M. Mahmud Khan

Use of a Balanced Scorecard in strengthening health systems in developing countries: an analysis based on nationally representative Bangladesh Health Facility Survey.

This paper illustrates the importance of collecting facility-based data through regular surveys to supplement the administrative data, especially for developing countries of the world. In Bangladesh, measures based on facility survey indicate that only 70% of very basic medical instruments and 35% of essential drugs were available in health facilities. Less than 2% of officially designated obstetric care facilities actually had required drugs, injections and personnel on-site. Majority of (80%) referral hospitals at the district level were not ready to provide comprehensive emergency obstetric care. Even though the Management Information System reports availability of diagnostic machines in all district-level and sub-district-level facilities, it fails to indicate that 50% of these machines are not functional. In terms of human resources, both physicians and nurses are in short supply at all levels of the healthcare system. The physician-nurse ratio also remains lower than the desirable level of 3.0. Overall job satisfaction index was less than 50 for physicians and 66 for nurses. Patient satisfaction score, however, was high (86) despite the fact that process indicators of service quality were poor. Facility surveys can help strengthen not only the management decision-making process but also the quality of administrative data.

Are We There Yet? Compliance with Physical Activity Standards in YMCA Afterschool Programs

BACKGROUND In 2011, the YMCA of the United States adopted physical activity standards for all their afterschool programs (ASPs), which call for children to accumulate 30 minutes of moderate-to-vigorous physical activity (MVPA) while attending YMCA ASPs. The extent to which youth attending YMCA ASPs achieve this standard is unknown. METHODS Using a cluster-stratified design, 20 ASPs were sampled from all YMCA-operated ASPs across South Carolina (N = 102). ASPs were visited on four unannounced, nonconsecutive weekdays. Accelerometer-derived minutes spent in MVPA were dichotomized to ≥30 min/d of MVPA and <30 min/d of MVPA. Program characteristics were measured through document review and direct observation and compared to MVPA levels using random-effects quantile regression. RESULTS Boys (n = 607) and girls (n = 475) accumulated a median of 25.3 and 17.1 min/d of MVPA, respectively, which translated into 33% (range 6.2%-67.3%) and 17% (0%-42.6%) achieving the 30 min/d of MVPA standard, respectively. Increase in time scheduled for activity (10.7-11.7 min/d of MVPA), limited sedentary choices during activity time (6.9-8.9 min/d of MVPA), and staff activity-promotion training (4.8-7.9 min/d of MVPA) were associated with higher accumulated minutes of MVPA for boys and girls. Program revenue, percent activity structure that was for free play, and indoor/outdoor space were inconsistently related to meeting the MVPA standard. CONCLUSIONS Modifiable programmatic structures were associated with higher amounts of MVPA. These findings suggest that simple programmatic changes could help ASPs to achieve the MVPA standard, regardless of infrastructure or finances.

Decision-making process of Kala Azar care: results from a qualitative study carried out in disease endemic areas of Nepal

BackgroundAnalysis of consumer decision making in the health sector is a complex process of comparing feasible alternatives and evaluating the levels of satisfaction associated with the relevant options. This paper makes an attempt to understand how and why consumers make specific decisions, what motivates them to adopt a specific health intervention, and what features they find attractive in each of the options.MethodThe study used a descriptive-explanatory design to analyze the factors determining the choices of healthcare providers. Information was collected through focus group discussions and in-depth interviews.ResultsThe results suggest that the decision making related to seeking healthcare for Kala Azar (KA) treatment is a complex, interactive process. Patients and family members follow a well-defined road map for decision making. The process of decision making starts from the recognition of healthcare needs and is then modified by a number of other factors, such as indigenous knowledge, healthcare alternatives, and available resources. Household and individual characteristics also play important roles in facilitating the process of decision making. The results from the group discussions and in-depth interviews are consistent with the idea that KA patients and family members follow the rational approach of weighing the costs against the benefits of using specific types of medical care.ConclusionThe process of decision making related to seeking healthcare follows a complex set of steps and many of the potential factors affect the decision making in a non-linear fashion. Our analysis suggests that it is possible to derive a generalized road map of the decision-making process starting from the recognition of healthcare needs, and then modifying it to show the influences of indigenous knowledge, healthcare alternatives, and available resources.

