Research is undertaken to identify solutions to com- plex health problems and health system challenges, and it must be translated into practical recommendations that are then implemented. Guidelines can be used as a knowledge source, but also as a way to translate evi- dence into practice . This is even more important in low-income countries, where resources are scarce em- phasizing the need for evidence-informed decisions. However, the presence of guidelines may not guarantee their implementation or utility, and some studies have documented the failure of guidelines to influence the implementation of health programs [7,11-13]. Much of the published work that reviews the utility of guidelines stems from a clinical perspective [12,14]. Health services planning and management is a relatively new discipline, and much less work has been carried out on the subject . The increase in the production of guidelines in health services planning and management will likely occur as the discipline matures. For example, the num- ber of guideline documents on the websites of the World Health Organization (WHO) and other agencies has increased significantly in the last decade. At the country level, decentralization and the subsequent separation of tasks between the management and operational levels seems to have spurred an increase in the number of guidelines. It is not clear whether this increase has been matched with reviews to assess the utility of these guide- lines in influencing implementation.
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milestone is community entry where steps are taken to foster discussions on the activities of CHPS, mainly through durbars and community meetings. The third milestone focuses on the construction of a community health compound referred to as CHPS compound. As indicated earlier, the construction of this building is spearheaded by community leaders and volunteers through community resource mobilization, partly to ensure a sense of community ownership and participation in its operation. Considered the most critical, the fourth milestone involves the posting of CHOs/nurses to run these CHPS compounds. In doing so, assigned CHOs/nurses are introduced to residents within the zone during organized community durbars. The fifth milestone involves the purchase of relevant clinical equipment and related logistics to provide health services. The sixth and final milestone involves the deployment of volunteers based on recommendations by the sub- District Health Management Team to assist CHOs/nurses in the discharge of their duties. These volunteers are trained on community health promotion and resource mobilization. Meeting these milestones is vital to an efficient and sustainable CHPS. Unfortunately, the CHPS implementation process has been inconsistent, occasioned by logistical and
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10 optimal quality of provision: despite being observed by survey staff, providers across all sectors nevertheless omitted many essential components of an adequate consultation for all age groups of clients. Thus, strategies to improve quality of care in facility based family planning services need to tackle provider behaviour and clinical standards as a priority. From the present study, clinical standards emerge as a more pressing concern than potential bias against at-risk groups such as adolescents, for which we did not find supporting evidence. Whether staff had received recent training or not did not influence the findings: while beyond the scope of our analysis, it is likely that effective facility management with supportive supervision including regular observation of consultations to assess compliance with clinical standards and build good consulting behavioural habits is required. Furthermore, we were unable to assess provision for young men owing to their absence from this part of the survey.
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Background: During the 1990s, researchers at the Navrongo Health Research Centre in northern Ghana developed a highly successful community health program. The keystone of the Navrongo approach was the deployment of nurses termed community health officers to village locations. A trial showed that, compared to areas relying on existing services alone, the approach reduced child mortality by half, maternal mortality by 40%, and fertility by nearly a birth — from a total fertility rate of 5.5 in only five years. In 2000, the government of Ghana launched a national program called Community-based Health Planning and Services (CHPS) to scale up the Navrongo model. However, CHPS scale-up has been slow in districts located outside of the Upper East Region, where the “ Navrongo Experiment ” was first carried out. This paper describes the Ghana Essential Health Intervention Project (GEHIP), a plausibility trial of strategies for strengthening CHPS, especially in the areas of maternal and newborn health, and generating the political will to scale up the program with strategies that are faithful to the original design. Description of the intervention: GEHIP improves the CHPS model by 1) extending the range and quality of services for newborns; 2) training community volunteers to conduct the World Health Organization service regimen known as integrated management of childhood illness (IMCI); 3) simplifying the collection of health management information and ensuring its use for decision making; 4) enabling community health nurses to manage
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There is a leadership and governance framework with a national steering committee on CHPS and Technical Working Group in place. These two national groups have oversight responsibilities with specific terms of references to ensure CHPS is effectively implemented. There is a National CHPS coordinator at the Ministry and a coordinator at the Ghana Health Service Headquarters (main implementing agency) with Regional, Districts, Sub-district CHPS coordinators. The community members are not left out. We have Community Health Volunteers who support the community health officer. We also have Community Health Management Teams in place. Roles of key stakeholders have been outlined in the implementation guidelines. Different resources are required at different stages for the effective and efficient implementation of CHPS. A combination of these resources is necessary for effective functioning of CHPS. CHPS implementation essentially is dependent on effective leadership and governance from the national to the community level coupled with provision of basic medical equipment, reliable means of transportation for outreach services and incentive for staff.
