Health Policy and Management

Telemedicine is a renowned name in the healthcare market for faster diagnosis and easy accessibility to healthcare services. Telemedicine acceptance needs to be understood under the context of TAM which helps to understand the role of in-person visits compared to online visits. It is also helpful in exploring the idea that how It is also helpful in exploring the idea that how the user experiences can be supportive in facilitation projects perceived useful in facilitation projects under perceived usefulness and perceived ease of use. The study aims to review the telemedicine acceptance under the TAM to identify the barriers and understand how technological support can be there in revealing the needs of users to increase the applicability of telemedicine. The study has adopted a primary quantitative plan to conduct the data collection and analysis process. The data has been collected from online respondents having an experience with telemedicine in some way. The sample is comprised of 100 people online filling out the Google survey form which is closed-ended. The data has been retrieved in an Excel sheet which has been further explored with the help of smart PLS software. The output helps contrast the variables and summing of the hypothesis. It has been concluded that telemedicine acceptance has increased with time under perceived usefulness. However, some technological and communication barriers need to be addressed to increase telemedicine acceptance as identified by TAM.

If we do not send a strong message that each human being has a human right to dignity, to live in decent conditions, to have decent work, to access public services, we will not be able to defend the democracies of our nations, nor will we be able to address the fundamental root causes of injustice and inequality.

Background: Cancer patients experience financial hardship due to rising expenses related to cancer treatment and declining income levels associated with reduced employability. Employment Insurance Sick Benefits (EI-SB) is a social income support program which provides temporary income replacement to Canadians when they fall ill. Although EI-SB is designed to maintain continuity of income during an illness, little is known about the perspectives of cancer patients who receive EI-SB. This knowledge can inform the development of public policies which are responsive to the needs and priorities of cancer patients. Methods: We conducted a theory-informed thematic analysis of data collected from twenty semi-structured interviews with participants who were receiving care in a cancer centre in Cape Breton, Nova Scotia and had received EI-SB. A coding framework was developed using Taplin and colleagues’ intermediate outcomes of patient care across the cancer care continuum. Interpretation of ...

Background: Being one of the most important elements in healthcare system, Community Health Center has been promoted to improve its quality and capacity of services. Accreditation is a method that can be used to improve and measure the quality of health service. Quality service improvement is expected to enhance patient satisfaction. This study aimed to investigate the asssociations between accreditation status, patient socioeconomic factors, insurance type, patient perceived quality of service, and satisfaction at Community Health Center. Subjects and Method: This was an analytic observational study with crosssectional design. This study was conducted at Community Health Center in Surakarta, Central Java from June to July 2017. A total of 8 Community Health Centers with different accreditation status (not accredited, lowest, medium, and highest) were selected for this study. A sample of 200 patients were selected from the 8 Comunity Health Centers by proportional random sampling. The independent variables were accreditation status, patient education level, family income, and insurance type. The dependent variables were perceived quality of service and patient satisfaction. The data were collected by a set of pre-tested questionnaires. Accreditation status was identified from the record at District Health Office. Data were analyzed by path analysis. Results: Patient satisfaction was associated with Commuity Health Center acrreditation status (b= 0.39; SE= 0.22; p= 0.069), perceived quality of service (b= 0.05; SE= 0.02; p= 0.022), patient education level (b= -1.16; SE= 0.48; p= 0.017), and insurance type (b= 0.61; SE= 0.31; p= 0.044). Perceived quality of health services was associated by accreditation status (b= 2.22; SE= 0.74; p= 0.003), patient education level(b= -4.51; SE= 1.68; p= 0.007), and insurance type (b= 2.79; SE= 1.06; p= 0.008). Family income did not show statistically significant association with perceived quality of health service (b= -0.17; SE= 0.11; p= 0.123). Conclusion: Patient satisfaction is associated with Commuity Health Center acrreditation status, perceived quality of service, patient education level, and insurance type. Perceived quality of health services is associated with accreditation status, patient education level, and insurance type.

Background: Diabetes mellitus is a chronic metabolic disorder or disease with numerous etiologies characterized by high blood glucose levels accompanied by lipid, protein, and carbohydrate metabolism disorders. Type 2 diabetes is the most common type of diabetes with about 90% of all diabetes cases. The International Diabetes Federation (IDF) estimates that the number of diabetics in the world can reach 783.7 million people while in Indonesia it is estimated to reach 28.57 million people in 2045. This number is an increase of 46% compared to 536.6 million in 2021. The study aims to discover how much influence internet-based self-management has on blood glucose control in type-2 diabetes mellitus patients. Subjects and Method: It was a meta-analysis study using PRISMA flowchart guidelines with the PICO formulation. P = type 2 diabetes mellitus patients. I = Internet-based self-management. C= No internet-based self-management. O= HbA1C. This study was conducted by searching for articl...

Background: Public service is an important element in improving the quality of life in the community. The government plays an important role in providing public services, especially in the emergency department. This study aims to analyze the implementation of the Padang mayor's regulation number 21 of 2020 regarding the implementation of an integrated safety service center in the city of Padang.

