An assessment of the provision of women-friendly care and its associated factors among mothers who gave birth at public health institutions in South Gondar Zone, Northwest Ethiopia.

Introduction: "Women-friendly care" is one of the categories of respectful maternal care and is a method of providing care that improves women's access to safe parenting and to reproductive health services by creating a friendly environment at all levels. Improving service use is crucial, particularly in situations where it is low. There is limited data on women-friendly care during childbirth in Ethiopia. Objective: This study aimed to assess the provision of women-friendly care and its associated factors among mothers who gave birth at health institutions in the South Gondar zone, Northwest Ethiopia. Methods: A multicenter institutional-based cross-sectional study design was conducted among mothers who gave birth at South Gondar Zone public health institutions, from February 01 to March 30/2021. Three hundred forty-eight study participants were selected by using systematic random sampling. A validated questionnaire was used for data collection. For analysis, the data were imported into Epi-Data version 4.6 and exported to SPSS version 25. A multivariable logistic regression analysis was performed to identify factors associated with the outcome variable. An adjusted odds ratio with a 95% confidence interval was computed to determine the level of significance. Results: The study had 344 participants in total, with a response rate of 98.85%. The study revealed that a full 73% [95%; CI: 68.6, 77.3%] its participants received women-friendly care. Having antenatal care follow-up [AOR: 3.02, 95% CI: 2.16-11.68], being a primipara [AOR = 2.30 95% CI: 1.23-5.49], not experiencing complications during childbirth [AOR: 2.13, 95% CI: 1.17-12.4], stays at health care facilities, specifically between 13 and 24 h [AOR: 0.25, 95% CI: 0.09-0.67], place for delivery [AOR: 2.01, 95% CI: 1.29-6.09] and delivering during daytime hours [AOR = 2.17, 95% CI: 1.08-5.65] were significantly associated with the provision of women-friendly care. Conclusions: Only two-thirds of the study participants received Women's-friendly care during childbirth. It was found to be low in our study area in contrast with the majority of the previous findings. Our own findings also suggest the importance of minimizing elective induction of labor during night, of providing comprehensive counseling on antenatal care follow-up, of ensuring mothers remain at health care facilities until the recommended duration, and of implementing early prevention and management of childbirth complications to ensure that mothers receive women-friendly care.

Consented maternal care and associated factors among mothers who gave birth at public health institutions in South Wollo Zone, Amhara region, Ethiopia 2022.

Introduction: Informed consent in healthcare services is a legal, ethical, and professional requirement on the part of all treating health providers and providing person-centered care. The methods of requesting consent during childbirth have not been extensively studied. In Ethiopia, there is not at all a single study done. Objective: The purpose of this study is to determine associated factors among mothers who gave birth at health institutions in the South Wollo Zone, Amhara region, Ethiopia in 2022. Methods: Mothers who gave birth at South Wollo Zone public health institutions, from 01 March to 30 April 2022 participated in a multi-center institutional-based cross-sectional study design. Systematic random sampling was used to select 423 study participants. A validated questionnaire was used for data collection, and the data were collected through face-to-face interviews. Data were entered into Epi-Data version 4.6 and exported to SPSS version 23 for analysis. A multivariable logistic regression analysis was performed to identify factors associated with the outcome variable. The level of significance was determined using an adjusted odds ratio with a 95% confidence interval. Result: The study had 416 participants in total, with a response rate of 98.3%. Out of the 416 respondents interviewed, 67.1% of the women received consented care. The age group of 30-34, complications during childbirth, intended pregnancy, merchant, and primary and referral hospital were significantly associated with consented care. Conclusion: The level of non-consented care during delivery was high compared with other literature reflecting substantial mistreatment. Therefore, stakeholders should strengthen monitoring and assessment systems to prevent abuse, and further study is required to look for practical ways to make improvements. Key elements of consented care have also been included in Basic and Emergency Obstetric Care training sessions and given to health providers.

(Dis)harmony in times of crisis? An analysis of COVID-related strategic communication by Swiss public health institutions.

