Studies on the use of mental health services in Nigeria are scarce. Most of the existing studies have focused on psychiatric illnesses. However the context for the assessment and treatment of many mental health disorders in developing countries including Nigeria is moving from mental hospitals to primary healthcare providers (PHC). This present study was conducted in Delta State Nigeria to assess the use and provision of mental health services in PHCs (General Hospitals). Two sets of questionnaires were used for the study; one set was given to health practitioners (15), while the other was given to 50 community respondents who were patients in these facilities. The results show that there is low utilization of mental health services in PHCs. In addition, patients do not have a positive attitude towards the use of formal mental health services and also lack an awareness of the availability of these services in PHC settings.
Turbulent market conditions have forced the healthcare sector to re-examine its business and operational practices. Healthcare has become increasingly complex as decisions and planning are reframed in light of the current lagging economy, an increased demand for services, new global competition, and impending legislation reform. The stress is felt most keenly within the nation’s hospitals and consortia of healthcare facilities. Facility planning decisions are no exception. Hospital administrators are abandoning the once commonplace rules governing aging infrastructure renovations. Instead, administrators are basing decisions within their respective strategic context and are attempting to align buildings, services, personnel, and technology to an overall plan that looks at markets, operations, and finances as resources for competitive advantage. This paper reviews the strategic facilities planning literature and applies those best practices which support this organizational alignment for healthcare. An application in the mid- Atlantic demonstrates that hospital facilities, by design, need to support the current and future needs of healthcaredeliverysystems, while dated structures impede industry advances. Healthcare infrastructure improvements must proactively address technological, regulatory, and financial changes facing the sector.
Health is a fundamental human right and that the attainment of the highest possible level of health is a most important world- wide social goal. This realization requires the action of many other social and economic sectors in addition to health sector. The existing gross inequality in the health status of the people particularly between developed and developing countries as well as within the country is politically, socially and economically unacceptable. Though the Indian population has largest healthcaredeliverysystems in the world, people of country still suffer from a multitude of preventable and treatable general and oral health problems To overcome such situation of dental workforce, solutions will almost certainly involve a oral health and public healthcare professionals, representatives from minority interests, insurers and other payers such as businesses, consumers, and most importantly, central and state legislatures. In the role of primary care in global health, the continuity and doctor-patient relationships offered by family oriented primary care, alongside the patient education, early intervention and treatment, chronic disease management, counselling and reassurance offered to patients would be impossible to provide in a secondary care setting. (Lyn et al., 2011) A health system built on a strong foundation of public health and primary care must be synergized with public policies that promote critical intersectoral approaches. (Yeravdekar et al., 2013) Therefore high quality care is the only way in the epidemiological spectrum to achieve good health for all. (Lyn et al., 2011) The primary healthcare is thus a broad concept within the realms of public health, clinical services and health system that requires optimal performance from various inter-related sectors acting in tandem to achieve the goal of providing essential healthcare to all citizens. (Yeravdekar et al., 2013)
Tobacco dependence treatment programs should be available to adolescents who are tobacco dependent. Healthcaredeliverysystems should consider collaborations with schools to minimize barriers to adolescents ’ ability to access these programs. Healthcare facilities should not subscribe to or display magazines, videos, or other materials that contain advertisements for tobacco products or images that model any tobacco product use. Campuses of institutions or ofﬁces where children’s healthcare is delivered should be tobacco free, including both indoor and outdoor spaces. To protect children, retail-based clinics should not be located within or near retail establishments that promote or sell tobacco products.
Introduction: The increasing demands for effective and efficient healthcaredeliverysystems worldwide have resulted in an expansion of the desired competencies that physicians need to possess upon graduation. Presently, medical residents require additional professional compe- tencies that can prepare them to practice adequately in a continuously changing healthcare environment. Recent studies show that despite the importance of competency-based training, the development and evaluation of management competencies in residents during residency train- ing is inadequate. The aim of this literature review was to find out which assessment methods are currently being used to evaluate trainees’ management competencies and which, if any, of these methods make use of valid and reliable instruments.