Establishment of Sustainable Development Goals (SDGs) in the year 2015 was a historic global promise of sustainable and inclusive development to the world. Monitoring and Evaluation (M&E) is the linchpin that is centrally critical to tracking progress, taking accountabilities, and to enable making of informed decisions that are rooted in rigorous evidence, all for achieving these aspirational goals. The paper puts forth the proposition that attaining the SDGs is inherently precarious and unstable without functioning and robust M&E systems. It not only establishes the primordial importance and centrality of M&E to the sustainable development context but identifies several of the issues and challenges that are inherent to the status quo. It defines specific measures and policies that are intended to strengthen M&E systems so as to achieve wider and deeper effects. Through conceptual analysis, rigorous case studies, and vast statistical evidence, the paper examines the immense ways in which rigorous M&E can enable and allow sustainable progress in the longer term. It champions the call for M&E to transform, to become more inclusive, technology-intelligent, and agile in nature, thereby ensuring that no individual nor populace is left behind in the seminal journey to sustainable development.

Sempu Public Health Centre (PHC) where the IDP of NCD activity was only applied under 1% in 2014 which the fact remains that Sempu PHC ironically is the first PHC which has IDP of NCD in Banyuwangi regency. This research aimed to find out how Posbindu PTM Al-Mubarok activity worked in Sempu PHC. This research used descriptive study with qualitative data supported. The informants of this research were purposively taken which included coordinator surveillance of Health Department in Banyuwangi regency, coordinator IDP of NCD, midwife, nurse, two cadres, the work partners and two IDP of NCD members. This research collected the data by doing interview, attentive observation and triangulation technique. Then, the data gathered were analyzed descriptively. The result showed that activity process of Posbindu PTM Al-Mubarok in Sempu PHC was different with IDP of NCD guidelines. The process did not go well because of the input which included the insufficient of human resources, incomprehensi...

Suicide is a major public health issue that causes over 800,000 deaths each year globally. Korea ranks high in suicide rates, in which around 24.3 per 100,000 individuals are reported to have died by intentional self-harm in 2017 according to Statistics Korea. The aim of this study was to examine the current status and trend of suicide ideation and attempt using data from the following five sources:

Background: Considering the effect of human right observance on patients' satisfaction from the treatment process, in Iran the Patient Rights Charter (PRC) was developed by the Ministry of Health and Medical Education (MOHME) in 2001 and enforced to all hospitals across the country. The purpose of the current study was to evaluate patients' awareness of their rights based on PRC in two tertiary teaching hospitals affiliated with Shiraz University of Medical Sciences (SUMS) in Iran. Methods: Current study was a cross-sectional descriptive and analytical survey. The research sample consisted of 200 inpatients and data were gathered through questionnaires filled out during the interview. The rate of awareness of patients was measured on a Likert scale ranging from 1 to 4. Validity and reliability of the questionnaire were confirmed. Data were analysed by descriptive and analytical statistics. Results: In 30.5% of cases, the total awareness of patients was weak, in 59.4% was moderate, and in 10.1% of them was good. The most awareness was about trust and assurance to confidentiality of treatment team, and the least was about providing sufficient information about treatment options and their complications. There was a significant relationship between educational level and the place of residency with patients' awareness (P<0.001). Total awareness of patients from their rights was medium. Although compared to similar studies this rate was not unsatisfactory, attempts should be made to improve it. Health care organizations are to deliver PRC to patients and make sure they have proper information about their rights. Assuring observance of patients' rights requires not only informing healthcare policy makers and providers, but also educating citizens about what they must expect from their governments and health care providers. This will consequently improve the quality of services. Establishment of Patient Right Committee for supervision and monitoring of informing and observance of patients' rights is also recommended.

Bridging this gap between health equity and technological tools by integrating Social Determinants of Health (SDOH) into real-time population health surveillance methods is becoming essential to managing the population's health responsively and inclusively.. This conceptual overview dwells on the theoretical backgrounds, existing practices, and prospects of how SDOH can be embedded in dynamic surveillance systems in public health. Based on important frameworks, such as the WHO SDOH model, the Dahlgren and Whitehead model, syndemic theory, systems thinking, and equity-oriented surveillance, this study emphasizes how health outcomes are determined by what is captured concerning the socio-economic and environmental contexts. Although the introduction of real-time surveillance tools like electronic health records (EHRs), mobile health applications and instruments, geospatial information systems (GIS), and artificial intelligence (AI) have enhanced the speed and scope of data capture, these technologies have mostly been clinically oriented. The review also outlines key obstacles to SDOH integration. Data fragmentation, insufficient standardized indicators, privacy issues, and the inability to deal with real-time data are the key obstacles to SDOH integration. It also points at potential initiatives like cross-sector collaborations of data-sharing, implementing health equity impact indicators, and predictive analytics that can be used to detect vulnerable populations. The paper's conclusion will propose creating standardized data models, ethical data governance frameworks, more investment in public health informatics, and pilot projects to demonstrate the practicability of various models. Finally, this paper argues in favor of a paradigm shift in how surveillance is conducted in public health surveillance, which is not just about monitoring the incidence of disease but also about questioning and dealing with the social determinants of health. This form of integration can be transformative in terms of more inclusive, equitable, and proactive public health systems.