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intervention designs. All interventions involved two or more levels of the primary health system (e.g. commu- nity health workers, clinics, hospitals, district-or provincial-level management) recognizing that each level needed strengthening as well as coordination between the levels. Commonly employed intervention compo- nents to address these gaps included capacity building of health care workers including community health workers (CHWs); clinical and systems quality improve- ment, including mentoring, improved data quality and utilization; and strengthening of management and super- vision systems [22–24]. However, some external context- ual factors influenced the variability seen in some components. In Mozambique, the health system strengthening initiative was implemented in areas with high rates of health care service utilization at the baseline . Therefore, the PHIT project opted to focus on improving data quality, data utilization, and management capacity to drive improvement in quality. In Ghana, expanding health care coverage was a priority, and the PHIT project leveraged an existing and well-funded CHW program (Community-based Health Planning and Services, or “CHPS”) to focus on interventions strengthen- ing the community health service delivery model . In Tanzania, the PHIT project reinforced the existing health system by introducing a new cadre of trained and com- pensated CHWs who provided diagnostic and therapeutic services to community members .
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Results: The respondents delivering public health services rated the highest scores to AHTs (4.42 ± 0.7), followed by those engaged in management of chronic conditions (4.41 ± 0.57) and Traditional Chinese Medicine (TCM) (4.29 ± 0.55). Around 90 % of health workers believed that AHTs were meaningful for rural patients; however, only 69 % of health workers believed that the technologies encouraged by the government were sufficiently developed or “ mature ” , and more than 24 % acknowledged difficulties in using those technologies. Overall, patients were satisfied with AHTs, with 71.6 % feeling “ very satisfied ” or “ satisfied ” , 24.2 % feeling “ acceptable ” and 1.6 % feeling “ dissatisfied ” . Most (83 %) patients were satisfied or very satisfied with Traditional Chinese Medicine, compared with management of chronic conditions (80 %), family planning (67 %), public health services (64 %), and finally with maternal and child health care (59 %). Conclusions: Local acceptability should be taken into consideration in determination of AHTs; consumer health literacy needs improvement, particularly in relation to public health and preventive services.
of Multidisciplinary Residency was recognized, especially by your role in the critical perception of management in health, in the dialogue between different knowledge and practices and rapprochement between the Academy and health services (Lima, 2015). As a health professional and experiences in management, through the coordination of primary health care, especially in the family health strategy, I had the opportunity in the year of 2012 to get in touch with the Multiprofessional Residency Program in the Health Family – RMSF, University of the State of Pará, being invited to develop activities of Preceptorship. During the experience as a preceptor, identified the difficulty of students about the work process development of family health teams, in particular the achievement of the health planning based on Territorialization. In this way the health planning is essential to the achievement of the proposed objectives, and "constitutes a continuous instrument for diagnosing the reality and propose alternatives to transform it, the means to provide that happen and the opportunities to perform the actions planned, which may require a restart of the cycle " (Lacerda, Botelho e Colussi, 2016). Based in the understanding submitted on health planning main objective of the study was to analyze the students ' knowledge of the Multi professional Residency in family health, about the planning of health and your relationship with the dimensions political, social and economic planning, in virtue of the Multi professional Residency in Family Health, by using innovative technologies to the teaching service, be a strategy to achieve this professional training and health system needs.
Becoming sick less frequently, seeking care, more timely cure for acute conditions, and improved access to health services in general were the most frequently cited benefits. Participants also discussed other ways CHPS have impacted their lives personally as well as the community at large, with strengthening of social capital being the most reported. The strengthening of social networks was reported in all focus group discussions, and this is largely due to the physical location of the CHPS compound serving as a community hub where residents interact regularly. The development of community ties not only within but also between communities was also credited to CHPS due to the initiatives whereby residents of the multiple communities served by each compound are required to work together to solve issues related to CHPS. These ties have developed beyond the initial purpose of management of the CHPS compound to meetings regarding other emerging issues relevant to adjacent communities. Reports of increased human capital were associated with health education and skill
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95. Funding from the Scottish Government to support the costs of implementation and transitions were warmly welcomed by many of our interviewees. However, this welcome was more than outweighed by serious concerns about services’ ability to cope with the increasing demand to deliver high-quality services for adults, children and families. For example, one senior manager faced with major budget cuts saw the future as short-term crisis care for only the highest tariff individuals and families, leaving others to third sector providers or their own devices until such time as they reached crisis point. 96. It was also evident from interviewees in both case study areas that those who plan and deliver
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Other competencies, such as competencies in social mobi- lization or specific research tools, have not been identified as priority training objectives, neither in the focus groups, nor by the questionnaire-study respondents. Regarding the social mobilization it might well reflect the feeling of the professionals that "they have what it takes" to perform well. Regarding research, it still is a neglected field in the domain of health and human rights  and few institu- tions are active in this area in Africa . Of course train- ing needs in various domains vary depending on the target populations, yet the opinion of these target popula- tions is important in defining training objectives and con- tents [33,34].
