Perception of Adolescents on the Attitudes of Providers on Their Access and Use of Reproductive Health Services in Delta State, Nigeria

This paper examines the perception of adolescents on the attitudes of providers on their access and use of reproductive health services (ARHS) in Delta State, Nigeria, with a view of assessing the impact of providers’ attitude on the use of adolescents’ reproductive health services in Delta State. The study adopted a survey design to collect primary data using questionnaires and focus group discussions (FGDs) from adolescents in a sample of schools. A sample size of 1500 respondents was taken from 12 schools in six Local Government Areas in three Senatorial Districts in Delta State, Nigeria. The locations of the schools were such that six each were in rural and urban communities respectively. The result from the study was that unfriendly attitudes of providers which keep adolescents waiting, inadequate duration of consultations, judgmental attitudes of some providers, lack of satisfactory services provision and lack of confidentiality will put off adolescents from accessing and using adolescents’ reproductive health services irrespective of their sex, age, class, religion, residence, ethnic group, parents’ education or income levels. The paper concludes that medical personnel take all these issues very seriously when dealing with adolescents to enhance access and use adolescents’ reproductive health services in Delta State and indeed Nigeria.

The Relationship between Size and Performance of Palestinian Water Service Providers

Studies investigating the relationship between size and performance of water service providers are abundant. Yet, this relationship has not been fully addressed in Palestinian water sector, particularly, after the issuance of water law 2014 which calls for merging water providers into large regional utilities. This research evaluates the significant effect of the size of Palestinian water service providers on non-revenue water, staff productivity, collection efficiency, average consumption, average price, operating and maintenance cost, working ratio, and gross profit. The multivariate analysis shows that there are significant differences in working ratio, non-revenue water, staff productivity, average price, and gross profit based on the size. On the other side, no significant differences have been found in average daily consumption, operating and maintenance cost per unit, and collection efficiency based on those providers’ size. The small service providers perform better in non-revenue water, staff productivity, and collection efficiency;wherein, large service providers are more profitable than small service providers. Implications of these findings by conducting further studies will add the value for better merging of the Palestinian water providers and the reforming process.

Identifying Service Needs from the Perspective of Service Providers—A Qualitative Study

The provision of high-quality medical care has become a key challenge in many countries. At the same time, there is a growing awareness that the early detection of chronic diseases can reduce mortality rates. Therefore, it is important to identify service needs which influence to participate in health screening. To date, little research has been conducted into the perspectives of service providers on this topic. In this preliminary study, we aimed to explore the perspectives of service providers who work in a community-based setting in order to identify perceived barriers to chronic disease screening and incentives which can increase participation rates. In-depth interviews were conducted with 10 experienced health service providers from October 2017 to December 2017. Interviewees included physicians and community health representatives who had been working in a community-based health screening service for at least 3 years. The study identified several aspects of health screening services for chronic diseases that are in need of improvement, including a shortage of appropriate health service providers, inadequate attendance promoting measures, a lack of continually accessible and affordable medical services, healthcare professionals who possess inadequate communication skills, and rural-urban health care disparities. Service providers believe that current services do not fulfill community needs. Older adults who live in rural areas experience especially significant screening-related health disparities, which are mainly affected by structural service barriers. To improve the quality of medical services, healthcare screening services should be evaluated according to the perspectives of both participants and service providers.

“It All Goes Back to the Services”: A Rural/Urban Comparison of Service Providers’ Perceptions of Challenges and Facilitators to Disability Services

Purpose: The purpose of this qualitative study was to explore rural/urban differences in service providers’ perceptions of challenges and facilitators to services for children with special health care needs (CSHN) and their families in southeast Georgia. Methodology: A total of 23 individual interviews were conducted with service providers in one rural county in southeast Georgia (N = 12) and in one urban county in north central Georgia (N = 11). Interviews were based on the National Survey of Children with Special Health Care Needs 2009-2010 survey. All interviews were audio recorded, transcribed and coded with the intent of identifying themes and illustrative quotes. Findings: Service providers discussed a variety of challenges to accessing services related to socioeconomic status and the transition out of the school system. Urban and rural service providers’ perceptions were similar overall, with the exception of lack of transportation and access to a variety of services in rural area. Service providers overcome challenges through identifying parents’ needs and limitations and adapting service provision. Some of the facilitators mentioned by both urban and rural service providers are availability of transportation and resources. Practical Implications: The results of this study provide public health practice and policy implications that could guide the pathways of targeted interventions to improve the access and availability of variety of services for CSHCN. Originality/value of paper: This paper represents an in-depth exploration of service provider’s perceptions of challenges and facilitators related to service provision for children with special healthcare needs.

