ASSESSING PUBLIC SERVICE QUALITY & SERVICE SATISFACTION:WITH REFERENCE TO GOVERNANCE IN KARNATAKA, INDIA

Being a democratic country India has brought in various acts and reforms to uphold citizen centricity. Right to service act has been one of such initiatives. As on 2023, the state of Karnataka has been able to provide highest number of services under this act. This study explores and investigates citizen's perspective of service quality & service satisfaction attained by availing the public services. A questionnaire survey was formulated and study found that the ve factors 'Reliability' 'Assurance', 'Empathy', 'Valence', and 'Waiting Time' are determinants of the quality of citizen/government services. The outcome indicate that overall service quality has signicantly positive impact on service satisfaction. This research is of greater value to scholars who are interested in the area of governance, administration, and service delivery.

SAKLAY: A Guide to an Assistive Technology Service Delivery Process in the Philippines

@#Occupational Therapy (OT) can help enhance human performance and well-being through assistive technology (AT). This entails guiding clients through the AT selection and acquisition process down to helping them integrate these tools’ use as supports to their day-to-day living. Unfortunately, the AT prescription and acquisition process can be tedious, costly, complicated, and uncoordinated in some countries such as the Philippines. AT service delivery is an undeveloped area of practice among Filipino occupational therapists due to the lack of local evidence-based research, practice models, and practical knowledge of the process. Moreover, access to AT is affected by economic factors and by some Filipinos’ negative attitudes towards assistive devices as being a validation of one’s incapacitation. The SAKLAY is a service delivery framework that was created to offer a practical and systematic guide to Filipino occupational therapists who render AT services for persons with disabilities (PWD) that takes into account the client’s needs, resources, abilities, and contexts.

Traducción y adaptación de la Escala de Continuidad de Servicios de Salud Mental de Alberta en un contexto latinoamericano

Introducción: La continuidad de atención es considerada como un proceso que involucra una atención ordenada, un movimiento ininterrumpido de personas entre los diversos elementos del sistema de prestación de servicios. No existe evidencia suficiente en cuanto a instrumentos de medición en Iberoamérica. Por lo anterior, el objetivo del presente estudio consiste en describir el proceso de traducción, adaptación cultural a un contexto latinoamericano, así como la consistencia interna y validez de constructo de la Escala de Continuidad de Servicios de Salud Mental de Alberta (ACSS-MH). Método: Este instrumento fue sometido a la evaluación de validez de contenido por expertos y este fue aplicado a una población rural en un contexto colombiano. Se realizaron pruebas de consistencia interna y validez de constructo para cada una de las partes de la escala. Resultados: Bajo el consenso del experto, se realizan cambios en algunos ítems, buscando una mejor adaptabilidad del instrumento a las características lingüísticas del español, sin perder de vista el objetivo de evaluación de cada uno de los ítems del cuestionario original. El resultado del análisis de la parte A convergió en 5 componentes que explican el 69,69% de la varianza con 24 ítems; de igual forma, el análisis de la parte B agrupó 13 ítems en cuatro componentes, los cuales explican el 72.02% de la varianza. Conclusiones: este instrumento podría ser implementado para mejorar la prestación de los servicios en salud mental en contextos latinoamericanos, donde la continuidad del cuidado ha presentado importantes dificultades.

Objective: Describe the process of translation, cultural adaptation to Colombia, as well as the internal consistency and construct validity of the Alberta Continuity of Services Scale for Mental Health (ACSS-MH). Methods: This instrument was subdued to the evaluation of validity of the content by experts and this was applied to a rural population in a Colombian context. Were performed tests of internal consistency and construct validity for each of the parts of the scale. Results: Under the consensus of the expert, it is made changes on some items, looking for a better adaptability of the instrument to the linguistic characteristics of Spanish, without losing sight of the evaluation objective of each one of the items on the original questionnaire. The result of the analysis of part A converged in 5 components that explain the 69.69% of the variance with 24 Items; Similarly, the analysis of part B grouped 13 items into four components, which explain the 72.02% of the variance. Discussion: This scale could be implemented to improve the provision of mental health services in Latin American contexts, where continuity of care has presented significant difficulties.

