Towards a green hospital approach in Oman: A case study of quantifying an environmental impact.

INTRODUCTION: The environmental impact of hospitals and healthcare providers practices is substantial, although often unnoticed and infrequently tracked. A green and healthy hospital is one that promotes public health by continuously monitoring and reducing its environmental impact. METHODS: We adopted a descriptive case study design with a multi-dimensional evaluation and monitoring of carbon emission equivalence (CO2e) using two examples from a tertiary care hospital practice in Oman. One example (1) was related to inhalation anaesthetic gases (IAG) consumption and the second example (2) was related to estimation of telemedicine clinics (TMCs) CO2e travel-related savings. RESULTS: The cumulative consumption of three different (1) IAG over three years (2019, 2020, 2021) was generated with estimated CO2e for each year for sevoflurane, isoflurane and desflurane. Desflurane had the lowest consumption with a yearly cumulative consumption of 6000 mL, 1500 mL, and 3000 mL for the years 2019, 2020 and 2021. The (2) TMCs during the first two years of the COVID-19 pandemic travel related CO2e savings were in the range of 12.65-3483.1 tonnes. In the second year of launching this service it doubled to a range of 24-6610.5 tonnes of CO2e savings. CONCLUSION: A green and healthy hospital approach of tracking and monitoring environmental impact of healthcare providers practices is critical for health planning and management of the environmental policy. This case study illustrated the importance of closely tracking hospital-based practices from an environmental perspective towards a green hospital approach.

Economics of primary healthcare: cost estimation of clinical services at primary care facilities in the six countries of the Gulf Cooperation Council.

OBJECTIVE: While the Gulf Cooperation Council (GCC) countries have demonstrated a strong commitment to strengthening primary healthcare (PHC), the costs of delivering these services in this region remain relatively unexplored. Understanding the costs of PHC delivery is essential for effective resource allocation and health system efficiency. DESIGN: We used an ingredient-based method to estimate the cost of delivering a selection of services at PHC facilities in the six GCC countries in 2019. Services were categorised into eight programmes: immunisation; non-communicable diseases (NCDs); oral and dental care; child health; nutrition; mental health; reproductive, maternal, neonatal and child health and general practice. The cost estimation focused on two key ingredients: the costs of drugs and supplies and the healthcare workforce cost. The coverage rates of specific types of health services, including screening and mental health services, were also estimated. Data for the analysis were obtained from ministries of health, health statistics reports, online databases, national surveys and scientific literature. RESULTS: The estimated costs of delivering the selected services at public PHC facilities in the six GCC countries totalled US$5.7 billion in 2019, representing 0.34% of the combined 2019 GDP. The per capita costs varied from US$69 to US$272. General practice and NCD programmes constituted 79% of the total costs modelled while mental health ranged between 0.0% and 0.3%. Over 8 million individuals did not receive NCD screening services, and over 30 million did not receive needed mental health services in public PHC facilities across the region. CONCLUSIONS: To our knowledge, this is the first study to estimate the costs of services delivered at PHC facilities in the GCC countries. Identifying the main cost drivers and the services which individuals did not receive can be used to help strengthen PHC to improve efficiency and scale up needed services for better health outcomes.

Characterizing No-shows in the Omani Primary Healthcare Setting.

Objectives: Patient 'no-shows' (failure to keep or cancel appointments) is a global problem that impacts healthcare systems by delaying patient access to healthcare, reducing quality of care, and wasting resources. The no-show phenomenon has not yet been studied in Oman despite it having grown in importance ever since the appointments system was implemented in 2014. This study aimed to characterize the no-shows in primary healthcare facilities in Oman. Methods: We collected and analyzed administrative data during the period 2014-2017 from 14 primary healthcare institutions in Oman focusing on the ophthalmology, ear, nose, and throat, and dermatology clinics therein. Results: The overall no-show rates were > 50.0%. No-show probabilities were higher in males, younger adults, new appointments, early morning appointments, appointments during Ramadan, and appointments scheduled farther in advance. Patient experience with the appointment system reduced the no-show probability. Conclusions: Policymakers should consider these trends to optimize the number of appointments per day, and researchers should further investigate no-shows for other specialties and levels of care.

