Public Health Systems & Services Research

Background Prolonged sitting time is a risk factor for chronic disease, yet recent global surveillance is not well described. The aims were to clarify: (i) the countries that have collected country-level data on self-reported sitting time; (ii) the single-item tools used to collect these data; and (iii) the duration of sitting time reported across low- to high-income countries. Methods Country-level data collected within the last 10 years using single-item self-report were included. The six-stage methodology: (1) reviewing Global Observatory for Physical Activity! Country Cards; (2–4) country-specific searches of PubMed, the Demographic and Health Survey website and Google; (5) analysing the Eurobarometer 88.4; and (6) country-specific searches for World Health Organization STEPwise reports. Results A total of 7641 records were identified and screened for eligibility. Sixty-two countries (29%) reported sitting time representing 47% of the global adult population. The majority of dat...

Health cooperatives are not developed in Serbia, but during 2020 there was created Initiative for reopening health cooperatives submitted to the Parliament explaining benefits of such organizational form and requesting change of public policies based on the previous research. This paper propose model that might be of practical power for the existing settings of healthcare system of Serbia, particularly reaching vulnerable groups in rural areas. Global experiences of healthcare cooperatives are presented especially considering COVID19 pandemic. Methodology is based on the analysis of the literature and synthesis of historical and modern aspects of health cooperatives in order to propose model of worker based health cooperatives that should be created into the rural areas in order to achieve results more effective than current in provision of the healthcare services.

Anemia is a globally widespread condition in women and is associated with reduced economic productivity and increased mortality worldwide. Here we map annual 2000–2018 geospatial estimates of anemia prevalence in women of reproductive age (15–49 years) across 82 low- and middle-income countries (LMICs), stratify anemia by severity and aggregate results to policy-relevant administrative and national levels. Additionally, we provide subnational disparity analyses to provide a comprehensive overview of anemia prevalence inequalities within these countries and predict progress toward the World Health Organization’s Global Nutrition Target (WHO GNT) to reduce anemia by half by 2030. Our results demonstrate widespread moderate improvements in overall anemia prevalence but identify only three LMICs with a high probability of achieving the WHO GNT by 2030 at a national scale, and no LMIC is expected to achieve the target in all their subnational administrative units. Our maps show where lar...

Medical tourism is a growing phenomenon with policy implications for health systems, particularly of destination countries. Private actors and governments in Southeast Asia are promoting the medical tourist industry, but the potential impact on health systems, particularly in terms of equity in access and availability for local consumers, is unclear. This article presents a conceptual framework that outlines the policy implications of medical tourism's growth for health systems, drawing on the cases of Thailand, Singapore and Malaysia, three regional hubs for medical tourism, via an extensive review of academic and grey literature. Variables for further analysis of the potential impact of medical tourism on health systems are also identified. The framework can provide a basis for empirical, in country studies weighing the benefits and disadvantages of medical tourism for health systems. The policy implications described are of particular relevance for policymakers and industry practitioners in other Southeast Asian countries with similar health systems where governments have expressed interest in facilitating the growth of the medical tourist industry. This article calls for a universal definition of medical tourism and medical tourists to be enunciated, as well as concerted data collection efforts, to be undertaken prior to any meaningful empirical analysis of medical tourism's impact on health systems.

Introduction: Globally every day, about 830 women die due to complications of pregnancy and child birth. Of these deaths, 99% occur in low-resource settings, and most could be prevented. Use of Modified Early Obstetric Warning System (MEOWS) would be appropriate. MEOWS is a monitoring chart intended to identify mothers at risk and initiate the right action, at right time by the appropriately skilled clinicians, at a time when treatment might make a difference to reduce maternal mortality and morbidity. Objectives: To determine the sensitivity, specificity and predictive values of Modified Early Obstetric Warning System (MEOWS) in correctly identifying women at risk of developing obstetric morbidity in St. Francis Hospital_Nsambya between January and February, 2016 Methods: The study was a prospective cohort study conducted at St. Francis Hospital Nsambya, maternity ward, from January to February 2016. MEOWS monitoring tool was used alongside with questionnaires. Result: 502 respondent mothers were enrolled in the study. 160patients (31.9%) triggered and of which: 11.5% of them had obstetric morbidity which included postpartum haemorrhage-35.5%, preeclampsia-26.3%, suspected infection-22.4%, third degree perineum tear-5.3%, anaesthetic complications-4% and prolong hospital stay-7%. MEOWS was 81.7% sensitive (95% CI 80-94%), 76.3% specific (95% CI 74-81%), with a positive predictive value 36.3% (95% CI 31-44%) and negative predictive value of 96.2% (95% CI 94-99%). Conclusion: MEOWS chart is even effective for use in low resource setting, like Uganda.

