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Abraham Lincoln University Improving Healthcare Accessibility Globally Discussion

Hello buddy! Check the attached assignment and the reference materials.Running head: IMPROVING HEALTHCARE ACCESSIBILIY GLOBALLLYImproving Healthcare Accessibility GloballyStudent s NameInstitutional Affiliation1IMPROVING HEALTHCARE ACCESSIBILIY GLOBALLLY2Improving Healthcare Accessibility GloballyDelivering quality healthcare services was a top on the list of the millennium goals,and the beginning of 2000 saw increased activities in all countries aimed at achieving thisgoal. Evaluation of the MDG performance in 2015 indicated commendable improvements inhealthcare delivery, given the significant reductions in maternal and infant deaths, malaria,HIV/AIDS, and tuberculosis (Leslie et al., 2017). However, developing countries stillstruggle to meet the delivery of universal healthcare services. The developing countries havea high population coupled with few healthcare facilities, which causes an acute shortage ofpeople-centered, timely, safe, equitable, and efficient healthcare services. Both the developedand developing countries need to collaborate to ensure there is create a sustainable delivery ofhealthcare services globally.The shortage of healthcare workers is a significant setback in delivering qualityhealthcare, given the population increase. The world cannot achieve providing qualityhealthcare to the population unless the governments and healthcare agencies urgently addressthe shortage. Studies indicate that sub-Saharan countries spend only 1% of the world sfinancial resources on healthcare despite having the world s largest population and having atleast 24% of the world s disease burden. The data can be compared with that of the US where50% of world s financial resource is used on healthcare, and it has a 10% of the world sdisease burden (Edmonson et al., 2017). The margin indicates that developing countries needassistance in advancing healthcare delivery services by financing and employing morehealthcare workers.Lack of sufficient healthcare facilities is another challenge in developing countries.The available facilities are poorly equipped, and people have to seek advanced treatmentfrom advanced countries in Asia, America, and Europe. However, the challenge was reflectedmore after the COVID-19 pandemic, where the hospitals in both developed and developingIMPROVING HEALTHCARE ACCESSIBILIY GLOBALLLY3countries could not handle the large number of patients requiring admission into the hospitals.The phenomenon has raised the need for home-based care health services. Developing homebased healthcare services can be of great help even in the future where community healthworkers can check on home-based patients who can not access the hospital facilities. It alsocalls for advancement in medical technology for smaller and mobile equipment that is userfriendly (Durrani, 2016). Access to non-institutionalized care can significantly improve thedelivery of health care services.In conclusion, there has been a significant improvement in healthcare delivery sincethe MDGs were set, but there are still challenges that need to be addressed globally. Thehealthcare sector challenges worsened with the onset of coronavirus pandemic, where newtactics in delivering healthcare services such as engaging more health workers have beenprioritized. Lack of enough financial resources in developing countries is the majorcontribution of delays in the attainment of universal healthcare. The developed countries canhelp developing countries by financing the developing countries in healthcare sectorprojects.IMPROVING HEALTHCARE ACCESSIBILIY GLOBALLLY4ReferencesDurrani, H. (2016). Healthcare and healthcare systems: inspiring progress and futureprospects. Mhealth, 2(3), 1-9. C., McCarthy, C., Trent-Adams, S., McCain, C., & Marshall, J. (2017). EmergingGlobal Health Issues: A Nurse s Role. The Online Journal Of Issues In Nursing, 22(1). H., Sun, Z., & Kruk, M. (2017). Association between infrastructure and observedquality of care in 4 healthcare services: A cross-sectional study of 4,300 facilities in 8countries. PLOS Medicine, 14(12), e1002464. ARTICLEAssociation between infrastructure andobserved quality of care in 4 healthcareservices: A cross-sectional study of 4,300facilities in 8 countriesHannah H. Leslie*, Zeye Sun, Margaret E. Kruka1111111111a1111111111a1111111111a1111111111a1111111111Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston,Massachusetts, United States of America* [email protected] ACCESSCitation: Leslie HH, Sun Z, Kruk ME (2017)Association between infrastructure and observedquality of care in 4 healthcare services: A crosssectional study of 4,300 facilities in 8 countries.PLoS Med 14(12): e1002464. Editor: Lars ke Persson, LondonSchool of Hygiene and Tropical Medicine, UNITEDKINGDOMReceived: June 30, 2017Accepted: October 25, 2017Published: December 12, 2017Copyright: 2017 Leslie et al. This is an openaccess article distributed under the terms of theCreative Commons Attribution License, whichpermits unrestricted use, distribution, andreproduction in any medium, provided the originalauthor and source are credited.Data Availability Statement: The SPA files used inthis analysis are available for download from theDemographic and Health Surveys (DHS) Programwebsite. These data are publicly available butrequire permission from the DHS Program. DHSregistration can be obtained at the followingwebsite: This work was partially supported by theBill & Melinda Gates Foundation ( is increasingly apparent that access to healthcare without adequate quality of care is insufficient to improve population health outcomes. We assess whether the most commonlymeasured attribute of health facilities in low- and middle-income countries (LMICs) thestructural inputs to care predicts the clinical quality of care provided to patients.Methods and findingsService Provision Assessments are nationally representative health facility