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A glimpse of public health in China

Low WY, Binns C

Asia Pac J Public Health, 2015 Mar;27(2 Suppl):7S-8S.
PMID: 25712494 DOI: 10.1177/1010539515574405
Matched MeSH terms: Health Services Accessibility/organization & administration
Fulltext Equitable Access to State-of-the-Art Medical Technology-a Malaysian Mini-Public-Private Partnership Case Study

Waran V, Thillainathan R, Karuppiah R, Pickard JD

World Neurosurg, 2022 01;157:135-142.
PMID: 34687934 DOI: 10.1016/j.wneu.2021.10.112

BACKGROUND: The provision of equitable and affordable health care has become increasingly challenging as advanced technology is introduced, particularly in developing countries. We explored the hypothesis that focused, small-scale mini-public-private partnerships have a potential role in providing equitable and affordable access to advanced technology for the benefit of all patients in developing nations, particularly middle-income countries.
METHODS: A clinician-led financial plan was developed at the University of Malaya to create the Centre for Image Guidance and Minimally Invasive Therapy (CIGMIT) to provide an integrated platform for high-end care for Malaysian patients of all ages, both public and private, requiring complex neurosurgical and spinal procedures and stereotactic and intensity-modulated radiotherapy. The challenges faced during development of the plan were documented together with an audit of patient throughput and analyses of financial risk and return.
RESULTS: CIGMIT opened in 2015. Patient throughput, both public and private, progressively increased in all facilities. In 2015-2019, 37,724 patients used the Centre's facilities. CIGMIT has become progressively more profitable for the University of Malaya, the public and private hospitals, and the investor. CIGMIT has weathered the challenges posed by coronavirus disease 19.
CONCLUSIONS: Focused, small-scale mini-public-private partnerships have a potential role in providing advanced technology for the benefit of patients in developing nations, particularly middle-income countries, subject to an approach that balances equity of access between public and private health care systems with fair reward.

Matched MeSH terms: Health Services Accessibility/organization & administration*
Fulltext Barriers of modern contraceptive practices among Asian women: a mini literature review

Najafi-Sharjabad F, Zainiyah Syed Yahya S, Abdul Rahman H, Hanafiah Juni M, Abdul Manaf R

Glob J Health Sci, 2013 Sep;5(5):181-92.
PMID: 23985120 DOI: 10.5539/gjhs.v5n5p181

Family planning has been cited as essential to the achievement of Millennium Development Goals (MDG). Family planning has a direct impact on women's health and consequence of each pregnancy. The use of modern contraception among Asian women is less than global average. In Asia a majority of unintended pregnancies are due to using traditional contraceptive or no methods which lead to induced unsafe abortion. Cultural attitudes, lack of knowledge of methods and reproduction, socio demographic factors, and health service barriers are the main obstacles to modern contraceptive practice among Asian women. Culturally sensitive family planning program, reforming health system, and reproductive health education through mass media to create awareness of the benefits of planned parenthood are effective strategies to improve modern contraceptive practice among Asian women.

Matched MeSH terms: Health Services Accessibility/organization & administration
Experience of a rapid access falls and syncope service at a teaching hospital in Kuala Lumpur

Gan SY, Saedon NI, Sukanya S, Fairuz NHA, Sakinah SMN, Fatin NIAH, et al.

Med J Malaysia, 2017 08;72(4):203-208.
PMID: 28889130 MyJurnal

No abstract available.

Matched MeSH terms: Health Services Accessibility/organization & administration
Malaysia: a refugee conundrum

Bemma A

Lancet, 2018 01 13;391(10116):107-108.
PMID: 29353607 DOI: 10.1016/S0140-6736(18)30052-7
Matched MeSH terms: Health Services Accessibility/organization & administration*
Fulltext Malaysian primary care doctors' views on men's health: an unresolved jigsaw puzzle

Tong SF, Low WY, Ismail SB, Trevena L, Willcock S

BMC Fam Pract, 2011;12:29.
PMID: 21569395 DOI: 10.1186/1471-2296-12-29

BACKGROUND: Men have been noted to utilise health care services less readily then women. Primary care settings provide an opportunity to engage men in health care activities because of close proximity to the target group (men in the community). Understanding attitudes towards men's health among Malaysian primary care doctors is important for the effective delivery of health services to men. We aimed to explore the opinions and attitudes of primary care doctors (PCDs) relating to men's health and help-seeking behaviour.
METHODS: A qualitative approach to explore the opinions of 52 PCDs was employed, using fourteen in-depth interviews and eight focus group discussions in public and private settings. Purposive sampling of PCDs was done to ensure maximum variation in the PCD sample. Interviews were recorded and transcribed verbatim for analysis. Open coding with thematic analysis was used to identify key issues raised in the interview.
RESULTS: The understanding of the concept of men's health among PCDs was fragmented. Although many PCDs were already managing health conditions relevant and common to men, they were not viewed by PCDs as "men's health". Less attention was paid to men's help-seeking behaviour and their gender roles as a potential determinant of the poor health status of men. There were opposing views about whether men's health should focus on men's overall health or a more focused approach to sexual health. There was also disagreement about whether special attention was warranted for men's health services. Some doctors would prioritise more common conditions such as hypertension, diabetes and hypercholesterolaemia.
CONCLUSIONS: The concept of men's health was new to PCDs in Malaysia. There was wide variation in understanding and opposing attitudes towards men's health among primary care doctors. Creating awareness and having a systematic approach would facilitate PCDs in delivering health service to men.