Mothers’ perspectives on utilization of maternal health services in Rural Health Units in Luzon: A qualitative study

Introduction@#Despite implementing various maternal health care programs and integrating these into Service Delivery Networks, the Philippines continues to have high maternal mortality. Identifying factors that impede the utilization of available maternal care services may help reduce maternal morbidity and mortality and bridge the gap between the need and actual use of such services among mothers in the community. @*Objectives@#This study identified barriers, hindrances, and other factors influencing mothers in availing maternal health services in Luzon, the largest island in the country and the area that accounted for more than half of total maternal mortality. @*Methods@#Eight focus group discussions participated in by a total of 78 pregnant women and mothers were conducted across all of the eight regions of Luzon. In each session, the participants were asked to answer questions based on a semi-structured interview guide. The interviews were recorded, translated and back-translated, transcribed, and compiled before analysis by the deductive-dominant approach using NVivo12. @*Results@#Factors affecting maternal health service utilization center on the capacity of health facilities to provide services like evaluation of the progress of pregnancy, laboratory examinations, free medicines, and immunizations; and on region-bound individual factors. The availability of skilled health personnel and lack of financial resources were the most common subthemes. @*Conclusion@#This study identified some key factors that deter patients from availing of existing maternal health services in Luzon. Eliminating these barriers will not only help strengthen local health infrastructure and improve service delivery but also promote the utilization of such services, leading to better maternal outcomes.

Implementation of newborn hearing screening in Rizal, Philippines, and Northern California: Lessons learned

Objective@#The universal newborn hearing screening program has been implemented in the Philippines for the past ten years. However, screening rates in the country are still low. The current study aimed to describe the universal newborn hearing screening program (UNHSP) delivery system in Rizal, Philippines, and Northern California. @*Methods@#The study utilized a case study research design using data triangulation of FGD, KII, and document review to characterize and compare the implementation of the Universal Newborn Hearing Screening Program in Rizal Province and Northern California. @*Results@#Several differences were found in the protocols for newborn hearing screening in Rizal, Philippines, and Northern California, including centralization of the program, availability of surveillance data, screening protocols, and tracking system. @*Conclusion@#There is an immense need to disseminate universal newborn hearing screening among healthcare practitioners and create a system to monitor and evaluate real-time data.

Developmental kindergarten classroom intervention for spatial relational terms

ABSTRACT Purpose Relational ability is a key attribute of language. Knowledge of relational terms, including spatial terms, can facilitate development of relational ability. Acquisition of spatial terms can be challenging and necessitates experience and input due to the abstractness of the concepts. Service delivery models for school-based speech-language pathologists (SLPs) are changing from traditional "pull-out" therapy to intervention in the classroom. Response to Intervention (RtI) and multi-tiered system of support (MTSS) frameworks have expanded SLPs' roles to working with all children at-risk for academic difficulties. Methods Given the importance of spatial terms, and the changing roles and service delivery models for school-based SLPs, this investigation evaluated a six-week classroom-based intervention targeting spatial terms in a developmental kindergarten classroom of five-year-old children. Results At post-test, more than half of the children who did not understand the targeted spatial terms at pre-test demonstrated understanding of the words first, front, last, behind, center, below, under, and right by correctly identifying pictures representing these words. Around and left were the only two words learned by fewer than half of the children. Conclusion These findings augment research used by SLPs providing language support to children within the first tier of Response to Intervention or multi-tiered system of support.

Nigeria in the COVID era: Health system strengthening for national security and prosperity

The coronavirus disease­19 pandemic has spread to all parts of the world. As of 20 May 2022, over 500 million confirmed cases have occurred with over 6 million deaths. In Nigeria, over 255,000 cases have occurred with more than 3000 deaths. The pandemic has adversely affected virtually all aspects of human endeavour, with a severe impact on the health system. The Nigerian health system was ill prepared for the pandemic, and this further weakened it. The impacts of the pandemic on the health system include disruption of health services, low motivation of the health workforce, unresponsive leadership and poor funding. The national response, though initially weak, was ramped up to expand capacity building, testing, public enlightenment, creation of isolation and treatment centres and research. The funding for the national response was from the government, private sector and multilateral donors. Nigeria must comprehensively strengthen its health system through motivating and building the capacity of its human resources for health, improved service delivery and provision of adequate funding, to be better prepared against future pandemics.