Quality-Oriented Climate and Service Quality Among Healthcare Providers： Evidence From a Rehabilitation Center in Italy

The importance of quality in service provision is widely recognized in health service research. However, a limited number of studies have investigated antecedents of quality in healthcare service provision. This article tries to shed further light on this under-researched field. Specifically, the aim of this study is to verify the relationship between the quality-oriented climate and service quality as perceived by employees. The study was conducted in a private non-profit Rehabilitation Centre in Italy using a questionnaire administered to all healthcare workers. The questions focused on perceptions of quality-oriented climate （priorization of quality care, social cooperation, and exchange）, four different connotations of the quality in healthcare provision （provision of high quality service, adequacy of time spent with patients, freedom in clinical decisions, and continuing relationships with patients）, as well as on respondents＇ background. Of the 248 healthcare workers, 183 completed the questionnaire. Hierarchical regression analysis was used to study the relationship between quality-oriented climate and outcome variables （quality in healthcare provision）. The results suggest that a quality-oriented climate does explain service quality in Healthcare settings： When an organization has implemented a quality-oriented climate, the service care provided by healtheare workers can determine an increase for three of the four investigated aspects of quality service provision （quality of care, freedom to make clinical decisions to meet patients＇ needs, and continuing relationships with patients）. The paper demonstrates that the offer of quality services involves in a different way the various healthcare professionals and/or management staff. This research provides interesting findings for healthcare manager in Health Service settings regarding the management of a quality-oriented process of service provision.

Referral and counter-referral practices in obstetric emergencies among health-care providers in selected health facilities in Plateau state,Nigeria

Objective:This study aimed to examine the referral and counter-referral practices in obstetric emergencies among health-care providers in selected health facilities in Plateau state of Nigeria.Materials and Methods:A concurrent embedded descriptive mixed method consisting of both quantitative and qualitative methods was adopted for the study.Participants(104)were recruited using multistage sampling and 8 participants using purposive sampling techniques for quantitative and qualitative aspects of the study,respectively.The three-phase delay model directed the study.A self-developed structured questionnaire and an in-depth interview guide were used to elicit quantitative and qualitative responses from the participants.Quantitative instrument was tested for reliability,while the qualitative instrument went through the rigors of qualitative data.Results:Findings revealed low level of referral and counter-referral practices as only 19(18.27%)and 30(28.85%),respectively,of care providers referred patients above 10 times in a year.The study also revealed inadequate human and material resources for referrals and counter-referrals.The mean on barriers to referral was 2.90,which was above the cutoff of mean of 2.50,which indicates that the barriers are militating against referral and counter-referral in obstetric emergencies.Conclusions:Low levels of referral and counter-referral practices are identified with inadequate resources among others posing as barriers.Therefore,provision of standard operational procedures/protocols in every health-care facility as well as provision of adequate material and skilled human resources among others is recommended to enhance referral and counter-referral network in obstetric emergencies.There is also a need for teamwork and synergy among all stakeholders in the referral chain.