La creación de un centro estatal de salud pública, con una dotación adecuada de recursos, permitirá afrontar los desafíos de la salud pública del presente y del futuro en España. Para ello, las funciones de esta futura institución, que se propone como Agencia Estatal, deben abordar, además de las necesidades habituales de organización de la salud pública, la conexión de estas con los Objetivos de Desarrollo Sostenible, coordinando una estrategia estatal que integre distintos actores de salud en una red generosa y cooperativa, y desarrollando una estrategia de comunicación en salud pública innovadora, referente y priorizada, entre otros aspectos. La falta de recursos, la relativa desconexión actual de las funciones esenciales de salud pública en el ámbito estatal y la inequidad en el desarrollo autonómico y municipal de estas propician el desarrollo del proyecto de la Agencia como una red de redes, tal como se defiende en este trabajo. Aportamos ideas para un proceso que confiamos en que será decisivo para la salud pública española del siglo xxi.

T he use of qualitative methods in health research has increased substantially in the past decade among researchers from a range of health disciplines. While qualitative research methods were developed by the social sciences, and it is in this literature that we find description of a wide range of approaches to their use, 1,2 there is also the approach of evaluation 3 and the practical focus of clinical disciplines such as general practice and nursing. 4,5 These different approaches draw upon a range of theoretical models and frameworks including health behaviour and community change models. 6 It is not surprising, therefore, that there has been a lively debate between the disciplines about how best to conduct studies using qualitative methods. Researchers who feel constrained by the deductive methods of quantitative approaches such as surveys and randomised controlled trials may see qualitative research methods Abstract Objective: To define the role of social theory and examine how research studies using qualitative methods can use social theory to generalise their results beyond the setting of the study or to other social groups. Approach: The assumptions underlying public health research using qualitative methods derive from a range of social theories that include conflict theory, structural functionalism, symbolic interactionism, the sociology of knowledge and feminism. Depending on the research problem, these and other social theories provide conceptual tools and models for constructing a suitable research framework, and for collecting and analysing data. In combination with the substantive health literature, the theoretical literature provides the conceptual bridge that links the conclusions of the study to other social groups and settings. Conclusion: While descriptive studies using qualitative research methods can generate important insights into social experience, the use of social theory in the construction and conduct of research enables researchers to extrapolate their findings to settings and groups broader than the ones in which the research was conducted.

Despite the significant growth of Indian Economy and health standard of the Indian citizens accessibility of the basic healthcare to majority of the people is a big challenge in developing country like India. The inequalities have been increased among the various sections of the society particularly in last two-three decades. The Indian state has been failed to distribute the benefits of the economy and health facilities equally. The three-fourth of the Indian population is still living in rural areas with about twenty percent of the health facilities. More than half of the children and women are suffering anemia, even 92% of the mother never heard the word malnutrition. Indian public healthcare system is able to treat only 40-45% of the In-patients and only 18% of the total outpatients. About 80% population is unable to get essential drugs for basic illness because public sector is unable to provide i.e. private sector becoming dominating, which is controlling about 80% of the health infrastructure and 85-87% of the total expenditure on health.

Background: Till 2008, Jharkhand had only 12 designated first referral units (FRUs) at the district level and none of them were fully functional. Aims & Objective: This paper focuses on the processes, experiences and health system challenges in operationalizing FRUs in Jharkhand. Materials and Methods: In an operations research, a pre and post assessment of designated FRUs in the study area was undertaken using standardized tool during March 2009 and February 2011. Results: There was 33 % (04) increase in availability of obstetricians, surgeons and pathologists across the facilities. The availability of pediatrician was improved in 26% (02) facilities, while there were only 14 % (01) of anaesthetists across all the seven facilities.

Mozambique eyecare project carried out in June 2013 to estimate the socio-economic benefit of an Optometry Programme by calculating the benefits of addressing refractive error in terms of productivity gained as a result of the intervention.

The aim of this article is to discuss how neoliberal policies implemented in the Chilean health system during the Pinochet regime have a lingering effect on equal access to health care today. The two-tier health system – public and private – that was introduced in the early 1980s as a means to improve efficiency and lower health-related costs, has led instead to inequality of access and dehumanisation of health care. Health has changed from being a right to being a marketable need, thus creating a structural disadvantage for several parts of the population – particularly the poor, the elderly, and women – who cannot afford the better-quality services and timely attention of private health providers, and thus, are not adequately protected against health risks. Despite the recent health reforms that aim at improving equity in health care access and financing, we argue that the Chilean health system is still biased against the poorer segments of the population, while it favours the more affluent groups that can afford private health care.

