Reforms for financial protection schemes towards universal health coverage, Senegal

Advancing the public health insurance system is one of the key strategies of the Senegalese government for achieving universal health coverage. In 2013, the government launched a universal health financial protection programme, la Couverture Maladie Universelle. One of the programme's aims was to establish a community-based health insurance scheme for the people in the informal sector, who were largely uninsured before 2013. The scheme provides coverage through non-profit community-based organizations and by the end of 2016, 676 organizations had been established across the country. However, the organizations are facing challenges, such as low enrolment rates and low portability of the benefit package. To address the challenges and to improve the governance and operations of the community-based health insurance scheme, the government has since 2018 planned and partly implemented two major reforms. The first reform involves a series of institutional reorganizations to raise the risk pool. These reorganizations consist of transferring the risk pooling and part of the insurance management from the individual organizations to the departmental unions, and transferring the operation and financial responsibility of the free health-care initiatives for vulnerable population to the community-based scheme. The second reform is the introduction of an integrated management information system for efficient and effective data management and operations of the scheme. Here we discuss the current progress and plans for future development of the community-based health insurance scheme, as well as discussing the challenges the government should address in striving towards universal health coverage in the country

Purchasing reforms and tracking health resources, Kenya

As low- and middle-income countries undertake health financing reforms to achieve universal health coverage, there is renewed interest in making allocation of pooled funds to health-care providers more strategic. To make purchasing more strategic, countries are testing different provider payment methods. They therefore need comprehensive data on funding flows to health-care providers from different purchasers to inform decision on payment methods. Tracking funding flow is the focus of several health resource tracking tools including the System of Health Accounts and public expenditure tracking surveys. This study explores whether these health resource tracking tools generate the type of information needed to inform strategic purchasing reforms, using Kenya as an example. Our qualitative assessment of three counties in Kenya shows that different public purchasers, that is, county health departments and the national health insurance agency, pay public facilities through a variety of payment methods. Some of these flows are in-kind while others are financial transfers. The nature of flows and financial autonomy of facilities to retain and spend funds varies considerably across counties and levels of care. The government routinely undertakes different health resource tracking activities to inform health policy and planning. However, a good source for comprehensive data on the flow of funds to public facilities is still lacking, because these activities were not originally designed to offer such insights. We therefore argue that the methods could be enhanced to track such information and hence improve strategic purchasing. We also offer suggestions how this enhancement can be achieved

Child functioning and disability in children living with human immunodeficiency virus in a semi-rural healthcare setting in South Africa

Background: Children living with HIV (CLHIV) often experience HIV-related impairment and disability. Aim: The study sought to understand the level of child functioning and access to rehabilitative care in the context of South African healthcare in order to inform an integrated rehabilitative framework. Setting: District level semi-rural healthcare facility in KwaZulu-Natal. Methods: The Washington Group/United Nations International Children's Emergency Fund Module on Child Functioning, was administered to carers of CLHIV aged between 5 and 10 years, and accessing care at the study setting. Results: Forty-four caregivers of children receiving treatment from June 2018 to March 2019, at the facility, participated. Four (9.1%) children had difficulty with seeing, 13 (29.5%) children had difficulty with hearing and 10 (22.7%) children had difficulty with walking. In the cognitive and behavioural domains, 17 (38.6%) children reported difficulties in communication and concentration, with 16 (36.4%) children experiencing difficulties in learning and remembering. Difficulties reported in accepting change and controlling behaviour were both experienced by 23 (52.3%) children. Although many children experiencing impairments were referred for rehabilitation, many caregivers did not follow-up after the initial assessment, because of financial constraints, lack of time and transport restrictions. Conclusion: Functional difficulties were frequently experienced by children living with HIV. Disability screening would be beneficial at various points of care to promote early identification and timely referral to healthcare professionals. Decentralising rehabilitative care to homes and communities could offer a solution to some of the reported barriers to accessing care

Constraints; Challenges and Prospects of Public-Private Partnership in Health-Care Delivery in a Developing Economy