Matched MeSH terms: Health Services Accessibility/organization & administration
Strengthening acute coronary syndrome referral network: Insights from initiatives of Penang General Hospital cardiology centre

Abdul Kader MAS

Med J Malaysia, 2019 08;74(4):355-358.
PMID: 31424052

The importance of networking for the management of acute coronary syndrome (ACS) has been emphasised in the 2012 guidelines by the European Society of Cardiology (ESC) on ST-segment elevation myocardial infarction (STEMI). In Penang, the ACS referral network has the Penang General Hospital (PGH), a percutaneous coronary intervention (PCI)- capable hospital, with 14 other hospitals referring their patients for PCI to PGH on a daily basis. In one of its review regarding the referral methodology in the network, PGH's Cardiology centre observed gaps in the referral systems, which was leading to poor quality of referrals. To address these issues, the PGH Cardiology centre developed a standardised protocol and conducted a one-day workshop to educate medical officers about the standardised protocol. This commentary piece is a proof of this concept, and aims to share the experience and provide an overview on the initiatives by the PGH, which has resulted in improved quality of PCI referrals.

Matched MeSH terms: Health Services Accessibility/organization & administration*
Fulltext The Kuala Pilah cluster cataract study: Accessible eye care reduces cataract blindness

Nur Hanis Y, Raman P, Premala Devi S, Mohd Khalid KH

Med J Malaysia, 2019 08;74(4):296-299.
PMID: 31424036

OBJECTIVE: The Ministry of Health introduced the cluster hospital project in Kuala Pilah district in 2016 to allow sharing of resources between the hospitals in the same vicinity. The aim of this study is to compare the demographic profile, prevalence of cataract blindness and low vision among patients who presented for cataract surgery before and after the programme.

METHODOLOGY: This is a retrospective cohort study of patients who underwent cataract surgery in Kuala Pilah Cluster Hospitals between 2010 and 2017. A total of 2539 records of patients were reviewed. Patients were assigned into two groups: Group 1 (2010-2012)- before the programme (2010-2012) and Group 2 (2015-2017) after the introduction of the programme.

RESULTS: There was a significant increase in number of cataract cases in the district hospital after the cluster initiative. The mean age of patients undergoing cataract surgery was similar in both groups. The common comorbidities were hypertension (Group 1=57.3%; Group 2=70.8%) and diabetes mellitus (Group 1=40.6%; Group 2=51.1%). In 2010-2012, most of the patients were one eye blind (34.4%), whereas in 2015-2017 majority of patients presented with vision better than 6/18 (43.5%). The proportion of patients with cataract blindness reduced from 6% in 2010-2012 to 4.3% in 2015-2017 (p<0.01).

CONCLUSION: There is a significant decrease in percentage of patients with cataract blindness and low vision after the introduction of Kuala Pilah Cluster Hospital Program. We believe that that cluster hospital system is effective in improving accessibility to eye care and therefore increases the cataract detection rate.

Matched MeSH terms: Health Services Accessibility/organization & administration*
Fulltext Strengthening health systems for universal health coverage and sustainable development

Kieny MP, Bekedam H, Dovlo D, Fitzgerald J, Habicht J, Harrison G, et al.

Bull World Health Organ, 2017 07 01;95(7):537-539.
PMID: 28670019 DOI: 10.2471/BLT.16.187476
Matched MeSH terms: Health Services Accessibility/organization & administration
Maternal mortality in developing countries: challenges in scaling-up priority interventions

Prata N, Passano P, Sreenivas A, Gerdts CE

Womens Health (Lond), 2010 Mar;6(2):311-27.
PMID: 20187734 DOI: 10.2217/whe.10.8

Although maternal mortality is a significant global health issue, achievements in mortality decline to date have been inadequate. A review of the interventions targeted at maternal mortality reduction demonstrates that most developing countries face tremendous challenges in the implementation of these interventions, including the availability of unreliable data and the shortage in human and financial resources, as well as limited political commitment. Examples from developing countries, such as Sri Lanka, Malaysia and Honduras, demonstrate that maternal mortality will decline when appropriate strategies are in place. Such achievable strategies need to include redoubled commitments on the part of local, national and global political bodies, concrete investments in high-yield and cost-effective interventions and the delegation of some clinical tasks from higher-level healthcare providers to mid- or lower-level healthcare providers, as well as improved health-management information systems.