An assessment of Nigeria's health systems response to COVID-19

Objectives: This study aims to understand and report on selected health system interventions considered nationally and sub-nationally of particular significance both in terms of COVID-19 responses and in strengthening the health system for the future. Design: A review of published and grey literature, including journals, news/ media and official documents, was conducted from 1st December 2019 to 31st December 2020. The reviewers read and extracted relevant data using FACTIVA in a uniform data extraction template. Responses that related to service delivery were captured. Setting: The assessment considered responses at the national and two state levels: Lagos and Enugu, representing the epicentre and a low COVID-19 burden centre. Inclusion criteria: Documents and news that mentioned COVID-19 response, particularly service delivery aspects, were included in this review. Results: The identified interventions were mostly technical support targeted at health workers: including training of about 17,000 health workers, supervising and engaging more health workers, upgrading laboratories and building new ones to improve screening and diagnosis, and motivation of health workforce with incentives. Furthermore, the influx of philanthropic contributions improved the data and information systems supply of medicines, medical products and non-pharmaceutical protective materials through local production. The presence of political will and the government's efforts in health system's response to COVID-19 facilitated these interventions. Conclusions: Interventions of state and non-state actors have strengthened the health systems to some extent. However, more needs to be done to sustain these gains and make the health system resilient to absorb unprecedented shocks.

A literature review on the facilitators and barriers to the uptake of interprofessional collaboration in the field of assistive technology within rehabilitation medicine

@#Assistive technology (AT) enables an optimized life for persons with disability through the scaffolding of functional capabilities. However, AT provision faces challenges such as long approval processes, funding inadequacies, and difficulties integrating evidence into practice. A means to address these issues is through interprofessional collaboration (IPC), the process by which health professionals efficiently coordinate and work with each other towards a common goal to maximize limited resources. To promote its effective implementation, there is a need to know the facilitators and barriers that affect its implementation. Thus, this paper aims to review the facilitators and barriers to the uptake of IPC in the field of AT within rehabilitation medicine identified by existing literature. This literature review followed the steps outlined by The Model Systems Knowledge Translation Center. Articles published between January 2000 until September 2019 were retrieved from four electronic databases (Cochrane Library, PubMed, Scopus, Science Direct). Three studies were included in the study. Facilitators identified were: (1) optimal work culture, (2) professional competence, and (3) associating with team members. Barriers to effective IPC in the field of AT were identified as: (1) presence of professional silos, (2) lack of unified language, and (3) gaps in bureaucratic support. The mechanisms and factors in implementing interprofessional collaboration identified by the World Health Organization are vital in the field of AT. However, the barriers identified above need to be addressed to promote the uptake of IPC within this specialized field.

Barriers to an Effective Maternal Health Service Delivery Network: A Qualitative Study among Health Providers in Legazpi City, Albay

Objectives@#To A functioning referral system is critical to the maternal health program, especially in the management of obstetric emergencies. This study explored supply-side barriers affecting the effective implementation of the said service delivery network (SDN) in Legazpi, Albay in the Bicol Region of the Philippines. @*Methods@#Face-to-face in-depth interviews using semi-structured questionnaires were performed with health care providers involved in the SDN in Albay. Extensive note taking was done by the primary investigator while participants were observed during performance of duties from June - November 2018. Interviews were audio-recorded, transcribed, translated into English, and analyzed thematically along with the observation notes using NVivo. A deductive-dominant approach was utilized for the data content analysis.@*Results@#Referral system barriers identified were cross-cutting across the different components of the health system such as governance, human health resource, service delivery and information systems. The barriers were further classified into individual, organizational and external-related factors in relation to the SDN. Examples of barriers included lack of knowledge of protocols and guidelines, lack of coordination between facilities, poor data management, inadequate capacity building opportunities, and constantly changing political landscape and policies.@*Conclusions@#The study is the first to explore barriers to effective service delivery network in maternal health in the country. Findings from the study provide significant insight to areas of improvement in the SDN that must be addressed to strengthen local health systems, especially with the country’s movement towards Universal Health Care where local health systems play a key role.

