Patient-focused quality improvement in primary health care: Opportunities with the patient evaluation scale

Background: Patient evaluation of primary health care (PHC) is an evidenced-based approach to quality assessment but its use in Nigeria is still minimal.Objective: This article explored approaches for using the patient evaluation scale (PES) for PHC performance measurement, ranking, comparing sub-national PHC systems and undertaking patient-focused quality improvement of PHC in Nigeria.Method: Secondary analyses of data obtained from a cross-sectional national representative exit survey of patients’ experiences of PHC which was conducted with the PES. The PES QUALISTAT is an array of analytic procedures and approaches for presenting data on PHC performance. Colour coding of performance (red colour = severe underperformance requiring urgent action, yellow = suboptimal performance requiring action and green = optimal performance) in relation to thresholds of a standard performance scale were illustrated. The implications of this for practice and policy which shows the opportunities for patient-focused quality improvement using the PES were discussed.Results: Raw analysis shows red colours in 0-38%, 4-29% and 0-16% of attributes across the various health centres, Local Governments Areas and States, respectively. The most frequently rated attribute as being satisfactory was neatness reported in 20.8% of health centres. A preponderance of health centres had deficiencies in relation to availability of electricity (58.3%) and water supply (58.3%).Conclusion: This study demonstrates the opportunities in patient-based review using the PES for the development of PHC in Nigeria. The use of simple, clear and actionable presentation of finding may make it suitable and attractive for use by researchers, practitioners and policy makers. Implications are the imperatives for administrative and policy support needed to institutionalised periodic nationwide patient surveys, benchmarking, performance ranking of PHC facilities and trend analysis to enhance timely identification and remediation of problems in Nigeria’s PHC system.Keyword: Primary health care, Patient evaluation, Performance, Patient Evaluation Scale, Nigeria

Questionnaires for Patient Evaluation of Primary Health Care: A Systematic Review and Implications for the Nigerian Practice Setting

Background: An increasing number of questionnaires have been developed for patient evaluation of primary health care (PHC) but these are mostly designed for developed countries' settings.Aim: To review the development, contents, measurement properties of published questionnaires for patient evaluation of PHC and draw implications for the Nigerian practice setting.Design: A systematic reviewData Sources: Systematic search for worldwide published literature from Medline (1950 to 2014), CINAHL Plus, EMBASE, and PsycINFO databases were concluded on the 30th of April 2014.Study eligibility criteria: Studies included in this review reported the development and/or validation of a questionnaire for patients' evaluation of primary (health) care.Data extraction: Data was extracted with a template prepared in accordance with the review objectives. Template had article identifier, setting, context, developmental processes, contents (domains, items, and scales), potential utility and measurement properties (reliability, validity, and acceptability) were extracted and narrative reports were presented.Findings: Twenty-three studies met all the eligibility criteria for inclusion. The majority were published after 2000 (83%), developed in Europe (61%), and mostly in the United Kingdom (48%). Only 2 (9%) of these questionnaires were developed in countries in Africa. Majority (65%) of these questionnaires were developed through the cycle, contained between 20 – 40 core items (44%) and had bipolar response scale (52%) The most commonly reported measurement index was the Cronbach's alpha (74%) and contents of 58% of questionnaires had scope for potential evaluation of the continuum of structure, process and outcome dimensions of quality. There was no published report on the development or validation of any of these questionnaires for the Nigerian practice setting.Conclusion: Most questionnaires were developed to suit specific context and practice setting. The wholesome transfer of such questionnaire across cultural and practice setting remains a difficult issue. The limited application of existing questionnaires in the Nigerian PHC setting could be a justification for the development of a contextually sound and conceptually relevant measure for local use