surveys conducted by the Demographic and Health Survey Program with support from the US Agencyfor International Development. These surveys assess health system capacity in LMICs.We drew data from assessments conducted in 8 countries between 2007 and 2015: Haiti,Kenya, Malawi, Namibia, Rwanda, Senegal, Tanzania, and Uganda. The surveys includedan audit of facility infrastructure and direct observation of family planning, antenatal care(ANC), sick-child care, and (in 2 countries) labor and delivery. To measure structural inputs,we constructed indices that measured World Health Organization-recommended amenities,equipment, and medications in each service. For clinical quality, we used data from directobservations of care to calculate providers adherence to evidence-based care guidelines.We assessed the correlation between these metrics and used spline models to test for thepresence of a minimum input threshold associated with good clinical quality. Inclusion criteria were met by 32,531 observations of care in 4,354 facilities. Facilities demonstrated moderate levels of infrastructure, ranging from 0.63 of 1 in sick-child care to 0.75 of 1 for familyplanning on average. Adherence to evidence-based guidelines was low, with an average of37% adherence in sick-child care, 46% in family planning, 60% in labor and delivery, and61% in ANC. Correlation between infrastructure and evidence-based care was low (median0.20, range from 0.03 for family planning in Senegal to 0.40 for ANC in Tanzania). Facilitieswith similar infrastructure scores delivered care of widely varying quality in each service.We did not detect a minimum level of infrastructure that was reliably associated with higherPLOS Medicine | December 12, 20171 / 16Association between infrastructure and observed quality of caregatesfoundation.org/) grant OPP1161450 (MEK)and the McLennan Family Fund at the Harvard T.H.Chan School of Public Health ( (MEK). The funders had no role instudy design, data collection and analysis, decisionto publish, or preparation of the manuscript.Competing interests: I have read the journal spolicy and the authors of this manuscript have thefollowing competing interests: MEK is a member ofthe Editorial Board of PLOS Medicine.Abbreviations: ANC, antenatal care; ICC, intraclasscorrelation; IQR, interquartile range; LMICs, lowand middle-income countries; MDG, MillenniumDevelopment Goal; SARA, Service Availability andReadiness Assessment; SDG, SustainableDevelopment Goal; SPA, Service ProvisionAssessment; WHO, World Health Organization.quality of care delivered in any service. These findings rely on cross-sectional data, preventing assessment of relationships between structural inputs and clinical quality over time;measurement error may attenuate the estimated associations.ConclusionInputs to care are poorly correlated with provision of evidence-based care in these 4 clinicalservices. Healthcare workers in well-equipped facilities often provided poor care and viceversa. While it is important to have strong infrastructure, it should not be used as a measureof quality. Insight into health system quality requires measurement of processes and outcomes of care.Author summaryWhy was this study done? Improved quality of care is increasingly recognized as a necessary step towards achievement of better population health outcomes in low- and middle-income countries. Much of the current measurement effort focuses on inputs to care. It is not known whether such measures provide insight on the quality of care delivered.What did the researchers do and find? We quantified facility infrastructure using international guidelines for readiness in eachservice applied to health facility audits in 8 countries; we defined quality of clinical carebased on adherence to evidence-based protocols measured using direct observation inthe same facility assessments. We calculated the level and correlation of infrastructure and average adherence toguidelines for each of 4 clinical services in this sample: family planning (1,842 facilities),antenatal care (1,407 facilities), delivery care (227 facilities), and sick-child care (4,038facilities). Infrastructure scored higher than observed clinical quality in each service, and the correlation between the 2 was modest.What do these findings mean? Assessment of infrastructure is insufficient to estimate the quality of care delivered towomen and children in need. Measurement priorities should be reassessed to support more timely information forquality improvement purposes and more pertinent information on the quality of caredelivered for monitoring and comparison.PLOS Medicine | December 12, 20172 / 16Association between infrastructure and observed quality of careIntroductionThe first decade of the 2000s saw a dramatic increase in global health activity, with doubledigit increases in international development assistance for health [1], reflecting the globalfocus on the HIV epidemic and intensified efforts to meet the Millennium Development Goals(MDGs) [2]. Two lessons learned in the pursuit of the health MDGs have particular saliencefor the current effort to achieve Sustainable Development Goal (SDG) 3: ensuring healthy livesand promoting well-being for all at all ages [3]. First, measurement can drive progress. Withthe assistance of several global initiatives, including the Countdown to 2015 and the GlobalBurden of Disease Study, countries closely tracked and compared population coverage ofessential health services. As a result, remarkable global and national increases in coverage ofservices such as facility-based delivery and measles vaccination were achieved [2]. Improvements in health-related indicators that were MDG targets outstripped those in non-MDG targets by nearly 2-fold [4]. Second, for many conditions, increased access to care is insufficientto improve population health when care is of poor quality. In areas such as maternal and newborn health, studies from India, Malawi, and Rwanda have demonstrated that expanded accessto