Examining the oral health of Filipinos: Policy analysis

Background@#High prevalence of oral health problems persists across all age groups among Filipinos despite the continued endeavors of the government and professional societies. This position statement aimed to generate consensus policy recommendations to protect and promote oral health in the Philippines as an integral part of the healthcare service in light of the Universal Health Care (UHC) Act. @*Methods@#An evidence-based policy brief and presentations of dental and policy experts were used as discussion points in the roundtable discussion conducted by the UP Manila Health Policy Development Hub. Key stakeholders from various sectors were convened to generate inputs for policy actions and amendments to oral health related policies. ools.@*Results@#Thematic analysis of the discussion was organized using the WHO Building Blocks of Health Systems, which yielded practical, accessible, and population-wide interventions (2010). The following issues were highlighted: (a) health service delivery needs strong collaboration of LGUs; (b) insufficient workforce of dental professionals; (c) market availability of sufficiently fluoridated toothpaste per age group; and (d) health financing scheme on oral health services.@*Conclusion and Recommendations@#With the shift in the health system landscape brought by the UHC Act, timely and responsive inter-sectoral interventions, focusing on prevention, must be set to attain the target decrease in the prevalence of dental caries. It was also to recommend to (i) engage the academe and training institutions to increase the workforce, (ii) consider adopting international standards on sugar consumption as appropriate, and (iii) ensure sufficient funds for sustainability of oral health programs, particularly school-based caries prevention program starting in pre-schools.

Implementación, resultados iniciales y sostenibilidad de la reforma de servicios de salud mental en el Perú, 2013-2018 / Implementation, initial results, and sustainability of the mental health services reform in Peru, 2013-2018

RESUMEN Se analiza la implementación, resultados iniciales y sostenibilidad de innovaciones en la prestación, financiamiento y gestión de servicios de salud mental en el Perú, realizadas en el periodo 2013-2018. Aplicando nuevos mecanismos de financiamiento y estrategias de gestión pública se implementaron 104 Centros de Salud Mental Comunitarios y ocho Hogares Protegidos que muestran ser más eficientes que los hospitales psiquiátricos. El conjunto de los 29 centros creados entre 2015 y 2017, produjeron en el 2018 un número equivalente en atenciones (244 mil vs. 246 mil) y atendidos (46 mil vs. 48 mil) que el conjunto de los tres hospitales psiquiátricos, pero con el 11% de financiamiento y el 43% de psiquiatras. Se está cambiando la forma de atender la salud mental en el Perú involucrando a ciudadanos y comunidades en el cuidado continuo y creando mejores condiciones para el ejercicio de los derechos en salud mental. La reforma en salud mental comunitaria ha ganado amplio respaldo de sectores políticos, internacionales, académicos y medios de comunicación. Se concluye que la reforma de los servicios de salud mental de base comunitaria en el Perú es viable y sostenible. Está en condiciones para escalar a todo el sector salud en todo el territorio nacional, sujeto al compromiso de las autoridades, el incremento progresivo de financiamiento público y las estrategias colaborativas nacionales e internacionales.

ABSTRACT This paper analyzes the implementation, initial results, and sustainability of innovations in the provision, financing, and management of mental health services in Peru, carried out during 2013-2018. By applying new financing mechanisms and public management strategies, 104 Community Mental Health Centers and eight Protected Homes were implemented, which prove to be more efficient than psychiatric hospitals. The set of 29 centers created between 2015 and 2017 produced in 2018 an equivalent number in consultations (244,000 vs. 246,000) and patients attended (46,000 vs. 48,000) than the set of three psychiatric hospitals, but with 11% of financing and 43% of psychiatrists. The way mental health care is being provided is changing in Peru by involving citizens and communities in ongoing care and creating better conditions for the exercise of mental health rights. Community mental health reform has gained broad support from political, international, and academic sectors, and from the media. We conclude that the reform of community-based mental health services in Peru is viable and sustainable. It is in a position to scale up the entire health sector throughout the country, subject to the commitment of the authorities, the progressive increase in public financing, and national and international collaborative strategies.

Construction of Assistive Products Service System Using Internet Plus and Artificial Intelligence / 中国康复理论与实践

Objective:To establish an Internet Plus intelligent assessment and assistive technology service system. Methods:Based on International Classification of Functioning, Disability and Health, we used new-generation information technology to establish a system for assessment and assistive technology service, and analyze the path of achieving Internet Plus and intelligence from the elements of the National Health Coverage Health Service System. Results:The architecture of assessment and assistive technology service system was proposed. Conclusion:A new kind architecture of assessment and assistive technology service system was established by using new-generation information technology.