Background: In Nigeria; concerns on the quality and financing of health-care delivery especially in the public sector have initiated reforms including support for public-private partnerships (PPP) at the Federal Ministry of Health. Likewise; Enugu State has developed a draft policy on PPP since 2005. However; non-validation and non-implementation of this policy might have led to loss of interest in the partnership. Aim: The aim of this study was to provide evidence for planning the implementation of PPP in Enugu State health system via a multi-sectoral identification of challenges; constraints and prospects. Subjects and Methods: Pre-tested questionnaires were administered to 466 respondents (251 health workers and 215 community members); selected by multi-stage sampling method from nine Local Government Areas of Enugu State; Nigeria; over a study period of April 2011 to September 2011. Data from the questionnaires were collated manually and quantitative data analyzed using SPSS version 15 (Chicago; IL; USA). Results: Only 159 (34.1; 159/466) of all respondents actually understood the meaning of PPP though 251 (53.9) of them had claimed knowledge of the concept. This actual understanding was higher among health workers (57.8; 145/251) when compared with the community members (6.5; 14/215) (P 0.001). Post-PPP enlightenment reviews showed a more desire for PPP implementation among private health-care workers (89.4; 101/113) and community leaders/members (55.4; 119/215). Conclusion: PPP in health-care delivery in Enugu State is feasible with massive awareness; elaborate stakeholder's engagements and well-structured policy before implementation. A critical challenge will be to convince the public sector workers who are the anticipated partners to accept and support private sector participation

Hospital Reform and Staff Morale in South Africa: a Case Study of Dr Yusuf Dadoo Hospital

Objectives: This study explored major factors that influenced staff motivation at a district hospital in South Africa following hospital reforms and comparison of these factors across the two main staff categories. Design: This study was a cross-sectional descriptive survey. Settings and subjects: This study included all medical and nursing staff working at the district hospital. Outcome measures: A semi-structured questionnaire coded for anonymity was used. It comprised three sections: the introduction; demographic information and a list of factors to which participants responded by indicating their level of agreement or disagreement using the Likert's scale. The questionnaire's reliability was confirmed using Cronbach's coefficient alpha with a value of 0.9. Results: Of the 179 participants; 122 returned the questionnaires. This equated to a response rate of 68. The staff expressed more demotivation than motivation. Major factors that played a role were institutional in character; namely poor management and leadership; unfavourable institutional policies and administration practices with regard to staff development; conflictual inter- and intraprofessional relationships; a paucity of equipment and retention and recruitment strategies. The unique motivator was the individual value of the vocational aspect of the profession. Distance travelled to the workplace did not have any association with the identified motivating and demotivating factors. Conclusion: Staff mo tivation is crucial in any institution or organisation. Presently; the South African healthcare sector is undergoing transformation in terms of implementation of National Health Insurance. The effectiveness of the healthcare system in achieving its goals will be impacted by the prioritisation of institutional strategies that contribute to staff motivation. Managers' skills in healthcare facilities are critical to the success of the implementation of reforms in South Africa

Evidence of Strategic Human Resource Management Practice in a Public Sector Organisation: a Content Analysis of the HRM Policy and Strategy of the Ministry of Health of Ghana; 2007- 2011

Competitive forces coupled with new and continuing demands require public sector organisations to be increasingly careful in thinking about their strategies. This is complicated especially for the health sector because it must do so in a multi-sectoral environment where system complicate decision making. This paper examines the evidence of Human Resource Management Strategies and practices in a public sector organization; the Ministry of Health of Ghana. The paper examines strategies of the Human Resources of the Ministry of Health of Ghana to achieve the objectives of reforms which are largely to make quality health care accessible and affordable to the people of Ghana with the right staff doing the right job at the right place. It is an established fact that the success of every organization depends greatly on its human resource. However having the right quantity and quality of employees at the right place is the problem. HRM strategy is about providing the right numbers and calibre of staff; as well as retaining and motivating staff to enhance productivity. There are difficulties in developing appropriate HRM strategies to enable especially public sector organisations achieve their objectives. There is no perfect solution as to how to evolve an effective HRM strategy. Nonetheless there are some general principles of best practice that policy makers should keep in mind. Where these principles are not considered and a balance is not achieved; a policy may be impotent at birth and not facilitate organisational success

Health providers' perception towards safe abortion service at selected health facilities in Addis Ababa

In Ethiopia, unsafe abortion accounts up to 32% of maternal deaths. The perception of health providers towards safe abortion provision at selected health facilities in Addis Ababa, Ethiopia was assessed. A stratified random sampling was used to select 431 health providers. A cross-sectional study was conducted from March 25-April15, 2008 using a structured self-administered questionnaire. The results were interpreted using descriptive statistics and odds ratios. A majority of the health providers (96.4%) recognized that unsafe abortion was a serious health problem. Providers who had safe abortion practice were 2.57(95% CI 1.49-4.44) times more likely to have favorable attitude towards safe abortion than those without practice. Similarly, providers who knew the law governing abortion were 1.77 (95% CI 1.12-2.78) times more likely to have this favorable attitude than those who lack this knowledge. In conclusion, training of health providers on safe abortion and reproductive rights are essential to reduce maternal mortality (Afr J Reprod Health 2011; 15[1]: 31-36)