Health Providers’ Points of View on the Impact of the Project to Strengthen the Expanded Program of Routine Vaccination from 2014 to 2018 in the Barumbu Health Zone in Kinshasa, Democratic Republic of Congo

According to the World Health Organization, approximately 3 million deaths are prevented each year in the world thanks to vaccination and then, in addition, each year, it makes it possible to avoid nearly 750,000 children suffering from serious physical, mental or neurological handicaps and 1.5 million other deaths could be avoided if the vaccination coverage is improved. However, vaccination coverage is often not achieved due to various difficulties encountered by health providers in the expanded program on vaccination activities. Yet, it is important to strengthen the program. This research paper aimed to assess health providers’ points of view on the impact of the project to strengthen the routine expanded program on vaccination in the Barumbu health zone in Kinshasa, Democratic Republic of Congo (RDC). To do so, we surveyed a convenience sample of 234 health providers involved in the implementation of the project, including 210 community relays, 9 permanent nurses, 9 health committee chairpersons and 6 health authorities. A questionnaire related to the objective of the research was submitted to them. After analyzing the data, we found that the points of view of health providers are negative. The performance of the vaccination program was not great. Several reasons were given for this, including the non-involvement of the political and administrative authorities, the failure to respect the funds disbursement circuit and the non-effective financing of vaccination activities in the Barumbu health zone in Kinshasa, DRC.

Hepatitis B Virus (HBV) Infection in Pregnancy: Knowledge and Practice of Care Providers in Nigeria

Purpose: To determine the practice of obstetric care providers regarding routine screening for hepatitis B virus infection, and to assess their knowledge of the management of the positive pregnant women. Methods: A cross sectional descriptive study of obstetric care providers in southwestern Nigeria. Mean and standard deviation was used to summarize continuous variables while frequency and percentage was used for categorical variables. Categorical variables were compared with chi-square test and Fisher’s exact tests as appropriate;while continuous variables were compared using the t-test. The level of statistical significance was set at P ≤ 0.05. Scoring of the outcome variables for knowledge was done, and the score categorized into good and poor knowledge, depending on if the respondent scored above or below the mean score. Results: Three hundred and eighty-one (67.4%) of the care givers routinely screen pregnant women for the serum marker (HBSAg) of HBV infection. Two hundred and seventy-four (48.5%) of the respondents had good knowledge score of the management of HBV infection in pregnancy. Routine screening for HBV infection was significantly associated with age (p = 0.002), years of practice (p < 0.001), specialty (p = 0.001) and professional cadre (p < 0.001), while knowledge was significantly associated with age (p = 0.012), years of practice (p = 0.003), specialty (p = 0.047) and types of practice (p = 0.014). Conclusion: Screening for HBV infection in pregnant women is not universal in southwestern Nigeria, and the care providers have poor knowledge of the management of the positive mothers.

Healthcare Providers' Perceptions of the Sexual and Reproductive Health Needs (Including Family Planning) of Elderly Women from Selected Sites in Botswana

Much of the sexual and reproductive health services and service delivery including family planning target women of child bearing ages (15 - 49 years) and sometimes men. Hardly are there programmes/interventions that specifically target the needs of the elderly women (50 years and above), yet this group has serious sexual and reproductive health needs as many of them are still sexually active. This cross-sectional study obtained the views of a stratified random sample of 169 healthcare providers (doctors, nurses and pharmacists) from four selected sites, Gaborone, Selibe Phikwe, Barolong and Kweneng East health districts in Botswana on how the healthcare system in the selected sites is meeting the SRH/FP needs of the elderly women. The study found out that while overwhelming majority of the healthcare providers feltthat the healthcare system has no programme that specifically target the SRH/FP needs of this significant others and their SRH/FP needs are not being met ,less than 15% indicated that Pap smear screening as well as screening of cervical cancer were on-going. Although there are SRH/FP services available in the healthcare system, the elderly women are minimally accessing these services. Only condom, combined oral contraceptives, progestogen-only pills, treatment of STIs, screening for HIV/AIDS and screening for cervical cancer are accessed and information is also limited to these services. Reasons given by the healthcare providers for the non-accessibility of these services were cultural diversity (80%), people's sexual behavior and perceptions about sex (79%), lack of knowledge about the desired SRH/FP services (76%), religion (73%) and gender issues (62%). The study, advocates as part of policy options to mitigate the obstacles to accessing SRH/FP services, the expansion of counseling programmes, screening and treatment for breast cancer, public awareness campaigns, production and circulation of appropriate educational materials, effective training of healthcare providers and the establishment of separate clinic days for the elderly women' SRH/FP services.

