Suchergebnisse

The policy of hospital autonomy has been discussed for some time in Uganda. There is little evidence from Uganda or elsewhere that increased autonomy will improve hospital performance. The article compares the performance of three private not-for-profit (PNFP) and public hospital pairs to address this question, focusing on management structures, personnel management, drug supply management, workloads, and price levels. There are no clear differences in efficiency between PNFP and public hospitals but there is some evidence of higher quality levels in PNFP hospitals. (Inwent/DÜI)

BACKGROUND: The emergence of Global Health Initiatives (GHIs) has been a major feature of the aid environment of the last decade. This paper seeks to examine in depth the behaviour of two prominent GHIs in the early stages of their operation in Uganda as well as the responses of the government. METHODS: The study adopted a qualitative and case study approach to investigate the governance of aid transactions in Uganda. Data sources included documentary review, in-depth and semi-structured interviews and observation of meetings. Agency theory guided the conceptual framework of the study. RESULTS: The Ugandan government had a stated preference for donor funding to be channelled through the general or sectoral budgets. Despite this preference, two large GHIs opted to allocate resources and deliver activities through projects with a disease-specific approach. The mixed motives of contributor country governments, recipient country governments and GHI executives produced incentive regimes in conflict between different aid mechanisms. CONCLUSION: Notwithstanding attempts to align and harmonize donor activities, the interests and motives of the various actors (GHIs and different parts of the government) undermine such efforts.

From Springer Nature via Jisc Publications Router ; History: received 2022-01-03, accepted 2022-05-13, registration 2022-05-16, pub-electronic 2022-06-23, online 2022-06-23, collection 2022-12 ; Publication status: Published ; Funder: the National Social Science Foundation Of China; Grant(s): 20&ZD122 ; Funder: Department for International Development, UK Government; doi: http://dx.doi.org/10.13039/501100002992; Grant(s): Communicable Disease and Health Service Delivery Research Consortium ; Funder: UK-China Educational Trust; Grant(s): Chinese Students Award ; Funder: Santander Current Student Scholarship ; Funder: Henry Lester Trust Scholarship ; Abstract: Background: In China, tuberculosis (TB) care, traditionally provided through the Centre for Disease Control (CDC), has been integrated into 'designated' public hospitals at County level, with hospital staff taking on delivery of TB services supported by CDC staff. Little is known about the impact of this initiative on the hospital-based health workers who were delegated to manage TB. Drawing on a case study of two TB 'designated' hospitals in Zhejiang province, we explored factors influencing hospital-based health workers' motivation in the context of integrated TB service delivery. Methods: We conducted 47 in-depth interviews with health officials, TB/hospital managers, clinicians, radiologists, laboratory staff and nurses involved in the integrated model of hospital-based TB care. Thematic analysis was used to develop and refine themes, code the data and assist in interpretation. Results: Health workers tasked with TB care in 'designated' hospitals perceived their professional status to be low, related to their assessment of TB treatment as lacking need for professional skills, their limited opportunities for professional development, and the social stigma surrounding TB. In both sites, the integrated TB clinics were under-staffed: health workers providing TB care reported heavy workloads, and expressed dissatisfaction with a perceived gap in their ...

From Crossref journal articles via Jisc Publications Router ; Suzanne Fustukian - orcid:0000-0002-4570-5800 orcid:0000-0002-4570-5800 ; Background: The perception within literature and populace is that the private for-profit sector is for the rich only, and this characteristic results in behaviours that hinder advancement of Universal health coverage (UHC) goals. The context of Northern Uganda presents an opportunity for understanding how the private sector continues to thrive in settings with high poverty levels and history of conflict. ; Objective: The study aimed at understanding access mechanisms employed by the formal private for-profit providers (FPFPs) to enable pro-poor access to health services in post conflict Northern Uganda. ; Methods: Data collection was conducted in Gulu municipality in 2015 using Organisational survey of 45 registered formal private for-profit providers (FPFPs),10 life histories, and 13 key informant interviews. Descriptive statistics were generated for the quantitative findings whereas qualitative findings were analysed thematically. ; Results: FPFPs pragmatically employed various access mechanisms and these included fee exemptions and provision of free services, fee reductions, use of loan books, breaking down doses and partial payments. Most mechanisms were preceded by managers' subjective identification of the poor, while operationalisation heavily depended on the managers' availability and trust between the provider and the customer. For a few FPFPs, partnerships with Non-governmental organisations (NGOs) and government enabled provision of free, albeit mainly preventive services, including immunisation, consultations, screening for blood pressure and family planning. Challenges such as quality issues, information asymmetry and standardisation of charges arose during implementation of the mechanisms. ; Conclusion: The identification of the poor by the FPFPs was subjective and unsystematic. FPFPs implemented various innovations to ensure pro-poor access to health services. ...

Abstract
Background
This paper explores the changing experience of giving birth in Cambodia over a 53-year period. During this time, Cambodian people experienced armed conflict, extreme privation, foreign invasion, and civil unrest.

Methods
An historical perspective was used to explore the changing place and nature of birth assistance given to Cambodian women between 1950 and 2013. Twenty-four life histories of poor and non-poor Cambodians aged 40–74 were gathered and analysed using a grounded thematic approach.

Results
In the early lives of the respondents, almost all births occurred at home and were assisted by Traditional Birth Attendants. In modern times, towards the end of their lives, the respondents' grand-children and great grand-children are almost universally born in institutions in which skilled birth attendants are available. Respondents recognise that this is partly due to the availability of modern health care facilities but also describe the process by which attitudes to institutional and homebirth changed over time. Interviews can also chart the increasing awareness of the risks of homebirth, somewhat influenced by the success of health education messages transmitted by public health authorities.

Conclusions
The life histories provide insight into the factors driving the underlying cultural change: a modernising supply side; improving transport and communications infrastructure. In addition, a step-change occurred in the aftermath of the conflict with significant influence of extensive contact with the Vietnamese recognised.

Trial registration
None.