Utilization of Hospitals Located Outside Patients' Residential Areas among Those with Acute Cerebral Infarction / 보건행정학회지

BACKGROUND: The current study evaluated the hospital utilization and characteristics of patients who received health care services for acute cerebral infarction outside their own residential area. METHODS: Using the 2014 national patient survey data, information on 2,982 patients diagnosed with acute cerebral infarction through emergency department were retrieved for the analyses. Multiple logistic regression was performed to investigate the characteristics associated with using hospitals outside residential area among patients diagnosed with acute cerebral infarction. RESULTS: Fifteen point nine percent of patients admitted for acute cerebral infarction utilized hospitals outside their residential area. Patients residing in a province were 7.7 times more likely to utilize hospitals located outside their residential areas compared to those living in Seoul metropolitan city. Patients living in Gangwon and Jeolla were 0.26 times and 0.48 times more likely to go to hospitals in different geographical areas. Also, patients within the age group of 80 years and over were 0.65 times less likely to be admitted to hospitals outside their residential area compared to those in their 40s–50s. CONCLUSION: The use of hospitals outside patient's residential area is shown to be substantial, given that the acute cerebral infarction requires immediate recognition and treatment. The findings on the geographical differences in the hospital utilization suggest further investigation.

Describing the health service delivery network of an urban poor area and a rural poor area

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> This study aimed to assess the health workforce's service capacities within a health Service Delivery Network (SDN) of an urban poor and a rural poor setting.</p><p style="text-align: justify;"><b>METHODS:</b> This is a concurrent mixed-methods study implemented in Navotas and Masbate, an urban poor and a rural poor area, respectively. Health needs of the residents were assessed through records review, qualitative methods and a household survey. Health facilities in the identified SDN were assessed using the Service Availability and Readiness Assessment (SARA) tool. Training data of Human Resource for Health (HRH) were also obtained.</p><p style="text-align: justify;"><b>RESULTS:</b> SDN in the two areas are different in terms of formality where memoranda of agreement were prepared between Masbate facilities but not in Navotas. Health worker to population ratios were 12.1 per 10,000 in Navotas and 2.7 in Masbate, respectively. The primary care facilities in the two sites met the recommended level of trainings for health workers in obstetric care, immunization, childhood nutrition and tuberculosis. There was a lack of post-graduate training in non-communicable diseases in all facilities. Poverty and geography were significant factors affecting health service delivery.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> In terms of human resources, both sites have limited number of health workers and the ratios fall far below WHO guideline. Recommendations include: Primary health care staff complement should be increased in the two SDNs. HHRDB should conduct a study to settle the issue of continuing medical education requirements that are not congruent with WHO recommendations. The SDNs should include the access of medicines and commodities by poor patients in private facilities during times of stock outs. Also, during stock outs or unavailability of government health personnel, transportation should be made available via the SDN to transport poor patients to private or nongovernment facilities with the needed personnel. The DOH and HHRDB should investigate innovative strategies for telehealth services that do not require continuous electricity, nor telephone or cellphone signal.</p>

Health information sources awareness, use and service delivery of resident doctors in babcock university teaching hospital, Ogun state

The study investigated the relationship between health information source awareness, use and service delivery of resident doctors in Babcock University Teaching Hospital. The study adopted descriptive research design. Out of the 60 copies of questionnaire administered to all the resident doctors, 52 (87%) were returned and used for the study. The data were analyzed using percentages, mean and Pearson Product Method correlation. The findings revealed there is no significant relationship between health information use and service delivery (r = 452, p < .05). The findings also revealed that the major health information sources consulted in Babcock University Teaching Hospital by resident doctors were medical textbooks, internet and personal collections. The major challenges facing resident doctors in Babcock University Teaching Hospital were non-availability of relevant information, inadequate information retrieval skills, lack of accessibility of sources. The study concluded that there is a need to provide more relevant materials and enhance the internet service in order to improve the quality of service delivery of resident doctors. Key words: health information sources use, awareness, service delivery, resident doctors.

Políticas de saúde e lacunas federativas no Brasil: uma análise da capacidade regional de provisão de serviços / Health policies and federative gaps in Brazil: an analysis of regional capacity of services delivery

Resumo No artigo são analisadas as regiões de saúde no Brasil segundo sua capacidade de provisão de serviços a partir do debate sobre a crise do federalismo cooperativo no SUS decorrente do processo de descentralização definido pela Constituição de 1988. Foram selecionados indicadores traçadores de capacidade de oferta de serviços segundo regiões e as análises estatísticas mostraram maior capacidade das regiões na atenção hospitalar e grandes assimetrias com relação a disponibilidade de médicos, equipamentos de alta complexidade e cobertura de seguros privados. Conclui-se pela necessidade de soluções que aumentem a capacidade governamental de reduzir desigualdades regionais a partir de maior coordenação central.