DOST Model’ for DR-TB Patients, New Delhi: Perspectives of Healthcare Providers

Introduction: In India, tuberculosis continues to be a major public health problem and there is a growing concern about drug-resistant tuberculosis as most of the patients are from private sector. The National TB Elimination Programme (NTEP) in collaboration with TB Alert, India (TBAI) and Clinton Health Association of India (CHAI) had implemented a collaborative project to strengthen the network between the private practitioners and public healthcare facilities in New Delhi during 2019 and 2020. Methods: A study was conducted to understand the enablers and challenges encountered by them during the implementation of the project. This is a qualitative exploration of the “healthcare providers” on a project linking DR-TB patients in private sector with government health facilities. The process of data collection involved face-to-face in-depth interviews of healthcare providers, the Doctors mainly from private and public health facilities, the paramedical workers from general health system and paramedical from the project using an interview guide administered through a trained researcher. Results: The study findings revealed that all healthcare providers were completely aware of the DOST project in the health system, the model led to early diagnosis and initiation of quality treatment. There were no major challenges to the implementation of the project. The healthcare providers wish to have this project implemented for a longer duration. Conclusion: The perspectives of healthcare providers towards the “DOST” project were optimistic and call for re-initiating the project in the area.

The Pattern of Women’s Reliance on Family Planning Providers in Egypt

Understanding choice of family planning provider is fundamental for policy makers and program managers as they seek ways to both improve the coverage and increase the sustainability and efficiency of family planning services for Egypt to achieve its population objectives. This study focuses first on providing a descriptive profile of the patterns of reliance on sources of family planning services during the early 2000s. Binomial logit models are then estimated to obtain a more in depth understanding of the determinants of the choice of family planning providers in Egypt using the 2000 Egypt Demographic and Health Survey. The study offers insights into a number of aspects of family planning service provision about which there has been less previous investigation. There are marked differences in the extent to which Egyptian women rely on public or private providers for family planning services depending on the type of method they are seeking. Among the more important findings is the consistency women display in the choice of provider among women reporting multiple segments of use. With regard to the determinants of the choice of provider for family planning services, perhaps the most interesting finding is that household wealth was not a significant determinant of the choice of provider. This may reflect that private sources met the demand for family planning services of significant proportions of women in rural areas and among those in the low income groups.

The Impact of Water Price on the Financial Sustainability of the Palestinian Water Service Providers

The impactof water sales price on the performance of water service providers is typically something of a mystery. High prices mean more revenue and profit;but it may lead to less bills collection and encourage the illegal connections. Yet, this argument has not been fully addressed in the Palestinian water sector;this research evaluates the effect of average water prices on the financial sustainability key indicators as collection efficiency, profit or loss percentage, non-revenue water, staff productivity, daily consumption, operating, and maintenance cost. The average price of cubic meter sold is segmented into low, medium, and high categories. Multivariate analysis shows that there are significant differences in profit or working ratio, daily consumption, and operating cost based on the different price categories. Further significant differences have been found in non-revenue water, collection efficiency, and water production based on low and high price categories. On the other hand, no significant difference has been found in staff productivity. The results show high price set by Palestinian water providers, leads to an increase in the bill collection rate and profit margin. However, negative relationship has been found between the price on one hand, and non-revenue water, average daily consumption, and water production on the other hand. The implication of these findings reveal that the Palestinian water providers should increase water prices gradually to cover operating and maintenance cost for better financial performance and sustainability.

