Water, sanitation and hygiene infrastructure and quality in rural healthcare facilities in Rwanda.

BACKGROUND: WHO and UNICEF have proposed an action plan to achieve universal water, sanitation and hygiene (WASH) coverage in healthcare facilities (HCFs) by 2030. The WASH targets and indicators for HCFs include: an improved water source on the premises accessible to all users, basic sanitation facilities, a hand washing facility with soap and water at all sanitation facilities and patient care areas. To establish viable targets for WASH in HCFs, investigation beyond 'access' is needed to address the state of WASH infrastructure and service provision. Patient and caregiver use of WASH services is largely unaddressed in previous studies despite being critical for infection control. METHODS: The state of WASH services used by staff, patients and caregivers was assessed in 17 rural HCFs in Rwanda. Site selection was non-random and predicated upon piped water and power supply. Direct observation and semi-structured interviews assessed drinking water treatment, presence and condition of sanitation facilities, provision of soap and water, and WASH-related maintenance and record keeping. Samples were collected from water sources and treated drinking water containers and analyzed for total coliforms, E. coli, and chlorine residual. RESULTS: Drinking water treatment was reported at 15 of 17 sites. Three of 18 drinking water samples collected met the WHO guideline for free chlorine residual of >0.2 mg/l, 6 of 16 drinking water samples analyzed for total coliforms met the WHO guideline of <1 coliform/100 mL and 15 of 16 drinking water samples analyzed for E. coli met the WHO guideline of <1 E. coli/100 mL. HCF staff reported treating up to 20 L of drinking water per day. At all sites, 60% of water access points (160 of 267) were observed to be functional, 32% of hand washing locations (46 of 142) had water and soap and 44% of sanitary facilities (48 of 109) were in hygienic condition and accessible to patients. Regular maintenance of WASH infrastructure consisted of cleaning; no HCF had on-site capacity for performing repairs. Quarterly evaluations of HCFs for Rwanda's Performance Based Financing system included WASH indicators. CONCLUSIONS: All HCFs met national policies for water access, but WHO guidelines for environmental standards including water quality were not fully satisfied. Access to WASH services at the HCFs differed between staff and patients and caregivers

Improving the network transmission cost of differentiated web services

This paper investigates into the transmission cost of web services related messages which is affected by network latency. Web services enable seamless interaction and integration of e-business applications. Web services contain a collection of operations so as to interact with outside world over the Internet through XML messaging. Though XML effectively describe message related information and is fairly human readable, it badly affects the performance of Web services in terms of transmission cost, processing cost, and so on. This paper aims to minimize network latency of message communication of Web services by employing pre-emptive resume scheduling. Fundamental principle of this approach is the provision of preferential treatment to some messages as compared to others. This approach assigns different priorities to distinct classes of messages given the fact that some messages may tolerate longer delays than others. For instance, shorter messages may be given higher priority than longer messages, or the Web service provider may give higher priority to the messages of paying subscribers

Water, Sanitation and Hygiene In Health Care Facilities: Status in Low- and Middle-income Countries and Way Forward

This report presents, for the first time, a global assessment of the extent to which health care facilities provide essential water, sanitation, and hygiene (WASH) services. Drawing on data from 54 low- and middle-income countries, this report finds that 38 percent lack access to even rudimentary levels of water. The World Health Organization, UNICEF, governments, and other partners must develop a global plan to address the pressing needs and ensure that all health care facilities have WASH services

End-to-End QoS Support for a Medical Grid Service Infrastructure

Quality of Service support is an important prerequisite for the adoption of Grid technologies for medical applications. The GEMSS Grid infrastructure addressed this issue by offering end-to-end QoS in the form of explicit timeliness guarantees for compute-intensive medical simulation services. Within GEMSS, parallel applications installed on clusters or other HPC hardware may be exposed as QoS-aware Grid services for which clients may dynamically negotiate QoS constraints with respect to response time and price using Service Level Agreements. The GEMSS infrastructure and middleware is based on standard Web services technology and relies on a reservation based approach to QoS coupled with application specific performance models. In this paper we present an overview of the GEMSS infrastructure, describe the available QoS and security mechanisms, and demonstrate the effectiveness of our methods with a Grid-enabled medical imaging service