Comparative Study of the Primary Healthcare Systems in China and Mali

"Background: Community health centres (CHCs) are an important component of the health system in Mali and China. Despite patient support and commitment from the authorities; the management and the quality of care of these structures need to be improved. This research aimed to compare the management style of the relevant boards with users' satisfaction pertaining to CHC services in Mali and China. Method: Between September 2009-January 2010; a study was conducted in eight CHCs in Mali and in 16 CHCs in China. A total of 480 householders; [60 (Mali) and 320 (China)]; and 24 management committee members (Mali) and 48 management committee members (China) were interviewed. An in-depth interview technique was used on members of the management committee; while a structured interview was carried out to ollect data during face-to-face contact with householders in their residences. In residences in which there were two or more households; the first willing householder was interviewed. Questions about the level of satisfaction were coded from 1-5 and ranged from ""excellent"" to ""very bad"" respectively. Results: The CHCs in China were managed by the government; whereas in Mali; they were overseen by the local population. The most satisfied people in both countries were those living in the poorest socioeconomic conditions; the elderly; and those who attended the healthcare meetings. Chinese households were more satisfied with the quality of the CHC services than those in Mali. The Chinese management boards proposed standardisation of rules and more funding; whereas those in Mali advocated that government provide more funding and human resources allocation. Conclusion: A high level of satisfaction regarding the CHC services was observed. However; users reported on deficits in the quality of care; whereas management suggested a need for greater resource allocation."

Monitoring and Evaluation of Health Sector Reforms in the WHO African Region

Objectives: To describe a comprehensive analytical framework for assessing health sector reforms and demonstrates use of the analysis framework using cost-recovery mechanisms as a case study in the WHO African Region. Data sources: Health sector reforms published literature review. Study selection: No selection involved. Data extraction: This paper draws from previous published literature to describe a comprehensive framework to assess the performance of health sector reforms in the African region. Using this framework; it goes on to illustrate how it may be used to analyze cost recovery reforms as a case study. The major elements for the analysis include a description of the context; design; process and intended results. Data synthesis: In terms of context and design of the cost recovery reform; there were gaps in the stewardship role of governments as evidenced by the lack of appropriate policies and information to monitor and/or influence the process. Regarding the cost recovery implementation; it is not clear from the literature reviewed in this paper that there was a comprehensive stakeholder coordination mechanism that catered for all who were involved. Concerning results of the expected results of implementing cost recovery reforms such as improved quality of health services; equitable service utilisation; social sustainability through active community participation; and gains in efficiency were not always realised. Conclusions: Given that the aspects of the analysis framework described in this paper are interrelated; reviewing one without another provides an answer to a specific question but is insufficient for a comprehensive assessment

Characterisation and Quantification of Anatomy Concepts in a Standard Clinical Methods Textbook: a Content Analysis Approach

"Aim: To analyse the nature and quantity of anatomy concepts intrinsic in a standard clinical methods textbook; used for teaching medical students clinical methods; in order to identify anatomy concepts to be taught to medical students in preparation. Methods: Five categories of anatomy indicators developed in consultation with and accepted by an international panel of anatomists were used to content analyse the 19th Edition of Hutchinson's Clinical Methods. The five categories were subdivided into two classes designated ""General Anatomy Terms"" and ""Technical Anatomy Terms"". The inter-rater reliability of coding instructions was 0.76 (P value = 0.0005). Results: A total of 17; 223 recording units were coded of which 10;162 were anatomy indicators and 6;980 were technical anatomy terms. The average total anatomy indicators ratio (TAIR = total anatomy indicators/total recording units) was 0.55 and the technical anatomy terms ratio (TATR = technical anatomy terms/total anatomy terms) was 0.68 respectively. There was variability in requirement for technical anatomical terms between the 17 different chapters in the textbook. Sixty-five anatomy themes emerged from the 17 chapters. Conclusions: These results suggest that a student cannot benefit sufficiently from Hutchinson's Clinical Methods without substantial knowledge of anatomy. The implications for medical educationists are that 1) educators must be wary of teaching methods that consider anatomy learning in a superficial and simplistic manner; and 2) educators must ensure that students attain adequate depth and scope of anatomy knowledge before or concurrently to learning clinical methods."

