The study found evidence that health system factors do impact on the capacity to implement TBIC. Further, factors beyond TBIC such as sociocultural factors have an important influence on the way TBIC is implemented. The results of this study are useful for clinicians, health administrators and policymakers to improve the interventions and application of TBIC procedures at the rural health facilities in PNG. The study is limited to health services in Madang Province, and therefore the findings cannot automatically be generalised to other district hospitals and health centres in other parts of PNG. However, the WHO TBIC is a standardised policy and the results of the findings may be useful for other health facilities that manage TB patients in PNG and for future health systems researchers to help improve the generalisability of the findings. Further research is needed to explore health workers' experiences of conditions, actions and everyday practical issues affecting the application of TBIC measures in the rural health facilities of PNG.
Background Papua New Guinea (PNG) is one of the 14 countries categorised as having a triple burden of tuberculosis (TB), multidrug-resistant TB (MDR TB), and TB-human immunodeficiency virus (HIV) co-infections. TB infection prevention and control (TB-IPC) guidelines were introduced in 2011 by the National Health Department of PNG. This study assesses the implementation of this policy in a sample of district hospitals in two regions of PNG. Methods The implementation of TB-IPC policy was assessed using a survey method based on the World Health Organization (WHO) IPC assessment framework (IPCAF) to implement the WHO’s IPC core components. The study included facility assessment at ten district hospitals and validation observations of TB-IPC practices. Results Overall, implementation of IPC and TB-IPC guidelines was inadequate in participating facilities. Though 80% of facilities had an IPC program, many needed more clearly defined IPC objectives, budget allocation, and yearly work plans. In addition, they did not include senior facility managers in the IPC committee. 80% (n = 8 of 10) of hospitals had no IPC training and education; 90% had no IPC committee to support the IPC team; 70% had no surveillance protocols to monitor infections, and only 20% used multimodal strategies for IPC activities. Similarly, 70% of facilities had a TB-IPC program without a proper budget and did not include facility managers in the TB-IPC team; 80% indicated that patient flow poses a risk of TB transmission; 70% had poor ventilation systems; 90% had inadequate isolation rooms; and though 80% have personal protective equipment available, frequent shortages were reported. Conclusions The WHO-recommended TB-IPC policy is not effectively implemented in most of the participating district hospitals. Improvements in implementing and disseminating TB-IPC guidelines, monitoring TB-IPC practices, and systematic healthcare worker training are essential to improve TB-IPC guidelines’ operationalisation in health settings to reduce TB prevalence in PNG.
Introduction: Healthcare service is an essential determinant to population health. This qualitative case study aims to explore health service users’ perspective of effective health services delivery and the current challenges affecting the management and delivery of health services at a primary healthcare facility in Madang Province, Papua New Guinea (PNG). Methods: Qualitative data were collected using semi-structured interviews with key informants (KI) representing academics, undergraduate students, administration staff, patients and healthcare workers. The interviews covered three main areas: users’ views of effective health services, current challenges affecting effective planning and management of primary healthcare services, and interventions to improve health services planning and delivery. Results: The services users associated effective health services delivery with increased availability, accessibility, acceptability, and quality healthcare. Many factors exist to influence the effective planning and delivery of health services. The results show that health systems and personal factors have a major influence on the planning and health services delivery. Conclusion: The findings from this study call for an evaluation of the current healthcare system, particularly at the primary healthcare level, as the primary point of contact to the formal healthcare system, and the need for developing a contextual model of healthcare that meet the needs of the service users. We concluded that if health services users’ perspectives are considered in health policy, the local community may experience significant improvement in health status.
Background: Tuberculosis (TB) is a highly transmissible infectious disease killing millions of people yearly. Implementing TB infection prevention and control (TB-IPC) is pivotal to preventing TB transmission in health institutions. This study aimed to investigate diverse stakeholders’ perspectives relating to barriers and strategies of TB-IPC in rural hospitals in Papua New Guinea (PNG). Methods: Multiple qualitative case studies were conducted with 32 key stakeholders with experience in TB services in rural hospitals. Data collection drew on three primary sources to triangulate data: semi-structured interviews, document reviews, and field notes. The data were analysed using hybrid thematic analysis. Results: Our results reveal that key stakeholders perceive multiple interdependent factors that affect TB-IPC. The key emerging themes include strategic planning for and prioritising TB-IPC, governance, leadership, and accountability at the provincial and district level, community attitudes towards TB control, institutional capacity to deliver TB, healthcare workers’ safety, and long-term partnership and integration of TB program. Conclusion: The evidence suggests that a multi-perspective approach to TB-IPC programs is needed for effectively implementing TB-IPC guidelines in healthcare institutions. Interventions focusing on addressing health systems strengthening may improve the implementation of TB-IPC guidelines.
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