The INA-CBG’s (Indonesia Case Based Groups) package rate implementation for National Health Insurance Program member since 1st January 2014 suffering from stroke has forced all hospitals in Indonesia to do a quality control and efficient service cost. Stroke, one of the catastrophic diseases often accompanied with some of its comorbid factors, requires high treatment cost. Thus, a cost analysis study is needed to prevent hospital loss. This study was aimed at determining the suitability of cost between the real cost of stroke therapy and the Indonesian Case-Based Groups (INA-CBG) rate according to the Ministry of Health Decree number 69 of 2013. This study was an observational study with a cross-sectional design. Data collection was done retrospectively. Study subjects were all that hospitalized strokes of patients who were members of the National Health Insurance and also met the inclusion and exclusion criteria registered between January to June 2014. The study data were in real d...

Preeclampsia, a life-threatening condition affecting pregnant women and their fetuses, is particularly prevalent in lowand middle-income countries. Despite advancements in diagnostic methods, current techniques for predicting and preventing preeclampsia have shown limited precision, often requiring high technical skills, internet access, or relying on a single parameter. Preeclampsia is characterized by metabolic abnormalities, an increased inflammatory response, endothelial dysfunction, and hypertension caused by elevated peripheral vascular resistance. Early detection is crucial, but the delayed onset of clinical symptoms often leads to late diagnoses. This project aims to develop a multi-parameter approach for predicting the likelihood of preeclampsia, offering a more reliable, accessible solution that can be used both during pregnancy and postpartum. By incorporating multiple indicators, this method will provide a practical tool for healthcare workers in resource-limited settings, improving early stratification and management of preeclampsia to enhance maternal and fetal health outcomes.

Purpose: This study evaluated the effectiveness of emergency preparedness policies in managing healthcare disruptions in Peshawar, Pakistan, while identifying priority areas for improvement. Design: A cross-sectional survey was conducted with 429 physicians, nurses, allied health professionals, and administrators, sampled through stratified random sampling across public and private hospitals in both urban and peri-urban settings. Measures: A structured questionnaire assessed four preparedness dimensions: clarity of plans, coordination with external agencies, resource availability, and frequency of drills, along with overall satisfaction. Items were rated on a 5-point Likert scale (1 = poor readiness; 5 = excellent readiness). Analysis: Data reliability was confirmed using Cronbach's alpha (α = 0.77-0.84). Pearson correlations examined associations among preparedness attributes and satisfaction, while multiple linear regression identified independent predictors. Independent-samples t-tests and ANOVA compared preparedness across facility type (public vs. private) and region (urban vs. rural). Results: All preparedness attributes were positively associated with satisfaction. The strongest predictors were clarity of plans (β = 0.32, p < 0.001) and coordination with agencies (β = 0.28, p < 0.001), followed by drill frequency (β = 0.19, p = 0.003) and resource availability (β = 0.15, p = 0.036). Public hospitals reported higher clarity of plans (p < 0.05), while urban facilities conducted drills more frequently than rural ones (p < 0.05). Conclusion: Emergency preparedness policies in Peshawar are viewed positively, with policy clarity and inter-agency coordination emerging as the most critical drivers of healthcare resilience. To sustain effectiveness, greater emphasis on equitable resource allocation and institutionalizing regular drills is needed, particularly in peri-urban and private facilities.

This thesis investigates the intersection of marketing, brand development, and digital innovation in the context of Bulgaria's underutilized cultural heritage sector. It examines how branding strategies rooted in storytelling, emotional connection, and sensory design can elevate cultural institutions beyond their traditional roles. The research is structured in three chapters: the first introduces theoretical frameworks related to brand identity, consumer behavior, and the experience economy; the second analyzes the state of Bulgarian museums and cultural sites through field observations, brand communication audits, and perception metrics; and the third presents the development of Eavesdrop-a conceptual brand designed to enhance the cultural experience through gamified audio tours, digital quests, and communitybased content. Drawing on branding models such as Holt's cultural branding theory, Roberts' Lovemarks framework, and Keller's brand equity pyramid, the thesis argues that cultural institutions can evolve into emotionally resonant brands through strategic communication and experiential design. A survey and prototype validation experience further support the project's user-centric orientation. The thesis concludes with actionable recommendations for future branding efforts of museums and cultural-historical sites in Bulgaria in order to ensure strategic partnerships and long-term cultural relevance with contemporary audiences.

The  study  examines  Nepal’s  health  insurance  performance,  focusing  on  enrollment, premium collection, and claims disbursement, identifying operational and policy barriers affecting sustainability and equity.  A  descriptive  study  analyzed  secondary  data  (2015–2024)  from  Nepal’s  Health  Insurance  Board,  using  percentage-based  trend  analysis of insured citizens, premium collected, claim paid, and premium-claim ratio under Universal Health Coverage (UHC). Nepal’s  health  cover  has  grown  rapidly  since  F/Y  2015-16,  enhancing  universal  health  cover  but  at  the  cost  of  gender  and  marginal  group  equity  gaps.  COVID-19  caused  claim  spikes  and  financial  instability,  though  premiums  bounced  back in F/Y 2023-24. Despite higher utilization, satisfaction remains moderate due to service gaps. Regional disparities in health security access are evident in Social Health Security  Program  (SHSP)  enrollment  trends.  The  Health  Insurance  Board needs  an  urgent reform in premium pricing to ensure longevity of the policy.  Nepal’s  insurance  scheme  faces  systemic  inefficiencies,  with  an  unsustainable  premium-claim  ratio  (331.3  percent  in  F/Y  2023-24)  and  irregular  enrollments across  provinces,  undermining  UHC.  To  improve  retention  and  equity,  streamlined processes, awareness campaigns, and policy reforms are urgently needed to ensure financial stability and equitable access. To attain fair UHC, Nepal must address regional disparities, maintain financial stability, and advance inclusive policies.