The current study identified some reasons for not using modern contraceptive methods. The most common rea- sons were spousal (husband’ s) opposition (38.8%), religious principles (17.7%), concern and fear of side effects (14.8%), long distance of FP service (5.9%). Similar reasons were reported in another studies. Religious opposition (55.9%), fear of side effects (25.5%), and husband’s opposition (17.5%) were the reasons for non-use of modern contra- ceptive methods . In Pakistan perceived side effects such as excessive bleeding and abdominal pain, infertility were the major reasons for not using contraceptive methods . In Malawi, women discontinued modern contraceptives because of their perceived side effects and partner opposition . Moreover, evidence from Nigeria  and Uganda  revealed that husband opposition was the major reason for not using modern contracep- tives. Therefore, male’s forums on FP services should be arranged to make them involved in FP and to increase their responsibility for family planning.
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health services . On the other hand, complaint can give feedback on the service providers’ performance or specify the fields in which performances are weak . Therefore, it may create an opportunity to design strategies for improving the healthcare quality . Nowadays, dealing with complaints is considered an essential part of the healthcare system in order to promote the healthcare standards . In Iran, stud- ies have shown that 92% of hospitals have complaint boxes, and 77% of them have complaint lines. More- over, 30% of the university hospitals inform the com- plainer of the results after the complaint is dealt with, and there is no system for pursuing the complaints in any hospitals in the country . The results of differ- ent studies have also indicated that more than 83% of the complaints made by patients were resolved in the hospital, and only 3% of them were referred to legal authorities [6, 12].
10. The legislation to integrate adult health and social care, under the Public Bodies (Joint Working) (Scotland) Act was designed to address issues around delayed hospital discharge, bed blocking and disconnections within the NHS through the formation of new partnerships to improve joint working between, primarily, local government (who have statutory responsibilities for social care) and the NHS. The explanatory material stated that the legislation was aimed at strengthening community- based services so that more care can be provided in homes and communities to ease pressures on NHS acute and A&E services, and to make more effective and efficient use of resources, particularly in respect of supporting older people.
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Many of the efforts to measure quality are integrated into routine work and monitoring and evaluation rather than existing as separate data collection efforts for per- formance measurement or evaluation. As a result, all the Partnerships recognize the need and challenge of ensur- ing that these data are of adequate quality – a priority reflected in the work of building systems and capacity for data quality. In addition, using these data for evidence- based decision making is used as a strategy to strengthen other building blocks, most prominently in leadership and governance. The approach to improve identified gaps in quality varied across Partnership projects, but all recognize the need for strong, supportive supervision, and mentoring. This includes direct mentoring of care providers, mentoring and training of managers to respond to system gaps – including resource allocation – and ongoing adaptations of the interventions to increase quality and in turn improve expected impact. Comparing the approaches with the Leatherman description of the role of QI in HSS, the cross-building block- QI approach to strengthen health systems captures almost all of the potential benefits regardless of the program analyzed . The Partnerships measures capture these areas of improvement as well as additional areas within the build- ing blocks identified by the projects as critical to achiev- ing a quality health system able to improve population health. A challenge for the PHIT Partnerships is to iden- tify areas of common intervention and measurement where lessons learned can be shared and approaches compared within the constraints of the different inter- vention models and settings. Work to develop focused cross-Partnership evaluations in areas such as mentoring and strengthening data utilization are under discussion.
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At the community level, surveillance activities are undertaken by local volunteers who are trained to ob- serve and report diseases to the peripheral health facil- ities using simple case definitions [16, 17]. For example, a simple case definition of cholera for community sur- veillance is any person aged five years or over with lots of watery diarrhoea and sometimes vomiting profusely as well, while in case of cholera outbreak, any person who passes watery/loose stool is a suspected case . Any person with fever and neck stiffness in the commu- nity is considered a suspected case of meningitis . These simplified case definitions aim to enhance early detection of public health threats at the community level and prompt response from the health facility level. At the health facilities, the data are differentiated into out- patient, in-patient, consulting room and laboratory regis- ters and transferred into daily summary sheets by the disease control officers. The data of the summary sheets are then entered into the IDSR reporting forms and sent to the District Health Directorate (DHD) as weekly, monthly or quarterly reports. The IDSR reports are re- ceived at the DHD by the district disease control officer or health information officer who enters the data from the paper-based forms into the DHIMS2 . The infor- mation includes suspected cases, laboratory confirmed cases and deaths [20, 27]. Disease surveillance data ana- lysis is required at all levels of the health system to determine trends and appropriate interpretation for ef- fective response [16, 17]. Routinely, graphical presenta- tions of the analyzed data are posted on the notice
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Finally, we explored the determinants of catastrophic health expenditure in the household by estimating bin- ary logistic regression models. The purpose was to as- certain the independent effect of health insurance on the occurrence of CHE in the household by controlling for other confounding variables. The probability (P) of a household incurring CHE (y) is specified as: P (y = 1|x) = exp (β’x) / 1 + exp (β’x), where the dependent variable y = 1 if the household incurred CHE and y = 0 if the household did not incur CHE, x is a vector of the in- dependent variables, β is the parameters . The litera- ture suggests that the probability of a household incurring CHE is a function of its socio-demographic characteristics such as the size and age composition, place of residence, health status of members, health insurance status of mem- bers, economic status (e.g. wealth status), type and place of treatment as well as the characteristics of the household head [37–41]. The household wealth status was generated by Principal Components Analysis (PCA) based on thirty- two items including households’ dwelling characteristics, access to utilities and ownership of consumer durables. Weights from the first principal component were used to generate the household wealth quintiles . Two mul- tiple logistic regression models were estimated. Model 1 was estimated for all households (2,418) while Model 2 was restricted to only users of NHIS accredited facilities for the recent reported illness (584). The model goodness- of-fit was assessed using Hosmer–Lemeshow test and the results showed that they were satisfactory (p = 0.1936 for model1 and p = 0.4711 for model 2) . All statistical analyses were performed using Stata 12.