Collaborative Documentation for Behavioral Healthcare Providers: An Emerging Practice

This article considers the practice of collaborative documentation (CD) for behavioral healthcare providers; the legislative, technological, and philosophical milieu in which it developed; the attributed benefits for providers and clients; and the peer-reviewed research supporting its use. Collaborative documentation has emerged following significant legislative and technological changes in healthcare delivery and shifts toward client-centered healthcare practices including more shared decision-making between clients and practitioners

Towards Autonomic Service Provisioning Systems

This paper discusses our experience in building SPIRE, an autonomic system for service provision. The architecture consists of a set of hosted Web Services subject to QoS constraints, and a certain number of servers used to run session-based traffic. Customers pay for having their jobs run, but require in turn certain quality guarantees: there are different SLAs specifying charges for running jobs and penalties for failing to meet promised performance metrics. The system is driven by an utility function, aiming at optimizing the average earned revenue per unit time. Demand and performance statistics are collected, while traffic parameters are estimated in order to make dynamic decisions concerning server allocation and admission control. Different utility functions are introduced and a number of experiments aiming at testing their performance are discussed. Results show that revenues can be dramatically improved by imposing suitable conditions for accepting incoming traffic; the proposed system performs well under different traffic settings, and it successfully adapts to changes in the operating environment.Comment: 11 pages, 9 Figures, http://www.wipo.int/pctdb/en/wo.jsp?WO=201002636

Northumbria Police custody health needs assessment

A health needs assessment of detainees in poilce custody in Northumbri

SLAng: A language for defining service level agreements

Application or web services are increasingly being used across organisational boundaries. Moreover, new services are being introduced at the network and storage level. Languages to specify interfaces for such services have been researched and transferred into industrial practice. We investigate end-to-end quality of service (QoS) and highlight that QoS provision has multiple facets and requires complex agreements between network services, storage services and middleware services. We introduce SLAng, a language for defining Service Level Agreements (SLAs) that accommodates these needs. We illustrate how SLAng is used to specify QoS in a case study that uses a web services specification to support the processing of images across multiple domains and we evaluate our language based on it

Interoperable subject retrieval in a distributed multi-scheme environment : new developments in the HILT project

The HILT (HIgh-Level Thesaurus) project (http://hilt.cdlr.strath.ac.uk/), based primarily at the Centre for Digital Library Research (CDLR) (http://cdlr.strath.ac.uk/) at Strathclyde University in Glasgow is entering its fourth stage following the completion of Phases I (http://hilt.cdlr.strath.ac.uk/index1.html) and II (http://hilt.cdlr.strath.ac.uk/index2.html) and the Machine to Machine (M2M) Feasibility Study (http://hilt.cdlr.strath.ac.uk/hiltm2mfs/). HILT is funded by the Joint Information Systems Committee (JISC) in the United Kingdom (UK) to examine an issue of global significance - facilitating interoperability of subject descriptions in a distributed, cross-service retrieval environment where different services use different subject and classification schemes to describe content, making cross-searching by subject difficult. HILT Phase I determined that there was a community consensus in the UK in favour of using inter-scheme mapping to achieve interoperability between services using different schemes, an approach followed by several recent projects (Heery et al, 2001; Koch et al, 2001; MACS, 2005; Saeed and Chaudhury 2002). HILT Phase II chose a spine-based approach to mapping and chose the Dewey Decimal Classification (DDC) as the central scheme to which all other schemes would be mapped. It also built an illustrative pilot mapping service, based on an adaptation of the Wordmap (http://www.wordmap.com/) terminology-handling software and made a range of recommendations on issues requiring further research and ongoing development requirements