Determinants of Performance of Health Systems Concerning Maternal and Child Health: A Global Approach Is the public healthcare sector a more strenuous working environment than the private sector for a physician? The effects of expanded mental health benefits on treatment costs. Unravelling the quality of HIV counselling and testing services in the private and public sectors in Zambia Perceptions and utilization of primary health care services in Iraq: findings from a national household survey Organisation of asthma care: what difference does it make? A systematic review of the literature. Emtonjeni—A Structural Intervention to Integrate Sexual and Reproductive Health into Public Sector HIV Care in Cape Town, South Africa: Results of a Phase II Study [Interventions to improve the management of diabetes mellitus in primary health care and outpatient community settings].
Aims To assess the association of social determinants on the performance of health systems around the world . Methods A transnational ecological study was conducted with an observation level focused on the country . In order to research on the strength of the association between the annual maternal and child mortality in 154 countries and social determinants :  corruption , democratization , income ine quality and cultural fragmentation , we used a mixed linear regression model for repeated measures with r and om intercepts and a conglomerate-based geographical analysis , between 2000 and 2010 . Results Health determinants with a significant association on child mortality(<1year ) : higher access to water ( βa Quartile 4(Q4 ) vs Quartile 1(Q1 ) = -6,14 ; 95%CI : -11,63 to -0,73 ) , sanitation systems , ( Q4 vs Q1 = -25,58 ; 95%CI : -31,91 to -19,25 ) , % measles vaccination coverage ( Q4 vs Q1 = -7.35 ; 95%CI : -10,18 to -4,52 ) , % of births attended by a healthcare professional ( Q4 vs Q1 = -7,91 ; 95%CI : -11,36 to -4,52 ) and a % of the total health expenditure ( Q3 vs Q1 = -2,85 ; 95%CI : -4,93 to -0,7 ) . Ethnic fragmentation ( Q4 vs Q1 = 9,93 ; 95%CI : -0.03 to 19.89 ) had a marginal effect . For child mortality<5 years , an association was found for these variables and democratization ( not free vs free = 11,23 ; 95%CI : -0,82 to 23,29 ) , out-of-pocket expenditure ( Q1 vs Q4 = 17,71 ; 95%CI : 5,86 to 29,56 ) . For MMR ( Maternal mortality ratio ) , % of access to water for all the quartiles , % of access to sanitation systems , ( Q3 vs Q1 = -171,15 ; 95%CI : -281,29 to -61 ) , birth attention by a healthcare professional ( Q4 vs Q1 = -231,23 ; 95%CI : -349,32 to -113,15 ) , and having corrupt government ( Q3 vs Q1 = 83,05 ; 95%CI : 33,10 to 133 ) . Conclusions Improving access to water and sanitation systems , decreasing corruption in the health sector must become priorities in health systems . The ethno-linguistic cultural fragmentation and the detriment of democracy turn out to be two factors related to health results Aims : The present study examined the differences between physicians working in public and private health care in strenuous working environments ( presence of occupational hazards , physical violence , and presenteeism ) and health behaviours ( alcohol consumption , body mass index , and physical activity ) . In addition , we examined whether gender or age moderated these potential differences . Methods : Cross-sectional survey data were compiled on 1422 female and 948 male r and omly selected physicians aged 25–65 years from The Finnish Health Care Professionals Study .  Logistic regression and linear regression analyses were used with adjustment for gender , age , specialisation status , working time , managerial position , and on-call duty . Results : Occupational hazards , physical violence , and presenteeism were more commonly reported by physicians working in the public sector than by their counterparts in the private sector . Among physicians aged 50 years or younger , those who worked in the public sector consumed more alcohol than those who worked in the private sector , whereas in those aged 50 or more the reverse was true . In addition , working in the private sector was most strongly associated with lower levels of physical violence in those who were older than 50 years , and with lower levels of presenteeism among those aged 40–50 years . Conclusions : The present study found evidence for the public sector being a more strenuous work environment for physicians than the private sector . Our results suggest that public healthcare organisations should pay more attention to the working conditions of their employees BACKGROUND Mental health disorders represent one of the most common problems facing adults in the labor force . It is estimated that within a 12-month period nearly 30 % of the US population experiences some diagnosable mental health or addictive disorder . This study examines the impact that corporate benefit policies can have on mental health treatment costs . AIMS To measure the effects of a change in mental health benefit design on treatment expenditures for employees of a large US-based company . METHODS Data came from mental health treatment administrative