Assessing the Regional and District Capacity for Operationalizing Emergency Obstetric Care through First Referral Units in Gujarat

Maternal mortality remains to be one of the very important public health problems in India. The maternal mortality estimates, is about (300-400/100,000 live births). There are diverse management issues, policy barriers to be overcome for improving maternal health. Especially, the operationalization of Emergency Obstetric Care (EmOC) and access to skilled care attendance during delivery. This study focuses on understanding the regional and district level capacity of the state government to operationalize First Referral Units for providing Emergency Obstetric care. This study is a part of a larger project for strengthening midwifery and Emergency Obstetric Care in India. The study apart from giving an in-depth insight into the functioning of various health facilities highlights the results from the basic to the more comprehensive level of EmOC services. It gives recommendation on various measures to rectify shortcomings noticed and make EmOC a more effective at different levels in the State of Gujarat. The study uses both primary and secondary data collection. The study was conducted in six regions of Gujarat -one district from each of these regions was selected. Out of these districts 27 health facilities were examined, which consists of seven district hospitals, eight designated as first referral units (FRU), four community health centers (CHC) and eight 24/7 primary health centers (PHC). Detailed field notes for individual facilities were prepared and analyzed subsequently for all facilities together. A common feature among all health centres were issues related to general infrastructure. Many times infrastructure planning (location, layout and maintenance) is left to engineers, who have limited knowledge about proper EmOC services. Poor infrastructure leads to poor quality of health services and wastage of resources. Through National Rural Health Mission (NRHM) and Rogi Kalyan Samiti funds major and minor repair/renovations are taking place to improve hospital buildings. In some health facilities from poor resource setting with high demand from patients were still able to deliver services. Human resources analysis suggests that there is shortage of specialists at FRUs, and committed nursing staff in labor room. As result of the Chiranjeevi initiative, the Below Poverty Line (BPL) population who earlier used to public health facilities are now accessing private facilities for delivery, and this has affected and decreased the workload of the public health facilities. Furthermore, there is lack of managerial skills at senior level hospital staff. Registers like birth, drug, Medical Termination of Pregnancy are maintained but not in standard format. Since complicated cases are not registered properly, maternal deaths are not reported. Even though the system of monitoring is well established at the state and district level, they are not properly followed. The funds for operationalization of First Referral Units come from department of family welfare. However, the administrative control is in the hands of department of medical services. Due to this factor monitoring system has become weak. The weak link between these two departments is the Regional Deputy Director who has only one administrative staff to take care of the issues in their region. The problem of monitoring the Primary Health Centres has become smooth with the appointment of new District Project Coordinators. Some facilities especially in district hospital reported that internal meetings and monitoring are happening because of the special interest of facility managers and newly appointed assistant hospitals administrators. In lower facilities this type of internal monitoring exists in a weak form. Underutilization of government facilities is a result of poor quality of services provided. In spite of reasonably developed health system, several problems of infrastructure, staffing, accountability and management capacity contribute to the poor functioning of facilities to act as an EmOC service delivery center. Some of the major bottlenecks in improving EmOC services are limited management capacity, lack of availability of blood in rural areas and poor registration of births and deaths and no monitoring of EmOC. District hospitals, FRUs, CHCs and Sub district hospitals come under the administrative control of the department of medical services. The clinical monitoring of these facilities lies with the department of health and family welfare. At the district level monitoring of these facilities are not properly done, therefore it effects directly the operationalization of the facilities. In the absence of adequate management capacity, the operationalization of EmOC is not well planned, executed or monitored, which results in delays in implementation and poor quality of care.

Cross-collaborative supply chains. How logistics services contribute to social responsibility.