Background The growing aging population is a significant global achievement. Addressing the specific needs of the older adults and creating age-friendly cities are essential priorities. This study aimed to identify health-related needs and indicators of an age-friendly city from the perspective of older adults in a province in southeastern Iran. Methods This descriptive-cross-sectional study was conducted on 1,000 older adults in Kerman province. Participants were selected through multi-stage sampling. Three questionnaires were used to collect data: the demographic questionnaire, the Camberwell Assessment of Need for the Elderly, and the World Health Organization's questionnaire of age-friendly city indicators. Data analysis was conducted using descriptive and inferential statistics in SPSS 26. Results The study results revealed that older adults perceived alcohol and self-care as the highest and lowest levels of no needs. Additionally, physical health and benefits obtained the highest frequencies for met and unmet needs, respectively. Friends/relatives mostly helped with self-care but did not help with benefits. In contrast, statutory services provided help with accidental self-harm but did not help with physical health. Age-friendly city indicators in Kerman province were found to be suboptimal, with the Community Support and Health Services index scoring the highest and Transportation index scoring the lowest. Conclusion This study offers valuable insights into the health-related needs and indicators of an age-friendly city for older adults in a province in Iran. The results can guide managers, policymakers, and planners in developing effective strategies for elderly care at both national and regional levels.

Zegers and colleagues’ study codifies the perceived burden of quality monitoring and improvement stemming from the work by clinicians of registering (documenting) quality information in the medical record. We agree with Zegers and colleagues’ recommendation that a smaller, more effective and curated set of measures is needed to reduce burden, confusion, and expense. We further note that focusing on validity of clinical evidence behind individual measures is critical, but insufficient. We therefore extend Zegers and colleagues’ work through a pragmatic, tripartite heuristic. To assess the value of and curate a targeted set of performance measures, we propose concentrating on the relationships among three factors: (1) The purpose of the performance measure, (2) the subject being evaluated, and (3) the consumer using information for decision-making. Our proposed tripartite framework lays the groundwork for executing the evidence-based recommendations proposed by Zegers et al, and provi...

Background: The first pillar of the UNAIDS 90-90-90 goal seeks to accurately identify persons living with HIV (PLHIV), a process that is predicated on facilities having the necessary HIV tests available to perform the task. In many rural settings, the identification of PLHIV is accomplished through a two-step process involving the sequential use of 2 separate rapid diagnostic tests (RDTs). Inadequate inventory of either test has ramifications for the success of HIV-related programs. The purpose of this study was to evaluate the inventory levels of HIV RDT kits at specific healthcare facilities in Zambézia province, Mozambique. Methods: Using facility-level pharmacy stock surveillance data from October 2015 through September 2016, we assessed the inventory levels of HIV RDTs at 75 health facilities in 8 districts within Zambézia province, Mozambique. Using programmatically established categories (good, sufficient, threatened, or stockout), defined in conjunction with the provincial h...

Background: Mental, neurological, and substance (MNS) use disorders are a leading cause of disability worldwide; specifically in Peru, MNS affect 1 in 5 persons. However, the great majority of people suffering from these disorders do not access care, thereby making necessary the improvement of existing conditions including a major rearranging of current health system structures beyond care delivery strategies. This paper reviews and examines recent developments in mental health policies in Peru, presenting an overview of the initiatives currently being introduced and the main implementation challenges they face. Methods: Key documents issued by Peruvian governmental entities regarding mental health were reviewed to identify and describe the path that led to the beginning of the reform; how the ongoing reform is taking place; and, the plan and scope for scale-up. Results: Since 2004, mental health has gained importance in policies and regulations, resulting in the promotion of a mental health reform within the national healthcare system. These efforts crystallized in 2012 with the passing of Law 29889 which introduced several changes to the delivery of mental healthcare, including a restructuring of mental health service delivery to occur at the primary and secondary care levels and the introduction of supporting services to aid in patient recovery and reintegration into society. In addition, a performance-based budget was approved to guarantee the implementation of these changes. Some of the main challenges faced by this reform are related to the diversity of the implementation settings, eg, isolated rural areas, and the limitations of the existing specialized mental health institutes to substantially grow in parallel to the scaling-up efforts in order to be able to provide training and clinical support to every region of Peru. Conclusion: Although the true success of the mental healthcare reform will be determined in the coming years, thus far, Peru has achieved a number of legal, policy and fiscal milestones, thereby presenting a unique and fertile environment for the expansion of mental health services.