OBJECTIVES: This study aims to assess COVID-related communication by Swiss public health institutions (PHI) as well as the challenges they faced in implementing their communication strategies. STUDY DESIGN: This study uses a two-part mixed methods design, combining automated content analysis of press releases by PHI and semi-structured interviews with PHI communication experts. METHODS: The automated content analysis uses natural language processing techniques to measure semantic themes and linguistic properties of 1882 press releases from national and regional PHI during the first year of the COVID-19 pandemic. The semi-structured interviews with 25 communication experts from key PHI explore the challenges faced in implementing their communication strategies. RESULTS: The content analysis reveals key themes in press releases, including non-pharmaceutical interventions, quarantine, testing, contact tracing, hospital situations, and the pandemic's impact on the economy. The linguistic measures indicated a decrease in complexity and readability over time, with no significant differences between national and regional PHI. Interviews revealed challenges arising from organizational structures, the multi-systemic nature of the pandemic, and from expectations of the public. CONCLUSIONS: The study highlights the importance of agility in public health communication and the need for efficient coordination within and between PHI. Organizational structures should be adapted to allow for more agile modes of operation during crises. Policymakers should clarify roles and responsibilities of different actors in public health frameworks to ensure streamlined communication. Understanding the communication efforts and challenges faced by PHI during the pandemic helps preparing for future health crises and improve public health communication practices.

Post-abortion contraceptive utilization and associated factors among women who attended abortion services: A health facility cross-sectional study.

Background: Post-abortion contraceptive utilization prevents unintended pregnancies, reduces the number of abortions, and lowers the morbidity and mortality related to obstetric complications. It plays a central role in improving maternal health and reducing child mortality. However, many women are suffering from unintended pregnancy and its complications after abortion care. Hence, the main objective of this study was to determine the magnitude of post-abortion contraceptive utilization and its associated factors in Bahir Dar City. Methods: Health-facility-based cross-sectional study was conducted in Bahir Dar city health facilities from April 1 to May 30, 2018. A systematic random sampling technique was used to select 354 eligible study participants. A pre-tested semi-structured questionnaire was used to collect the data. Data entry was done using Epi Data version 3.7 software and analyzed by SPSS v23 software. Descriptive statistics were done based on the nature of the data. A simple logistic regression model was used to identify the association and strength of exploratory variables and the outcome variables. Associations were announced at a 95% confidence interval and p-value <0.05 with adjusted odds ratio. Model fitness was checked by the Hosmer-Lemeshow goodness of fit test for logistic regression. Results: In this study, 348 aborted participants were involved with a mean age of 24.37 (±5.73) years. About 40% of the participants were not currently married and 12.9% were unable to read and write. The magnitude of post-abortion contraceptive utilization was 65.8%. The number of alive children (adjusted odds ratio: 7.0, 95% confidence interval: 1.54, 31.95), lower income (adjusted odds ratio: 0.14, 95% confidence interval: 0.03, 0.60), and (adjusted odds ratio: 0.11, 95% confidence interval: 0.02, 0.46), primary school education (adjusted odds ratio: 0.18, 95% confidence interval: 0.03, 0.97), and currently unemployed (adjusted odds ratio: 0.23, 95% confidence interval: 0.06, 0.85) were significantly associated with the post-abortion contraceptive utilization. Conclusion: The level of post-abortion contraceptive utilization is low as per the national plan. The number of alive children, lower income, lower education, and currently unemployed were the identified factors affecting post-abortion contraceptive utilization. Therefore, a collaborative effort is needed among stakeholders to increase the utilization and avoid factors that prevent the utilization of post-abortion contraceptive utilization.

Collaboration with medical colleges and public health institutions for implementation of national health programs: The way forward.

Health system strengthening is a much-needed priority to achieve the major public health goals of control, elimination, and eradication of various diseases. It depends on improving the country's ability to successfully perform essential functions while focusing on sustainability, equity, effectiveness, and efficiency. Medical colleges and public health institutions play an integral role in health system strengthening by educating and training the current and the future generations of health-care workforce with a vision to achieve the global standards in public health. This discussion focuses on the role of medical colleges and public health institutions in the success of various national health programs with a focus on challenges and improvement areas for the same.

Efficiency and equity of bed utilization in China's health institutions: based on the rank-sum ratio method.