cl aims and eligibility information provided by the company and a comparable set of cl aims for a r and omly selected control group for the years 1995 - 1998 . We measure the effect of a change in mental health benefits consisting of three major elements : a company-wide effort to destigmatize mental illness ; reduced cost-sharing for mental health treatment ; and the implementation of a provider network that emphasized access to non-physician mental health specialists . We use a two-part regression model within a difference in differences framework to examine outpatient , pharmaceutical , and combined outpatient and pharmaceutical expenditures between the treatment company and the control group . RESULTS We find that the program led to a statistically significant dollar 17 increase in outpatient costs ( excluding pharmaceutical costs ) per employee . Similar to outpatient care we find that the benefit change was associated with a statistically significant increase in pharmaceutical costs of about dollar 15 . DISCUSSION The results reveal that the mental health benefit expansion at the company led to a significant increase in aggregate mental health expenditures among employees . However , the aggregate increase in cost masks a number of interesting underlying trends in mental health utilization . First , conditional upon any mental health treatment , mental health costs were virtually unchanged before and after the benefit change . Conditional on any use , outpatient and pharmaceutical expenditures went in opposite directions , with outpatient expenditures falling and pharmaceutical expenditures increasing . IMPLICATION S FOR HEALTH CARE PROVISION AND USE Private sector initiatives can increase use of mental health care treatment through decreased cost-sharing , improved access to specialty providers , and destigmatization of mental disorders . IMPLICATION S FOR HEALTH CARE POLICY FORMULATION : Given that the vast majority of people in the US get their health insurance through employer-sponsored health insurance , efforts on the part of the private sector to recognize and treat serious chronic illnesses such as mental disorder in a proactive manner should be encouraged . IMPLICATION S FOR FUTURE RESEARCH While the aggregate cost of corporate initiatives to improve access to quality mental health care is frequently examined , it is also important to decompose the aggregate cost changes into effects from a change in the rate of initiation and changes in utilization conditional upon initiation Background Despite the substantial investment for providing  HIV counselling and testing ( VCT ) services in Zambia , there has been little effort to systematic ally evaluate the quality of  VCT services provided by various types of health providers . This study , conducted in 2009 , examines  VCT in the public and private sectors including private for-profit and NGO/faith-based sectors in Copperbelt and Luapula . Methods The study used five primary data collection methods to gauge quality of  VCT services  : closed-ended client interviews with clients exiting  VCT sites ; open-ended client interviews ; interviews with facility managers ; review of service statistics ; and an observation of the physical environment for VCT by site .  Over 400 clients and 87 facility managers were interviewed from almost 90 facilities . Sites were r and omly selected and results are generalizable at the provincial level . Results The study shows concerning levels of underperformance in VCT services  across the sectors . It reveals serious underperformance in counselling about key risk-reduction methods . Less than one-third of clients received counselling on reducing number of sexual partners and only approximately 5 % of clients received counselling about disclosing test results to partners . In terms of client profiles , the NGO sector attracts the most educated clients and less educated Zambians seek  VCT  services at very low rates ( 7 % ) . The private for-profit performs equally or sometimes better than other sectors even though this sector is not adequately integrated into the Zambian national response to HIV . Conclusion The private for-profit sector provides  VCT services  on par in quality with the other sectors . Most clients did not receive counselling on partner reduction or disclosure of HIV test results to partners . In a generalized HIV epidemic where multiple concurrent sexual partners are a significant problem for transmitting the disease , risk-reduction methods and discussion should be a main focus of pre-test and post-test counselling Background After many years of sanctions and conflict , Iraq is rebuilding its health system , with a strong emphasis on the traditional hospital-based services . A network exists of public sector hospitals and clinics , as well as private clinics and a few private hospitals . Little data are available about the approximately 1400 Primary Health Care clinics ( PHCCs ) staffed with doctors . How do Iraqis utilize primary health care services ? What are their preferences and perceptions of public primary health care clinics and private primary care services