Relationships between health professionals and pharmaceutical manufacturers can unduly influence clinical practice. These relationships are the focus of global transparency efforts, including in Europe. We conducted a descriptive content analysis of the transparency provisions implemented by February 2017 in nine European Union (EU) countries concerning payments to health professionals, with duplicate independent coding of all data. Using an author-generated, semi-structured questionnaire, we collected information from each disclosure policy/code on: target industries, categories of healthcare professionals covered, scope of payments included, location and searchability of the disclosed data. Our analysis shows that although important improvements have been put in place in the past few years, significant gaps remain in disclosure requirements and their implementation. The situation differs substantially from country to country and the most striking differences are between government...

Posyandu merupakan suatu kegiatan perwujudan peran serta masyarakat yang dikelola oleh masyarakat, dari masyarakat dan untuk masyarakat dalam mencapai pelayanan kesehatan yang lebih baik. Penelitian ini bertujuan untuk mengetahui kemandirian posyandu di wilayah Desa Gunungpring Muntilan Magelang tahun 2011. Penelitian ini menggunakan datasekunder yang mencakup Frekuensi penimbangan, rata-rata kader, rata-ratacakupan D/S, Cakupan kumulatif KIA, Cakupan kumulatif KB, Cakupan Kumulatif Imunisasi, Program tambahan, cakupan dana sehat. Populasi penelitian ini adalah Posyandu yang berada di Desa Gunungpring Muntilan Magelang terhitung pada tahun 2011. Jumlah Posyandu di Desa Gunungpring Muntilan Magelang sebanyak 11 Posyandu. Pengumpulan data dengan melihat data dari Puskesmas dan melakukan wawancara menggunakan pedoman wawancara. Hasil penelitian menunjukkan bahwa banyaknya kemandirian posyandu dengan kategori Pratama yaitu sebanyak 6 posyandu (54,5%), kemandirian posyandu dengan kategor...

The widespread adoption of smartphones and mobile apps has revolutionized many industries, including the wellness sector. Wellness apps, which provide users with tools and resources to improve their physical and mental well-being, have gained significant popularity in recent years. However, to ensure long-term success and customer loyalty, these apps must prioritize customer satisfaction. This study explores the role of mobile app intelligence in enhancing customer satisfaction within the context of wellness apps. Through a comprehensive literature review and empirical research involving surveys and user data analysis, we investigate the key factors contributing to customer satisfaction in wellness apps and propose a framework for leveraging mobile app intelligence to optimize the user experience. Our findings highlight the importance of personalization, user engagement, and data-driven insights in driving customer satisfaction. We also discuss the implications of our research for mobile app developers, marketers, and wellness service providers, offering practical recommendations for improving customer satisfaction through mobile app intelligence. This study contributes to the growing body of literature on mobile app marketing and customer satisfaction, providing valuable insights for both academics and practitioners in the wellness industry.

This article explores the current state, challenges, and strategic pathways for improving medical colleges and hospitals in Bangladesh. It examines structural inefficiencies, governance issues, workforce shortages, and technological gaps, drawing on both national and international perspectives. The purpose is to provide a roadmap for reforms that enhance healthcare accessibility, equity, and quality. By integrating strategic management approaches, the article highlights the need for policy reforms, public-private partnerships, and investment in human resources. The expected outcome is the development of a more efficient, sustainable, and patient-centered healthcare system in Bangladesh.

India's population control policy has long narrowly focused on curtailing reproduction, even after it was rebranded in the late 1990s as family planning. It continues to prioritize a target-oriented approach limiting birth rates instead of promoting the well-being of families. In particular, deep-seated class prejudices against the low-income Muslim community have led to academic debates and policy interventions to curtail what is considered to be the high fertility rate of Muslims across the nation. Against this backdrop, my dissertation examines the ways that low-income Muslim women imagine, embody, and negotiate family planning in the context of their everyday lives. Drawing on fourteen months of ethnographic fieldwork in Delhi, I explore how women limit fertility and build families. Their narratives provide a critique of the neoliberal framework of choice that celebrates freedom, autonomy, and individual rights in the pursuit of reproductive goals. In contrast, women's decision making reveals how reproductive choice is embedded within the context of social, familial, and kinship relations, gendered dynamics inside and outside the household, neighborhood and migration histories, and state-imposed programs. Through a feminist analysis, I foreground the relational and contextual aspects of family building practices. I argue that women challenge the state's classed, gendered, and prejudiced discourses through their pragmatic family building rationales, which they commonly refer to as samajhdari ki yojana, or wise planning, especially within the context of scarce resources and infrastructural constraints. Women cultivate an ethos of judiciousness and responsibility; they understand their own physiological and mental health to be intrinsically connected to the well-being of their families. Thus, women navigate state and familial institutions while negotiating the use of both invasive and non-invasive contraceptive technologies such as sterilization, intrauterine devices, and oral pills. In this regard, I illustrate how their willingness to use IUDs is intertwined with their hopes for the safe delivery and immunization of their infants; how familial, medical, and social anxieties compel them to seek different contraceptive pathways to avoid failures and side effects; and how contingent circumstances and relations with community health volunteers motivate them to adopt or evade sterilization. This dissertation contributes to an understanding of women's challenges and contradictory and ambivalent negotiations with care arrangements within both familial and institutional settings. It also contributes to an understanding of how social ties and the dynamics of neighborhood building shape the parameters of intergenerational family building.