OBJECTIVE: The study aimed to analyze the efficiency and equity of bed utilization in Please check if the section headings are assigned to appropriate levels.China's healthcare institutions and to compare and analyze the overall health resource utilization efficiency in recent years and some specific utilization conditions in 2021, to provide empirical experience for the allocation of health care resources in epidemic China. METHODS: To compare and analyze the overall health resource utilization efficiency of the whole country with that of the East, middle, and West in 2021, and to analyze the bed utilization efficiency of different types of healthcare institutions in China and the bed utilization efficiency of various types of specialist hospitals in the country in 2021 by using the rank-sum ratio method. RESULTS: In 2021, the bed utilization rate of China's health institutions was 69.82%, and the number of bed turnover times was 27.65 times; the bed utilization rate of hospitals was 74.6%, and the number of bed turnover times was 26.08 times. The number of hospital bed turnovers was highest in the western region, lowest in the central region, and close to the national average in the eastern region. The average length of stay for discharged patients was the highest in the central region, the lowest in the eastern region, and the same as the national average in the western region. The analysis of rank-sum ratio method shows that among different types of health institutions' bed utilization efficiency (r = 0.935, P = 0.000), general hospitals and traditional Chinese medicine hospitals have the best bed utilization rate, and the bed utilization rate of community health service centers (stations) needs to be improved; while among various types of specialized hospitals' bed utilization efficiency (r = 0.959, P = 0.000), oncology hospitals, thoracic hospitals, and hematology hospitals, children's hospitals have high bed utilization efficiency; leprosy hospitals, cosmetic hospitals, and stomatology hospitals have low bed utilization efficiency. Health technicians per 1,000 population are highest in the western region, lowest in the central region, and lower in the eastern region than in the western region but slightly higher than the national average. The number of beds in health institutions per 1,000 population is the highest in the central region, the lowest in the eastern region, and slightly lower in the northwest than in the central region but higher than the national average. CONCLUSION: China's investment in health funding in the field of health care has been on the rise in recent years. However, there still exists the situation of uneven investment in health expenses and inconsistent medical efficiency among regions. And change such a status quo can be further improved in terms of government, capital, human resources, technology, information system, and so on.

Relaciones institucionales en la implementación de estrategias de promoción, protección y apoyo de la lactancia materna: una revisión integrativa / Institutional relationships in the implementation of breastfeeding promotion, protection and support strategies: an integrative review

Fundamentos: la importancia que tiene la lactancia materna en la salud y calidad de vida de los individuos hace necesario que las políticas establecidas para su promoción sean operadas mediante la participación y articulación de instituciones y a través de redes interinstitucionales. Métodos: para la compilación de la información se hizo una revisión integrativa de literatura, cuyo propósito fue ampliar la comprensión de un tema a partir de la recopilación, sistematización y análisis de producciones científicas. Resultados: se seleccionaron 14 artículos publicados entre 2013 y 2020 y, en su mayoría, escritos en inglés, provenientes de países como Estados Unidos, Alemania, Reino Unido y Samoa. Los temas más recurrentes fueron el análisis de políticas públicas, la coordinación de programas y la percepción del funcionamiento de las estrategias de promoción, protección y apoyo a la lactancia materna. En conclusión: las relaciones intra e interinstitucionales son claves a la hora de implementar políticas de promoción de la lactancia materna. Sin embargo, para su puesta en marcha, se requiere financiación y articulación en los niveles operativos de sistemas de salud. En definitiva, las labores de articulación, seguimiento y evaluación requieren relaciones fortalecidas que fomenten, protejan, promuevan y apoyen la práctica de la lactancia materna. (AU)

Background: the importance of breastfeeding in the health and quality of life of individuals makes it necessary for the policies established for its promotion to be implemented through the participation and coordination of institutions and through inter-institutional networks. Methods: for the compilation of the information, an integrative literature review was carried out, the purpose of which was to broaden the understanding of a topic through the collection, systematization and analysis of scientific productions. Results: 14 articles published between 2013 and 2020 and mostly written in English were selected from countries such as the United States, Germany, United Kingdom and Samoa. The most recurrent themes were the analysis of public policies, program coordination and perceptions of the functioning of breastfeeding promotion, protection and support strategies. Conclusions: Intra- and inter-institutional relationships are key to the implementation of breastfeeding promotion policies. However, their implementation requires funding and coordination at the operational levels of health systems. In short the articulation, monitoring and evaluation require strengthened relationships that encourage, protect, promote and support the practice of breastfeeding. (AU)

Maternal Satisfaction on Delivery Service and Its Associated Factors in Public Health Facilities at West Shewa Zone, Ethiopia.

Background: Maternal delivery satisfaction could be assessed to improve the quality and effectiveness. Thus, this study aimed to assess maternal satisfaction with delivery services and associated factors in public health facilities in West Shewa Zone, Ethiopia. Methods: An institution-based cross-sectional study was conducted on maternal satisfaction delivery services. Systematic and stratified sampling techniques were used to select mothers by using their delivery registration number and to select health facilities. A binary logistic regression model was used to identify associated factors. Results: Among mothers, the overall satisfaction with delivery service was 584 (87%). Shower service availability (39.8%), toilet cleanliness (32.6%), and waiting area cleanliness (31.1%) were significant areas of mothers' dissatisfaction with delivery services. Uneducated mothers, mothers of 1-6 education level, monthly income of mothers less than 500 Birr, mothers who followed antenatal care, mothers who had actual fetal outcome, mothers who admitted from 6:00 AM to 12:00, and mothers who admitted from 12:00 AM to 6:00 PM were satisfied with delivery services. Conclusion: The age of the mother, mother's education level, monthly income of mother, antenatal care, fetal outcome, place of delivery, and admission time of the mother were significantly associated factors for mothers' satisfaction with delivery services. Therefore, regional health bureaus and zonal health offices should work collaboratively on maternal care to improve maternal satisfaction during delivery.

