Background Cardiovascular disease presents an increasing health burden to low- and middle-income countries. Although ample therapeutic options and care improvement frameworks exist to address its prime risk factor, hypertension, blood pressure control rates remain poor. We describe the results of an effectiveness study of a multisector urban population health initiative that targets hypertension in a real-world implementation setting in cities across three continents. The initiative followed the “CARDIO4Cities” approach (quality of Care, early Access, policy Reform, Data and digital technology, Intersectoral collaboration, and local Ownership). Method The approach was applied in Ulaanbaatar in Mongolia, Dakar in Senegal, and São Paulo in Brazil. In each city, a portfolio of evidence-based practices was implemented, tailored to local priorities and available data. Outcomes were measured by extracting hypertension diagnosis, treatment and control rates from primary health records. Data from 18,997 patients with hypertension in primary health facilities were analyzed. Results Over one to two years of implementation, blood pressure control rates among enrolled patients receiving medication tripled in São Paulo (from 12·3% to 31·2%) and Dakar (from 6·7% to 19·4%) and increased six-fold in Ulaanbaatar (from 3·1% to 19·7%). Conclusions This study provides first evidence that a multisectoral population health approach to implement known best-practices, supported by data and digital technologies, and relying on local buy-in and ownership, can improve hypertension control in high-burden urban primary care settings in low-and middle-income countries.
Cardiovascular disease (CVD) is the leading cause of mortality worldwide, with 80% of that mortality occurring in low- and middle-income countries. Hypertension, its primary risk factor, can be effectively addressed through multisectoral, multi-intervention initiatives. However, evidence for the population-level impact on cardiovascular (CV) event rates and mortality, and the cost-effectiveness of such initiatives is scarce as long-term longitudinal data is often lacking. Here, we model the long-term population health impact and cost-effectiveness of a multisectoral urban population health initiative designed to reduce hypertension, conducted in Ulaanbaatar (Mongolia), Dakar (Senegal), and in the district of Itaquera in São Paulo (Brazil) in collaboration with the local governments. We based our analysis on cohort-level data among hypertensive patients on treatment and control rates from a real-world effectiveness study of the CARDIO4Cities approach (built on quality of care, early access, policy reform, data and digital, Intersectoral collaboration, and local ownership). We built a decision tree model to estimate the CV event rates during implementation (1–2 years) and a Markov model to project health outcomes over 10 years. We estimated the number of CV events averted and quality-adjusted life-years gained (QALYs through the initiative and assessed its cost-effectiveness based on the costs reported by the funder using the incremental cost effectiveness ratio (ICER) and published thresholds. A one-way sensitivity analysis was performed to assess the robustness of the results. The modelled patient cohorts included 10,075 patients treated for hypertension in Ulaanbaatar, 5,236 in Dakar, and 5,844 in São Paulo. We estimated that 3.3–12.8% of strokes and 3.0–12.0% of coronary heart disease (CHD) events were averted during 1–2 years of implementation in the three cities. We estimated that over the subsequent 10 years, 3.6–9.9% of strokes, 2.8–7.8% of CHD events, and 2.7–7.9% of premature deaths would be averted. The estimated ICER was USD 748 QALY gained in Ulaanbaatar, USD 3091 in Dakar, and USD 784 in São Paulo. With that, the intervention was estimated to be cost-effective in Ulaanbaatar and São Paulo. For Dakar, cost-effectiveness was met under WHO-CHOICE standards, but not under more conservative standards adjusted for purchasing power parity (PPP) and opportunity costs. The findings were robust to the sensitivity analysis. Our results provide evidence that the favorable impact of multisector systemic interventions designed to reduce the hypertension burden extend to long-term population-level CV health outcomes and are likely cost-effective. The CARDIO4Cities approach is predicted to be a cost-effective solution to alleviate the growing CVD burden in cities across the world.
Objective: To evaluate the level of job satisfaction among the employees of maternity hospitals and to describe variables related to their job satisfaction. Methods: A cross-sectional study was undertaken that focused on 480 full time staff of three maternity hospitals located in the capital city of Mongolia, Ulaanbaatar. Data was collected between July 2019 and September 2019. We selected 3 hospitals as our sample target in order to assess an organizational management capability index using 9 chapters with 90 criteria that used over 30 local public organizations. The Minnesota Satisfaction Questionnaire was used as a data gathering tool to assess employee's satisfaction which measures on a five-point Likert scale. Results: Overall, 48.0 % of participants had low levels of satisfaction with their jobs. Factors that were statistically significant to employees' job satisfaction in the univariate analysis were entered into the logistic regression analysis including employees' professional title, department work hours, work requirements, and life and work stress. The results of the logistic regression analysis suggested that employees' job satisfaction was related to their age, working hours, leadership attention, wage and promotion as well as cooperation with colleagues. Conclusion: There is an urgent need for maternal hospitals in Mongolia to establish a more reasonable promotion and management system for employees and pay more attention to less-experienced staff and help them release their work stress.
Healthcare organizations are implementing quality management system by forming legal entity, by carrying out administrative structural changes and developing healthcare organization’s structure, set-up, functional standards, clinical guideline, rules and employee´ moral principles. Introduction of accreditation system into healthcare organizations is becoming an accepted standard, however, healthcare paradigm shift outcome is insufficient. In this connection, researchers, citizens and policy makers are speaking out that the quality of and access to healthcare service is getting worse than before. Management capability index presents management assessment by score, assesses outcome of organizational functions and makes it possible to measure management capability. This study was performed at the Amgalan maternity hospital, Urguu maternity hospital and Khuree maternity hospital between July 2019 and September 2019 and cross-sectional study method was used. The study involved 480 employees of above-mentioned hospitals. We used 9 chapter and 90 criteria that were used in more than 30 Mongolian Public (i.e., Governmental) Organizations for capability assessment to determine management capability index of the maternity hospitals. Organization management capabilities, as an organizational goal and task, leadership skill in an organization, appropriate structure and set-up, organization’s incentive and motivation leverage schemes, organization’s relationship and collaboration, organizational behavior and culture, resource utilization, knowledge and innovation, organizational productivity, quality and performance were included in the questionnaire. Organizations capability index was calculated with a score point of 1 to 5 for each question. A total 480 employees, including 220 from the Urguu maternity Hospital, 125 from the Khuree maternity hospital and 135 from the Amgalan maternity hospital were included in this study. When responses to the question of management capability were according to duties and functions, not much difference was observed among the three hospitals, but when the responses were compared with that provided by doctors, nurses, obstetricians and other medical staff, a 1.8 percentage higher point was given by the administrative and service staff. Regression analysis showed strong relation between management capability assessment of doctors, nurses, obstetricians and other employee of the select hospitals (p<0.001 and R=0.89). Organizational management capabilities of Urguu and Khuree Maternity Hospitals, which have not yet introduced quality management system, are different from the Amgalan maternity hospital’s organizational management capability (p=.000). Doctors, obstetricians, nurses and other employee’ assessed organizational management capability by 73.5 percent respectively. There is a positive correlation ship between organizational capability and employee satisfaction. Better and higher management capability of an organization results in higher employee satisfaction.
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