Historical Aspects of Hospital and University Relationships It is often assumed that hospital and university alliances have remained constant. A historical review, however, reveals that this is a constantly evolving relationship. Mas- sachusetts General Hospital (MGH), one of the oldest and best-known teaching hospitals in the United States, has a well-known affiliation with Harvard University but is actually currently owned by Partners Healthcare™, a non- profit organization . It was not until 1869, 58 years after the founding of MGH in 1811, that the University of Michigan opened the first university-owned medical facil- ity in the United States . Yale-New Haven Hospital did not have "Yale" in its title at all until 1965 and is currently owned by the Yale-New Haven Health System Inc . Regardless of the nature of the ownership, most healthcaredeliverysystems are more closely associated with the hospital than a university. For example, the Centers for Medicare and Medicaid Services (CMS) through the Medi- care Part A trust fund, give funding to hospitals for gradu- ate medical education . The Joint Commission accredits hospitals based on a set of standards . Trauma verification is given to individual hospitals, not to healthsystems or universities . The quality awards mentioned above are typically given to hospitals. Further- more, because this association is so strong, the identity of the hospital becomes critical for marketing purposes . Finally, with declining physician reimbursement from Medicare, hospital subsidizing will likely play a larger role in some physician salaries . Universities, however, have expertise in research, education, and leadership that are not available elsewhere.
Abstract: Every society makes provisions for healthcaredeliverysystems for its members. This is with a view to providing medical and related services for the maintenance of good health, particularly through the prevention and treatment of diseases. This is in recognition of the pervasive importance of good health upon which life is contigent. These societies thus developed indigeneous medical systems through interactions with their environment wherein the health needs of the people were met. The aftermath of colonisation in Nigeria has however presented two healthcaresystems- traditional and orthodox- which seem to work at cross purposes in meeting the health needs of the people. While orthodox practice enjoys official recognition, traditional practice is derided by the authorities. Yet a significant proportion of the population (about 70 per cent) still patronise the traditional health practitioners. It is obvious that the two forms of medical practice have come to stay and it is logical therefore to explore the possibility of both being available to the people for improved healthcaredelivery system for the people . This paper, through literature reviews, examines the structures and features of both medical systems in Nigeria with a view to finding a convergence that will be to the advantage of the populace.
The ‘Health for All’ movement started in the 1970s and set the path towards the current goal of universal health coverage. Its principles were assembled in 1978 in the Declaration of Alma-Ata, which called for a political commitment to implement sustainable and integrated primary healthcare (PHC) as the essential care for all the individuals in their communities . The inter- national endorsement of the declaration anticipated a turning point in the organisation of healthsystems to- wards health promotion and disease prevention, and a multisectoral action to tackle socioeconomic determi- nants of health. However, the political and economic in- stability of the succeeding years hindered its implementation. In the European area that concerns our study, the fall of the Soviet Union left many countries in transition in a global environment of market-driven re- forms and constrained budget allocation to public ser- vices [2–4]. Worldwide, the spread of HIV/AIDS, tuberculosis and malaria contributed to the loss of advo- cates for holistic PHC in benefit of selective approaches . Selective PHC proposed more objective and ac- countable targets to allocate health resources and, thus, attracted the political and economic efforts required to pursue the Alma-Ata commitments . This was also supported by the World Bank and international donors, which played an important role in healthcare agenda-setting at that time [7, 8]. The holistic PHC ap- proach itself was also commonly misunderstood  – it was either considered as inexpensive healthcare only appropriate for rural areas and developing countries or as unaffordable and utopic. It was also criticised for be- ing focused on people’s assumed health needs instead of looking at health demands .