Analyzing the Effectiveness of Data-Linked Projects for Health Promotion in Public Health Centers of South Korea.

Purpose: The purpose of this study lies in verifying the effectiveness of the health promotion project which the public health center at the local level conducted by systematically linking the health examination results from the Health Insurance Corporation. We intend to emphasize the importance of linking the health-related public data. Methods: A survey was conducted to measure the effect of improving health behavior using EQ-5D-5L and demographic variables. Results: As a result of the analysis, the residents (3.13) who had experienced the use of public health centers recognized more necessity for the service linked systematically with health checkup data than those (2.93) who had not. In addition, the residents who had experienced the use of public health centers responded that their chronic diseases had improved compared to a year ago (2.78→2.93). Next, those (3.04) who had experienced the services linked with health checkup data recognized that their chronic diseases and health conditions had been improved compared to those (2.81) who had not. However, in EQ-5D-5L, after using the service, mobility showed no difference between those who had used the service and those who had not. Furthermore, even in terms of self-management, daily life, etc., the management ability was further improved compared to those who had not used it, before using the service. Conclusion: This study showed the improved health level when the health promotion service of the public health center was provided by systematically linking the health checkup data of the Health Insurance Corporation in Korea. In order to increase the effectiveness of health data-linked projects, it is necessary to prepare guidelines for linking the public health data and to expand the data-linked project. It will be needed to further subdivide the health checkup results to provide customized services, and to secure dedicated personnel to reinforce the system link.

Factors Affecting Participation in Cervical Screening by Female Nurses in Public Health Institutions in Vhembe District, Limpopo Province.

In South Africa, the prevalence and death rates as a result of cervical cancer remains high, creating social and economic instability. The main objective of this study was to determine factors affecting participation in cervical screening by female nurses in public health institutions in Vhembe district, Limpopo Province. Early diagnosis and treatment are essential in cervical cancer screening as the prevalence of the disease decreases. The study was carried out at public health institutions in Vhembe district, Limpopo Province. A quantitative, descriptive, cross-sectional design was used in this study. Structured self-reported questionnaires were used in the collection of data. Descriptive statistics were used when analysing data to identify statistically significant differences in variables using SPSS version 26, and the findings were presented in percentages to generate evidence for the study. According to the study findings, (218, 83%) female nurses had been screened for cervical cancer, while the minority (46, 17%) had not been screened. The reasons cited were that they thought they were healthy (82, 31%), (79, 30%) felt embarrassed, and (15%) feared positive results. The majority (190) of them had last been screened more than three years before, with only a few (27, 10%) screened within the previous three years. A hundred and forty-two (53.8%) displayed negative attitudes and practices towards screening if it is paid for, and a hundred and eighteen (44.6%) perceived themselves as not vulnerable to acquiring cervical carcinoma. Furthermore,(128, 48.5%) strongly disagreed and 17(6.4%) were undecided about being screened by a male practitioner. The study concluded that negative attitudes, poor perception, and embarrassment are factors leading to low uptake by female nurses. Therefore, this study recommends that the Department of Health should build the capacity of nursing staff on matters of national significance to achieve sustainable goals and be a healthy nation. Nurses should be at the forefront of departmental programmes.

The Effect of Leadership Style on Midwives' Performance, Southwest, Ethiopia.

Background: Leadership is the basis of professional and organizational commitment, teamwork and success. Midwives leaders' leadership skills and capabilities have long been recognized as essential contributors to health services and outcomes. However, there are insufficient reports on the effect of leadership styles on midwives' performance in African countries including Ethiopia. Therefore, this study aimed to determine the effect of leadership style on midwives' performance in public health Institutions, southwest Ethiopia. Objective: This study aimed to determine the effect of leadership style on midwives' performance, Southwest Ethiopia/2022. Methods and Materials: A cross-sectional study was conducted on 121 midwives using a random sampling technique and a pre-tested questionnaire from May 19/2022-June to 6/2022. Data were entered into Epi-data version 4.4.2.1, edited, coded, categorized and cleaned before analysis. Data were analyzed using the SPSS version 24; and the results are presented in tables, and statements. Correlations and linear regressions were conducted to identify the relationship between leadership style and midwives' performance. Results: In this study, the autocratic leadership style was predominantly practiced by midwifery leaders with a mean score of 2.996 followed by democratic (Mean=2.632) and laissez-faire (Mean=2.49) leadership styles. Inferential statistics (Correlation) analysis revealed a positive relationship between democratic and laissez-faire leadership styles and a negative relationship between autocratic styles and midwives' performance. Multiple linear regressions showed that both democratic (P=0.02) and laissez-faire leadership styles (P=0.00) had a positive effect where as autocratic leadership style (P=0.60) had a negative effect on midwives' performance. Conclusion and Recommendation: Autocratic Leadership is the most practiced leadership style in the study area. An autocratic leadership style was negatively related to midwives' performance, while democratic and laissez faire styles were positively related. Therefore, health care leaders, administrators, supervisors and department heads should implement democratic and laissez-faire leadership styles to enhance midwives' performance.