Abstract This paper analyzes Brazilian health regions according to their service delivery capacity from the debate on the crisis of cooperative federalism in the SUS that resulted from decentralizing process established in the 1988 Constitution. Service delivery capacity tracer indicators were selected by regions and statistical analyses evidenced greater regional capacity in hospital care and large asymmetries with regard to the availability of physicians, high complexity equipment and private insurance coverage. In conclusion,we argue that further solutions are required to strengthen governmental capacity to reduce regional inequalities throughincreased central coordination.

An Assessment of Bicycle Intervention to Improve Service Delivery by Accredited Social Health Activists in Selected Blocks of West Champaran District of Bihar.

Background: Several programmatic and logistic issues affect the overall performance of Accredited Social Health Activists (ASHAs). Bihar Government provided bicycles to ASHAs in West Champaran district for increasing coverage of services by improving their mobility. Objective: To assess the use of bicycles by ASHAs and it’s effect on service delivery. It also captures the perspectives of ASHAs in terms of its utilization for performing tasks. Methods: A community-based quasi-experimental study was undertaken during March-May 2016. Proportion of newborn babies visited within 24 h of birth was the primary outcome. Data were collected from two intervention blocks (West Champaran district) and a control block from the neighboring East Champaran district. A total of 323 (177 from intervention blocks and 146 from control block) mothers having children <3 years of age and who had delivered at home were interviewed. Besides, 88 ASHAs working in intervention blocks were also interviewed. Results: Significantly higher proportion of mothers and newborn babies (44%) received postnatal care within 24 h of delivery in intervention blocks as compared to the control block (16%, P < 0.001). Nearly 73.1% of ASHAs were using the bicycle themselves. ASHAs were twice more likely to visit a newborn on the day of delivery if she was provided with mobility support. However, the likelihood of continuing visits after the 1st day was not statistically significant. Conclusion: The intervention demonstrated the potential of ASHAs to improve their functioning at the grass-root level. The scale-up of bicycle intervention should be supplemented with reforms in financial incentives disbursement and better system support.

The Concept and Challenges for Public Health Systems / 보건행정학회지

The study of public health systems is an important, but very difficult task. The concept and functions of public health systems are influenced by the views, interests, and influence of the various stakeholders belonging to public health systems and broader social, economic, political, and environmental sectors. To define public health system with conceptual clarification, we must take into account the dynamic and complex aspect of the public health system. This paper reviews health systems and public health systems literature to suggest the concept, goals, and functions of public health systems. In addition, this paper recognizes some challenges, such as leadership and management, resource development, economic support, and service delivery to strengthen public health systems for improving health and well-being of population.

A Study of the Current State of the Mental Health Service Delivery System Using the Focused-Group Interview / 신경정신의학

OBJECTIVES: To use focus-group interviews (FGI) to determine the current state of the Korean mental health service delivery system, inter-agency patient links, and identify associated problems. METHODS: The FGI were conducted by seven workers from psychiatric rehabilitation centers and community mental health centers and seven social workers from mental health hospitals. RESULTS: Within the mental health service delivery system, disconnection of the community network after discharge is considered a serious problem. The following improvement proposals are suggested : 1) the control tower should govern the community network after discharge, 2) consider insurance costs during activation of hospital links, and 3) expand information sharing related to community social facilities. With regard to non-voluntary admission and long-term hospitalization, most focus group members considered the revolving-door phenomenon to be more serious than non-voluntary admission. In order to prevent unnecessary long-term hospitalization, the FGI results indicated that the government should proactively intervene in the admission/discharge process. In addition, the following improvement proposals were suggested : 1) functional activation of the mental health review board via the reinforcement of workers' expertise, 2) expansion of local mental health centers, and 3) undertake institutional changes related to the family-related issue of preferring hospitalization over a stay at a secure facility. CONCLUSION: For the government to improve the efficiency of the mental health service delivery system, it is necessary to improve institutional linkages, expand mental health infrastructure, and develop an integrated management system.