Over the past few years, the electronic medical record (EMR) has increasingly been touted as a necessary vehicle for increasing the quality of care for patients. The EMR is aimed at reducing (or ideally eliminating) paper patient records, thereby increasing the efficiency of “handoffs” during the patient care process, decreasing the likelihood of patient care errors, and ultimately facilitating the exchange of health information across carehealthcare providers, between providers and patients, as well as between providers and third-party payers. Although the aims of the EMR are generally accepted, there is not a consensus on what constitutes an EMR system and how best to design one. Therefore, EMR system characteristics are not uniform across all caredelivery organizations. That is, EMR systems likely vary between hospitals with respect to the set of applications in the system, the levels of
This evaluation had many limitations. Studies have shown that data from health information systems in SSA can be both inaccurate and incomplete and do not adequately reflect improvements in settings where rapid scale-up of interventions have taken place (Ndabarora, Chipps, & Uys, 2014). Of note, limitations with data quality existed at both group care and comparison facilities. We placed less emphasis on record keeping and more emphasis on learning how to facilitate discussions in our training of CHVs and health providers. As a result, Afya Jamii attendance records had large amounts of missing data and we were not able to report individual health uptake of all participants, specifically place of delivery and CHV 48 hour follow-up visit. In addition, CHVs failed to record when women did not attend a visit. As a result, we included missing data as non-
health services. The purpose was to include studies using the same methods to measure the differences, and in the same countries, to avoid confounding factors related to overall differences in service quality between countries. We included studies conducted in LMICs that assessed ambulatory care, defined as the ‘‘delivery of personal healthcare services on an outpatient basis’’ . We only included studies that compared private and public services in the same country, at the same time, using the same methods, and which met particular quality criteria (Table S1). ‘‘Private’’ refers to ‘‘all organizations and individuals working outside the direct control of the state’’ , and we included only those working within the allopathic medical systems. ‘‘Private for-profit provid- ers’’ included individuals or groups of practitioners in privately owned clinics, hospitals, and pharmacies that operate on a for- profit basis, while ‘‘private not-for-profit providers’’ included practitioners in facilities that operate on a non-profit basis, such as various (missionary or non-missionary) NGOs and private voluntary organizations. Informal providers included those without formal health professional qualifications, such as street vendors and shop keepers. We included studies reported in English, French, or German and published from January 1970 to April 2009. We screened all titles/abstracts found by the search methods described below for potential inclusion, and then carefully applied the detailed inclusion criteria (Table S1) to the full text of those identified in the screening search. Studies using qualitative methods were identified and were included if they (a) used internationally accepted data collection methods (e.g., in- depth interviews, focus group discussion, or observation), (b) indicated the methods used in analysis (e.g., thematic analysis, content analysis, or grounded theory), and (c) presented data by theme or in the form of verbatim quotes.
RTD priorities professional healthcare: systems enhancing the ability of healthcare professionals for prevention, diagnosis, care and rehabilitation, such as intelligent systems for non-invasive diagnosis and therapy, intelligent medical assistants, and advanced medical imaging; advanced telemedicine applications; “virtual hospitals” offering single-point-of-entry services; high-speed secure networks and applications for linking hospitals, laboratories, pharmacies, primary care and social centres for continuity of care; health service workflow management and re-engineering; new generation electronic healthcards for sophisticated health data objects; personal healthsystems: systems for personal health monitoring and fixed or portable prevention systems, including advanced sensors, transducers and micro-systems; personal medical advisors for supervision of prevention and treatment; tele-systems and applications for supporting care in all contexts; user-friendly and certified information systems for supporting health education and health awareness for citizens; “design-for-all” products, systems and service, including improved participatory design methods, multi-modal terminals and universal interfaces; adaptive systems: communication tools for persons with special requirements, mobility support devices, both at home or in the wider environment, robotics control systems; multimedia applications for supporting daily living and social integration at home, work, education, transport, leisure, etc., social support and intervention networks, new methods of service delivery; long-term research to create the knowledge and understanding to underpin the development of future services.