Evaluación económica de las instituciones de salud basado en el análisis de los costos de los servicios

La calidad de los servicios constituye una prioridad en cualquiera de los sectores o empresas que tenga como finalidad prestar un servicio o un bien, independientemente del tipo que sea. La calidad de los servicios brindado depende de varios factores, pero, sin duda alguna, la evaluación de costos constituye un factor fundamental en la evaluación económica de las empresas, especialmente en instituciones de salud. El objetivo de esta investigación fue analizar la influencia que puede ejercer el estudio de los costos de los servicios en la evaluación económica de las instituciones de salud. Para esto se realizó un análisis de los elementos generales de la evaluación económica y específicos de su aplicación en instituciones de salud; con énfasis en el análisis de costos de servicios. Los resultados muestran que los costos determinan varios elementos relacionados con la calidad de los servicios prestados, de ahí que se concluya que un eslabón importante en la evaluación económica de las instituciones de salud lo constituye el análisis de los costos; ya qua a partir de ellos se pueden identificar brechas y puntos vulnerables que con acciones directas puedan ser solucionados parcial o totalmente; a partir de ellos se puede mejorar la calidad del servicio prestado.

The quality of the services constitutes a priority in any of the sectors or companies whose purpose is to provide a service or a good, regardless of the type it is. The quality of the services provided depends on several factors, but, without a doubt, the evaluation of costs constitutes a fundamental factor in the economic evaluation of companies, especially in health institutions. The objective of this research was to analyze the influence that the study of the costs of services can exert on the economic evaluation of health institutions. For this, an analysis of the general elements of economic evaluation and specifics of its application in health institutions was carried out; with emphasis on service cost analysis. The results show that costs determine various elements related to the quality of the services provided, hence it is concluded that an important link in the economic evaluation of health institutions is cost analysis; since from them it is possible to identify gaps and vulnerable points that with direct actions can be partially or totally solved; from them the quality of the service provided can be improved.

Mapeo de la percepción individual y del entorno organizacional para la práctica clínica basada en la evidencia entre enfermeras renales en España / Mapping of individual perception and the organizational environment for evidence-based clinical practice among renal nurses in Spain

Objetivo: Analizar la percepción de las enfermeras renales en España en relación con el entorno organizacional para la práctica clínica basada en la evidencia (PCBE); y determinar qué factores profesionales y del contexto influyen en esta percepción. Material y Método: Estudio observacional transversal multicéntrico, en 15 servicios de nefrología de distintos hospitales en España y 2 centros de diálisis. Se utilizaron los instrumentos Practice Environment Scale of Nursing Work Index (PES-NWI) y Evidence Based Practice Questionnarie (EBPQ). Se realizó un análisis estadístico descriptivo, bivariado (ANOVA, Kruskall-Wallis), y regresión logística con la puntuación total del EBPQ como variable dependiente.Resultados: Se recibieron 397 encuestas (participación 84,28%), tras depuración encuestas, fueron válidas 382 (81,1% población): 82,7% mujeres, edad media 42 años, media de experiencia profesional como enfermera 18,2 años (12,2 años en nefrología), 94,8% clínicas, 81,9% de hemodiálisis. Puntuación media PES-NWI 62,35±15,10 (IC 95%: 60,78-48,06). Presentaron menores puntuaciones en algunos factores del PES-NWI las enfermeras de centros >500 enfermeras, que trabajan en hemodiálisis y >11 años de experien-cia profesional. Las enfermeras gestoras presentaron mayores puntuaciones en todos los factores del PES-NWI. Puntuación media EBPQ 81,05±21,92 (IC 95%: 78,70-83,4). Presentaron mayores puntuaciones en varios factores del EBPQ las enfermeras con menor experiencia profesional, mejor puntuación en PES-NWI y que poseían estudios de postgrado.Conclusiones: Los factores que más influyen en la percepción de las enfermeras renales en España son la experiencia profesional, el rol dentro de la organización, un contexto favorable y la formación de postgrado.(AU)

