Assessing Indian public health standards for community health centers: a case study with special reference to essential newborn care services

The main objective of the study is to identify the availability of infrastructure facility, human resources, investigative services, and facility based newborn care services with respect to Indian Public Health Standards (IPHS) at community health centers (CHC) of Bharatpur District of Rajasthan State. Data were collected from service providers at CHC through well structured questionnaire at thirteen CHCs situated at Bharatpur District of Rajasthan State. It was found that infrastructure facilities were available in almost all the CHCs, but shortage of manpower especially specialists was observed. Availability of investigative services was found quite satisfactory except ECG. It was also observed that none of the CHCs have fully equipped facility based newborn care services (including newborn corner and newborn care stabilization unit). As per IPHS suggested in the revised draft (2010) important deficiencies were revealed in the studied CHCs of Bharatpur district and by additional inputs such as recruiting staff, improving infrastructure facilities, CHCs can be upgraded.     

Quality improvement and its impact on the use and equality of outpatient health services in India

This paper examines the impact of quality improvements in conjunction with user fees on the utilization and equality of outpatient services at a range of public sector health facilities in India. Project impact on outpatient visits was estimated via the difference-in-difference method using pooled time series visit data from project and control facilities. The results indicate that the quality improvements significantly increased visits at all facility types. The project effect was largest at primary health center (PHC) and community health center (CHC), followed by district hospital (DH) and female district hospital (FDH). Pro-rich inequalities in outpatient visits increased at DHs and FDHs while at CHCs and PHCs the distribution remained equitable. This suggests that quality improvements at public sector health facilities can increase utilization of outpatient services in the presence of nominal user fees, but can also promote greater inequality favoring the better-off. At the referral hospital level, quality improvements should be made in conjuction with programs which encourage utilization by the poor. In contrast, the benefit of quality improvements at PHCs and CHCs is equitably distributed.     

我国西部四省县乡级助产机构新生儿早期基本保健技术能力现状调查

目的 了解我国西部四省县乡助产机构新生儿早期基本保健技术能力现状,为制定有针对性的干预措施提供依据。方法 采用信函调查方式,于2017年6月-2018年9月收集贵州、青海、四川、宁夏4省(区)21个县的助产机构数据,采用描述性统计方法分析各省新生儿早期基本保健干预措施的开展情况,采用χ²检验比较不同级别机构的干预措施实施率。结果 233所县、乡级助产机构参与调查。1)孕产妇相关干预措施:高危孕妇管理率(98.9%)、梅毒孕妇治疗率(97.9%)、孕妇叶酸服用率(88.8%)等均处于较高水平,早产儿胎膜早破母亲使用抗生素治疗的比例较低(60.1%)。2)新生儿分娩后相关干预措施:出生后进行90 min母婴皮肤接触的比例为41.8%,生后1 h内完成首次母乳喂养的比率为77.7%,开展早产儿袋鼠式护理的机构比例为24.7%。3)新生儿疾病相关干预措施:可开展新生儿败血症和新生儿肺炎疾病诊疗的机构分别为33.5%和47.8%,接受肌肉注射维生素K₁的新生儿比例为69.8%。结论 我国西部4省县乡级助产机构的新生儿早期基本保健技术实施现状与世界卫生组织的建议存在差距,应针对这些不足和差距开展干预。     

袋鼠式护理对足月新生儿疼痛的护理效果

目的：探究袋鼠式护理对足月新生儿疼痛的护理效果及其临床意义。方法：将本院2012年10月-2013年2月内足月出生的58例新生儿随机平均分为两组,各29例。研究组采用袋鼠式护理,对照组采用常规护理,比较两组新生儿疼痛程度、心率和血氧饱和度方面的差异。结果：在疼痛程度和心率方面,研究组明显低于对照组比较,差异具有统计学意义（P〈0.05）;在血氧饱和度方面,研究组明显高于对照组,比较差异具有统计学意义（P〈0.05）。结论：袋鼠式护理对比较于足月新生儿疼痛的护理效果显著,能够有效降低足月新生儿的疼痛感,对于新生儿的心理和生理均有良好的促进作用。     

Comprehensive measurement of health system performance at district level in India: Generation of a composite index

