration of a relatively new specialist family physician (SFP) role into the state public health sector of Sri Lanka. Methods: In-depth qualitative interviews were conducted with 11 SFPs attached to the Ministry of Health. Data were analysed using inductive thematic analysis. Results: SFPs had faced initial challenges related to recognition and collaboration within the state health sector. They provided comprehensive primary care in a variety of roles; most importantly in care of NCD and elderly care, and focused on professional development of medical officers and support staff in the settings where they worked. Challenges were insufficient laboratory facilities, medication availability, primary care trained manpower and linkages with secondary care. These barriers hindered the ability of the SFPs to provide a full range of family practice-oriented health services. Conclusion: SFPs have integrated well into the public health sector of Sri Lanka providing comprehensive primary care services. The findings identify areas that need strengthening to further improve primary care services in the country and operationalise proposed new primary care service models.

Challenges in providing surgical procedures during the COVID-19 pandemic: Qualitative study among Operating Department Practitioners in Pakistan.

The surgical theatre is associated with the highest mortality rates since the onslaught of the COVID-19 pandemic. However, Operating Department Practitioners (ODPs) are neglected human resources for health in regards to both professional development and research for patient safety; even though they are key practitioners with respect to infection control during surgeries. Therefore, this study aims to describe challenges faced by ODPs during the pandemic. The secondary aim is to use empirical evidence to inform the public health sector management about both ODP professional development and improvement in surgical procedures, with a specific focus on pandemics. A qualitative study has been conducted. Data collection was based on an interview guide with open-ended questions. Interviews with 39 ODPs in public sector teaching hospitals of Pakistan who have been working during the COVID-19 pandemic were part of the analysis. Content analysis was used to generate themes. Ten themes related to challenges faced by ODPs in delivering services during the pandemic for securing patient safety were identified: (i) Disparity in training for prevention of COVID-19; (ii) Shortcomings in COVID-19 testing; (iii) Supply shortages of personal protective equipment; (iv) Challenges in maintaining physical distance and prevention protocols; (v) Human resource shortages and role burden; (vi) Problems with hospital administration; (vii) Exclusion and hierarchy; (viii) Teamwork limitations and other communication issues; (ix) Error Management; and (x) Anxiety and fear. The public health sector, in Pakistan and other developing regions, needs to invest in the professional development of ODPs and improve resources and structures for surgical procedures, during pandemics and otherwise.

Mapping a high-level overview of information flows in the Dutch declaration chain for medical specialist health care.

This study is based on Philippe van der Voorn's master's dissertation at the Utrecht University, Department of Science, Information and Computing Sciences. The problem identified was a lack of an integrated information chain and clear governance structure for information flow in the Netherlands' health care sector. The method of Design Science was followed to construct an overview model of the chain, and towards a business process model that is intuitive for both technical and business users. An initial declaration chain was identified in the literature and presented, to be confirmed and elaborated on via eight interviews at seven different organisations in the medical specialist health care sector. Based on these interviews, the draft overview was adjusted and a Business Process Model and Notation model created that indicates the shared understanding of the data elements and activities between the organisations. The contribution of the overview of the declaration chain, in particular, can help medical specialist staff obtain an understanding of the administrative side of their work, and with a clear information infrastructure lead to better working processes and information quality. F.J.

Epidemiology of laboratory-confirmed mumps infections in South Africa, 2012-2017: a cross-sectional study.

BACKGROUND: Data on the burden of mumps in South Africa are limited and the epidemiology of mumps in this setting is not well understood. We present an analysis of mumps data in South Africa from 2012 to 2017. METHODS: This cross-sectional study included secondary data on laboratory-confirmed mumps infections from 2012 to 2017, archived at the South African National Health Laboratory Services' data repository as well as from four private laboratories. Mumps-specific immunoglobulin M (IgM) and/or viral nucleic acid positive results represented acute infections. We used age-specific mid-year population estimates for each study year as denominators when calculating annual cumulative incidence. Seasonality was based on the season that showed a peak in infections. RESULTS: Out of 48,580 records obtained from the public and private sectors, 46,713 (96.2%) were from the private sector. Over the study period, there were 7494 acute infections, 7085 (94.5%) of which were recorded in the private sector. Of these 7494 infections, 3924 (52.4%) occurred in males. The proportion of samples tested that were IgM positive was 18.6% (1058/5682) in 2012, 15% (1016/6790) in 2013, 15.8% (1280/8093) in 2014, 15.5% (1384/8944) in 2015, 13.1% (1260/9629) in 2016 and 15.8% (1496/9442) in 2017. The cumulative incidence rate per 100,000 was highest in children between one and 9 years throughout the study period. The cumulative incidence of infections was highest in the Western Cape, Gauteng and the Northern Cape. Infections peaked in June and November. CONCLUSION: Laboratory-confirmed mumps infections predominantly occurred in spring, affecting children below 10 years of age and individuals who were male. There were fewer tests performed in the public sector compared to the private sector. Since only laboratory data was analysed our results represent and underestimate of disease burden. Further studies that include clinical data are required to provide better estimates of disease burden in South Africa.

[Liability in medical-assisted suicide].

Summarizing the contents of the Italian Constitutional Court's judgment n. 242/2019 on the non-liability in medical-assisted suicide, the author looks at how the new scenarios thus opened might undermine the safety and dignity of the most fragile and vulnerable people. He voices his concerns on the shifting relationship between doctors and patients and on the delegitimization of medical ethics that must instead continue to illuminate, with its guiding principles, professional behavior.

Con la ley y sin la ley/With and without the law: Utilization of abortion services and case fatality in Mexico, 2000-2016.