Objective: To analyze the perception of renal nurses in Spain regarding the organizational environment for evidence-based clinical practice (EBCP), and to determine what professional and context factors influence such perception.Material and Method: A crosssectional observational multicenter study was carried out in 15 nephrology services from different Spanish hospitals and 2 dialysis centers. The Practice Environment Scale of Nursing Work Index (PES-NWI) and Evidence-Based Practice Questionnaire (EBPQ) tools were used. A descriptive, bivariate statistical analysis (ANOVA, Kruskall-Wallis) and logistic regression were performed with the EBPQ total score as the dependent variable.Results: A total of 397 surveys were received (participation rate: 84.28%), and after processing the surveys 382 were valid (81.1% of the population): 82.7% were women, with a mean age of 42 years, a mean of 18.2 years of professional experience as a nurse (12.2 years in nephrology), 94.8% were clinical nurses, and 81.9% worked in hemodialysis. The average PES-NWI score was 62.35±15.10 (95% CI:60.78-48.06). Nurses in centers with more than 500 nurses, those who worked in hemodialysis, and those with more than 11 years of professional experience had lower scores on some PES-NWI factors. Nurse managers had higher scores in all PES-NWI factors. The average EBPQ score was 81.05±21.92 (95% CI:78.70-83.4). Nurses with less professional experience the better PES-NWI scores; also, postgraduate nurses had higher scores on several EBPQ factors. Conclusions: Factors that most influence the perception of Spanish renal nurses are professional experience, role within the organization, a favorable context, and postgraduate education.(AU)

Primary medical and health preparedness and people's life satisfaction in China: The mediating role of satisfaction with medical and health services.

Objective: To examine the association between primary medical and health preparedness (PMHP), satisfaction with medical and health services (SMHS), and life satisfaction (LS). Methods: Using the latest national representative data from the 2019 Chinese Social Survey and the 2018 Health Statistics Yearbook for each province in China, we conducted multi-level models to test the effect of three aspects of PMHP (the number of primary medical and health institutions (PMHIs), the number of beds in PMHIs, and the number of staff in PMHIs) on LS, and the mediation role of SMHS in this effect. Results: The number of staff in PMHIs has a significant positive effect on people's LS. Besides, this effect is mediated completely by SMHS. However, the number of PMHIs and the number of beds in PMHIs do not affect LS significantly. Conclusions: PMHP has a positive impact on LS, but this impact is associated only with the number of staff in PMHIs. Therefore, governments should focus on optimizing human resources in PMHIs to meet the LS needs of individuals.

The relationship between individual-level socioeconomic status and preference for medical service in primary health institutions: a cross-sectional study in Jiangsu, China.

Background: While China's primary health care (PHC) system covers all citizens, the use of medical services supplied by primary health institutions (PHIs) is not at ideal levels. This study explored the impact of socioeconomic status (SES) on residents' first choice of medical services provided by PHIs. Methods: This community-based, cross-sectional study was conducted in Jiangsu Province, China, from October 2021 to March 2022. A custom-designed questionnaire was used to evaluate 4,257 adults, of whom 1,417 chose to visit a doctor when they were sick. Logistic regression was used to test the relationships among SES, other variables and the choice of medical services, and interaction effects were explored. Results: A total of 1,417 subjects were included in this study (48.7% female; mean age 44.41 ± 17.1 years). The results showed that older age (p < 0.01), rural residence (p < 0.01), a preference for part-time medical experts in PHIs (p < 0.01), and lack of coverage by basic medical insurance (p < 0.05) were associated with the first choice to use PHIs. In the multiple logistic regression model, SES was not associated with the first choice of medical services supplied by PHIs (p > 0.05), but it interacted with three variables from the Commission on Social Determinants of Health Framework (material circumstances, behaviors and biological factors, and psychosocial factors). Conclusion: Vulnerable individuals who are the target visitors to PHIs are older, live in rural areas, and suffer from chronic diseases. SES, as a single factor, did not impact whether medical services at PHIs were preferred, but it mediated relationships with other factors.