Une gestion manageriale des structures hospitalieres du Benin

La gestion des services hospitaliers reste un probleme dans les etats africains et plus particulierement au Benin. Elle doit etre un instrument d'aide a la definition des orientations strategiques et des dispositions a mettre en oeuvre pour les realiser. Cet article presente des elements de dysfonctionnement des etablissements de soins au Benin et plus particulierement la gestion hospitaliere au regard des reformes en cours. L'analyse aborde aussi les strategies prioritaires et l'importance du role central de l'element humain dans toute action d'organisation manageriale. Cette organisation de management participatif demande encore beaucoup d'efforts pour son application dans les hopitaux beninois; dont entre autres : la prise en compte de l'environnement des structures de sante dans un systeme ouvert; le renforcement de la formation continue des personnels; la dotation de personnel technique competent; la creation de modules de formation en gestion hospitaliere

Patient Satisfaction at the Muhimbili National Hospital in Dar Es Salaam; Tanzania

Objectives: Patients are the primary beneficiaries of the services and care that hospitals provide. The Patient Satisfaction study examined the extent to which patients at the Muhimbili National Hospital (MNH) were satisfied with the services and care they received at MNH. This was part of a baseline study that sought to determine the level of performance of the hospital before massive restructuring; reform; and renovations were undertaken. Methodology: Exit interviews were the main research method used to determine patient satisfaction. Patients were interviewed as they were leaving the OPD clinics; laboratory; X-ray; pharmacy and inpatient wards. Results: The study found that most patients were satisfied with the services and care they received. This high level of satisfaction must be viewed within the context of a hierarchical public health care delivery system; with MNH at the apex. The services and care MNH provides can only be excellent compared to that provided by lower level health facilities. Indeed; patients covered by this study perceived the services provided by MNH as superior; and this was reflected in the high level of satisfaction they reported. Some patients expressed dissatisfaction with specific aspects of the services that they received. They were particularly dissatisfied with long waiting times before receiving services; the high costs of treatment and investigations charged at MNH; poor levels of hygiene in the wards; and negative attitudes of staff towards patients. Conclusion: Although only a small proportion of patients expressed dissatisfaction with these aspects of the services provided; they are significant in that they constitute a call for action by the MNH management to encourage the health personnel to embrace a new staffpatient relationship ethos; in which the patient is a viewed as a customer

Management and Organization Reforms at the Muhimbili National Hospital: Challenges and Prospects

Objective: To establish the state of organization structures and management situation existing at the Muhimbili National Hospital (MNH) and Muhimbili University College of Health Sciences (MUCHS) prior to the start of the MNH reforms and physical infrastructure rehabilitations. Methods: A checklist of key information items was used to get facts and figures about the organization of the MNH and management situation. Interviews with MNH and MUCHS leaders; and documentation of existing hospital data were done to gather the necessary information. Results: The survey reveals that there are a number of organizational; managerial and human resource deficiencies that are impinging on the smooth running of the hospital as a national referral entity. The survey also revealed a complex relationship existing between the hospital and the college (MUCHS) that has a bearing on the functioning of both entities. Conclusion: In order for the hospital to function effectively as a referral hospital with a training component inbuilt; four basic things need to be put in place among others: a sound organization structure; adequate staffing levels especially of specialist cadre; a functional information system especially for inpatient services and a good working relationship with the college

Sex Work; Reform Initiatives and HIV/AIDS in Inner-City Johannesburg

The on-going criminalisation of sex work in South Africa; concurrent sexual partnerships; socio-economic vulnerability; migrant status and gender-based violence intensify sex workers' risk of contracting HIV. These factors combine to restrict the skills; ability and resources of sex workers to negotiate safer sex and to access HIV prevention; treatment and healthcare services. The paper situates the living and working conditions of sex workers in Hillbrow; an inner-city area of Johannesburg; within the South African legal context; especially in regard to current law reform initiatives regarding sex work; as well as the increasing anxiety about the influx of (sex) tourists during the 2010 FIFA World Cup. In addition; the paper describes an intervention by the Reproductive Health et HIV Research Unit at the University of the Witwatersrand; Johannesburg; an innovator in providing mobile healthcare services and education to hotel-based sex workers in Hillbrow. The paper contends that a legal-rights-approach to HIV risk and vulnerability; together with powerful public health considerations; render decriminalisation an imperative response to sex workers' material conditions

Rationalising Human Resource Deployment in the Wake of Reforms : the Need for Measuring Health Workers Workload

The ongoing reforms that cut across various sectors in Tanzania encompass as one of the major changes; the disposition and remuneration of civil servants including health workers. Retrenchment of health workers that started in the early 1990s; staff allocation and relocation in the facilities and the introduction of incentive packages have been implemented without the guidance of information on the actual magnitude and distribution of workload among them. This paper presents findings of the outpatient workload for clinicians based on a review of routinely available data from two districts in Tanzania. It was revealed that the average workload was 29 outpatients per clinician per day in health centres and 20 in dispensaries. Workload was found to be higher in Government dispensaries (20 outpatients/clinician/day) compared to private for profit owned facilities (8 per clinician/day). It was concluded from the study that there is an enormous variation in workload among facilities of the same type and between districts. It was therefore recommended that future plans on staff disposition and incentive schemes should take into consideration the burden of work shouldered by health workers at their respective working places. Further research should be conducted in order to establish workload among health workers of other cadres that will encompass services other than OPD