OBJECTIVE: To describe utilization of health services for, and case fatality from, abortion in Mexico. METHOD: A historical cohort study using a census of state-level aggregate hospital discharge and primary care clinic data across Mexico's 32 states from January 2000 to December 2016. Abortive events and changes over time in utilization per 1000 women aged 15-44 years, and case fatality per 100 000 abortion-related events were described by year, health sector, and state. Associations of location (Mexico City vs 31 other states) and time (Mexico City implemented legal abortion services in 2007) with outcomes were tested by linear regression, controlling for secular trends. RESULTS: The national abortion utilization rate was 6.7 per 1000 women in 2000, peaked at 7.9 in 2011, and plateaued to 7.0 in 2016. In Mexico City, utilization peaked at 16.7 in 2014 and then plateaued. Nationwide, the case-fatality rate declined over time from 53.7 deaths per 100 000 events in 2000 to 33.0 in 2016. Case fatality declined more rapidly in Mexico City than in the other 31 states to 12.3 in 2015. CONCLUSION: Case fatality from abortive events has decreased across Mexico. Where abortion became legal, utilization increased sharply but plateaued afterward.

'I have no love for such people, because they leave us to suffer': a qualitative study of health workers' responses and institutional adaptations to absenteeism in rural Uganda.

BACKGROUND: Achieving positive treatment outcomes and patient safety are critical goals of the healthcare system. However, this is greatly undermined by near universal health workforce absenteeism, especially in public health facilities of rural Uganda. We investigated the coping adaptations and related consequences of health workforce absenteeism in public and private not-for-profit (PNFP) health facilities of rural Uganda. METHODS: An empirical qualitative study involving case study methodology for sampling and principles of grounded theory for data collection and analysis. Focus groups and in-depth interviews were used to interview a total of 95 healthcare workers (11 supervisors and 84 frontline workers). The NVivo V.10 QSR software package was used for data management. RESULTS: There was tolerance of absenteeism in both the public and PNFP sectors, more so for clinicians and managers. Coping strategies varied according to the type of health facility. A majority of the PNFP participants reported emotion-focused reactions. These included unplanned work overload, stress, resulting anger directed towards coworkers and patients, shortening of consultation times and retaliatory absence. On the other hand, various cadres of public health facility participants reported ineffective problem-solving adaptations. These included altering weekly schedules, differing patient appointments, impeding absence monitoring registers, offering unnecessary patient referrals and rampant unsupervised informal task shifting from clinicians to nurses. CONCLUSION: High levels of absenteeism attributed to clinicians and health service managers result in work overload and stress for frontline health workers, and unsupervised informal task shifting of clinical workload to nurses, who are the less clinically skilled. In resource-limited settings, the underlying causes of absenteeism and low staff morale require attention, because when left unattended, the coping responses to absenteeism can be seen to compromise the well-being of the workforce, the quality of healthcare and patients' access to care.

Knowledge and practices of parents about child eye health care in the public sector in Swaziland.

BACKGROUND:  Swaziland, like many other developing countries, lacks appropriate eye health services, particularly for children. AIM:  To determine the knowledge and practices of parents about child eye health care in the public sector in Swaziland. SETTING:  The setting for this study was Swaziland. METHODS:  A descriptive study involving cross-sectional sampling methodology and quantitative analysis was employed with 173 randomly selected parents whose children attended public schools in Swaziland. RESULTS:  Out of 173 participants, 104 (60.1%) parents reported that they have never taken their children for an eye test and 69 (31.7%) felt that their children's vision was fine. Ninety-seven (53.1%) parents indicated having no knowledge about child eye conditions and no significant association was found between level of education and knowledge of eye conditions affecting children (p = 0.112). Having an immediate family member who wore spectacles increased the likelihood of a child being taken for eye testing (p = 0.001), but decreased the likelihood of being well informed about eye health (p = 0.218). Of those parents who reported taking their children for eye tests, 34 (49.3%) reported that they were given eye drops and 31 (44.9%) stated that their children were prescribed spectacles. Eighty-seven (50.3%) parents accepted the idea of their children wearing spectacles. CONCLUSION:  The findings of the study suggest the need for parents to be informed about basic child eye health care and the importance of their children having regular eye examinations.

Trends of geographic distribution of general practitioners in the public health sector of Iran.

BACKGROUND: Proper distribution of general practitioners (GPs) is one of the challenges in all health systems. This study aimed to investigate geographical distribution of GPs in public health sector in Iran between 2010 and 2016. METHODS: The study is a descriptive-cross-sectional study. The population of provinces was extracted from Iran's National Statistic Center, while information on GPs was gathered from deputy of statistic and information technology in Ministry of Health and Medical Education. Data analysis was carried out using descriptive statistics, Gini coefficient (GC), and by drawing geographical distribution map of GPs. Data analysis was performed by excel 2013, Stata V.14, and Arc GIS software. RESULTS: The results of calculating the number of GPs per 100,000 population in Iran showed that, in year 2010, Chaharmahal and Bakhtiari Province had the highest (10.39) and Alborz Province had the lowest (0.66) number of per capita GPs. The highest number of GPs per 100,000 population among Iran's provinces belonged to Chaharmahal and Bakhtiari (8.97), while the lowest belonged to Tehran (0.28) in year 2016. The GC was 0.31 in year 2010 and 0.283 for 2011. The lowest GC belonged to year 2012 (GC = 0.272), while the largest coefficient belonged to year 2016 (0.356). CONCLUSIONS: According to the results of this study, the distribution of GPs in public health sector of Iran in between 2010 and 2016 showed inequality. Therefore, along with increasing the number of GPs working in public health sector, it is necessary to pay attention to their distribution. Further studies are needed to investigate inequality of GPs within and between the provinces.