BackgroundPrevious studies show that health systems governance influences health system performance and health outcomes. However, there are few examples of how to implement and monitor good governing practices in fragile and conflict affected environments. Good governance has the potential to make the health system people-centered. More research is needed on implementing a people-centered governance approach in these environments.Case descriptionWe piloted an intervention that placed a people-centred health systems governance approach in the hands of multi-stakeholder committees that govern provincial and district health systems. We report the results of this intervention from three provinces and eleven districts in Afghanistan over a six month period. This mixed-methods exploratory case study uses analysis of governance self-assessment scores, health management information system data on health system performance, and focus group discussions. The outcomes of interest are governance scores and health system performance indicators.We document the application of a people-centred health systems governance conceptual model based on applying four effective governing practices: cultivating accountability, engaging with stakeholders, setting a shared strategic direction, and stewarding resources responsibly. We present a participatory approach where health system leaders identify and act on opportunities for making themselves and their health systems more accountable and responsive to the needs of the communities they serve.Discussion and evaluationWe found that health systems governance can be improved in fragile and conflict affected environments, and that consistent application of the effective governing practices is key to improving governance. Intervention was associated with a 20% increase in antenatal care visit rate in pilot provinces. Focus group discussions showed improvements across the four governing practices, including: establishment of new sub-committees that oversee financial transparency and governance, collaboration with diverse stakeholders, sharper focus on community health needs, more frequent presentation of service delivery data, and increased use of data for decision making.ConclusionsOur findings have implications for policy and practice within and beyond Afghanistan. Governance is central to making health systems responsive to the needs of people who access and provide services. We provide a practical approach to improving health systems governance in fragile and conflict affected environments.Electronic supplementary materialThe online version of this article (doi:10.1186/1752-1505-9-2) contains supplementary material, which is available to authorized users.
Background: Ageing women suffer problems associated with senility along with that of the reproductive tract changes. Unless the woman is treated as a whole, her problem is actually not addressed. With this background, the present study was undertaken with the following objectives: to identify the major health problems of postmenopausal women, to determine the level of knowledge, attitude and practices of postmenopausal women in terms of seeking Health care facilities for their problems and to determine the utilization pattern and barriers to utilization of health care services by these women. Methods: It was a community based cross-sectional study conducted in the registered field practice areas of the
Poor governance contributes to poor health outcomes and may constrain a country's progress in attaining its health goals. Yet, governance is not commonly used as a lever to improve the health sector or health system performance. Lack of a clear body of evidence linking governance interventions to better health system performance is one likely reason. This quasi-experimental study conducted in Afghanistan examines the causal impact of a provincial health governance intervention on the provincial health system's performance. It compares health system performance indicators between 16 intervention provinces and 18 nonintervention provinces using a difference-in-differences analysis to draw inference. The intervention consisted of governance action planning, implementation of the governance action plan, and self-assessment of governance performance before and after the intervention. The intervention had a statistically and practically significant impact on six indicators. Specifically, the intervention increased a province's rate of outpatient department visits per person by an average of 18 percentage points and achievements in Penta 3 immunization, antenatal visits, postnatal visits, tuberculosis case detection, and facility delivery by 17, 14, 12, 11, and five percentage points, respectively (P < 0.01). No impact was detected on tetanus toxoid administration to pregnant mothers and tuberculosis cure; a marginally negative impact was seen in community health worker home visits and new family planning users. Governing bodies provide an opportunity for governance reform. Improving health system governance is relevant to the current situation in low-income countries, where weak health systems are a significant barrier to addressing epidemics and providing high-quality health services.
BackgroundNational public health associations (PHAs) are key partners with governments and communities to improve, protect and promote the public’s health. Governance and organizational capacity are among the key determinants of a PHA’s effectiveness as an advocate for appropriate public health policies and practice.MethodsDuring 2014, the World Federation of Public Health Associations (WFPHA) conducted an on-line survey of its 82 PHA members, to identify the state of organizational governance of national public health associations, as well as the factors that influence optimal organizational governance. The survey consisted of 13 questions and focused on the main elements of organizational governance: cultivating accountability; engaging stakeholders; setting shared direction; stewarding resources; and, continuous governance enhancement. Four questions included a qualitative open-ended response for additional comments. The survey data were analyzed using Microsoft Excel. The qualitative data was analyzed using thematic content analysisResultsResponses were received from 62 PHAs, constituting a 75.6 % response rate. The two most important factors that support governance effectiveness were a high degree of integrity and ethical behavior of the PHA’s leaders (77 %) and the competence of people serving on the PHA’s governing body (76 %). The lack of financial resources was considered as the most important factor that negatively affected organizational governance effectiveness (73 %). The lack of mentoring for future PHA leaders; ineffective or incompetent leadership; lack of understanding about good governance practices; and lack of accurate information for strategic planning were identified as factors influencing PHA governance effectiveness. Critical elements for PHA sustainability included diversity, gender-responsiveness and inclusive governance practices, and strategies to build the future generation of public health leaders.ConclusionNational PHA have a responsibility to put into place the practices and infrastructure that enhance organizational governance. This will enhance their ability to be effective advocates for policies and practices that enhance, protect and promote the public’s health. The WFPHA has an important role to play in providing the technical assistance and financial resources to assist PHAs in attaining and sustaining a higher level of governance capacity.
INTRODUCTION Menstruation is a part and parcel of women's physiology starting of which is associated with a number of physical, hormonal, and psychological changes in the body of adolescent girls. These changes mostly results in a lot of stress and physical problems in the girls. Menstruation is dealt with secrecy in most of the underdeveloped and developing countries including India. Discussion on menstruation and menstrual problems is regarded as taboo especially among rural communities. A study on Indian women by Narayan et al revealed that young girls are generally told nothing about Menstruation. 1 Hence, knowledge and information about reproductive functioning and reproductive health problems amongst the adolescent is poor. 2,3 No wonder that menses is associated with many complaints in girls. These complaints are mostly related to either flow of blood or ABSTRACT Background: Menses is associated with many complaints in girls. Very little work is done on prevalence of menstrual problems among Indian population. Problem of pain is by far the most common problem reported by majority of girls. This has an impact on public and occupational health. In India the girls hesitate to discuss these problems even with their parents. Thus most of the time either they do not take any medication to resolve their problem, or take some pills on their own to get relief. Finding out the common menstrual problems and the pattern of medication use will be helpful in planning a health care program for the population. Objectives of the study were to assess the prevalence of common menstrual complaints among undergraduate students of Moradabad region and to assess the pattern of medication, used by them, for these complaints. Methods: 396 female first year students pursuing undergraduate course were studied with the help of a structured pilot tested questionnaire. Results: 93.4% girls were found to have some or the other complaint during menstruation. Body-ache (64%) was the most common complaint reported followed by pain in abdomen (59%) and backache (57%). 37.9% subjects reported to use some medicine for menstrual problems. 65.3% of those who used medicine used it for pain in abdomen, either alone or in combination with some other complaints. Only 23.9% of those belonging to rural background consulted doctor before using medicine, as against 48.3% of those belonging to urban background. Conclusions: Present study shows a high prevalence of medical problems during menstruation. Mostly medicines were used for the pain in abdomen either alone or in combination with other complaints. Menstrual problems constitute an important unmet area of reproductive health services. Packages of reproductive health care should include modules for education, diagnosis and treatment of most menstrual morbidities.
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