Enhancing customer satisfaction for health services

The Family Planning (FP) 2020 global partnership has achieved significant gains since its inception, and while it strives to accelerate uptake of voluntary FP services, women in developing countries continue to face an unmet need for modern contraceptive services. Critical opportunities for action exist in the area of understanding the effects of quality of family planning services and continued contraceptive use. Measuring and tracking the quality of FP services is an important aspect of improving service delivery, and client feedback also offers critical insight into the design of demand generation and uptake strategies for a contraceptive. In this report, we present a literature review on the current trends in customer feedback management in the private sector, particularly in industries that closely resemble the health-services sector. We believe that the well-tested business principles that drive success in the services business can be effectively used to scale solutions to address client satisfaction in the global health sector

Assessing the potential market for a progesterone contraceptive vaginal ring (PCVR) as a new contraceptive option in sub-Saharan Africa using needs-based market segmentation

Developing countries, especially in sub-Saharan Africa, have disproportionately high unmet contraceptive needs compared to other regions, and especially high levels of unmet need for spacing pregnancies. To address some of sub-Saharan Africa’s barriers to effective contraception, there is renewed focus on new methods that offer greater ease of use. New methods under investigation would not require daily action, their use would be controlled by women themselves, and they would require no medical providers or significant health-system infrastructure for service delivery. Contraceptive vaginal rings hold great potential by offering not only ease of use but a safe and effective FP solution. The Population Council has developed a variety of vaginal rings for reproductive health. The progesterone contraceptive vaginal ring (PCVR) was designed exclusively for lactating women’s postpartum family planning (PPFP). The PCVR works with the Lactational Amenorrhea Method (LAM) to enhance LAM’s pregnancy protection. The Population Council is studying the potential market in Kenya, Nigeria, and Sénégal. The market segmentation analysis presented in this report will clarify the PPFP landscape in these three countries and aid PCVR’s effective introduction

QUALITY, SATISFACTION AND VALUE IN OUTSOURCING: ROLE OF RELATIONSHIP DYNAMICS AND PROACTIVE MANAGEMENT

Service Quality, Value and Satisfaction literature in the past have shown that quality drives satisfaction leading to loyalty and financial growth – both revenues and better profits. Recently Relationship Marketing, Information Systems and Service Science streams have focused on relationship factors. But the dynamic perspective of this interdisciplinary model has not been studied within business-to-business context. We show, based on a qualitative study of three large outsourcing accounts, how networked relationships between provider and client plays a crucial role in driving the dynamics of this model. At an operational level, relationship helps manage the expectations so that the client satisfaction levels can be sustained higher and create the opportunity for value proposition. When managed proactively, it helps facilitate value creation with the clients. At extended levels, it helps enhance client value perceptions. From a theoretical perspective, grounded theory from the cases suggests recursive dynamics between quality and satisfaction

Willingness to pay for contraceptive vaginal rings in Nigeria

During the last two decades, Nigeria’s contraceptive prevalence rate (CPR) for modern methods remained at 10 percent, one of the lowest rates in sub-Saharan Africa. Following the renewed global commitments culminating in the 2012 London Summit on Family Planning with promises to reach an additional 120 million new users of modern contraceptives worldwide, Nigeria’s Federal Ministry of Health set a new target of raising Nigeria’s CPR to 36 percent by 2018. One way to accomplish this is by meeting the contraceptive needs of women in the immediate postpartum period and beyond. Attention is being focused on making proven contraceptive methods more available and affordable for postpartum use by including newer technologies that are breastfeeding-friendly. The progesterone vaginal ring is an effective method specifically geared for breastfeeding women. For use beyond the postpartum period, an investigational long-acting contraceptive vaginal ring (CVR) is being developed. As a prelude to introducing the rings in sub-Saharan Africa, the Population Council conducted a “Willingness to Pay” study in Kenya, Nigeria, and Senegal. This study provides key findings on the maximum consumers are willing to spend for the PVR and CVR in Nigeria

Identification of key regulators of pancreatic cancer progression through multidimensional systems-level analysis

Background: Pancreatic cancer is an aggressive cancer with dismal prognosis, urgently necessitating better biomarkers to improve therapeutic options and early diagnosis. Traditional approaches of biomarker detection that consider only one aspect of the biological continuum like gene expression alone are limited in their scope and lack robustness in identifying the key regulators of the disease. We have adopted a multidimensional approach involving the cross-talk between the omics spaces to identify key regulators of disease progression. Methods: Multidimensional domain-specific disease signatures were obtained using rank-based meta-analysis of individual omics profiles (mRNA, miRNA, DNA methylation) related to pancreatic ductal adenocarcinoma (PDAC). These domain-specific PDAC signatures were integrated to identify genes that were affected across multiple dimensions of omics space in PDAC (genes under multiple regulatory controls, GMCs). To further pin down the regulators of PDAC pathophysiology, a systems-level network was generated from knowledge-based interaction information applied to the above identified GMCs. Key regulators were identified from the GMC network based on network statistics and their functional importance was validated using gene set enrichment analysis and survival analysis. Results: Rank-based meta-analysis identified 5391 genes, 109 miRNAs and 2081 methylation-sites significantly differentially expressed in PDAC (false discovery rate ≤ 0.05). Bimodal integration of meta-analysis signatures revealed 1150 and 715 genes regulated by miRNAs and methylation, respectively. Further analysis identified 189 altered genes that are commonly regulated by miRNA and methylation, hence considered GMCs. Systems-level analysis of the scale-free GMCs network identified eight potential key regulator hubs, namely E2F3, HMGA2, RASA1, IRS1, NUAK1, ACTN1, SKI and DLL1, associated with important pathways driving cancer progression. Survival analysis on individual key regulators revealed that higher expression of IRS1 and DLL1 and lower expression of HMGA2, ACTN1 and SKI were associated with better survival probabilities. Conclusions: It is evident from the results that our hierarchical systems-level multidimensional analysis approach has been successful in isolating the converging regulatory modules and associated key regulatory molecules that are potential biomarkers for pancreatic cancer progression. Electronic supplementary material The online version of this article (doi:10.1186/s13073-016-0282-3) contains supplementary material, which is available to authorized users