The purpose of this thesis is to investigate potential key determinants of the success, or otherwise, of endeavours to address avoidable Visual Impairment (VI) by addressing Uncorrected Refractive Error (URE) in Mozambique and the wider region of sub-Saharan Africa by providing optometric services. It includes a Cost Benefit Analysis (CBA) of a higher education optometry training programme, barriers that might prevent the realisation of overarching goals despite a successful training programme, and a Willingness to Pay (WTP) analysis to inform the pricing structure and to determine the financial sustainability of the system. Methods A standard CBA methodology was applied to ascertain societal net benefit. Costs including those associated with establishing an optometry service. Benefits were calculated by considering how addressing URE could increase productivity. Disability weighting (DW) for VI was applied …

"BACKGROUND
In South Africa, lesbian, gay, bisexual and transgender (LGBT) people routinely experience discrimination by health care workers, and even refusal of care when seeking health services. Even though LGBT people are recognised in national health policy as a key population, HCW attitudes are not cognisant of this. As a result, many LGBT people delay seeking care, or avoid accessing health facilities altogether. Given that LGBT people, like other marginalised groups, have poorer health outcomes, the health system’s failure to provide accessible, non-discriminatory care is indefensible.

OBJECTIVE
To examine the experiences of LGBT people in SA public sector health facilities, in order to identify shortcomings in health care worker education

METHODS
An ongoing qualitative study in three SA provinces, comprised of semi-structured interviews and focus group discussions (FGD) with LGBT service users, representatives of LGBT organisations, and health care workers (HCW).

RESULTS
To date, 21 interviews and 2 FGDs with LGBT service users and organisations have been completed. All interviewees reported experiences of discrimination by HCWs based on their sexual orientation. Nurses were perceived to be more homophobic than doctors. Discrimination was rooted in homophobia and heteronormativity and took various forms:
1) HCWs refused to provide care to LGBT patients
2) HCWs articulated moral judgment and disapproval of LGBT patients’ identity
3) HCWs forcibly subjected LGBT patients in their care to religious practices
4) HCWs did not have knowledge about LGBT identities or health needs


CONCLUSION
Many HCWs’ attitudes towards LGBT patients are completely unprofessional and violate the ethical duty of care. There is an urgent need to challenge HCWs attitudes towards homosexuality and educate them about LGBT health.
"

his analysis of the Canadian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Life expectancy is high, but it plateaued between 2016 and 2017 due to the opioid crisis. Socioeconomic inequalities in health are significant, and the large and persistent gaps in health outcomes between Indigenous peoples and the rest of Canadians represent a major challenge facing the health system, and society more generally. Canada is a federation: the provinces and territories administer health coverage systems for their residents (referred to as “medicare”), while the federal government sets national standards, such as through the Canada Health Act, and is responsible for health coverage for specific subpopulations. Health care is predominantly publicly financed, with approximately 70% of health expenditures financed through the general tax revenues. Yet there are major gaps in medicare, such as prescription drugs outside hospital, long-term care, mental health care, dental and vision care, which explains the significant role of employer-based private health insurance and out-of-pocket payments. The supply of physicians and nurses is uneven across the country with chronic shortages in rural and remote areas. Recent reforms include a move towards consolidating health regions into more centralized governance structures at the provincial/territorial level, and gradually moving towards Indigenous self-governance in health care. There has also been some momentum towards introducing a national programme of prescription drug coverage (Pharmacare), though the COVID-19 pandemic of 2020 may shift priorities towards addressing other major health system challenges such as the poor quality and regulatory oversight of the long-term care sector. Health system performance has improved in recent years as measured by in-hospital mortality rates, cancer survival and avoidable hospitalizations. Yet major challenges such as access to non medicare services, wait times for specialist and elective surgical care, and fragmented and poorly coordinated care will continue to preoccupy governments in pursuit of improved health system performance.