There have been limited attempts at measurement of health system performance at decentralized levels in low‐ and middle‐income countries. This study was undertaken to develop a composite indicator to measure health system performance at district level in India. Primary data were collected from 377 public health facilities in 21 districts of Haryana state in India using health facility surveys. In addition, 1700 health care providers and 800 clients visiting health facilities were interviewed. Routine health management information system data at district and state level were also analyzed. These data were used for computing 67 input and process indicators covering six health system building blocks. Indicators were normalized and aggregated to generate domain‐specific and overall composite health system performance index (HSPI) for each district. Several sensitivity analyses were performed to assess robustness of results. Overall, Panchkula and Ambala districts were found to be the best performing in the state (with HSPI scores of 0.64 and 0.62 out of 1), while Mewat, Faridabad, and Palwal districts had the poorest performance (with HSPI scores of 0.46, 0.49, and 0.48 out of 1). Significant variation in performance was observed for each health system building block. Sensitivity analyses results showed that study findings were robust to variations in methods of aggregation of indicators. Our study provides a framework and methods to measure health system performance at district level in a comprehensive manner. The composite indicator provides a summary snapshot to benchmark performance, while building block and domain scores provide critical information for programmatic action.     

Caring for Young Children with Asthma: Perspectives from Urban Community Health Centers

Asthma disproportionately affects low-income, minority youth, with notable disparities among children <5 years of age. Understanding the perceptions of urban community health centers (CHCs) regarding treating young children with asthma could improve care for these patients. This study uses data from semi-structured focus groups with staff from eight urban CHCs. Themes emerged in three domains. Within the parent/family domain, providers noted low rates of follow-up visits, low health literacy, and—for young children specifically—misunderstanding about the diagnosis. At the CHC level, providers needed more staff, space, and comfort with applying the guidelines to infants and young children. CHCs reported asthma registries, population health oversight, and an asthma champion improved care. At the system level, providers wanted improved communication with emergency departments and community outreach programs. Reducing these multi-level barriers may improve care.     

WHO's Service Availability and Readiness Assessment of primary health care services of commune health centers in a rural district of Northern Vietnam

The objective of this study was to assess the availability and readiness of the primary health care (PHC) services of commune health centers (CHCs) in Quoc Oai, a rural district of Northern Vietnam based on the World Health Organization's Service Availability and Readiness Assessment (SARA) tool. The study was done in 2 steps. First, the heads of the 21 CHCs of Quoc Oai district were interviewed using SARA, a quantitative survey, and the responses were then validated by direct observations of each facility. The results showed that although the average number of health staffs in each CHC met the national standards (at least 5 staffs per CHC), its allocation within each CHC was not properly met because some CHCs had only 2 health staffs. Several health equipment and facilities were not fully available in many CHCs, and although the majority of the PHC services were available at the CHCs, their readiness remained limited. Several significant correlates between the availability of health care workers and the availability of the facilities and the PHC services were observed, suggesting that they depend upon and affect one another in the health system. Using the SARA‐based inventory, the study helps health managers and policy makers to prioritize efforts and allocate resources more appropriately. To be effective, attention should be given to how to make facilities, services, and human resources for health ready for PHC activities—more investment and support from the system (from higher to lower level) and the government.     

Taken to Health Care Provider or Not,Under-Five Children Die of Preventable Causes: Findings from Cross-Sectional Survey and Social Autopsy in Rural India

Background:Under-five children in India continue to die from causes that can either be treated or prevented. The data regarding causes of death, community care-seeking practices, and events prior to death are needed to guide and refine health policies for achieving national goals and targets.Findings:A total of 1,488 death histories were captured through verbal autopsy. Neonatal etiologies, acute respiratory infection (ARI), and diarrhea accounted for approximately 63.1% of all deaths in the under-five age group. The causes of death in neonates showed that birth asphyxia, prematurity, and neonatal infections contributed to more than 67.5% of all neonatal deaths, while in children aged 29 days to 59 months, ARI and diarrhea accounted for 54.3% of deaths. Care providers of 52.6% of the neonates and 21.7% of infants and under-five children did not seek any medical care before the death of the child. Substantial delays in seeking care occurred at home and during transit. For those who received medical care, there was an apparent amongst in their caregivers toward private health providers.Conclusion:The deaths of neonates and postneonates taken to any health facilities highlight the need for providing equitable and high-quality health services in India. The findings could be used for policy planning and program refinement in India.     

