District decision-making for health in low-income settings: a systematic literature review.

Health management information systems (HMIS) produce large amounts of data about health service provision and population health, and provide opportunities for data-based decision-making in decentralized health systems. Yet the data are little-used locally. A well-defined approach to district-level decision-making using health data would help better meet the needs of the local population. In this second of four papers on district decision-making for health in low-income settings, our aim was to explore ways in which district administrators and health managers in low- and lower-middle-income countries use health data to make decisions, to describe the decision-making tools they used and identify challenges encountered when using these tools. A systematic literature review, following PRISMA guidelines, was undertaken. Experts were consulted about key sources of information. A search strategy was developed for 14 online databases of peer reviewed and grey literature. The resources were screened independently by two reviewers using pre-defined inclusion criteria. The 14 papers included were assessed for the quality of reported evidence and a descriptive evidence synthesis of the review findings was undertaken. We found 12 examples of tools to assist district-level decision-making, all of which included two key stages-identification of priorities, and development of an action plan to address them. Of those tools with more steps, four included steps to review or monitor the action plan agreed, suggesting the use of HMIS data. In eight papers HMIS data were used for prioritization. Challenges to decision-making processes fell into three main categories: the availability and quality of health and health facility data; human dynamics and financial constraints. Our findings suggest that evidence is available about a limited range of processes that include the use of data for decision-making at district level. Standardization and pre-testing in diverse settings would increase the potential that these tools could be used more widely

NGOs and government partnership for health systems strengthening: A qualitative study presenting viewpoints of government, NGOs and donors in Pakistan

<p>Abstract</p> <p>Background</p> <p>Health systems are expected to serve the population needs in an effective, efficient and equitable manner. Therefore, the importance of strengthening of public, private and community health systems has been emphasized time and again. In most of the developing countries, certain weaknesses and gaps in the government health systems have been hampering the achievement of improved health outcomes. Public sector in Pakistan has been deficient in the capacity to deliver equitable and quality health services and thus has been grossly underutilized.</p> <p>Methods</p> <p>A qualitative study comprising in-depth interviews was conducted capturing the perceptions of the government functionaries, NGO representatives and donor community about the role and position of NGOs in health systems strengthening in Pakistan's context. Analysis of the data was done manually to generate nodes, sub-nodes and themes.</p> <p>Results</p> <p>Since many years, international and local non-governmental organizations (NGOs) have endeavored to fill the gaps in health service delivery, research and advocacy. NGOs have relatively performed better and achieved the results because of the flexible planning and the ability to design population based projects on health education, health promotion, social marketing, community development and advocacy. This paper captures the need and the opportunity of public private partnership in Pakistan and presents a framework for a meaningful engagement of the government and the private and nonprofit NGOs.</p> <p>Conclusion</p> <p>Involving the NGOs for health system strengthening may eventually contribute to create a healthcare system reflecting an increased efficiency, more equity and good governance in the wake of the Millennium Development Goals. Nevertheless, few questions need to be answered and pre-requisites have to be fulfilled before moving on.</p

Factors affecting engagement of NGOS for health systems strengthening in Pakistan-developing a framework for meaningful public-private partnership

Background/Rationale Health system strengthening (HSS) can be defined as any array of initiatives and strategies that improves one or more of the functions of the health system and that lead s to better health through improvements in access, coverage, quality, or efficiency (Health Systems Action Network 2006). This has been evident now over a period of many years that public sector in Pakistan i s lacking in capacity in delivery and management of health services. Also, it is having issues in quality, efficiency and coverage of these services. Moreover, there has been a growing realization regarding the poor governance of public health sector due to corruption and also grossly under-financed and thereby under-utilized. Global and national development goals, donor agenda, existing public sector\u27s capacity, bureaucratic and governance system, and dearth of resources has instituted a need for meaningful engagement of NGO and public sector for health system strengthening. There have been many examples where NGO sector has attempted to fill these gaps and this includes projects like TACMIL, FALAH and PAIMAN by USAID in which NGOs have been engaged at various levels with the public sector, they have resulted into positive results in better and quality provision of services, availability of health care staff at primary health care level, better management of the facilities etc. however, there has been many issues that has affected the collaborative working of public sector with NGO sector and undermined the positive outputs and outcomes. These issues are related to both the sectors and include lack of smooth coordination between the partners, issues of capacity of NGOs and public sector employees, unstable financing of projects and most importantly the issues of sustainability of the projects. To address these issues, there is a need to regulate the working of the NGO sector in addition to setting of strategies for these collaborative efforts which has been emphasized by many subject experts as well. The need for framework to engage the private/NGO sector properly to have better results and effective project management by the government itself has been often emphasized. To develop such a framework, one needs to have a clear understanding of the views and perspectives of the stakeholders involved in it, along with giving a thoughtful consideration to the evidences from the past and present of such engagements in th e country at various levels. This study has attempted to address both these needs by employing a qualitative methodology. Objectives I. To explore the perceptions of government and non-government stakeholders at the Federal and provincial level to involve the NGOs for Health System s Strengthening in Pakistan. 2. To catalogue the issues, challenges and success chronicles of previous NGO engagements in health sector from year 2000-2009 in Pakistan. 3. To recommend evidence based framework for meaningful engagement of NGO sector and Public private partnership for Health Systems Strengthening in Pakistan. Results Though both parties lack trust and confidence in each other, yet there is a realization of the importance of each other\u27s existence and contribution in health systems strengthening in Pakistan. The study has informed the government policy makers about the modus operandi /framework of engaging the Non-Governmental Organizations for health systems strengthening in Pakistan. The framework has shown that selection of the right NGO to work in collaboration with public sector is the first step in the direction of a successful partnership. NGOs should be selected to in a competitive manner by the government on the basis of explicit standards and criteria. Further, while keeping the stewardship with the government a clear division of roles and responsibilities among the partners is crucial. Conclusion The policy and decision makers at the Federal level have a responsibility to set the directions to achieve the objectives and goals of the health sector in terms of responsive and efficient health care systems leading to improved health of the population on an equitable basis along with social and financial risk protection