Medical intelligence and surveillance is the active and ongoing manual and automatic gathering of
large data from different sources to effectively monitor the outbreak of communicable diseases, pattern of
behavioral disorders, chemical, radiological or biological attack, and provide prompt preparedness and response
measures to mitigate the incident, and rehabilitation measures for victims. As a key area that will enormously
shape global diplomacy and safety in the future, there utmost need in enhancing development of effective
medical intelligence and surveillance around the world, particularly through technological advancement and
intelligence. Several lines of evidences show that development of effective medical intelligence and
surveillance could have tremendous importance for an efficient global security network that will promptly and
effectively manage future events. Various models that will account for effective medical intelligence and
surveillance are presented.

Abstract Complementary medicine research, including naturopathic medicine research, is plagued with many methodological challenges. Many of these challenges have also been experienced in public health research. Public health research has met these challenges with a long history of multidisciplinary, multimethod, and whole systems approaches to research that may better resonate with the “real world” clinical settings of naturopathic medicine.

The development of this policy seeks to address shortcomings resulting from the existing referral system in the Health Care Institutions. The absence of the referral policy has negatively impacted accessibility in health care provision and is overstretching the resources of teaching hospitals and tertiary care institutions like SKIMS
This document will outline the following main aspects related to the referral of patients; referral criteria; communication between different levels of health care delivery to facilitate the proper referral; transportation of referred patients; and equitable distribution of resources to improve the management of referrals.
With proper Referral policy in place, state can excel in providing high quality care to patients at all levels, minimize duplication, reduce overcrowding in urban hospitals and ensure accessibility, affordability, equality and equity in health. It will also introduce accountability, transparency and responsiveness among health professionals and institutions.

The prevalence of alcohol consumption among young people across the globe is unprecedented; with many young drinking the lives away. In Ghana, the story is very similar to the growing worrying trend of alcohol consumption among young people all over the world. As such, this paper sought to explore how young people in Ghana are drinking their lives away through alcohol consumption. Specifically, the paper discusses the factors that facilitates this phenomenon, some consequences of alcohol consumption and suggest some measures to regulate the consumption of alcohol among young people in Ghana. The paper suggests that young people in Ghana consume alcohol as a result of the influences of their peers, family and the media. Additionally, the study brought to fore that young people who consume alcohol are more likely to suffer social, biomedical and mental health consequences as well as sexual health consequences. The paper therefore recommends that in order to protect young people from engaging in alcohol consumption, there must be a conscious effort to stifle the physical, economic and social availability of alcohol to young people and forge a collaborative effort.

Recent years have seen a widening gap between growing global demand and a shrinking supply with donor blood worldwide, including Germany. One reason is that the generation of the so-called “baby boomers”, who have long been the backbone of donor blood supply, have passed the age limit for donations. Younger generations appear to be less willing to donate. It is, therefore, imperative to identify ways that enable blood donation agencies to re-engage with prospective donors to motivate them to donate blood. One feasible strategy might be to tap into methods proposed by “behavioural economics”. This approach uses insights from economics, psychology, and rigid experimentation to design interventions. This article seeks to understand if approaches from this school of thought might be useful to increase the number of blood donors, using the example of corporate blood drives in Germany. To this end, eight qualitative interviews with experts from blood donation agencies were conducted to map the current donor recruitment processes in corporate drives. An additional five experts in behav- ioural science were interviewed to understand what their approach could contribute to improving donor recruitment. The key result of the study is that applying behavioural science’s principles to designing a successful blood drive, namely ensuring participation, foster experimentation, and rigorous evaluation, might contribute to higher recruitment rates of blood donors.

The Circumpolar Health Systems Review [CircHSR] is an international
collaborative effort to describe and compare the health care systems that exist in the northern regions of Arctic States. The project was proposed by the Arctic Human Health Expert Group and authorized by Senior Arctic Officials of the Arctic Council in April 2010. Funding for the project was provided by the Canadian Institutes of Health Research to the University of Toronto, by Health Canada to the Institute for Circumpolar Health Research, and by the Nordic Council of Ministers to the International Association of Circumpolar Health Publishers. For a variety of reasons, we were unable to secure final contributions from the Faroe Islands, Sweden, and the Russian Federation. However, statistical data from these countries and regions were collected and included in the overview chapter, so that this report can be considered truly circumpolar.
This report consists of a series of narrative and statistical profiles of
selected northern regional health care systems, followed by discussion of several cross-cutting issues. A concluding chapter identifies policy implications (but not recommendations) and suggests potential future research. It is intended for wide dissemination among knowledge-user partners,researchers, and stakeholders in regional and national health ministries and agencies, indigenous people’s organizations, and international intergovernmental bodies such as the Arctic Council and Northern Forum.