formal healthcare has failed to yield survival benefits [5 7]. It is increasingly apparent thatthe path to achievement of SDG 3 will require similar attention to the measurement andimprovement of healthcare quality as the MDG era brought to healthcare access [8,9].Quality of care has been defined as the degree to which health services for individuals andpopulations increase the likelihood of desired health outcomes and are consistent with currentprofessional knowledge [10]. Efforts to operationalize this broad definition have included theidentification of key characteristics of quality, namely care that is safe, timely, effective, equitable, efficient, and people centered [11,12]. Health system theorists further agree that the delivery of high-quality care is contingent on adequate readiness of the health system or programand, once delivered, should yield impacts from improved health to client satisfaction [13,14].In the same vein, measures of healthcare quality have traditionally been divided into 3domains: structure or inputs to care, process or content of care, and outcomes of care [15].Each domain has advantages and disadvantages: inputs are the necessary foundations for carebut are not sufficient to describe its content or effects, process measures pertain directly tocare delivery but are challenging to collect, and outcome measures assess the ultimate goal ofthe health system but reflect many factors beyond the health system itself.In low- and middle-income countries (LMICs), information on healthcare quality is sparse[16]. A major source of data on health system performance has been standardized facility surveys, with over 100 unique surveys completed in the last 5 years alone [17 22]. Implementation of facility surveys is costly and typically supported by multilateral donor organizationssuch as the World Bank; World Health Organization (WHO); Global Fund for AIDS, Tuberculosis and Malaria; and the US Agency for International Development [20,21]. Among themost commonly used facility surveys is the Service Availability and Readiness Assessment(SARA), developed by WHO [22]. The SARA aims to measure facility readiness to provideessential care and hence focuses on inputs such as infrastructure, equipment, supplies, andhealth workers. Completion of a SARA survey costs a minimum of US$100,000 to generatenational estimates for a small to medium country; more complex sampling to generate regionalestimates can require several times that amount [23]. Other facility surveys also focus on inputmeasures. For example, of 20 survey tools assessing health facility quality and readiness forfamily planning, 7 are limited to structural quality alone; across all 20 tools, indicators of structure are collected 5 times more frequently than indicators of process [18]. A review of 8,500quality indicators used to assess performance-based financing programs found that over 90%measured structural aspects of quality [24]. The emphasis on input-based measures shapesPLOS Medicine | December 12, 20173 / 16Association between infrastructure and observed quality of carehealth system research and monitoring: in the growing area of effective (quality-adjusted) coverage assessment, multiple studies look to input-based measures to estimate capacity to provide high-quality care [25 27].The reliance on inputs to measure quality in LMICs reflects the notion that these are necessary for good care. However, while some inputs are clearly essential for care provision (e.g.,health workers must be present; drugs must be in stock), it is not clear that overall availabilityof inputs is related to health processes or outcomes [28 31]. With growing attention to qualityof care as a driver of future health gains and scarce resources available for measurement, selecting the right measures is important. Is infrastructure a reasonable proxy for quality of clinicalcare?In this paper, we compare structural and process quality of 4 essential health services family planning, antenatal care (ANC), delivery care, and sick-child care using data fromnationally representative samples of health facilities in 8 LMICs. The aims of this work are todescribe facility inputs and observed adherence to guidelines for good clinical care for theseservices and to assess the strength of the relationship between these measures.MethodsEthical approvalThe original survey implementers obtained ethical approval for data collection; primary datado not include identifiable patient information. The Harvard University Human ResearchProtection Program approved this secondary analysis as exempt from human subjects review.Study design and sampleThe Service Provision Assessment (SPA) is a standardized survey designed to measure thecapacity of health systems in LMICs. It is conducted by the Demographic and Health SurveyProgram of the US Agency for International Development in coordination with a national statistics agency in the countries surveyed. All health facilities in each country are listed, and anationally representative sample is selected. The facility assessment includes a standard setof tools: an audit of facility services and resources, interviews with healthcare providers, anddirect observation of the provision of clinical services.In this analysis, we pooled data from all SPA surveys conducted between 2007 and 2015that included observations of family planning, ANC, delivery care, and/or sick-child care.The surveys were from Haiti (2013), Kenya (2010), Malawi (2014), Namibia (2009), Rwanda(2007), Senegal (2013 2014), Tanzania (2015), and Uganda (2007). Surveys in Kenya, Senegal,Tanzania, and Uganda are nationally representative samples of the health system; those inHaiti, Malawi, Namibia, and Rwanda are censuses or near censuses. Observations were conducted in all services in all countries with the exception of delivery care, which was observedonly in Kenya and Malawi. Patients are selected for observation using systematic random sampl

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