Significant health care paper

The US health care system is rapidly changing in an effort to deliver better care, improve health, and lower costs while providing care for an aging population with high rates of chronic disease and co-morbidities. Among the changes affecting clinical practice are new payment and delivery approaches, electronic health records, patient portals, and publicly reported quality metrics—all of which change the landscape of how care is provided, documented, and reimbursed. Navigating these changes are health care professionals HCPswhose daily work is critical to the success of health care improvement.

Significant health care paper

Correspondence to Stephan Brenner email: Bulletin of the World Health Organization ; Moving some fiscal decision-making towards front-line providers allows for additional mechanisms to overcome day-to-day limitations in service provision such as inadequate supplies or low staff motivation faced by health facilities.

While performance-based financing schemes in principle are designed to help health workers and service managers to achieve better health-care quality outcomes, their actual effect in doing so remains unclear. A Tanzanian scheme directly providing incentives for facilities to manage essential drugs and supplies failed to prevent stock-outs of essential equipment, medicines and commodities.

The scheme enabled participating facilities to use financial rewards gained for positive performance to purchase additional drugs, which successfully reduced subsequent stock-outs. This is partially because many schemes narrowly focus on service utilization or the clinical aspect of health-care quality, often overlooking elements directly tied to the structural aspect.

Methods Study Setting Malawi has a centralized tax-based health system that receives significant external donor support. First, the country has inadequate human resources and suffers from shortages of qualified health workers, poor remuneration, limited career opportunities and insufficient supervision and training opportunities.

Similar to other performance-based incentive schemes, the initiative provides financial rewards for maternal care providers and district health management teams upon meeting defined performance goals performance-based incentives. It also provides conditional cash transfers financial rewards for pregnant women upon meeting defined compliance targets.

The initiative was implemented in selected emergency obstetric care facilities across four districts Balaka, Dedza, Mchinji and Ntcheu.


Similar to other performance-based incentive programmes, the initiative combines financial rewards for maternal care providers and district health management teams upon meeting defined performance goals performance-based incentives with conditional cash transfers financial rewards for pregnant women upon meeting defined compliance targets.

Enrolment of facilities into the initiative was non-random and was based on performance of emergency obstetric care signal functions, functionality of referral system, geographical emergency obstetric care coverage and catchment population size.

Significant health care paper

Each enrolled facility received initial start-up financial support conditional on need related to immediate infrastructural requirements i. Incentives for facilities are largely tied to clinical and general service management performance; district health management team incentives are largely tied to equipment maintenance and drug supply management across all facilities within each district.

Study design This paper focuses on the performance-based financing component of the initiative and assesses its effects on maternal and newborn health service quality. The study is part of a larger impact evaluation that uses a non-randomized controlled before and after study design with independent controls.

The control sample included all health facilities within the same study districts that were not, or not yet, enrolled in the initiative at baseline: Data were collected at three time-points: In addition, at each time point we identified a small number of pregnant women giving birth per each sampled facility using a convenience-sampling approach.

To measure effects on clinical performance, we observed the following processes: Performance indicators and related measures of the performance-based financing scheme in Malawi Clinical performance indicators and process measuresa A.

Proportion of pregnant women giving birth in the facility and show signs of pre-eclampsia or eclampsia who received magnesium-sulfate. Birth attendant asks patient for symptoms related to pre-eclampsia. Birth attendant checks for signs of pre-eclampsia.

Proportion of partographs completed and appropriately filled among women giving birth in the facility. Birth attendant monitors partograph during first stage labour 2.

Birth attendant documents record of complete partograph. Implementation of at least one infection control action per reporting period.Health care has been influenced by numerous significant events throughout history.

These events have helped change and shape health care in efforts to improve it, and to fit in with the current needs of the population. Some of the influences include society, culture, finance, religion, politics. Implementation research to improve quality of maternal and newborn health care, Malawi Stephan Brenner a, Danielle Wilhelm a, Julia Lohmann a, Christabel Kambala b, Jobiba Chinkhumba b, Adamson S Muula b & Manuela De Allegri a.

a. Institute of Public Health, Ruprecht-Karls Universität Heidelberg, Im Neuenheimer Feld , Heidelberg, Germany.

This white paper presents a framework for health care organizations to improve health equity in the communities they serve, guidance for measuring health equity, a case study of one organization that has strategically integrated health equity throughout its system, and a self-assessment tool for organizations to gauge their current focus on and efforts to improve health equity.

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Social determinants of health (SDoH) is a relatively new term in health care. As defined by the World Health Organization (WHO), SDoH are “the conditions in which people are born, grow, live, work and age.

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WHO | Implementation research to improve quality of maternal and newborn health care, Malawi