Makanan sebagai sumber protein, karbohidrat, lemak, vitamin, dan mineral sangat diperlukan bagi kesehatan fisik, pertumbuhan, dan mengatur proses metabolisme. Makanan yang berkualitas, aman dan menarik dapat diperoleh melalui perlakuan yang tepat pada setiap tahapan produksi, mulai dari persiapan, pengolahan, penyimpanan, pemasaran dan penggunaannya. Makanan yang tidak aman jika dikonsumsi dapat menimbulkan gangguan kesehatan bahkan berakibat pada kematian (Suryana, 1994, dalam Sundari, 2013). Undang-undang Nomor 7 Tahun 1996 menyatakan bahwa kualitas pangan yang dikonsumsi harus memenuhi beberapa kriteria, diantaranya adalah aman, bergizi, bermutu, dan dapat dijangkau oleh daya beli masyarakat. Aman maksudnya mencakup bebas dari cemaran biologis, mikrobiologi, kimia, logam berat, dan cemaran lain yang dapat mengganggu, merugikan dan membahayakan kesehatan manusia (Mudjajanto, 2014). Dalam Islam dikenal dengan istilah makanan halalan thayyiban. Makanan halalan (halal) yaitu makanan yang tidak diharamkan, dan tidak menyalahi hukum syari`at Islam untuk dikonsumsi sesuai Al-Qur'an dan sunnah nabi. Makanan yang baik atau dalam istilah agama thayyiban yaitu baik dari sudut pemenuhan kebutuhan gizi bagi tubuh, pengolahan makanan baik, dan bahan campuran yang baik. Saat ini, Industri pangan di Indonesia telah berkembang dengan pesat, ditandai dengan munculnya industri kecil dan industri rumah tangga yang 1

The COVID-19 pandemic continues to ravage the world, with the United States being highly affected. A vaccine provides the best hope for a permanent solution to controlling the pandemic. Several coronavirus disease (COVID-19) vaccines are currently in human trials. However, to be effective, a vaccine must be accepted and used by a large majority of the population. This study aimed to investigate the acceptability of COVID-19 vaccines and its predictors in addition to the attitudes towards these vaccines among public. This study did an online survey during the period June-September 2020, were collected from 26,852 individuals aged 19 years or older across six continents as part of 60 nationally representative surveys to determine potential acceptance rates and factors influencing acceptance of a COVID-19 vaccine. Results revealed that two-thirds of respondents were at least moderately worried about a widespread COVID-19 outbreak. Differences in acceptance rates ranged from almost 93% (in Tonga) to less than 43% (in Egypt). Respondents reporting higher levels of trust in information from government sources were more likely to accept a vaccine and take their employer's advice to do so. Systematic interventions are required by public health authorities to reduce the levels of vaccines' hesitancy and improve their acceptance. These results and specifically the low rate of acceptability is alarming to public health authorities and should stir further studies on the root causes and the need of awareness campaigns. These interventions should take the form of reviving the trust in national health authorities and structured awareness campaigns that offer transparent information about the safety and efficacy of the vaccines and the technology that was utilized in their production.

Risk assessment, by itself, does nothing to reduce risk or improve safety. It can only change outcomes by informing the design and management of effective risk control interventions. But current practice in healthcare risk management suffers from an almost complete lack of support for risk control. This first installment of a 2-part series on rebalancing risk management describes a new framework to guide risk control practice: The Process for Active Risk Control.

Introduction: An estimated 78 million babies or every three in five are not breastfed within the first hour of life, putting them at advanced risk of death and disease and most of these babies are born in low- and middle-income countries (WHO, 2018). In the republic of South Sudan mothers who were exposed to the infant, formula advertisements were two times more likely to delay initiation of breastfeeding (Bruno et.al,2018).
Objective: To examine the factors contributing to breastfeeding success at el Sabah children hospital, Juba-South Sudan
Methodology: The study implies both quantitation and qualitative methods of data collection, quantitation methods include, secondary data and structure questioner. While qualitative methods, key informant guide, and observation. The analytical sample comprised 138 respondents from Alsabah children hospital in Juba South Sudan. Epi-Info software and excel 2013 was used to get frequencies and crosstabulation results.
Results: Our results show that the 100-study population, were included in this study and completed their interviews, giving a response rate of 100%. 64% of the respondents are male while 36% of the respondents are female. The majority of 61% of respondents describe nipple disorders as problems faces during breastfeeding. majority of respondents 90% describe colostrum as that first milk from the breasts. Necessary feeding options needed or child 65% of respondents recommended both breastfeeding and formula feeding. The study population had misconceptions breastfeeding practices such as; avoid sex during breastfeeding.
Conclusion: Evidence from this study shows that high knowledge of breastfeeding importance and family planning is not matched with the low exclusive breastfeeding and low contraceptive use in South Sudan. Therefore, more behavior chance communication on breastfeeding and family planning is needed with interventions that should be paying attention to both couples. scientific suggestion to illustrate that untimely weaning leads to an increased risk of disease and poorer outcomes for infants and their mothers both in the short and long term. The effects of which are dose-related more breastfeeding decreases the danger of morbidity and mortality.