Abstract Purpose - The collaboration between profit and nonprofit entities has become a burning topic in supply chain management studies and corporate strategies. The world’s largest logistics service providers (LSPs) have been developing several practices improving social responsibility while collaborating with nonprofit actors. In particular, their core competences and offered services become extremely relevant in the context of humanitarian logistics initiatives. A key purpose of this article is to examine the projects currently undertaken by LSPs in humanitarian logistics. Methodology/Approach - This research follows a qualitative approach based on multiple case studies. Findings - The paper provides an overview of the leading LSPs’ involvement in humanitarian logistics and presents an analysis of their current “best practices” services in disaster relief with high impact in terms of social responsibility. Research Limitations/implications - There has been increased interest on the part of international academic and professional communities in humanitarian logistics. This study constitutes a platform for benchmarking analysis of logistics services to assure effective implementation of social responsibility principles. Originality/Value of paper - Humanitarian logistics is a rather new field in logistics management. This paper addresses the innovative socially responsible initiatives undertaken by the main international LSPs in the area of humanitarian logistics. Keywords - logistics services, logistics service providers, humanitarian logistics and supply chain management, disaster relief, social responsibility, profit/nonprofit collaboration Type of paper - Research pape

Barnes Hospital Bulletin

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Dancing on a Pin: Health Planning in Arizona

This publication challenges us to step back and reflect on the past, present and future of health systems. Take a deeper look at planning and how we got here, review the roles of competition and regulation, and learn about the health planning matrix along with the concept of health planning bridges. Discover for yourself if these thoughts and tools help the signal of quality health planning rise more clearly from out of the noise

Key dimensions for the prevention and control of communicable diseases in institutional settings. a scoping review to guide the development of a tool to strengthen preparedness at migrant holding centres in the EU/EEA

Migrant centres, as other institutions hosting closed or semi-open communities, may face specific challenges in preventing and controlling communicable disease transmission, particularly during times of large sudden influx. However, there is dearth of evidence on how to prioritise investments in aspects such as human resources, medicines and vaccines, sanitation and disinfection, and physical infrastructures to prevent/control communicable disease outbreaks. We analysed frequent drivers of communicable disease transmission/issues for outbreak management in institutions hosting closed or semi-open communities, including migrant centres, and reviewed existing assessment tools to guide the development of a European Centre for Disease Prevention and Control (ECDC) checklist tool to strengthen preparedness against communicable disease outbreaks in migrant centres. Among articles/reports focusing specifically on migrant centres, outbreaks through multiple types of disease transmission were described as possible/occurred. Human resources and physical infrastructure were the dimensions most frequently identified as crucial for preventing and mitigating outbreaks. This review also recognised a lack of common agreed standards to guide and assess preparedness activities in migrant centres, thereby underscoring the need for a capacity-oriented ECDC preparedness checklist tool

Population, health, and nutrition : fiscal 1991 sector review

The theme of this year's annual sector review blends two special topics: poverty alleviation and the development of management and institutional capacity. Based on a review of project experience, both within and outside of the population, health and nutrition (PHN) sector, this report distills lessons that should assist task managers in the design and implementation of interventions to develop poverty-sensitive management and institutional capacity in the PHN sector. The Bank's ability to strengthen institutions, especially those needed to alleviate poverty, are constrained by the number and the skills mix of PHN staff, by the absence of standards and guidelines for analyzing and addressing institutional and management issues, and by too little time to spend on institutional and management issues. Therefore, the sector review recommends : a) improving the sector staff not only in numbers but in access to guidelines and training; b) revising Bank priorities and practices to ensure that enough time is spent on supervision and on upstream diagnostic work; c) grounding PHN policies in a macroeconomic and multisectoral framework oriented toward growth with poverty reduction, together with a sound strategy for building institutions and the capacity to implement and manage policy; and d) seeking more creative use of Bank instruments through a review and assessment of the best use of lending instruments for PHN sector interventions.Banks&Banking Reform,Poverty Assessment,Urban Services to the Poor,Health Monitoring&Evaluation,Health Economics&Finance

In the Eye of the Storm: A Special Report About the Robert Wood Johnson Foundation's Response to the 2005 Gulf States Disasters

Describes the foundation's early decision-making, immediate response, and long-term commitment to rebuilding in the hurricane-affected areas. Highlights staff and grantee activities, as well as lessons learned about the grantmaking process and strategy