Aspectos da confortabilidade de mulheres hospitalizadas na unidade materno-infantil: perspectiva dos profissionais de enfermagem / Aspectos involucrados en la comodidad de mujeres hospitalizadas en la unidad materno infantil: perspectiva de profesionales de enfermería / Aspects involved in the comfort of women hospitalized in the maternal and child unit: perspective of nursing professionals

Objetivo: conhecer os aspectos implicados na confortabilidade das mulheres hospitalizadas na unidade materno-infantil, na perspectiva dos profissionais de enfermagem. Método: pesquisa qualitativa de caráter exploratório e descritivo realizada em uma unidade materno-infantil, com 21 profissionais de enfermagem. A coleta de dados ocorreu por entrevista semiestruturada e, posteriormente, os dados foram submetidos a análise temática. Resultados: dentre os aspectos que contribuem para a confortabilidade destacam-se: mobiliário, serviço de hotelaria, métodos não farmacológicos para alívio da dor, respeito às escolhas da parturiente, direito ao acompanhante e disponibilidade da equipe. Como aspectos que dificultam a confortabilidade evidenciou-se a necessidade de adequação da estrutura física com a adoção de quartos pré-parto, parto e pós-parto, e espaços que permitam a vivência do luto em situações de óbito fetal. Considerações finais: a confortabilidade não está relacionada somente aos aspectos estruturais, materiais ou arquitetônicos, mas envolve as relações e interações estabelecidas na unidade materno-infantil.

Objetivo: conocer los aspectos involucrados en el confort de la mujer hospitalizada en la unidad materno-infantil, desde la perspectiva de los profesionales de enfermería. Método: investigación cualitativa exploratoria y descriptiva; realizada en una unidad materno-infantil, con 21 profesionales de enfermería. La recolección de datos ocurrió a través de entrevistas semiestructuradas, y posteriormente los datos fueron sometidos al análisis temático. Resultados: entre los aspectos que contribuyen al confort, se destacan: mobiliario, servicio hotelero, métodos no farmacológicos para el alivio del dolor, respeto a las elecciones de la parturienta, derecho a acompañante y disponibilidad del equipo. Como aspectos que dificultan el confort, se evidenció la necesidad de adecuar la estructura física con la adopción de salas de preparto, parto y posparto, y espacios que permitan la vivencia del duelo en situaciones de muerte fetal. Consideraciones finales: el confort no sólo está relacionado con aspectos estructurales, materiales o arquitectónicos, sino que involucra las relaciones e interacciones que se establecen en la unidad materno-infantil.

Objective: to know the aspects involved in the comfortability of women hospitalized in the maternal and child unit, from the perspective of nursing professionals. Method: qualitative exploratory and descriptive research conducted in a maternal-child unit with 21 nursing professionals. Data collection occurred by semi-structured interview, and subsequently the data were submitted to thematic analysis. Results: among the aspects that contribute to comfortability stand out: furniture, hospitality service, non-pharmacological methods for pain relief, respect for the choices of the parturient, right to the companion and availability of the team. As aspects that hinder comfortability, it was evidenced the need to adapt the physical structure with the adoption of pre-delivery, delivery and post-delivery rooms, and spaces that allow the experience of grief in situations of fetal death. Final considerations: comfortability is not only related to structural, material or architectural aspects, but involves the relationships and interactions established in the maternal-child unit.

Research on the allocation efficiency of primary medical and health institutions in China based on data envelopment analysis / 中华医院管理杂志

Objective:To analyze the input and output status of health resources in primary medical and health institutions and their allocation efficiency in different regions of China, and to provide an empirical basis for optimizing the allocation of primary medical and health resources in China among regions.Methods:The input index data (number of beds and number of health personnel) and output index data (number of primary medical and health institutions visits, number of family health services, number of hospital admissions) of primary medical and health institutions in China in 2020 were extracted from the China Health Statistical Yearbook 2021. Based on the BCC ( Banker, Charnes, Cooper) model of data envelopment analysis ( DEA), the Bootstrap- DEA method was used to correct bias, the allocation efficiency of primary medical and health resources in 31 provinces was calculated and the regional differences were analyzed. Results:After bias correction, the technical efficiency (TE) of resource allocation in primary medical and health institutions decreased by 0.102. The average TE score of all 31 primary medical and health institutions was 0.669, indicating a serious problem of ineffective use of technology. The TE of the eastern, central and western regions was 0.694, 0.663, and 0.649 respectively. There was obvious polarization in the central regions.Further analysis of the efficiency improvement of non DEA efficient provinces showed that 2 DEA weakly efficient provinces and 16 DEA ineffective provinces had several reference provinces for efficiency configuration improvement; The provinces that have been referenced more than 10 times were Zhejiang, Chongqing, Sichuan, and Ningxia, while the provinces that were listed as the first reference by other provinces were Ningxia, Chongqing, Zhejiang, and Tibet.Conclusions:The resource allocation efficiency of primary medical and health institutions in China is relatively low, and regional differences are obvious. The balance between different inputs and outputs should be considered when allocating the resources. Non DEA effective provinces can use DEA analysis to find the most suitable reference object and make reference improvements in the short term.