This research, conducted by the author when a Senior Researcher at Newcastle University, UK, was funded by a UK governance organisation to help them assess, integrate and improve their understanding of the governed population.

ABSTRACT: Governance organisations have been urged to develop more holistic evidence-based approaches with partners to better deal with issues affecting the governed population. This presupposes an understanding of the population, yet there has been little research work addressing how governance organisations come to understand their governed population, nor how this understanding can be improved upon within such organisations.

This case study examined in-depth how understanding of a governed population was developed within one UK local governance organisation and it explored how such understanding might be developed and improved through more holistic and evidence-based organisational learning within the organisation and its governance partnerships.

The research methodology involved placement within the governance organisation, participant observations on several projects and innovative initiatives, observations within, across, and outside the organisation, and also interviews with varied key stakeholders.

The study examined:

- stakeholder engagement and networks
- current and varied understandings of the population
- mechanisms actually used for developing understandings
- the influence of context on organisational learning

and analysed these to arrive at a recommendations to improve organisational understanding of the governed population.

In the case studied, significant strengths were found: including innovative past learning trials for development, extensive ongoing networking activities, and many varied and accumulating quantitative datasets available across partnerships.

However, entrenched organisational approaches and practices constrained the development of holistic evidence-based understanding, for instance: the absence of systematic maintained collective learning processes; weak recording and forgetting of understandings; methodological exclusion of stakeholders from the development of understanding; the relative neglect of qualitative data, explanations, investigations, interpretations, and reflexivity; and also implicit organisational acceptance of such limitations and low aspirations.

Nonetheless, untapped opportunities existed to enable change including: latent practitioner knowledge and innovative management champions, the desire for improvement and raised aspirations within learning networks, and the development potential of alterative learning approaches.

It was concluded that more holistic evidence-based understanding was possible, but required new learning approaches beyond those then in use in both local government or academia.   

Recommendations are made to utilise and develop improved organisational learning approaches trialed and reported in the case study.

It is argued that the case study findings, conclusions, and recommendations may be applicable to other similar local governance organisations and partnerships that seek to better understand local populations, services and interventions.

The work was also submitted for, and awarded, an MPhil (at Newcastle University, supervised by Prof. Patsy Healy)

Se hace una revisión breve sobre los conceptos, objetivos y funciones de un sistema de salud, a partir de la cual se analiza el funcionamiento del sistema de salud guatemalteco. Se identifican los principales desafíos que enfrenta el país en su perfil epidemiológico, conducción del sistema de salud, prestación de servicios, financiamiento y personal de salud.

Posyandu Euforbia merupakan posyandu yang dibina oleh puskesmas induk Natar yang memiliki tujuan memberdayakan masyarakat Desa Negara Ratu dengan melibatkan kader dan peran aktif partisipatif masyarakat dengan cara pemeriksaan kesehatan rutin, pemberian konseling dan penyuluhan.

Kegiatan Posyandu Euforbia ini rutin dilaksanakan pada hari rabu minggu pertama di tiap bulannya. Posyandu Euforbia ini juga telah memiliki sarana dan prasarana yang cukup lengkap, menerapkan sistem 5 meja, tenaga kesehatan yang cukup, tenaga kader yang cukup serta memiliki tenaga kebersihan.

Kegiatan Posyandu Euforbia ini juga tetap berjalan dengan cara yang sama seperti sebelum saat pandemi ini, namun dengan menerapkan protokol kesehatan yang ketat serta terdapat sanksi yang tegas untuk masyarakat yang melanggar protokol kesehatan.

Adapun hambatan dan kendala selama pelaksanaan kegiatan yaitu Kurangnya keaktifaan partisipatif masyarakat dikarenakan jadwal posyandu yang pagi dan banyak masyarakat yang mimiliki aktivitas dan bekerja pada waktu tersebut. Kurangnya keseriusan kader dalam mengemban tugasnya.