The evidence governance system in Oman.

Background: In addition to the general question about what works, policymakers consider whether health interventions will work in their context, and consider the social values such as affordability, acceptability, equity, equality, and human rights. Aims: To highlight the importance of having and using an evidence governance system to inform health policymaking in Oman. Methods: We reviewed the literature and analysed local documents on evidence governance systems in Oman. Results: The Government of Oman has shown increasing interest in research and innovation in the past few decades. This interest was reinforced through the announcement in November 2021 of the intention to establish a decision-making support unit. Oman's strategies for evidence-informed policymaking provide direct and well-integrated channels for expert advice, however, the capacity for implementation remains challenging, and there is a lack of clarity in the evidence use mandate. It is not clear how evidence was selected, synthesized and used to inform some of the government policies on health. This can limit the scope of operation and subsequent achievements. Conclusion: Efforts to strengthen evidence-informed policymaking should focus on building a system for good governance of evidence to ensure that rigorous, systematic, and technically valid evidence is used for policymaking.

Examining and Contextualizing Approaches to Establish Policy Support Organizations - A Critical Interpretive Synthesis.

BACKGROUND: In response to worldwide calls for the need to support evidence-informed policy-making (EIPM), more countries are increasingly interested in enhancing their efforts to use research to inform policy-making. In order to inform the efforts of those asked to lead the support of EIPM, our aim is to develop a conceptual framework to guide the process of establishing a policy support organization (PSO). METHODS: We conducted a critical interpretive synthesis (CIS). We conducted a two steps literature review. In the second step, we systematically searched OVID EMBASE, PsychInfo, HealthStar, CINAHL, Web of Science, Social Science Abstract, Health Systems Evidence, and ProQuest Dissertations and Theses Global databases for documents reporting the establishment of PSOs and the contextual factors influencing the process of establishing these organizations. We assessed the eligibility of the retrieved articles and synthesized the findings iteratively. RESULTS: We included 52 documents in the synthesis. Our findings suggest that a PSO establishment process has four interconnected stages: awareness, development, assessment, and maturation. The process of establishing a PSO is iterative and influenced by political, research and health systems contextual factors, which determine the availability of the resources and the trust between researchers and policy-makers. The contextual factors have an impact on each other, and the challenges that arise from one factor can be mitigated by other factors. CONCLUSION: For those interested in establishing a PSO, our framework provides a road map for identifying the most appropriate starting point and the factors that might influence the establishment process. Leaders of such PSOs can use our findings to expand or refine their scope of work. Given that this framework focuses only on PSOs in the health sector, an important next step for research would be to include other sectors from social systems and identify any additional insight that can enhance our framework.

Examining and Contextualizing Approaches to Establish Policy Support Organizations - A Mixed Method Study.

BACKGROUND: There has been an increase in the number of policy support organizations (PSOs) that have been created to foster the systematic use of evidence in health system policymaking. Our aim was to identify approaches for establishing a PSO or similar entities by soliciting insights from those with practical experience with developing and operationalizing PSOs in real-world contexts. METHODS: We used a sequential mixed method approached. We first conducted a survey to identify the views and experiences of those who were directly involved in the establishment of PSOs that have been developed and implemented across a variety of political-, health- and research-system contexts. The survey findings were then used to develop a purposive sample of PSO leaders and refine an interview guide for interviews with them. RESULTS: We received 19 completed surveys from leaders of PSOs in countries across the WHO regions and that operate in different settings (eg, as independent organization or within a university or government department) and conducted interviews with 15 senior managers from nine PSOs. Our findings provide in-depth insights about approaches and strategies across four stages for establishing a PSO, which include: (i) building awareness for the PSO; (ii) developing the PSO; (iii) assessing the PSO to identify potential areas for enhancement; and (iv) supporting maturation to build sustainability in the long-term. Our findings provide rich insights about the process of establishing a PSO from leaders who have undertaken the process. CONCLUSION: While all PSOs share the same objective in supporting evidence-informed policy-making (EIPM), there is no single approach that can be considered to be the most successful in establishing a PSO, and each country should identify the approach based on its context.

Prevalence and correlates of diabetes and its comorbidities in four Gulf Cooperation Council countries: evidence from the World Health Survey Plus.