Unidade local de saúde: Um modelo de integração vertical dos cuidados de saúde / Local health units: A vertical integration model of health care / Unidad local de salud: un modelo de integración vertical de los cuidados de salud

Resumo Enquadramento: As unidades locais de saúde (ULS) concretizam a integração de cuidados de natureza vertical, reunindo numa única entidade e com a mesma gestão, diferentes níveis de cuidados. Objetivos: Analisar o modelo organizacional das ULS e os potenciais ganhos económicos e em saúde. Metodologia: Estudo exploratório em que participaram cinco ULS que se localizam na zona norte e interior de Portugal. Os dados analisados incidiram sobre o acesso dos cidadãos aos cuidados de saúde, qualidade dos cuidados, eficiência produtiva e desempenho económico-financeiro, referentes ao período de 2015 a 2018. A fonte dos dados foi a Entidade Reguladora da Saúde (ERS) e a Administração Central do Sistema de Saúde (ACSS). Resultados: Pela análise dos dados da ACSS e da ERS parece haver evidência de que o modelo organizativo em ULS não traduz na prática ganhos económicos e em saúde. Conclusão: Na génese das ULS está o objetivo de criar uma melhor interligação dos diferentes níveis de cuidados, concluindo-se que este modelo de governação não aporta o valor acrescentado que teoricamente previa.

Abstract Background: The local health unit (Unidade Local de Saúde - ULS) model embodies the vertical integration of health care services, bringing together different levels of care within a single entity and under the same management. Objective: To analyze the ULS organizational model and its potential health and economic gains. Methodology: This is an exploratory study involving five ULSs located in Portugal's northern and inland areas. The data analyzed focused on citizens' access to health care, quality of care, productive efficiency, and economic and financial performance from 2015 to 2018. The Portuguese Health Regulation Authority (ERS) and the Central Administration of the Health System (ACSS) provided the data for analysis. Results: Considering the ACSS and ERS data analysis, there seems to be evidence that the ULS organizational model does not translate into economic and health gains. Conclusion: ULSs were created to allow a better interconnection between the different levels of care. However, this organizational management model does not provide the added value theoretically expected.

Resumen Marco contextual: Las unidades locales de salud (ULS) implementan la integración de los cuidados de carácter vertical reuniendo en una sola entidad y con la misma gestión diferentes niveles de cuidados. Objetivos: Analizar el modelo organizativo de las ULS y los posibles beneficios económicos y sanitarios. Metodología: Estudio exploratorio en el que participaron cinco ULS situadas en la zona del norte e interior de Portugal. Los datos analizados se centraron en el acceso de los ciudadanos a los cuidados de salud, la calidad de los cuidados, la eficiencia productiva y los resultados económico-financieros, para el período comprendido entre 2015 y 2018. La fuente de los datos fue la Entidad Reguladora de la Salud (ERS) y la Administración Central del Sistema de Salud (ACSS). Resultados: A través del análisis de los datos de la ACSS y de la ERS, parece que hay pruebas de que el modelo organizativo de las ULS no se traduce en la práctica en beneficios económicos y sanitarios. Conclusión: En la base de las ULS está el objetivo de crear una mejor interconexión entre los distintos niveles de cuidados, de lo que se concluye que este modelo de gobernanza no aporta el valor añadido que teóricamente prevé.

Closing human resources gap in health: Moving beyond production to proactive recruitments.

Human Resources for Health (HRH) plays an integral role in healthcare service delivery. Gap in HRH has been a major concern with our healthcare ecosystem for a long time. It is vital to have adequately staffed public healthcare facilities, which are freely accessible to the population. To understand the reasons, we looked at the production, availability, and vacancies of HRH existing in public sector as well as measures taken for closing HRH gap during the period 2014-2015 to 2019-2020 and best practices adopted by the some of the State/UTs. We relied on official websites and official reports/statistics. While teaching capacity has increased significantly in recent past, and there are sufficient numbers of registered HRH, it has not translated into the recruitment of HRH in public facilities. Measures like campus placement, assured career progression, efficient and transparent recruitment process, modern and responsive HR management system, financial and non-financial incentives and notification of the vacant posts can play a vital role in filling the existing gaps. Some of the states have taken proactive measures for filling the vacancies, which can be replicated. The vacancies need to be filled in a mission mode. States also need to sanction required posts as per the norms. The ratio between different categories of healhtcare staff should be taken into consideration while sanctioning posts for these cadres. Availability of HRH in public sector as per norms would contribute toward achieving Sustainable Development Goal-3, reducing out of pocket expenditure and bring enormous socioeconomic gains.