Does Quality of Care Differ When HIV Patients Are Treated by Non-Specialist and Specialist HIV Healthcare Providers in Developed Countries? A Systematic Narrative Review

Introduction: In developed countries, HIV care is mostly provided by trained specialist healthcare professionals. Due to the increasing demand for HIV care, pressure on healthcare providers to reduce cost and the current global economic constraints, many developed countries are searching for alternative HIV care models. This review aims to consider whether HIV treatment and care can be provided as effectively and safely by doctors and nurses with no HIV-specialist training compared to those with HIV-specialist training. Methods: Three electronic bibliographic databases MEDLINE, EMBASE and the Cochrane Library were searched for studies conducted between January 1996 and March 2015. Manual searches of reference lists of all relevant reports retrieved from the electronic databases were conducted. All comparative studies examining the quality of HIV care provided by different types of healthcare providers in developed countries were included. Results: Nine observational studies involving 27,015 patients were included in the review. Eight studies were conducted in the USA and one study in Switzerland. Healthcare providers with HIV-related expertise and or training and those without HIV-related expertise or training who collaborated with providers with HIV-related expertise and or training outperformed other healthcare providers in many virological, immunological and ART-related outcomes. Conclusion: This review found moderate quality evidence that HIV care can be provided effectively by non-HIV specialists if they have access to HIV specialists or experts for advice and support.

Survival Analysis of Logistics Service Providers: An Empirical Study of Chengdu, Area in China

This paper worked on a sample of 6791 logistics establishments registered in Chengdu, China over the period 1984-2016 to understand the survival status of logistics service providers (LSPs) by non-parametric Kaplan-Meier estimation, together with Cox proportional hazard regression model, to identify factors affecting the failure of LSPs. In particular, it studies the interaction effect between LSPs’ size and entry timing and location. The empirical results show that: 1) Regarding the survival time, 1365 of the 6791 sample LSPs exited from the market by 2017. The exit rate is 20.1%, and the average life of the 6791 LSPs is about 6 years. 2) The survival of LSPs depends on their typology, ownership structure. And there is no significant difference in the probability of survival for both independent LSPs and logistics branches after controlling the effects of other variables. 3) Location and entry timing also play an important role in the survival of small-scale LSPs, but these factors cannot explain large-scale LSPs’ failure.

The Extent of Partograph Use and Associated Factors among Obstetric Care Providers in Government Hospitals in Southern Ethiopia: A Cross-Sectional Study

Background: Prolonged labor is a significant contributor to maternal morbidity and mortality. The World Health Organization encourages using the partograph to keep track and solve this issue. The extent of partograph use in Ethiopia, however, is hardly understood. This study aimed to ascertain the level of partograph use and related variables among obstetric care providers in government hospitals in southern Ethiopia. Methods: A cross-sectional institutional study was conducted among obstetric care providers in government hospitals in southern Ethiopia, from March to December 2015. The data were collected using a pre-tested questionnaire and format. To establish a statistical relationship, an odds ratio with a 95% confidence interval was utilized. Results: A total of 212 (55.1%) obstetric providers reported routine use of partograph to monitor labor. Midwives [AOR: 3.4, 95% CI: (1.2, 9.4)], clinical nurses [AOR: 3.0, 95% CI: (1.1, 7.6)], knowledge of partographs [AOR: 2.0, 95% CI: (1.2, 3.5)], positive attitudes toward partograph use [AOR: 3.7, 95% CI: (1.7, 7.7)], service of 2 - 5 years [AOR: 3.4, 95% CI: (2.8, 4.4)] and service of more than five years [AOR: 2.3, 95% CI: (2.0, 3.3)] were associated with partograph use. Conclusion: This study has shown that the use of partographs to monitor labor among obstetricians is consistent with other studies from developing countries. However, this does not mean that obstetric care does not need to be strengthened, as a significant proportion of obstetricians still do not use the partograph for labor monitoring. Therefore, it is recommended that midwives and nurses be given preference in the delivery of obstetric services, the knowledge and attitudes of providers be improved, and mechanisms be developed that can help keep senior care providers.