BACKGROUND: The Gulf Cooperation Council countries are witnessing unprecedented changes due to fast economic development and population growth. The aims of this study were twofold: first, to estimate the prevalence of diabetes and its comorbidities; second, to examine the association of sociodemographic risk factors and healthcare service utilisation with diabetes. METHODS: Data from the World Health Survey Plus (WHS+) from Kuwait, Oman, Saudi Arabia and the United Arab Emirates were used. The WHS+ is a nationally representative household survey of the adult population, conducted between 2008 and 2009. Both logistic regression and zero-inflated Poisson models were applied to examine the associations of risk factors, comorbidity and treatment with self-reported diabetes. RESULTS: The highest level of diabetes was observed in Kuwait, with 40.8% among the oldest age group. High body mass index, older age and low education were all associated with diabetes in all settings. High levels of comorbidity existed within the diabetic population. Over 50% of diabetics in all countries reported having at least one chronic condition. In Kuwait and Saudi Arabia, one in five diabetics reported having two or more comorbidities. Treatment prevalence was above 80% across all sociodemographic categories. CONCLUSION: The burden of diabetes, although high, is not uniform across populations in the four Gulf countries. Differential exposure to risk, such as unhealthy lifestyles, may be creating a disadvantage for certain populations and influencing the co-occurrence of chronic conditions. In response, a multifaceted and patient-centred approach is needed at all levels of healthcare to control and prevent non-communicable diseases.

Uptake of breast and cervical cancer screening in four Gulf Cooperation Council countries.

In Gulf Cooperation Council States, there is limited information on national levels of mammography and Pap smear screening uptake. The aim of this study is to provide a baseline for national estimates for mammography and Pap smear screening and to explore associations between screening uptake and socioeconomic factors. The nationally representative World Health Survey Plus, implemented in 2008/2009 in Kuwait, Oman, Saudi Arabia and United Arab Emirates (UAE), was used. Uptake of mammography and Pap smear was estimated for each country, followed by the examination of associations between screening and a range of socioeconomic variables. Levels of breast and cervical cancer screening uptake within recommended intervals in all countries were low. The percentages of women aged 40-75 years who had a mammogram were 4.9% in Saudi Arabia, 8.9% in Oman, 13.9% in the UAE and 14.6% in Kuwait. The percentages of women aged 25-49 years who had a Pap smear test were 7.6% in Saudi Arabia, 10.6% in Oman, 17.7% in Kuwait and 28.0% in the UAE. Marital status, wealth, education, nationality and place of residence are associated with screening uptake, with the lower educated, poor and unmarried having the lowest percentages of uptake. The four Gulf Cooperation Council countries need to set clear targets and increase the proportion of women who have regular breast and cervical cancer screening examinations. Health education campaigns and awareness programmes that are fully integrated into the health system are required to ensure women use services that are available to prevent breast and cervical cancers.

Oman Vision 2050 for Health Research: A Strategic Plan for the Future Based on the Past and Present Experience.

Health care delivery in Oman has attained great heights since the modern renaissance in 1970. Although the health service had the main impetus all these years, the importance of health research began to take place by mid 1990's and is now gaining momentum as an important responsibility and activity of the Ministry of Health (MoH). Although there has been progressively increasing investment and commitment to research activities in the recent Five Year Plan for Health Development, it still lags behind in the quality and quantity of research output. Lack of factors like adequate infrastructure, dedicated human resources, empowerment of existing systems, and societal support for research have adversely affected research output. Centre of Studies and Research in MoH has proposed a strategic plan, the 'Health Vision 2050 for Health Research' with aim of making Oman the regional leader and a research hub of world standards in health research. The mission is to promote, facilitate, and conduct high quality health research addressing national health priorities to improve health care services and enhance the efficiency and effectiveness of the health system, reduce health inequity, and contribute to socioeconomic development. The strategy includes setting health research priorities, strengthening the health research capacity, defining and implementing norms and standards, developing health research (quality and quantity), translating evidence into policy, strategy and practice, monitoring and coordinating research, financing health research, and evaluating the effectiveness of the health research system. It should generate a multifold increase in the quality and quantity of health research in Oman, positively impacting the health system and health care service.