Disability Assessment Schedule (WHODAS) 2.0 as additional procedures for the effectiveness evaluation. Easy-to-use fea- tures will allow the patient to have access to the information at any time with explanations and recommendations. Automatic integration of collected between- and within-subject data in databases can provide the medical and research communities with an opportunity to assess effectiveness, enabling insights into illness evolution, the effects of drug therapy, treatment compliance, and rehabilitation process. Acceptance by the patient is reinforced by developing friendly and useful appli- cations. Furthermore, specific acceptance strategies of the e-health system may be developed through cocreation with the end user. In addition, the system may be integrated with microelectromechanical systems for the automatic delivery of drugs, making it compatible with regular Android and Apple smartphones, mobile and electronic companies, and with new protocols and services of data transmission, pro- cessing, storing, and protection (eg, HL7 Personal Health Monitoring Standard), thereby ensuring easy adaptability to most ambulatory recording devices already available in the health services where the system is deployed.
first report that shows higher MMR in secondary facilities as compared to tertiary hospitals using the same data set. Although both types of hospitals have traditionally provided emergency obstetric care in the country, there has been less attention devoted to providing human and infrastructural resources for care in secondary as compared to tertiary hos- pitals. This may be due to the fact that tertiary hospitals are managed by the Federal Ministry of Health, while secondary hospitals are managed by States Ministries of Health that allo- cate limited resources to health. Many Nigerian states often do not prioritize resource allocation to health, which accounts for the poor quality of maternal healthcare and emergency obstetric care in secondary care hospitals. The results of this study point to the need for Nigerian States to take steps to strengthen their healthcaresystems, especially the delivery of emergency obstetric care in secondary health facilities. Table 3 Distribution of maternal deaths by discharge diagnosis and facility
isolation from policy options for the overall healthcare system. Major stakeholders developing policy focused on cost, access, and quality for the general population and adults with chronic conditions often are unable to focus on the nuances of caresystems for CMC, especially when there is a negligible impact on larger care issues. For example, California has a $94 billion Medicaid budget covering 13.5 million people, of which CCS is ∼ $2 billion, or only 2% covering 180 000 children. In 2015, a bill entitled Advancing Care for Exceptional Kids Act was introduced in Congress. Under this proposed legislation, states would have the option of providing services to children with medically complex conditions under the Medicaid and CHIP programs through a Medicaid Children ’ s Care Coordination program. Eligible children would be enrolled in a Medicaid Children ’ s Care Coordination program within a nationally designated children ’ s hospital network with the aim of better coordination of care, improved health outcomes, and lowered costs. It is anticipated that this bill will be reintroduced in an upcoming session of Congress.
The results of patent protection expiry will be undoubtedly partially offset by a new wave of promising innovations that will allow meeting the demand of patients and significantly altering the treatment paradigm in several key therapeutic areas, including diabetes prevention, treatment of melanoma, multiple sclerosis, breast cancer and hepatitis C. In addition, according to the forecasts of «IMS Health», in 2011—2013 it will be agreed, patented and introduced to the market five new products being the potential blockbuster drugs, which annual sales will make more than USD 1 billion. Those among them may become thrombolytic Brilinta™ (ticagrelor, «AstraZeneca plc.»), anticoagulant apixaban from the companies «Pfizer» and «Bristol-Myers Squibb Co.», a medication for treating breast cancer iniparyb («Sanofi-Aventis S.A.») and a viricide telaprevir for hepatitis C treatment from «Vertex Pharmaceuticals Inc.». It is worth to note that according to the Pharmaceutical Research and Manufacturers of America (PhRMA), the average time for developing a new medication is 10—15 years. In addition, if the process cost a little over USD 300 million 20 years ago, today the cost of developing a new medication has increased almost three-fold. The development of biotechnology drugs is much more expensive and may reach USD 1 billion. Thus, only 3 of 10 medications that enter the market generate the revenues to cover the cost of its development and are beneficial for the developer.