Background: Previous studies indicate that, despite legal restrictions, northeastern states have the highest prevalence of underage drinking, with Arunachal Pradesh leading. Considering the harms associated with underage drinking, assessing its magnitude, and contributing factors is crucial. Methods: Using the Minimum Legal Drinking Age (MLDA) and the state-level National Family Health Survey (NFHS-5), data from 7,398 individuals aged 15-20 years were used to assess the districtwise prevalence of underage drinking in Arunachal Pradesh. Further bivariate and multivariate regression analyses were undertaken to identify the significant predictors of underage drinking.

The role of the information system in health services is increasingly needed in the implementation of the National Health Insurance (JKN) organized by BPJS Kesehatan. BPJS Kesehatan has an application called P-Care (Primary Care) BPJS. There are still problems with the use of P-Care application at primary health care. This study aims to evaluation of the BPJS primary care (P-Care) application on health services in primary health care. This study uses a systematic review through: 1) search using an indexing site (google scholar) with the specified keyword, 2) the literature obtained through indexing site then limited with certain categories, 3) the literature then selected with certain inclusion and exclusion criteria. Based on the results, it is found that the P care application is very useful and makes work easier, efficient, fast, effective in providing services and can increase the productivity of officers' performance. In addition, the P care application has provided the menus needed by the user. There are also some obstacles in implementing P Care, such as the power fails and P Care errors when a patient needs to be referred. BPJS Kesehatan need to evaluate and monitoring regularly to ensure that the P care application is running well.

The aim of this study was to investigate the socio-economic status (SES) and geographic differences in occurrence and burden of tropical endemic diseases, as well as the health seeking behaviours of individuals residing in Ebonyi State, Nigeria. The study was undertaken in three communities (urban, semi-urban and rural). A pre-tested structured interview schedule was used to collect data from randomly selected households. An asset-based SES index was used to examine the occurrence of socio-economic equity in burden of disease and health seeking behaviours, whilst comparisons between the three communities were used to explore geographic equity in the burden of disease and health seeking behaviours of households. The majority of the households reported occurrences of illness during the month preceding the survey. Malaria and diarrhoea were the most commonly reported illnesses. There were inequities in the burden of disease and treatment seeking behaviours amongst the study groups. The...

Background: Fiscal Decentralization (FD) in many cases is encouraged as a strong means of improving the efficiency and equity in the provision of public goods, such as healthcare services. This issue has urged the researchers to experimentally examine the relationship between fiscal decentralization indicators and health outcomes. In this study we examine the effect of Fiscal Decentralization in Medical Universities (FDMU) and Fiscal Decentralization in Provincial Revenues (FDPR) on Under-Five Mortality Rate (U5M) in provinces of Iran over the period between 2007 and 2010. Methods: We employed panel data methods in this article. The results of the Pesaran CD test demonstrated that most of the variables used in the analysis were cross-sectionally dependent. The Hausman test results suggested that fixed-effects were more appropriate to estimate our model. We estimated the fixed-effect model by using Driscoll-Kraay standard errors as a remedy for cross-sectional dependency. Results: Ac...

Background: Fiscal Decentralization (FD) in many cases is encouraged as a strong means of improving the efficiency and equity in the provision of public goods, such as healthcare services. This issue has urged the researchers to experimentally examine the relationship between fiscal decentralization indicators and health outcomes. In this study we examine the effect of Fiscal Decentralization in Medical Universities (FDMU) and Fiscal Decentralization in Provincial Revenues (FDPR) on Under-Five Mortality Rate (U5M) in provinces of Iran over the period between 2007 and 2010. Methods: We employed panel data methods in this article. The results of the Pesaran CD test demonstrated that most of the variables used in the analysis were cross-sectionally dependent. The Hausman test results suggested that fixed-effects were more appropriate to estimate our model. We estimated the fixed-effect model by using Driscoll-Kraay standard errors as a remedy for cross-sectional dependency. Results: According to the findings of this research, fiscal decentralization in the health sector had a negative impact on U5M. On the other hand, fiscal decentralization in provincial revenues had a positive impact on U5M. In addition, U5M had a negative association with the density of physicians, hospital beds, and provincial GDP per capita, but a positive relationship with Gini coefficient and unemployment. The findings of our study indicated that fiscal decentralization should be emphasized in the health sector. The results suggest the need for caution in the implementation of fiscal decentralization in provincial revenues.

Background: Over the last decade there has been an increase in healthcare expenditures while at the same time the inequity in distribution of resources has grown. These two issues have urged the researchers to review the determinants of healthcare expenditures. In this study, we surveyed the determinants of health expenditures in Economic Cooperation Organization (ECO) countries. Methods: We used Panel data econometrics methods for the purpose of this research. For long term analysis, we used Pesaran cross sectional dependency test followed by panel unit root tests to show first whether the variables were stationary or not. Upon confirmation of no stationary variables, we used Westerlund panel cointegration test in order to show whether long term relationships exist between the variables. At the end, we estimated the model with Continuous-Updated Fully Modified (CUP-FM) estimator. For short term analysis also, we used Fixed Effects (FE) estimator to estimate the model. Results: A long term relationship was found between the health expenditures per capita and GDP per capita, the proportion of population below 15 and above 65 years old, number of physicians, and urbanisation. Besides, all the variables had short term relationships with health expenditures, except for the proportion of population above 65 years old. The coefficient of GDP was below 1 in the model. Therefore, health is counted as a necessary good in ECO countries and governments must pay due attention to the equal distribution of health services in all regions of the country.