A Qualitative Evaluation of the Choice of Traditional Birth Attendants for Maternity Care in 2008 Sierra Leone: Implications for Universal Skilled Attendance at Delivery

Maternal and newborn death is common in Sierra Leone; significant reductions in both maternal and newborn mortality require universal access to a skilled attendant during labor and delivery. When too few women use health facilities MDGs 4 and 5 targets will not be met. Our objectives were to identify why women use services provided by TBAs as compared to health facilities; and to suggest strategies to improve utilization of health facilities for maternity and newborn care services. Qualitative data from focus group discussions in communities adjacent to health facilities collected during the 2008 Emergency Obstetric and Newborn Care Needs Assessment were analyzed for themes relating to decision-making on the utilization of TBAs or health facilities. The prohibitive cost of services, and the geographic inaccessibility of health facilities discouraged women from using them while trust in the vast experience of TBAs as well as their compassionate care drew patients to them. Poor facility infrastructure, often absent staff, and the perception that facilities were poorly stocked and could not provide continuum of care services were barriers to facility utilization for maternity and newborn care. Improvements in infrastructure and the 24-hour provision of free, quality, comprehensive, and respectful care will minimize TBA preference in Sierra Leone.     

EDITORIAL: HOMICIDE ON THE HIGHWAY

Mothers and their home birth attendants residing in rural Uttar Pradesh (UP), India, were taught to recognize and take action to resolve selected maternal and neonatal life-threatening problems. Community mobilization efforts were designed to reduce delays in transport to emergency obstetric care (EOC) referral units and to increase use of family planning. Retention of knowledge and skills for recognition and intervention for maternal bleeding and newborn sepsis was enhanced when pictorial depictions of the problem or take action message or both were used as memory aids. Advocacy efforts for use of EOC facilities were less successful. The community health promotion and home-based life-saving skills education efforts tested are recommended for replication.     

Outcomes of a community- and home-based intervention for safe motherhood and newborn care

Mothers and their home birth attendants residing in rural Uttar Pradesh (UP), India, were taught to recognize and take action to resolve selected maternal and neonatal life-threatening problems. Community mobilization efforts were designed to reduce delays in transport to emergency obstetric care (EOC) referral units and to increase use of family planning. Retention of knowledge and skills for recognition and intervention for maternal bleeding and newborn sepsis was enhanced when pictorial depictions of the problem or take action message or both were used as memory aids. Advocacy efforts for use of EOC facilities were less successful. The community health promotion and home-based life-saving skills education efforts tested are recommended for replication.     

Perinatal risk and severity of illness in newborns at 6 neonatal intensive care units

OBJECTIVES: This multisite study sought to identify (1) any differences in admission risk (defined by gestational age and illness severity) among neonatal intensive care units (NICUs) and (2) obstetric antecedents of newborn illness severity. METHODS: Data on 1476 babies born at a gestational age of less than 32 weeks in 6 perinatal centers were abstracted prospectively. Newborn illness severity was measured with the Score for Neonatal Acute Physiology. Regression models were constructed to predict scores as a function of perinatal risk factors. RESULTS: The sites differed by several obstetric case-mix characteristics. Of these, only gestational age, small for gestational age. White race, and severe congenital anomalies were associated with higher scores. Antenatal corticosteroids, low Apgar scores, and neonatal hypothermia also affected illness severity. At 2 sites, higher mean severity could not be explained by case mix. CONCLUSIONS: Obstetric events and perinatal practices affect newborn illness severity. These risk factors differ among perinatal centers and are associated with elevated illness severity at some sites. Outcomes of NICU care may be affected by antecedent events and perinatal practices.     