TERA- A Tool for Aero-engine Modelling and Management

One of the distinguishing features of the civil aero-engine market is its high competitiveness. The costs and risks associated with new projects are such that the difference between two apparently equally attractive options could result in success from one and a threat to the survival of the company from the other. To conceive and assess engines with minimum global warming impact and lowest cost of ownership in a variety of emission legislation scenarios, emissions taxation policies, fiscal and Air Traffic Management environments, a Techno-economic and Environmental Risk Assessment (TERA) model is needed. TERA incorporates multi-disciplinary modules for modelling gas turbine and aircraft performance, estimation of engine weight, noise and emissions as well as environment impact and operating economics. The TERA software is integrated with a commercial optimiser and provides a means for cycle studies. It is to be expected that new legislative and fiscal constraints on air travel will demand an extension to the customary range of asset management parameters. In such a business environment there is potential for TERA to develop into a useful tool for aircraft and engine asset management. This paper presents a description of this tool as well as gives some results from scenario studies

Implementing total productive maintenance in Nigerian manufacturing industries

Remarkable improvements have occurred recently in the maintenance management of physical assets and productive systems, so that less wastages of energy and resources occur. The requirement for optimal preventive maintenance using, for instance, justin-time (JIT) and total quality-management (TQM) techniques has given rise to whathas been called the total productive-maintenance (TPM) approach. This study explores the ways in which Nigerian manufacturing industries can implement TPM as a strategy and culture for improving its performance and suggests self-auditing and bench-marking as desirable prerequisites before TPM implementation

Out-of-Pocket Payment for Healthcare and Implications for Households: Situational Analysis in Yenagoa, Bayelsa State

Background: Healthcare financing remains a critical issue in the on-going discourse on universal health coverage (UHC). This community-based study sought to examine the payment for healthcare and its relationship to indicators of catastrophic health expenditure (CHE) among households (HH) in Yenagoa.Methods: Data was obtained from a cross-sectional survey of  households in two randomly selected communities in Yenagoa. A  pretested, structured, interviewer-administered questionnaire was used to obtain information on HH income, general expenditures and financing for healthcare. HH spending more than 10% total income and 40% non-food expenditure were deemed to have suffered CHE and both CHE thresholds were calculated for the sampled population and compared between payment modes.Results: Responses were received from 525 HHs with median HH monthly income, total and healthcare expenditures of ₦115,000,  ₦112,170 and ₦9,250, respectively. Out-of-pocket (OOP) was the most prevalent (95.6%) mode of payment for healthcare. The incidence of CHE was 32.8% with reference to total income and 12.8% using non-food expenditure threshold. The Catastrophic Overshoots were 7% and -19.9% while Mean Positive Overshoots were 21% and 12% with respect to both thresholds for the entire study population. The  incidence of CHE was significantly higher in HHs with OOP than  insured HHs.Conclusion: OOP was the main payment option for healthcare and exposes significantly higher proportion of HHs to CHE. Findings  support the need to expand the coverage of the social insurance scheme to reduce exposure to financial risks by HHs and achieve UHC in Yenagoa. Keywords: Out-of-pocket; Healthcare financing; Catastrophic Health Expenditure; Households; Yenagoa; Nigeria

Development and implementation of preventive-maintenance practices in Nigerian industries.

A methodology for the development of PM using the modern approaches of FMEA, root-cause analysis, and fault-tree analysis is presented. Applying PM leads to a cost reduction in maintenance and less overall energy expenditure. Implementation of PM is preferable to the present reactive maintenance procedures (still prevalent in Nigeria

Awareness, willingness and use of Voluntary HIV testing and counseling services by students of a university in south-south Nigeria

Background: HIV testing and counseling (HTC) is the entry point to HIV prevention, treatment, care, and support services. HTC can be voluntary or mandatory. This study aimed to determine the awareness, willingness, and use of voluntary HTC (VHTC) services by students of the Niger Delta University, Bayelsa State Nigeria.Method:  A cross sectional descriptive study was conducted in June 2012 using multi-stage random sampling to select 423 students who were administered a pre-tested, structured self-administered questionnaire adapted from the UNAIDS knowledge indicator questionnaire. Information about awareness, willingness and use of VHTC services were elicited from the respondents. Epi-Info 3.5.3 was used for data entry and analysis.Result:  There was almost universal awareness of HIV (99%) by respondents but a lower proportion (78.4%) were aware of VHTC services and a much lower proportion (14.8%) knew the services were available on the university campus. Furthermore, just about a half (53.8%) had ever undergone HIV testing (Female/male: OR=1.02, 95%CI: 0.68-1.55) and only 26.5% had voluntary HTC (Female/male: OR=1.34, 95%CI: 0.75-2.40). Majority (73.8%) of all respondents expressed willingness to undergo VHTC (significantly more females than males, OR=1.67, 95%CI: 1.04-2.68). Fear of positive result (39.1%) and stigma (25.7%) were the leading demotivators for those unwilling to have VHTC.Conclusion: Despite high awareness of HIV and voluntary HTC, actual use of VHTC services was low. There is a strong need for more education of the students and indeed the community at large as this would engender a more positive attitude and increased use of available VHTC services on campus.Keywords: HIV/AIDS, Voluntary HIV testing and counselling, HTC, undergraduate students, Niger Delta University, Bayelsa Stat