Objective This study aims to examine individuals' justifications and experiences regarding vaccine refusal in Türkiye. The findings of this study are expected to provide significant insights into policies for preventing vaccine refusal and hesitancy. Method This phenomenological qualitative study involved in-depth interviews with 23 participants. The participants were selected via purposive and snowball sampling methods. The interview data were analyzed via content, quotation, and thematic analysis techniques. Qualitative analyses were performed with NVivo 10 software. Results The thematic analysis identified four main themes: Justifications (23/23), Perceived Social Implications (20/23), Social Interaction (17/23), and Information Sources (23/23). The participants were determined to refrain from vaccination due to concerns about the ingredients in vaccines and their potential adverse health effects. Additionally, institutional distrust toward vaccine manufacturers, accompanied by conspiracy theories, has emerged as another significant justification for vaccine refusal. Furthermore, this study revealed that sources of information, such as the Internet, social media, books, and articles, play crucial roles in shaping vaccine refusal attitudes. Conclusion The findings of this study highlight that vaccine-related decision-making is shaped not only by scientific and economic factors but also by psychological, sociocultural, and political factors. These findings underscore the need for further research and the development of strategic policies to increase vaccine acceptance and trust.

Background: The failure of some high-income countries to retain their medical graduates is one driver of doctor immigration from low- and middle-income countries. Ireland, which attracts many international medical graduates, implemented a doctor retention strategy from early 2015. This study measures junior doctors’ migration intentions, the reasons they leave and likelihood of them returning. The aim is to identify the characteristics and patterns of doctors who plan to emigrate to inform targeted measures to retain these doctors. Methods: A national sample of 1148 junior hospital doctors completed an online survey in early 2018, eliciting their experiences of training and working conditions. Respondents were asked to choose between the following career options: remain in Ireland, go and return, go and stay away, or quit medicine. Bivariate analyses and a two-stage multivariable analysis were used to model the factors associated with these outcomes. Results: 45% of respondents plan...

Background: Sustainable diets, as a concept, was the status quo of human existence from time immemorial. Modern agriculture and industrial food systems of the 20th century had displaced the notion, until the alarming consequences of unsustainable food production and consumption started manifesting as harm to both human and ecosystem health. Scope and approach: Framed by the right to food, and the six dimensions of food security, this review will cover the re-emergence of sustainable diets in the scientific literature and in policy instruments, and its attendant features. Key findings and conclusions: Coverage includes (i) nutrients, ecosystems and biodiversity, with links to Indigenous Peoples' food systems; (ii) plant and animal source foods and planetary limits; (iii) ultra-processed foods, diet-related chronic diseases, and the misappropriation of the term "healthy" as applied to foods and diets. Multisectoral policy implications and applications are presented.

Background: In recent years the use of time to death (TTD) variables in the modeling of individual health expenditures has been of interest to health economics researchers. The aim of this study was to investigate the effect of age and TTD on hospital inpatient expenditure (HIE). Methods: We used a claims database from Iran Health Insurance Organization of Tehran city that includes considerable proportion of Tehran residents and contains information on insured individuals’ HIE. We included HIE of all insured decedents (30 to 90 years old) who died during March 2013 and March 2014 (n=1018). No sampling was required. According to the decedents’ date of death, we extracted their last 24 months HIE. The period of time March 30, 2011 until March 30, 2014 (3 years) was used to guarantee a full 24 months of observations for decedents. A two-part econometric model was employed to investigate the effect of age, TTD, and some demographic variables on probability and conditional amount of indi...

In the implementation of the results-based nancing (PBF) strategy in Burkina Faso, there is heterogeneity in the performance of technical quality of healthcare in basic healthcare facilities. This study aims to identify the factors that may explain this heterogeneity. We carried out a quantitative study in 30 basic public health facilities, thirteen of which have a quality score greater than or equal to 50% and 17 of which have a quality score less than 50%. Data from their pro les were collected using a direct observation grid. A total of 94 health professionals answered a series of semi-structured questions. A bivariate analysis using the Chi-square test and a multivariate analysis using the multiple regression model were used. The difference is statistically signi cant in favour of health facilities with good performance in technical quality in terms of health infrastructure (p=0.020), health equipment (p=0.004) and compliance with norms and standards in terms of health personnel (p=0.004). The variables used in the multiple regression model are ongoing training (p=0.000), internal communication (p=0.000) and nancial motivation (p=0.003) of health professionals. These results suggest that the effectiveness of the technical quality of healthcare in implementing the PBF depends on certain basic conditions in the health facilities, such as the presence of infrastructures, equipment and human resources that meet established norms and standards and the managerial dynamics of healthcare workers.