in general ? How does household wealth affect choice of services ? Methods A 1256 household national survey was conducted in the catchment areas of r and omly selected PHCCs in Iraq . A cluster of 10 households , beginning with a r and omly selected start household , were interviewed in the service areas of seven public sector PHCC facilities in each of 17 of Iraq 's 18 governorates . A question naire was developed using key informants . Teams of interviewers , including both males and females , were recruited and provided a week of training which included field practice . Teams then gathered data from households in the service areas of r and omly selected clinics . Results Iraqi participants are generally satisfied with the quality of primary care services available both in the public and private sector . Private clinics are generally the most popular source of primary care , however the PHCCs are utilized more by poorer households . In spite of free services available at PHCCs many households expressed difficulty in affording health care , especially in the purchase of medications . There is no evidence of informal payments to secure health services in the public sector . Conclusions There is widespread satisfaction reported with primary health care services , and levels did not differ appreciably between public and private sectors . The public sector PHCCs are preferentially used by poorer population s where they are important providers . PHCC services are indeed free , with little evidence of informal payments to providers OBJECTIVES : To evaluate the effectiveness of different forms of organisation ( delivery ) of asthma care . METHODS : A systematic review of the published evidence of effectiveness organisational methods of asthma management . Search es on computerised data bases including Medline , CINAHL , and HELMIS , and relevant citations and letters to experts were used to identify relevant studies . RESULTS : 27 studies were identified that evaluated different organisational methods of delivery across both primary and secondary sectors , such as shared care , general practice asthma clinics , outpatient programmes , inpatient admissions policies , and the use of specialists . Only one third of the studies used a r and omised controlled trial and many had small sample sizes . No conclusive evidence was found to favour any particular organisational form , although limited evidence would suggest that specialist care is better than general care and that shared care can be as effective as hospital led care . CONCLUSIONS : There is little good published research evaluating different ways of organising the delivery of asthma care . There is need for quality research on organisational methods of delivery of asthma care that could be used to inform policy makers , in particular examining whether patients treated by healthcare professional with expertise and interest in asthma will experience better outcomes Integration of sexual and reproductive health within HIV care services is a promising strategy for increasing access to family planning and STI services and reducing unwanted pregnancies , perinatal HIV transmission and maternal and infant mortality among people living with HIV and their partners . We conducted a Phase II r and omized futility trial of a multi-level intervention to increase adherence to safer sex guidelines  among those wishing to avoid pregnancy and  adherence to safer conception guidelines  among those seeking conception in newly-diagnosed HIV-positive persons in four public-sector HIV clinics in Cape Town . Clinics were pair-matched and the two clinics within each pair were r and omized to either a three-session provider-delivered enhanced intervention ( EI ) ( onsite contraceptive services and brief milieu intervention for staff ) or st and ard-of-care ( SOC ) provider-delivered intervention . The futility analysis showed that we can not rule out the possibility that the  EI intervention has a 10 % point or greater success rate in improving adherence to safer sex/safer conception guidelines than does SOC ( p = 0.573 ) , indicating that the intervention holds merit , and a larger-scale confirmatory study showing whether the EI is superior to SOC has merit UNLABELLED This review should be cited as : Renders CM , Valk GD , Griffin S. Wagner EH , Eijk JThM van , Assendelft WJJ . Interventions to improve the management of  diabetes mellitus  in primary care , outpatient and community setting s ( Cochrane Review ) . In : The Cochrane Library , Issue 2 , 2001 . Oxford : Up date Software . A substantive amendment to this systematic review was last made on 29 June 2000 . Cochrane review s are regularly checked and up date d if necessary . BACKGROUND Diabetes is a common chronic disease that is increasingly managed in primary care . Different systems have been proposed to manage diabetes care . OBJECTIVES To assess the effects of different interventions , targeted at health professionals or the structure in which they deliver care , on the management of patients with diabetes in primary care , outpatient and community setting s. SEARCH STRATEGY We