Background: Annually 6.2 million unnecessary Cesarean Deliveries (CD) are performed globally. Such high unnecessary CD rate is a concern not only due to the additional financial burden it places on the health system, but also because the quality of care could be compromised. There is an even more imperative need to reduce elective surgeries in moving towards the Universal Health Coverage (UHC), to ensure the ever stretched resources are effectively channeled for the best health outcomes.
Methods:The paper uses a case study method. China and Brazil were selected primarily due to their alarmingly high number and percentage of the CD rate. Systematic literature review was conducted and the analyses were structured based on the framework "Determinants of High Cesarean Delivery Rates", developed by the authors.
Results:In China and Brazil, cultural belief, fear of labor pain and patient's perception regarding quality of care may play a role in the patient's preference for CD but these perceptions are shaped by their health care providers as well. The principal-agent relation comes into play as the health professionals can modify perceived needs of their patients. Availability of health insurance to mothers, physicians' preference for convenient working hours, and payment incentives for performing higher yielding Cesarean procedures are driving the high CD rate phenomena in China and Brazil.Understand the social determinants of CD and using various instruments to change women's perceptions of birthing options and physicians' behaviors are critical in managing the CD rate.
Conclusion:In the context of the rapid movement towards UHC, the evidence presented in this paper supports the call for implementing complementary policy interventions and regulation to ensure minimal efficiency loss due to resources being diverted to unnecessary procedures or hospital stays.
(1) Background: Antimicrobial resistance causes significant disease burden in low- and middle-income countries. The objective of this paper is to describe antibiotic dispensing/prescribing practices and underlying factors associated with these practices among community-based healthcare workers. (2) Methods: Cross-sectional survey data were collected from private and public health facilities in 14 union councils, Lahore Pakistan. Respondents included physicians, nurses, lady health workers/volunteers, midwives, pharmacy and medicine shop employees, and medical technicians. Descriptive and bivariate analysis are used to present the data; (3) Results: 177 respondents completed the survey. In terms of weekly dispensing of antibiotics, the most common were Amoxicillin/Augmentin (2.3 [SD 1.5]), Cefixine (2.4 [SD 1.6]), and Azithromycin (2.5 [SD 2.1]). For children, antibiotics were more likely to be prescribed/dispensed for sore throat (54.3%/95) and diarrhea (48.9%/86). For adults, antibiotics were more likely to be prescribed/dispensed for sore throat (67.0%/118), diarrhea (59.7%/105) and burning sensation when urinating (55.7%/176). In total, 55.4% of respondents stated that they have sold partial antibiotic courses to patients/customers. A total of 44.6% of respondents incorrectly answered that antibiotics could be used for viral infections; (4) Conclusions: Data from this study and similar research emphasize the urgent need to implement community-based stewardship programs for all healthcare workers.
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