ABSTRACT
This study was a descriptive cross-sectional study on factors contributing to prevalence of jigger infestation among the community members of Mugumoini sub-location in Gatanga district. The specific objectives were; to asses’ community’s knowledge on jigger infestation, to find out the prevailing environmental conditions favoring jigger infestation and to identify the community’s practices contributing to jigger infestation. The desired sample size was 311 households but 180 were interviewed representing 58%. Purposive sampling, random sampling, simple random sampling and systematic random sampling were used.
The study revealed that more than three quarters(78.3%) of the respondents knew that jigger infestations as an attack by fleas, Majority (78.8%) had been infected with jiggers and more than half(58.9%) of the respondents associated the cause of jigger infestation as jigger flea, More than half(56.7%) knew one gets infested through walking bare footed, Majority(85.6%) could notice immediately through irritation on point of entry as majority(60.6%) knew effects of jigger infestation as walking difficulties. Most of the respondents (71.7%) kept domestic animals; Majority of them (35.7%) kept their animals next to their house. Majority of the respondents (43.9%) dispose their solid waste through dumping. More than four fifths (85.6%) said that jigger infestation peaks during the dry season. Majority of the respondents (71.7%) owned closed shoes, (57.4%) wore them on special occasion as slightly more than half (54.9%) could not afford closed shoes. Slightly less than half of the respondents (45.9%) used unsterilized needles/pins in jigger removal, Majority (37.2%) cleaned their house daily, and Most of this (76.1%) used dry sweeping method. The study concluded that; A significant number of community members had low levels of education  and this could have contributed to the increased rate of unemployment, knowledge on jiggers’ infestation is high but has not translated to jigger prevention and control in the area, Community members kept their domestic animals in the main house or just next to the house and attributed this to security reasons, a significant number of community members disposed their solid wastes through scattering, and the community members wore shoes only on special occasions.
The study also recommended that: The government through the ministry of education should ensure funding the free primary education, issue scholarships and charge low interest on loans to scholars among other strategic measures that would ensure quality education for all its citizens. This will increase the literacy level and reduce the rate of unemployment. The government, through the ministry of public health and sanitation, should ensure that PHOs, PHTs and CHWs conduct effective sensitization, to transform community knowledge to positive hygienic and sanitation behaviors that will contribute to jigger eradication consequently contributing to general health status and sustainable community development. The chief, in conjunction with the local administration should take appropriate measures to ensure that security in the area is maintained, to prevent theft of domestic animals which is a critical issue that forces the community members to either share their main houses with domestic animals or build the animals houses just next to their own houses. The area PHO should health educate households to make informed choices about improved hygiene and sanitation e.g. Proper solid waste management. Community members should take a collective action to ensure that they wear closed shoes to prevent the risk of infection. Finally, household members, CHEWs, CHWs, teachers and pupils should take special efforts to undertake communal activities aimed at jigger prevention and control e.g. public sanitation activities and this should translate to reduction and consequent eradication of the jigger menace.

Because employers provide health insurance, they play a major role in the population’s health and in its security. In the United States, historically, employment has always been the cornerstone of private health insurance. In fact, 90 percent of people under 65 get their health insurance through employment. But the health of the labor market varies and with it the health of the population it serves. Economic struggles leads to less disposable income and bad health. Job security has been revisited and is no longer a guarantee. In most households, both parents are working and any layoff or illness is tantamount to major stress on their health because the U.S. health care system is the most expensive in the industrialized world. While the economy has recovered from the 2007-2008 Great Recession, the prospect of future economic recessions is still looming and when the next one hits, the impacts have the potential to be great and widely felt because the recipe for disaster is ubiquitous: an unaffordable health care system that is spiraling out of control. Medical bills are often synonymous with bankruptcy. Health care costs are constantly rising and Americans are hit with higher out-of-pocket costs on a regular basis. Because the health care system is price-based and not value-based, its efficiency is hindered. That is, although the U.S. spends twice as much in health care compared with the other OECD countries, its health outputs are inferior to those of countries such as Canada, France, Germany, Japan, and the United Kingdom. Developments in communication and information technologies may be a golden opportunity to reverse the trend. These technologies may help improve the effectiveness of public health interventions. Telehealth or telemedicine, by integrating the patient – and because it’s moving to urban areas – is pivotal. Improving access, ensuring quality, and controlling costs to reduce wasteful spending should be the top priorities of health policy makers. Besides technology, emphasis should be put on health literacy programs and the valorization of communities. Also, there has been a lot of debate on whether the U.S. should embrace universal health coverage (UHC), also called Medicare-for-all or a single-payer system, or even a socialized medicine modeled after the U.K.’s health care system. At each end of the spectrum, proponents and opponents make their case using, of course, different arguments. The former think that health care should be made a fundamental right of citizenship while the latter think that health care is after all a service and people should pay for what they get, although amongst them some think that a public option – where private insurance and government insurance for all coexist – might be a better alternative to straight and universal socialized medicine benefiting every American regardless of their socioeconomic status.

