The effects of Ghana's capitation policy on hospital Under-5 mortality in the Ashanti Region

Objective: The study estimated the capitation policy's effect on the under-5 mortality (U5MR) rate in hospitals in Ashanti Region. Design: We used an interrupted time series design to estimate the impact from secondary data obtained from the DHIMS-2 database. Monthly under-5 deaths and the number of live births per month were extracted and entered into Stata 15.0 for analyses. The U5MR was calculated by dividing the number of live deaths by the number of live births for each of the 60 months of the study. Setting: Health facilities of the Ashanti Region with Data in the DHIMS 2. Intervention: the level and trend of U5MR for 31 months during the Capitation Policy implementation (January 2015 to July 2017) were compared with the level and trend 29 months after the withdrawal of the capitation policy (August 2017 to December 2019). Outcome measures: changes in trend or level of U5MR after the withdrawal of capitation. Main Results: During the capitation policy, monthly U5MR averaged 10.71 +/-2.71 per 1000 live births. It declined to 0.03 deaths per 1000 live births (p=0.65). After the policy withdrawal, the immediate (increase of 0.01 per 1000live births) and the trend (decline of 0.13 deaths per 1000 live births per month) were still not statistically significant. Conclusion: We conclude that the capitation policy did not appear to have influenced under-5 mortality in the Ashanti Region. The design of future healthcare payment models should target quality improvement to reduce under-5 mortalities

Application of kingdon and hall models to review environmental sanitation and health promotion policy in Ethiopia: a professional perspective as a review

BACKGROUND: In the world, many countries, including Ethiopia, are framing policies to roll back the problem of the sanitation. For this, the Kingdon and Hall models are the two distinct models formed to articulate the policy agenda to the health problem. The Kingdon model includes problem, policy and politics streams whereas the Hall model includes legitimacy, feasibility and support of the health policies. Therefore, this review aims to integrate the two models with diseases prevention and health promotion policies of Ethiopia. METHODS: We used the existing frameworks of the models as a guiding principle. Then, we applied the frameworks of the two models as an important consideration to interlink policy agenda to a given health problem. We also described the existing scientific literature about the sanitation and health promotion. After thoroughly reviewing, possible policy inputs and country setups were included with a brief discussion by comparing different kinds of literatures. RESULTS: The two models are recognized as an opportunity to get an essential sanitation policy. The government settled and has closed links to the new innovation as an emerged discourse. Therefore, the two model streams came together for setting sanitation problem on the policy agenda. The technical feasibility, public acceptability and congruence with existing values were all judged to be favorable. CONCLUSION: The integration of policies within the policy frameworks has very important outputs in various countries. Therefore, the field specialists should figure out the problem of policy integration through policy evaluation researches

A conceptual framework to guide public oral health planning in Limpopo province

Background: There is limited understanding of the complexities surrounding public oral health service delivery in South Africa and the resulting impact on oral health outcomes. Aim: This study aimed to identify the strengths and challenges in oral health decision-making within the public health sector and to propose a conceptual framework to guide oral health service delivery in the province. Setting: This study was performed in the Limpopo province. Methods: National and provincial health policy documents were reviewed to identify statements on oral health service delivery. A face-to-face, semi-structured interview was conducted with the Limpopo Provincial Manager of Department of Health, Oral Health Services. Data were collected on oral health policies and the organisational structure of public oral health services. A self-administered questionnaire was completed by five district managers of public oral health services to obtain data on the delivery of public oral health services in Limpopo province. Results: The results indicated that oral healthcare was not explicitly mentioned, included or referred to in the examined health policy documents. The interviews indicated that public oral health services do not have a dedicated budget and were not considered a priority. The questionnaire results revealed challenges in infrastructure, human resources and perceived marginalisation from the healthcare services. Participants agreed that there was a need for oral health to be clearly expressed and prioritised in health policy statements. Conclusion: This study proposed a framework that incorporated the identified core components that influenced oral health services provision in Limpopo province

Analysing disability policy in Namibia: an occupational justice perspective

Background: The Namibian disability policy of 1997 has not been reviewed for about 20 years, which has raised concerns with persons with disabilities and stakeholders in the fields of disability and rehabilitation. In March 2017, the government publicised its intention to review the policy. Thus, this study's purpose was to generate evidence that can contribute to the development of a more current disability policy that will promote occupational justice.Objectives: The aim of the study was to develop an alternative disability policy option for Namibia and to present outcomes and trade-offs using a policy analysis approach while applying the occupational justice framework to gather evidence.Method: A qualitative research design and Bardach's eightfold path approach to policy analysis were used. Critical disability theory provided the theoretical framework. The occupational justice framework was the conceptual framework for the study. Evidence from preceding phases of this study and appropriate literature was utilised to construct possible disability policy alternatives in Namibia, set evaluative criteria, project outcomes and confront trade-offs.Results: Three main disability policy alternatives emerged: access policy, support policy and universal coverage policy. Access policy had the fewest trade-offs, and the support policy had the most trade-offs in the Namibian context. Access policy was projected to foster occupational participation among persons with disabilities.Conclusion: Results have implications for selecting disability policy alternatives that promote occupational participation and justice among persons with disabilities in Namibia.Furthermore, the study has implications for advancing the practice of occupational justice in disability policy formulation