Background: Tanzania is experiencing acute shortages of Health Workers (HWs), a situation which has forced health managers, especially in the underserved districts, to hastily cope with health workers' shortages by adopting task shifting. This has however been due to limited options for dealing with the crisis of health personnel. There are on-going discussions in the country on whether to scale up task shifting as one of the strategies for addressing health personnel crisis. However, these discussions are not backed up by rigorous scientific evidence. The aim of this paper is two-fold. Firstly, to describe the current situation of implementing task shifting in the context of acute shortages of health workers and, secondly, to provide a descriptive account of the potential opportunities or benefits and the likely challenges which might ensue as a result of implementing task shifting. Methods: We employed in-depth interviews with informants at the district level and supplemented the information with additional interviews with informants at the national level. Interviews focussed on the informants' practical experiences of implementing task shifting in their respective health facilities (district level) and their opinions regarding opportunities and challenges which might be associated with implementation of task shifting practices. At the national level, the main focus was on policy issues related to management of health personnel in the context of implementation of task shifting, in addition to seeking their opinions and perceptions regarding opportunities and challenges of implementing task shifting if formally adopted. Results: Task shifting has been in practice for many years in Tanzania and has been perceived as an inevitable coping mechanism due to limited options for addressing health personnel shortages in the country. Majority of informants had the concern that quality of services is likely to be affected if appropriate policy infrastructures are not in place before formalising tasks shifting. There was also a perception that implementation of task shifting has ensured access to services especially in underserved remote areas. Professional discontent and challenges related to the management of health personnel policies were also perceived as important issues to consider when implementing task shifting practices. Additional resources for additional training and supervisory tasks were also considered important in the implementation of task shifting in order to make it deliver much the same way as it is for conventional modalities of delivering care.

A quarter of a century after the Harare Declaration on Strengthening District Health Systems Based on Primary Health Care (1987) was conceived, district health teams (DHTs) are facing a markedly changed situation. Rapid population growth, urbanization, a rapidly developing private sector, and the increasing role of vertical programs and global initiatives have marginalized the planning process and weakened the entire district health system (DHS). The Ugandan Ministry of Health (MoH) responded to these challenges by beginning a review of district planning: a key action point of the Harare Declaration. The first step was a critical review of relevant literature, then central and district health staff were engaged with to provide their input in developing the new strategy. Through a field experiment started in 2012-13, and still underway, the MoH is developing an innovative regional approach to health planning, which aims to encompass the complexity of the new context of health care provision and coordinate all new actors (private health providers, projects and local government staff from other sectors) operating in the health sector. A strategic revision of the planning process represents an opportunity to develop an appropriate 'Theory of Change', intended as a broader approach of thinking about the entire DHS and the relative role and functions of the DHT. Leadership and stewardship capacities of MoH staff, at central and peripheral level, must be strengthened and supported to achieve the expected changes and results.

Recent disclosures of failures of care in the National Health Service (NHS) in England have led to debates about compassion deficits disallowing health professionals to provide high quality responsive care. While the link between high quality care and compassion is often taken for granted, it is less obvious how compassion -often originating in the individual's emotional response -can become a moral sentiment and lead to developing a system of norms and values underpinning ethics of care. In this editorial, I argue why and how compassion might become a foundation of ethics guiding health professionals and a basis for ethics of care in health service organisations. I conclude by discussing a recent case of prominent healthcare failure in the NHS to highlight the relationship between compassion as an aspect of professional ethics on the one hand, and values and norms that institutions and specific policies promote on the other hand.

BackgroundThe COVID-19 pandemic disrupted the delivery of elective surgery in the UK. The majority of planned surgery was cancelled or postponed in March 2020 for the duration of the first wave of the pandemic. We investigated the experiences of staff responsible for delivering rapid changes to surgical services during the first wave of the pandemic in the UK, with the aim of developing lessons for future major systems change.MethodsUsing a rapid qualitative study design, we conducted 25 interviews with frontline surgical staff during the first wave of the pandemic. We also carried out a policy review of the guidance developed for those delivering surgical services in pandemic conditions. We used framework analysis to organise and interpret findings.ResultsStaff discussed positive and negative experiences of rapid service organisation. Clinician-led decision making, the flexibility of individual staff and teams, and the opportunity to innovate service design were all seen as positiv...

• This interplay shows the need for soli- darity within the global community to build resilient systems before the next pandemic • A global, multisectoral governance mechanism is needed to create the conditions to support solidarity and universal preparedness for health

In this present time, the debate about abortion in Indonesia is increasingly crowded. Abortion is also carried out by women-victims of rape to reduce the burden they suffered. The regulation on abortion in Indonesia has been regulated in the statutory regulations, namely the Criminal Code, especially in Article 346, Article 347, Article 348, and Article 349. In the RKUHP (Draft of Criminal Code), abortion regulation is regulated in two chapters namely, Chapter XIV Article 501 and Chapter XIX Articles 589, 590, 591, 592. In addition, the government has also issued several regulations governing abortion such as Government Regulation No. 61 of 2014 concerning Reproductive Health and also Law No. 36 of 2009 concerning health. However, the various regulations that exist between the Criminal Code, RKUHP, PP and the Act actually contradict to each other. There is no synchronization between the regulations regarding abortion by women rape victims. The KUHP and RKUHP clearly do not allow abortion in Indonesia and do not legalize it without any exception, including abortion carried out by women victims of rape. Whereas in Law Number 36 of 2009 concerning health, abortion can be carried out on an indication of medical emergencies and pregnancy due to rape that causes psychological trauma, so abortionists cannot be prosecuted as criminal.