Knowledge and perception of microbicides among healthcare providers in Calabar, Nigeria

Background: With the worldwide spread of HIV/AIDS, the absence of a known cure and the challenges associated with existing prevention  methodologies, there is need for new prevention technologies. The  successful uptake of healthcare products and services depend, to a large extent, on healthcare providers’ knowledge, perception and attitude  regarding them.Objectives: To determine the knowledge and perception of healthcare providers regarding microbicides.Methods: A semi-structured questionnaire was administered on 400  randomly selected health care providers in Calabar, Cross River State of Nigeria. Data obtained from the 350 returned questionnaire were analyzed using EPI –Info software version 3.5.1Results: One hundred and sixty-four (46.9%) respondents were medical doctors while 157 (44.9%) were nurses, 7 (2%) were Pharmacists and 22 (6.2%) belonged to “other” categories. Thirty- two percent knew the  advantages of microbicides over condoms. Sixty-eight percent indicated that microbicides would benefit only women while to 27%, it would benefit both men and women. Seventy-five percent of respondents would be willing to act as community advocates for microbicides while 21% would not be willing and 4% were not decided. There was a statistically significant association between professional group and willingness to act as  community advocates for microbicides. Medical doctors were more likely to act as advocates than other professional groups (p<0.05). Female  respondents were more likely to have correct knowledge regarding  microbicides than males (p<0.05)Conclusion: There are gaps in knowledge regarding microbicides among the health care providers. Capacity building would be successful since the majority are willing to act as community advocates

A study plan for investigating Smart brush for better oral hygiene in frail elderly

Oral health in Australia’s older population is of great concern and studies show that two-thirds of residents in aged care facilities have significant oral problems. Cognitive, and functional alterations that accumulate while ageing leads to increasing care dependency which then impacts on the ability to maintain good oral health. This paper presents ideas for a pilot investigation into the effectiveness of smart brush technology for improving oral health among the elderly. The proposed pilot study will follow a design that incorporates a Critical Realist methodological perspective known as the Context- Initiative-Mechanism-Outcome approach with a theoretical perspective, the theory of interactive Media effects (TIME). This paper presents a proposition suggesting smart brush as a means for improving oral health among the elderly through identification of context (frail elderly), initiative (smart brush), mechanism (interaction with the smart brush affordances), and outcome (improved oral health). Both qualitative (interviews) and quantitative data (plaque score, brushing duration/coverage) will be collected and analyzed for testing the proposition

Good manufacturing practices in the Kenyan pharmaceutical industry and impact of facility upgrading on domestic and international sales

Good Manufacturing Practice is the main regulatory standard for ensuring pharmaceutical quality. Manufacturers are required to comply with this standard to warrant medicines which do not pose risk to consumers. The aim of this study was to assess compliance of Kenyan pharmaceutical industry with Good Manufacturing Practices and to determine the impact of facility upgrading on domestic and international sales. Information on key quality elements was collected from 16 manufacturers using a structured questionnaire. Data on domestic and export sales for two upgraded facilities was evaluated for the period, 2010 to 2014. Compliance with Good Manufacturing Practices varied amongst the facilities; all had local accreditation, 11 were accredited by Drug Authorities in East Africa region and 3 held international certification. Domestic sales for two facilities declined after upgradation and international sales increased fivefold for the facility accorded international accreditation. Upgrading of facilities improved international trade but negatively impacted domestic sales.Keywords: Compliance, manufacturing, pharmaceutical, sales, upgradin