The Existence of Policies; Practices and Perceptions Regarding Children as Visitors to Public Hospitals in uMgungundlovu; KwaZulu-Natal Province

Background. Current policies and practices regarding child visitors in hospitals in uMgungundlovu; KwaZulu-Natal Province; South Africa; are unknown. Existing literature focuses on provision for child visitors in specialised units in well-resourced countries.Objective. To identify policies; describe current practices and determine the perceptions of healthcare workers to child visitors.Methods. Interviews were conducted with 7 nursing managers regarding the existence and content of a hospital visitors' policy; 12 operational managers (OMs) to describe ward practices regarding child visitors; and 12 professional nurses and 11 doctors to determine their attitudes towards children as visitors in all four general state hospitals in uMgungundlovu between October 2013 and July 2015.Results. Five out of seven nursing managers were aware of a visitors' policy in their hospital. These policies allowed children to visit family or parents in adult wards; but only 2 would allow children to visit a family member and only 1 would allow visits to a friend in the children's wards. According to the nursing managers; policy was that the visitor must be over 5 years of age to visit in an adult ward while 2 out of 3 nursing managers allowed only children over 12 years of age to visit in children's wards. Visits must occur during prescribed visiting times and the visitor must be accompanied by an adult. In practice; 7 out of 12 OMs allow child visitors in their wards. Only 2 out of 7 OMs allow unrestricted visitation by children and only to non-infectious patients in children's wards - this is subject to variable age restrictions in adult wards and an age limit of 12 years in children's wards. In all wards; visits by children are restricted to prescribed visiting times and conditional on an adult escort. Three out of seven OMs allow 2 visitors only; although most (5 out of 7) allow visits of unlimited duration. Staff who favoured child visitors were more likely to be younger; male and employed as health professionals for 5 years. More doctors than nurses believed that children should be allowed to visit family and/or friends in hospital. Justifications for not allowing children to visit centred on infection risks and the emotional trauma of visiting a sick loved one. The child; patient and health professional were seen to benefit socially from child visitors; although there are positive and negative emotional consequences for the patient and the child.Conclusion. Hospitals do make provisions for visitors; but most exclude young children; particularly those who are most vulnerable to the negative consequences of separation from a parent or family member. While policies do exist to guide child visitation in uMgungundlovu; such policies are restrictive; inconsistent and do not necessarily reflect day-to-day practices

Knowledge; Attitude; and Infection Control Practices of two Tertiary Hospitals in Port-Harcourt; Nigeria

Background: Surgical site infections (SSIs) are a significant cause of morbidity; emotional stress and financial cost to the affected patients and health care institutions; and infection control policy has been shown to reduce the burden of SSI in several health care institutions. This study assessed the effects of the implementation of the policy in a tertiary hospital in Port Harcourt; Nigeria. Materials and Methods: A cross-sectional; comparative study design was used for the study; with data collected using a structured questionnaire and guided observation of doctors and nurses involved in the management of patients that had caesarean sections in two comparable tertiary hospitals in Port Harcourt-the University of Port Harcourt Teaching Hospital (UPTH) and the Braithwaite Memorial Specialist Hospital (BMSH). Results: There were no statistically significant differences in the designations and length of practice of the respondents in both hospitals (P = 0.77). However; 63.64 of the respondents in UPTH were aware of the infection control committee; compared with none in BMSH. The appropriate timing for the administration of prophylactic antibiotics; and for the removal of the hair at the incision site were observed by 57.58 of the respondents in UPTH were aware of the infection control committee; compared with none in BMSH. The appropriate timing for the administration of prophylactic antibiotics; and for the removal of the hair at the incision site were observed by 57.58 and 69.69 respectively of the respondents in UPTH; compared with 22.86 (P = 0.00) and 0.00 (P = 0.02) in BMSH. The reasons given by the respondents in UPTH for nonadherence to the infection control policy include poor supervision (39.39) and lack of in-service training (21.21); while the respondents in BMSH gave reasons that include inadequate supply of consumables (34.29) and absence of a hospital's policy on infection control (22.88). Conclusion: The implementation of the infection control policy resulted in some improvements in certain infection control practices

Proposed Guidelines for a Workplace Health Promotion Policy and Implementation Framework

Since workplace health promotion programmes are often not guided by a specific policy or health promotion framework; a study was conducted to develop guidelines for the implementation of health promotion in South African workplaces. A Delphi technique involving twelve health promotion experts was used to reach consensus about the proposed policy framework and guidelines. These guidelines are directed towards implementing a comprehensive workplace health promotion programme that aims to accommodate all employee health and safety needs. They can be used to develop relevant health promotion or wellness policies that are easy to implement; monitor and evaluate

Community placement and reintegration of service users from long-term mental health care facilities

Objective: To ascertain community placement and reintegration of service users from long-term mental health care facilities. Method: This study reviewed the progress during 2003 with the alternative placement of a selected candidate group of 27 service users in some of Lifecare's long-term mental health care facilities in Gauteng. Results: Despite a significant amount of time and effort to find alternative options with family; old age homes or other non-governmental organizations; only 9 (33) were placed a year later. A longer follow-up period however is necessary to ascertain the actual successful outcome of these placements. Conclusions: Concerns exist about sufficient development of community-based services in accordance with the new Mental Health Care Act (Act No. 17 of 2002); parallel to hospital-based care