Rationale of a Cross Sectional Descriptive Study on Knowledge and Practices of Healthcare Providers on Postpartum Hemorrhage Management in Kinshasa, the Democratic Republic of the Congo

Background: Healthcare Providers’ knowledge and practice of postpartum hemorrhage (PPH) management are essential to reduce maternal morbidity and mortality. PPH is a public health problem due to the high maternal mortality (MM) associated with it worldwide (25%). Improving the quality of PPH management is a major challenge in low-income countries where, despite the progress made in its management, PPH remains a major contributor to maternal morbidity and mortality. Objective: We will evaluate the level of knowledge and practices of providers in the PPH management in Kinshasa in the Democratic Republic of the Congo (DRC). Methods: This study will be descriptive and cross-sectional. The minimum sample size will be 86. Our study population will consist of delivery room care providers. Results will be reported as percentage proportion and mean plus or minus standard deviation. Comparisons of means between groups will be made using Student’s t-test and Pearson’s chi-square test. The test will be statistically significant for a p value 0.05. Data will be collected and processed anonymously and confidentially. Conclusion: Improving quality of care must be a priority in obstetrics. This evaluation requires us to determine the level of knowledge and practices of providers in the PPH management in Kinshasa.

Sustainable tourism:a new international standard for accommodation providers

ISO 21401, Tourism and related services Sustainability management system for accommodation establishments Requirements, specifies the environmental, social and economic requirements for implementing a sustainability management system in tourist accommodation.

Mining and Modelling the Dynamic Patterns of Service Providers in Cellular Data Network Based on Big Data Analysis

Understanding the dynamic traffic and usage characteristics of data services in cellular networks is important for optimising network resources and improving user experience.Recent studies have illustrated traffic characteristics from specific perspectives,such as user behaviour,device type,and applications.In this paper,we present the results of our study from a different perspective,namely service providers,to reveal the traffic characteristics of cellular data networks.Our study is based on traffic data collected over a five-day period from a leading mobile operator's core network in China.We propose a Zipf-like model to characterise the distributions of the traffic volume,subscribers,and requests among service providers.Nine distinct diurnal traffic patterns of service providers are identified by formulating and solving a time series clustering problem.Our work differs from previous related works in that we perform measurements on a large quantity of data covering 2.2 billion traffic records,and we first explore the traffic patterns of thousands of service providers.Results of our study present mobile Internet participants with a better understanding of the traffic and usage characteristics of service providers,which play a critical role in the mobile Internet era.

Study on Task Assignment of Two-stage Multi-service Capability Port Logistics Service Providers

This paper mainly studies the problem of multi-task assignment of providers in port logistics service supply chain.As a core enterprise,port plays the role of logistics service integrator.With the continuous development of industrial integration,logistics service providers not only provide one kind of logistics service,but also develop into composite suppliers who capable of providing a variety of logistics services.This paper studies the task assignment problem of multi-service capability providers in the port logistics service supply chain.The two-stage logistics service provider task assignment model was built,which is based on the mixed evaluation method(including MOORA and FMEA)and the multi-objective planning method.Eventually,the effectiveness of the model method was verified by combining with an example.

Knowledge of coronavirus disease 2019(COVID-19) among healthcare providers: A cross-sectional study in Indonesia

Objective:To assess healthcare workers’knowledge of novel coronavirus disease 2019(COVID-19)in the early phase of the outbreak in Indonesia.Methods:A cross-sectional survey was conducted in 12 hospitals in Indonesia from March 6 to March 25,2020.Healthcare workers’knowledge on COVID-19 was assessed,and demographic data,workplace characteristics,and medical professional characteristics as well as the current local situation of COVID-19 were collected.To characterize determinants associated with knowledge,a logistic regression analysis was employed.Results:Out of 288 healthcare workers who completed the interview-assisted questionnaire,149(51.7%)respondents had a good knowledge.Nurses and other types of healthcare workers had lower odds of having good knowledge compared to doctors:adjusted odds ratio(aO R):0.38;95%CI:0.20-0.72 and aO R:0.31;95%CI:0.13-0.73,respectively.Compared to healthcare workers who had medical practice experience less than 5 years,those who had worked for more than 10 years had lower knowledge(a OR:0.43;95%CI:0.20-0.90).Healthcare workers who worked in the infection department had higher knowledge compared to those in the emergency room(aO R:14.33;95%CI:3.67-55.88).Conclusions:The knowledge of COVID-19 among surveyed healthcare workers was relatively low.The COVID-19 response in Indonesia will require further education and enhancement of the capacity of healthcare workers in the emergency room where COVID-19 patients may be treated the earliest.