search ed the Cochrane Effective Practice and Organisation of Care Group specialised register , the Cochrane Controlled Trials Register ( Issue 4 1999 ) , MEDLINE ( 1966 - 1999 ) , EMBASE ( 1980 - 1999 ) , Cinahl ( 1982 - 1999 ) , and reference lists of articles . SELECTION CRITERIA R and omised trials ( RCTs ) , controlled clinical trials ( CCTs ) , controlled before and after studies ( CBAs ) and interrupted time series ( ITS ) analyses of professional , financial and organisational strategies aim ed at improving care for people with Type 1 or Type 2 diabetes . The participants were health care professionals , including physicians , nurses and pharmacists . The outcomes included objective ly measured health professional performance or patient outcomes , and self-report measures with known validity and reliability . DATA COLLECTION AND ANALYSIS Two review ers independently extracted data and assessed study quality . MAIN RESULTS Forty-one studies were included involving more than 200 practice s and 48,000 patients . Twenty-seven studies were RCTs , 12 were CBAs , and two were ITS . The studies were heterogeneous in terms of interventions , participants , setting s and outcomes . The method ological quality of the studies was often poor . In all studies the intervention strategy was multifaceted . In 12 studies the interventions were targeted at health professionals , in nine they were targeted at the organization of care , and 20 studies targeted both . In 15 studies patient education was added to the professional and organisational interventions . A combination of professional interventions improved process outcomes . The effect on patient outcomes remained less clear as these were rarely assessed . Arrangements for follow-up ( organisational intervention ) also showed a favourable effect on process outcomes . Multiple interventions in which patient education was added or in which the role of the nurse was enhanced also reported favourable effects on patients ' health outcomes . REVIEW ERS ' CONCLUSION : Multifaceted professional interventions can enhance the performance of health professionals in managing patients with diabetes .  Organisational interventions that improve regular prompted recall and review of patients  ( central computerised tracking systems or nurses who regularly contact the patient ) can also improve diabetes management . The addition of patient-oriented interventions can lead to improved patient health outcomes . Nurses can play an important role in patient-oriented interventions , through patient education or facilitating adherence to treatment
Authors ' conclusions There is a paucity of evidence regarding how best to reduce corruption .
Promising interventions include improvements in the  detection and punishment of corruption  , especially efforts that are coordinated by an independent agency .
Other promising interventions include guidelines that prohibit doctors from accepting benefits from the pharmaceutical industry , internal control practice s in community health centres , and increased transparency and accountability for co-payments combined with reduced incentives for informal payments .
Key messages The review suggests that some strategies to fight corruption in the health sector can have an effect on corruption .
This study shows that these strategies may have led to fewer patients giving their doctors informal payments ( low certainty evidence ) . •
The study suggests that this may have changed doctors ' attitudes about the influence of pharmaceutical companies on their choice of medicines ( low certainty evidence ) . •
We do n't know what the effects of these strategies have on healthcare or people 's health , or if these strategies had any harmful effects .
Background Corruption is the abuse or complicity in abuse , of public or private position , power or authority to benefit oneself , a group , an organisation or others close to oneself ; where the benefits may be financial , material or non- material .
It is wide-spread in the health sector and represents a major problem .
Objectives Our primary objective was to systematic ally summarise empirical evidence of the effects of strategies to reduce corruption in the health sector .
Our secondary objective was to describe the range of strategies that have been tried and to guide future evaluations of promising strategies for which there is insufficient evidence .
The extent to which increased transparency alone reduces corruption is uncertain .
Interventions to reduce corruption in the health sector What is the aim of this review ?
The aim of this Cochrane review is to assess the effectiveness of strategies to reduce corruption in the health sector .
Corruption can occur in any area of the health sector , and happens when people abuse their own position to benefit themselves , their organisation , or other people close to them .
It can take many forms , including bribes , theft , or giving incorrect or inaccurate information deliberately .
It can take money away from healthcare , lead to poorer quality care and make access to healthcare unfair , and often affects poor people the hardest .