Matched MeSH terms: Health Services Accessibility/organization & administration
Fulltext Concerns of HIV-positive migrant workers in COVID-19 pandemic: A call for action

Ahmed A, Dujaili J, Sandhu AK, Hashmi FK

J Glob Health, 2020 Dec;10(2):020342.
PMID: 33110542 DOI: 10.7189/jogh.10.020342
Matched MeSH terms: Health Services Accessibility/organization & administration*
Fulltext The integrated care pathway for post stroke patients (iCaPPS): a shared care approach between stakeholders in areas with limited access to specialist stroke care services

Abdul Aziz AF, Mohd Nordin NA, Ali MF, Abd Aziz NA, Sulong S, Aljunid SM

BMC Health Serv Res, 2017 Jan 13;17(1):35.
PMID: 28086871 DOI: 10.1186/s12913-016-1963-8

BACKGROUND: Lack of intersectoral collaboration within public health sectors compound efforts to promote effective multidisciplinary post stroke care after discharge following acute phase. A coordinated, primary care-led care pathway to manage post stroke patients residing at home in the community was designed by an expert panel of specialist stroke care providers to help overcome fragmented post stroke care in areas where access is limited or lacking.

METHODS: Expert panel discussions comprising Family Medicine Specialists, Neurologists, Rehabilitation Physicians and Therapists, and Nurse Managers from Ministry of Health and acadaemia were conducted. In Phase One, experts chartered current care processes in public healthcare facilities, from acute stroke till discharge and also patients who presented late with stroke symptoms to public primary care health centres. In Phase Two, modified Delphi technique was employed to obtain consensus on recommendations, based on current evidence and best care practices. Care algorithms were designed around existing work schedules at public health centres.

RESULTS: Indication for patients eligible for monitoring by primary care at public health centres were identified. Gaps in transfer of care occurred either at post discharge from acute care or primary care patients diagnosed at or beyond subacute phase at health centres. Essential information required during transfer of care from tertiary care to primary care providers was identified. Care algorithms including appropriate tools were summarised to guide primary care teams to identify patients requiring further multidisciplinary interventions. Shared care approaches with Specialist Stroke care team were outlined. Components of the iCaPPS were developed simultaneously: (i) iCaPPS-Rehab© for rehabilitation of stroke patients at community level (ii) iCaPPS-Swallow© guided the primary care team to screen and manage stroke related swallowing problems.

CONCLUSION: Coordinated post stroke care monitoring service for patients at community level is achievable using the iCaPPS and its components as a guide. The iCaPPS may be used for post stroke care monitoring of patients in similar fragmented healthcare delivery systems or areas with limited access to specialist stroke care services.

TRIAL REGISTRATION: No.: ACTRN12616001322426 (Registration Date: 21st September 2016).

Matched MeSH terms: Health Services Accessibility/organization & administration
Fulltext Challenges in managing HIV in people who use drugs

Kamarulzaman A, Altice FL

Curr. Opin. Infect. Dis., 2015 Feb;28(1):10-6.
PMID: 25490106 DOI: 10.1097/QCO.0000000000000125

HIV management in people who use drugs (PWUD) is typically complex and challenging due to the presence of multiple medical and psychiatric comorbidities as well as social, physical, economic and legal factors that often disrupt the HIV continuum of care. In this review, we describe the individual, health systems and societal barriers to HIV treatment access and care retention for PWUD. In addition, the clinical management of HIV-infected PWUD is often complicated by the presence of multiple infectious and noninfectious comorbidities.

Matched MeSH terms: Health Services Accessibility/organization & administration
Hemovigilance in developing countries

Ayob Y

Biologicals, 2010 Jan;38(1):91-6.
PMID: 20133151 DOI: 10.1016/j.biologicals.2009.10.002

Hemovigilance like quality systems and audits has become an integral part of the Blood Transfusion Service (BTS) in the developed world and has contributed greatly to the development of the blood service. However developing countries are still grappling with donor recruitment and efforts towards sufficiency and safety of the blood supply. In these countries the BTS is generally fragmented and a national hemovigilance program would be difficult to implement. However a few developing countries have an effective and sustainable blood program that can deliver equitable, safe and sufficient blood supply to the nation. Different models of hemovigilance program have been introduced with variable success. There are deficiencies but the data collected provided important information that can be presented to the health authorities for effective interventions. Hemovigilance program modeled from developed countries require expertise and resources that are not available in many developing countries. Whatever resources that are available should be utilized to correct deficiencies that are already apparent and obvious. Besides there are other tools that can be used to monitor the blood program in the developing countries depending on the need and the resources available. More importantly the data collected should be accurate and are used and taken into consideration in formulating guidelines, standards and policies and to affect appropriate interventions. Any surveillance program should be introduced in a stepwise manner as the blood transfusion service develops.

Matched MeSH terms: Health Services Accessibility/organization & administration*