Achieving value for money in health: a comparative analysis of OECD countries and regional countries

OBJECTIVE To measure efficiency gains in health sector over the years 1995 to 2013 in OECD, EU, non-member European countries. METHODS An output-oriented DEA model with variable return to scale, and residuals estimated by regression equations were used to estimate efficiencies of health systems. Slacks for health care outputs and inputs were calculated by using DEA multistage method of estimating country efficiency scores. RESULTS Better health outcomes of countries were related with higher efficiency. Japan, France, or Sweden were found to be peer-efficient countries when compared to other developed countries like Germany and United States. Increasing life expectancy beyond a certain high level becomes very difficult to achieve. Despite declining marginal productivity of inputs on health outcomes, some developed countries and developing countries were found to have lowered their inefficiencies in the use of health inputs. Although there was no systematic relationship between political system of countries and health system efficiency, the objectives of countries on social and health policy and the way of achieving these objectives might be a factor increasing the efficiency of health systems. CONCLUSIONS Economic and political stability might be as important as health expenditure in improving health system goals. A better understanding of the value created by health expenditures, especially in developed countries, will require analysis of specific health interventions that can increase value for money in health. Copyright

A Low-Cost Partner Notification Strategy for the Control of Sexually Transmitted Diseases: A Case Study From Louisiana

OBJECTIVES We estimated the costs and effectiveness of implementing a partner notification (PN) strategy for highly prevalent sexually transmitted diseases (STDs) within the Louisiana STD/HIV Program. METHODS We carried out a telephone-based PN approach on an experimental basis in 2 public STD clinics in Louisiana from June 2010 to May 2012. We monitored data on the resources used for identifying, tracing, treating, and managing the infected cases and their partners to estimate the intervention costs. RESULTS Our results indicated that implementation of telephone-based PN should not increase the STD control programs expenses by more than 4.5%. This low-cost PN approach could successfully identify and treat 1 additional infected case at a cost of only

Is out-of-pocket cost a barrier to receiving repeat tests for chlamydia and gonorrhoea?

171. We found that the cost per disability-adjusted life year averted (a health outcome measure), because of the adoption of selective screening with partner tracing, was

Economic evaluation of a group randomized controlled trial on healthy eating and physical activity in afterschool programs

4499. This was significantly lower than the gross domestic product per capita of the United States, a threshold used for defining highly cost-effective health interventions. CONCLUSIONS Adoption of PN for gonorrhea and chlamydia should be considered a national strategy for prevention and control of these diseases.

Home-Based Direct Care Workers Their Reported Injuries and Perceived Training Knowledge

Summary We aimed to examine whether out-of-pocket (OOP) costs associated with chlamydia (CT) and gonorrhoea (GC) screening tests is a barrier to receiving CT/GC re-screening and follow-up annual screening. A major health insurance claims database 2006–2010 was used for analysis. The date of first CT/GC diagnosis was used as the index date, and OOP costs at index date for screening tests were retrieved. A re-screening test and an annual screening were defined as tests that occurred within 90–180 days and 181–395 days of the index date, respectively. Re-screening rates were 11.7% and 10.9% and annual screening rates were 24.7% and 23.7% for CT and GC cases, respectively. Compared with the CT patients without OOP expenses, those with OOP expenses of

Factors Affecting Life Satisfaction of Older Adults in Turkey

30 or higher had significantly reduced likelihood of receiving re-screening and annual screening. Similar results were found for GC patients. We concluded that OOP costs serve as a significant barrier to re-screening and annual screening.

Determinants of occupational injury for US home health aides reporting one or more work-related injuries

Limited information is available on the cost-effectiveness of interventions to achieve healthy eating and physical activity policies in afterschool programs (ASPs). The objective of this study is to present the costs associated with a comprehensive intervention in ASPs. Intervention delivery inputs (IDIs) associated with a group randomized delayed treatment controlled trial involving 20 ASPs serving >1700 children (5-12yrs) were catalogued prospectively across 2-years (2014-2015). IDIs, analyzed 2015, were expressed as increases in per-child per-week enrollment fees based on a 34-week school year in US