Social marketing for early neonatal care: Saving newborn lives in Pakistan.

According to the World Health Organization and the United Nations Children\u27s Fund, developing countries carry a large share of neonatal mortality in the world. According to UNICEF, almost 450 newborn children die every hour, mostly from preventable causes. Restricted access to quality and hygienic delivery services and limited knowledge about handling the newborn aggravate the situation. South Asia, and Pakistan in particular, have reduced their child and infant mortality during the last decade, however, neonatal mortality still remains unacceptably high. There are multiple reasons, mainly related to practices and behaviours of communities and traditional birth attendants. Rural and poor populations suffer most in Pakistan, where three out of five deliveries still occur at home. Traditional community practices and conservative norms drastically affect neonatal health outcomes. Preventing sepsis at the umbilical cord, keeping the baby at the correct temperature after birth and early initiation of exclusive breastfeeding are three simple strategies or messages that need to be disseminated widely to prevent many neonatal mortalities and morbidities. Since inappropriate practices in handling newborns are directly linked with persistent and unremitting behaviours among health providers and the community at large, we suggest doing robust social marketing for saving newborn lives. The objective of the paper is to present a social-marketing strategy and a marketing mix that will help address and surmount actual barriers and promote alternative behaviours in early neonatal care

Clinical Presentation and Outcome of Covid-19 Infection in Patients Undergoing Maintenance Hemodialysis

Background: WHO declared Covid-19 a pandemic disease; although 80% of patients with CoV-2 infection have no or mild symptoms, the remaining 20% of patients develop complications. In patients undergoing dialysis, mortality could be higher than that in the general population. This study was conducted to assess the frequency, clinical presentation, and outcome of COVID-19 infection in patients of end-stage renal disease (ESRD) on maintenance hemodialysis. Methodology: This Cross-sectional study was conducted at Department of Nephrology, Jinnah Postgraduate Medical Centre, Karachi, from April to September 2020. This study included 130 patients of either gender of End-Stage Renal Disease on maintenance hemodialysis for at least 3 months. Two Samples for COVID-19 PCR were taken through nasal swab. Blood samples were collected for hemoglobin level, total and differential leucocyte count, platelet count, intact Parathyroid hormone, vitamin D level, Urea, Creatinine, ferritin, transferrin saturation, procalcitonin, D-Dimer, C-reactive proteins, and lactate dehydrogenase. &nbsp;Radiological assessment was done by X-ray Chest. Urea reduction ratio and single pool Kt/V was used for assessment of adequacy of hemodialysis. Results: Out of 130 patients on hemodialysis, COVID-19 was detected in 52 patients, of which males were 69.2% and females were 30.8%. The most common presentation was shortness of breath (28.8%), followed by cough (19.2%). Home isolation was advised to 38.5% while noninvasive ventilation was given to 34.6%. Mechanically ventilated patients were 26.9%. There were 63.5% patients who recovered and were discharged from the hospital or home-isolated, while 19 patients died (36.5%). Conclusion: COVID-19 pandemic has high chances of infection with increased mortality in people with chronic diseases, especially those having ESRD on hemodialysis. This spreading of infection can be hampered with standard measures of disinfection in centers, social distancing in patients, and the use of a face mask. Keywords: Covid-19, Cough, Hemodialysis, Home isolation, Ventilation &nbsp