Implementation research on kangaroo mother care,Bangladesh

ObjectiveTo describe the implementation, coverage and performance of the national kangaroo mother care programme in Bangladesh.MethodsKangaroo mother care services for clinically stable babies with birth weight under 2000 g were set up in government-run health-care facilities in rural and urban areas of Bangladesh. Each facility provided counselling on kangaroo mother care, ensured adequate nutrition, and followed up mothers and babies. We studied implementation of the programme from January 2016 to March 2020 using data from the national database. We tracked the number of eligible babies enrolled and their outcomes, mortality and post-discharge follow-up.FindingsThe numbers of kangaroo mother care facilities increased from 16 in 2016 to 108 in 2020. Over the 4-year period 64 426 babies weighing under 2000 g were born in these facilities,  6410 of whom received kangaroo mother care. The quarterly percentage of eligible babies receiving kangaroo mother care increased from 4.7% (37/792) during the first quarter to 21.7% (917/4226) during the last five quarters of the programme. Deaths of babies receiving kangaroo mother care showed a downward trend over the study period. The overall mortality was 1.2% (77/6410), with large quarterly fluctuations in mortality. Post-discharge follow-up was low and only 15–20% of babies received four follow-up visits.ConclusionImplementation of kangaroo mother care interventions is feasible in low-resource settings. Such care has the potential to reduce mortality among low-birth-weight and premature babies. Challenges include low coverage, expanding the programme to the community and strengthening the monitoring system.     

Training health care providers to provide PrEP for HIV serodiscordant couples attending public health facilities in Kenya

ABSTRACT

To catalyse national scale up of PrEP for HIV serodiscordant couples in public health facilities in Kenya, the Partners Scale-Up Project, using a two-day case-based interactive curriculum, trained health care providers working in 24 high volume facilities in central and western Kenya on PrEP service delivery. Using a standardised test with questions about PrEP and antiretroviral-based HIV prevention we assessed gain in knowledge and confidence gain by comparing pre-and post-training test scores. We explored experiences of the training through key informant interviews after clinics started delivering PrEP. Of 716 health care providers trained, 235 (32.9%) were nurses, 144 (20.2%) were clinical officers and 155 (21.7%) were HIV counsellors. There was a significant improvement between the means of pre-test and post-test scores (61.7% (SD 17.4) vs 86.4% (SD 12.7) p?<?0.001). The proportion of those who reported being ‘very comfortable’ providing care to HIV serodiscordant couples increased from 22.8% to 67.3% (p?<?0.001). Key themes that training increasing both knowledge of PrEP and confidence to deliver PrEP to HIV serodiscordant couples emerged from interviews. This short, standardised training resulted in a substantial increase in knowledge of PrEP and in the confidence of the health providers to provide PrEP to HIV serodiscordant couples.

Trial registration ClinicalTrials.gov NCT03052010     

Primary Health Care in Community Health Centers and Comparison with Office-Based Practice

We examine the roles of nurse practitioners (NPs), physician assistants (PAs), and nurse midwives (CNMs) in community health centers (CHCs). We also compare primary care physicians in CHCs with office-based physicians. Estimates are from the National Ambulatory Medical Care Survey, a nationally representative annual survey of nonfederal, office-based patient care physicians and their visits. Analysis of primary care delivery in CHCs and office-based practices are based on 1,434 providers and their visits (n = 32,300). During 2006–2007, on average, physicians comprised 70% of CHC clinicians, with NPs (20%), PAs (9%), and CNMs (1%) making up the remainder. PAs, NPs, and CNMs provided care in almost a third of CHC primary care visits; 87% of visits to these CHC providers were independent of physicians. Types of patients seen by clinicians suggest a division of labor in caring for CHC patients. NPs and PAs were more likely than physicians to report providing health education services. There were no other differences among services examined. Office-based physicians were less likely to work alongside PAs/NPs/CNMs than CHC physicians. CHC staffing is contingent on a variety of providers. CHC staffing patterns may serve as models of primary care staffing for office practices as demand for primary care services nationwide increases.     