Girl-Child Sexual Abuse (CSA) constitutes an alarming social phenomenon. Heavily influenced by social and cultural factors, CSA is understood and dealt with differently by different societies. Ultimately, survivors are left to bear the indelible consequences of the abuse. The impact of this traumatic experience on their health and subsequent quality of life is well documented. These health effects range from the immediate physical scars to long-term psychosocial, emotional and physical problems (Finkelhor, 1993). Unfortunately, the dearth of research seeking to illuminate the socio-cultural context within which CSA flourishes, has led to the creation of CSA prevention and response systems that are inadequate and ineffective in many parts of the world. In Ghana, recent
statistics indicate 1 in 3 young women in Ghana experience CSA before the age of 18 (Appiah & Cusack, 1999). This constitutes an urgent public health concern, and it is for this reason this study was conceived. Using semi-structured interviews with 10 survivors and 16 key informants in Accra, this study sought to document the current understanding of CSA in Ghana, the perceived reasons for its occurrence and to make recommendations on how to deal with its root causes and its effects on the society.
I argue that an analysis of cultural key elaborating scenarios (Ortner, 1975) expressed through the Ghanaian concepts of “defilement” and “respect” illuminates societal rituals creating girl children’s vulnerability to CSA. Societal norms constituting these scenarios include: the continuance of a patriarchal tradition that overlooks men’s aberrant sexual behavior; children’s strong socialization to deference to adult instruction; easy access on the part of potential perpetrators girl-children due to girls’ socialized role as helper in the home; historic cultural rituals that emphasize female virginity at marriage as essential to family dignity; and, sexual inhibition emphasized for women. Altogether, these societal norms create an environment where the girl-child is extremely vulnerable to CSA and, subsequent to the abuse re-victimized by the stigma attached to her as the one who has brought disgrace on her family by virtue of her defloration outside of marriage. Additionally, the key metaphor of “worry” used by study participants in relation to the health effects of CSA illuminates the perceptions surrounding the depth of the effects of CSA on the survivor. Both survivors and key informants in the study recommended a re-examination of the socialization process that creates these key scenarios and the re-structuring of a response system centered around the survivors’ dignity and healing.

Street children worldwide do not have the information, skills, health services, and support they need to go through sexual
development during adolescence.This study is undertaken to systematically investigate the fit between street children’s sexual and
reproductive health needs and the existing services. A cross-sectional study was conducted among 422 street children and four
service providers. About 72.5% of the respondents were sexually active during data collection and 84.3% of males and 85.7% of
females tended to have multiple sexual partners.More than two-thirds (67.3%) of the participants had used at least one type of
substance. History of substance use (OR = 2.5; 95% CI = 1.42–4.56) and being on the street for the first one to three years (OR =
5.9; 95% CI = 1.41–7.22) increased the likelihood of having sexual activity. More than half (64.9%) of the street children did not
attend any kind of sexual or reproductive health education programs. Lack of information on available services (26.5%) was the
biggest barrier for utilization of local sexual and reproductive health services. From the individual interview with coordinator, the
financial and networking problems were hindering the service delivery for street children. In conclusion, street children who are
special high risk group have not been targeted and hence continue to remain vulnerable and lacking in sexual and reproductive
health services and sexual health services are poorly advertised and delivered to them.

Objective: To assess the core capacities for the implementation of the IHR (2005) for the prevention and control of infectious diseases, events and other conditions at the selected Points of Entry. Methods-A cross-sectional descriptive study and qualitative methods were employed at POEs visited. WHO core capacity assessment tools were used for data collection. Respondents were purposely chosen for the study. In depth interviews, focus group discussions in form of meetings and visits to isolation sites and general observations were conducted. A conceptual frame work for thematic areas and observations was followed. Thematic areas(Foster partnership, strengthen the POEs disease prevention and surveillance, strengthen the public health security in travel and transport, sustain rights, obligations and procedures and conducting studies and monitoring of progress including the core capacity measurements of compliance were used to generate study findings.