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Development of the tool involved an iterative process of brainstorming, literature reviews, focus groups, evalua- tions of use, and revisions. Development started in 1999 with the first version of the self-assessment tool that was informed by a review of the health literature on the major organizational capabilities for evidence-informed deci- sion-making . The result was a short, 'self-audit' ques- tionnaire that focused on accessing, appraising, and applying research. In 2000, the questionnaire was revised based on review of the business literature that encom- passed topics such as organizational behaviour and knowledge management . As a result, the question- naire's three A's (accessing, appraising, and applying) were supplemented with another A – adapting. Focus groups with representatives from regional health authori- ties, provincial ministries of health, and health services executives provided feedback on the strengths and weak- nesses of the instrument. Adjustments to the wording of items on the tool were made based on focus group input. Further, revisions reflected the need to create a group response with representatives from across the levels of the organization because both literature reviews and focus groups clearly indicated that while evidence-informed decision-making was often portrayed as a discrete event, it is in fact a complex process involving many individuals. The tool itself is organized into four general areas of assessment. Acquire: can your organization find and obtain the research findings it needs? Assess: can your organization assess research findings to ensure they are reliable, relevant, and applicable to you? Adapt: can your organization present the research to decision makers in a useful way? Apply: are there skills, structures, processes, and a culture in your organization to promote and use research findings in decision-making? Each of these areas contains a number of items. For example, under 'acquire', users are asked to determine if 'we have skilled staff for research.' Each item uses a five-point Likert scale (where a one means a low capacity or frequency of activity, while a five signifies something the organization is well-equipped to do or does often).
Out of twenty members of the support group approached, six participants who met the inclusion cri- teria initially consented. One was unable to attend the focus group due to ill health. All five participants were women, with a mean age of 62 years (SD 5.3) and mean disease duration 5.9 years (SD 2.7). All participants had experienced foot problems and had received National Health Service (NHS) podiatry services. Two partici- pants had attended group Patient Education sessions, relating to RA but not foot health, subsequent to their diagnosis. The remaining participants had not received any formalised patient education. Participants’ names have been replaced with a pseudonym for confidentiality.
Government of India intervention to correct the public health sector of the country. It was launched in April 2005 and had continued until March 2012. In fact Government of India had adopted a time bound and mission oriented approach to correct the public health situation in the country (MOHFW 2005). However it was all the probability that it would further continue during the 12th plan period starting from April 1, 2012. It was found that National Rural Health Mission was a combination of several programs including population stabilization, disease control, nutrition, water & sanitation, improvement of workforce, infrastructure, and logistics. Therefore it could say that National Rural Health Mission was like a sunshade or a podium under which several health and development programs were implemented however the main focus was towards providing financial and know how assistance to states to eliminate the gaps existing in terms of work force, infrastructure, and logistics. In addition it further took in hand health determinants especially nutrition to an extent. For all such diversified approaches National Rural Health Mission had to establish wide spread sectoral and intersectoral convergences, public private partnerships, forging alliances with developmental partners and outsourcing of some key supportive and medical services. It could be further evident from the NRHM framework of implementation Abstract: ASHA the lady health activist in the rural area is smoothening and promoting the health scenario of the rural women. Being a female she is working as custodian of the promotion of health status of females in her village. Interviewing the ASHA workers it is found that they are enjoying empowerment both social and economic empowerment. It has been found that this village lady with some basic education and health training performing the best. Her status in the family as well in the society has increased. Another important fact to be mentioned here is that the both the female is working as the promoter of health condition of the society one as a distributer( ASHA) and other as the receiver (the rural woman) of health care services.
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