America's Health Centers: Reducing Racial and Ethnic Disparities in Perinatal Care and Birth Outcomes

Objective. To examine whether community health centers (CHCs) reduce racial/ethnic disparities in perinatal care and birth outcomes, and to identify CHC characteristics associated with better outcomes.
Background. Despite great national wealth, the U.S. continues to rank poorly relative to other industrialized nations on infant mortality and other birth outcomes, and with wide inequities by race/ethnicity. Disparities in primary care (including perinatal care) may contribute to disparities in birth outcomes, which may be addressed by CHCs that provide safety-net medical services to vulnerable populations.
Methods. Data are from annual Uniform Data System reports submitted to the Bureau of Primary Health Care over six years (1996–2001) by about 700 CHCs each year.
Results. Across all years, about 60% of CHC mothers received first-trimester prenatal care and more than 70% received postpartum and newborn care. In 2001, Asian mothers were the most likely to receive both postpartum and newborn care (81.7% and 80.3%), followed by Hispanics (75.0% and 76.3%), blacks (70.8% and 69.9%), and whites (70.7% and 66.7%). In 2001, blacks had higher rates of low birth weight (LBW) babies (10.4%), but the disparity in rates for blacks and whites was smaller in CHCs (3.3 percentage points) compared to national disparities for low-socioeconomic status mothers (5.8 percentage points) and the total population (6.2 percentage points). In CHCs, greater perinatal care capacity was associated with higher rates of first-trimester prenatal care, which was associated with a lower LBW rate.
Conclusion. Racial/ethnic disparities in certain prenatal services and birth outcomes may be lower in CHCs compared to the general population, despite serving higher-risk groups. Within CHCs, increasing first-trimester prenatal care use through perinatal care capacity may lead to further improvement in birth outcomes for the underserved.     

Willingness to use and satisfaction of primary care services among locals and migrants in Shenzhen,China

The Chinese government has been reforming the health care system by developing a primary care system. The objectives of this study were to compare the willingness to use and satisfaction with community health care centres (CHCs), a component within the Chinese primary care system, between locals and migrants living in Luohu, Shenzhen, China. A 2019 cross-sectional survey data that interviewed 1,205 adult residents living in Luohu district were used for secondary data analysis. Two identifications of migrants were used for analysis, Shenzhen hukou status and urban village status. Linear probability models were used to determine relationship between migrants' status and the outcome variable of willingness to use CHCs and order logistic regression were used to determine the association between migrants' status and the outcome variable of satisfaction with CHCs. Among participants, 37.6% of the participants had Shenzhen hukou. Using the classification of urban village status, 29.1% of participants were urban villagers. Urban villagers were less likely to know the location of nearest CHCs and less likely to select CHCs as their frequently used health care institutions. No statistically significant difference was found on willingness to use CHCs or satisfaction with CHCs between Shenzhen hukou and non-Shenzhen hukou. But urban villagers were more satisfied with attitude and medical skills of health care workers. Our findings indicated that policymakers and social professionals need to adjust the organization and functioning of primary care institutions in the community to increase awareness and utilization of primary care services.     

基层卫生人员肥胖及糖尿病相关知识调查

[目的]了解北京顺义、天津红桥、浙江嘉兴和浙江桐乡基层卫生人员肥胖和糖尿病相关知识状况,为干预实施提供参考。[方法]采用自行设计的调查问卷,收集61名参与项目工作的疾控和医疗卫生人员相关知识的获取和知晓资料进行分析。[结果]92.9%的疾控卫生人员既往曾获得过肥胖和糖尿病相关知识,获取率最高和最低的知识内容为健康饮食和糖尿病药物治疗;94.6%的医疗卫生人员既往曾获得过肥胖和糖尿病相关知识,获取率最高和最低的知识内容为健康饮食和合理运动。疾控卫生人员平均得分为14.3分,医疗卫生人员平均得分为9.5分,差异有统计学意义。无论是疾控还是医疗卫生人员,掌握得最好的知识内容为糖尿病相关知识,其次为肥胖知识,掌握最差的为健康生活方式知识。[结论项目地区基层卫生人员在健康生活方式和肥胖相关知识还有待提高,需要加强相关知识的普及。     

Can Flip-Chart Assisted Maternal Education Improve Essential New Born Care Knowledge and Skills? A Randomized Controlled Trial

Maternal and Child Health Journal - Despite the implementation of essential newborn care (ENC) by the World Health Organization, knowledge gaps among postpartum women persist. Inappropriate...