Willingness to pay for contraceptive vaginal rings in Senegal

Contraceptive vaginal rings are an innovative category of products that have not been introduced into any sub-Saharan African country. As a result, there is little experience to guide the introductory pricing for the PVR and the one-year NES/EE CVR when it becomes available. The evidence generated by this consumer willingness to pay, and provider/procurer study has shed light on critical aspects of PVR introduction in Senegal. In general, the results generated here complement and reinforce findings from an acceptability study of the PVR and stakeholder discussions that have been occurring over the past three years. Results confirm that contraceptive vaginal rings, and in particular the PVR, are an acceptable method in Senegal with broad-based support for introduction utilizing a Total Market Model. Consumers expressed their willingness to pay for the PVR, providers to deliver it, and procurers to purchase it. Their voices will guide the introductory strategies for the PVR, including communication and promotional activities, integration with appropriate services such as Maternal and Child Health, and continued engagement with all stakeholders including consumers

Progesterone vaginal ring: Results of an acceptability study in Kenya

The progesterone vaginal ring (PVR) is used to extend the contraceptive effectiveness of lactational amenorrhea among breastfeeding women. Previous studies have shown that contraceptive vaginal rings are safe, effective, and well accepted in varied cultural settings. However, the extent to which the ring is acceptable in the sub-Saharan African context is unknown. This study examined the acceptability of the PVR in Kenya as part of a larger project that was also conducted in Nigeria and Senegal. The specific objectives of the study were to assess the factors influencing the acceptability of the method among clients, their spouses, providers, community members, and those who were counseled but did not choose the method, to inform future introduction efforts. Findings indicate that the ring was acceptable to most clients and key stakeholders. In addition, several positive attributes of the ring that were mentioned by participants are likely to increase uptake of the method

Progesterone vaginal ring: Results of an acceptability study in Nigeria

The progesterone vaginal ring (PVR) is used to extend the contraceptive effectiveness of lactational amenorrhea among breastfeeding women. The PVR was first registered in Chile and Peru in 1998 for use by postpartum women and has since been expanded to other Latin American countries. Previous studies have shown that contraceptive vaginal rings are safe, effective, and well accepted in varied cultural settings. However, the extent to which the ring is acceptable in the sub-Saharan African context is unknown. This study examined the acceptability of the PVR in Nigeria as part of a larger project that was also conducted in Kenya and Senegal. The specific objectives of the study were to assess the factors influencing the acceptability of the method among clients, their partners, providers, community members, and those who were counseled but did not choose the method, to inform future introduction efforts. Findings indicate that women and their partners, as well as family planning service providers, have positive attitudes toward the PVR, which is vital to its acceptance within the larger society

Willingness to pay for contraceptive vaginal rings in Kenya

Despite progress made in reducing fertility and increasing the contraceptive prevalence rate in Kenya, many women still experience high unmet need for contraception. Part of the challenge in addressing current levels of unmet need is the limited use of contraception by women during the first 12 months postpartum. New methods are needed that offer greater ease of use, are women-initiated, and do not require significant medical provider involvement for service delivery. One such method is the Progesterone Vaginal Ring (PVR), a reversible contraceptive that according to clinical trial data is safe and effective for breastfeeding women. New product introduction strategies often suffer from lack of available market research. The PVR, a new product in sub-Saharan Africa, faced such a challenge. A study on Willingness to Pay was deemed necessary to estimate the effect of price on potential consumer demand for the method in Kenya. This study’s findings will be integrated with results from a market segmentation exercise conducted earlier to develop a pricing model for the PVR

Temporal retinal transcriptome and systems biology analysis identifies key pathways and hub genes in Staphylococcus aureus endophthalmitis

Bacterial endophthalmitis remains a devastating inflammatory condition associated with permanent vision loss. Hence, assessing the host response in this disease may provide new targets for intervention. Using a mouse model of Staphylococcus aureus (SA) endophthalmitis and performing retinal transcriptome analysis, we discovered progressive changes in the expression of 1,234 genes. Gene ontology (GO) and pathway analyses revealed the major pathways impacted in endophthalmitis includes: metabolism, inflammatory/immune, antimicrobial, cell trafficking, and lipid biosynthesis. Among the immune/inflammation pathways, JAK/Stat and IL-17A signaling were the most significantly affected. Interactive network-based analyses identified 13 focus hub genes (IL-6, IL-1β, CXCL2, STAT3, NUPR1, Jun, CSF1, CYR61, CEBPB, IGF-1, EGFR1, SPP1, and TGM2) within these important pathways. The expression of hub genes confirmed by qRT-PCR, ELISA (IL-6, IL-1β, and CXCL2), and Western blot or immunostaining (CEBP, STAT3, NUPR1, and IGF1) showed strong correlation with transcriptome data. Since TLR2 plays an important role in SA endophthalmitis, counter regulation analysis of TLR2 ligand pretreated retina or the use of retinas from TLR2 knockout mice showed the down-regulation of inflammatory regulatory genes. Collectively, our study provides, for the first time, a comprehensive analysis of the transcriptomic response and identifies key pathways regulating retinal innate responses in staphylococcal endophthalmitis