Browsing by Author "Udayakumar, Krishna"

Given the rising budget constraints facing NHS overall, the aim of this study was to assess the barriers, facilitators and attitudes towards Reverse Innovation in NHS England. In this study Reverse Innovation was defined as a healthcare innovation from a Low or Middle Income Country (LMIC) adapted and implemented in a High Income Country. Eight semi-structured interviews were conducted with participants in order to ascertain their experiences with Reverse Innovation in NHS England. A thematic analysis identified systematic barriers to Reverse Innovation were identified as well as potential barriers to Reverse Innovation. Innovation Vetting protocols and procedures were identified as a key barrier to Reverse Innovation with the NHS. Given this, Barriers to Reverse Innovation in NHS England appear to be similar to those faced by other types of innovation. Recommendations generated for NHS England include streamlining the innovation vetting process as well as ensuring that formal partnerships, such as THET are indeed reciprocal. Recommendations for LMIC innovators include highlighting the frugality of their innovations and partnering with an Academic Health Science Network or similar organization before entering the NHS market.

Background: Peru had more COVID-related deaths per capita than any other country. Given its relative wealth as an Upper Middle Income Country, Peru did not receive many COVID vaccine donations through COVAX, and challenges directly negotiating for vaccines with pharmaceutical companies delayed Peru’s initial response. However, once vaccines were procured, Peru successfully initiated wide-spread vaccination campaigns. This study was done to understand Peru’s unique COVID challenges and successes and aims to explore barriers and enablers of Peru’s pandemic response to offer lessons for the scale-up of vaccinations, health innovations, and pandemic response capacity in Peru, Latin America, and globally. Methods: 31 semi-structured in- depth interviews were conducted in Lima, Peru with 35 individuals from public, private, academia, healthcare, and civil society sectors that worked in diverse geographies across Peru. Participants were recruited through purposeful and snowball sampling via WhatsApp, based on the inclusion criteria of being involved in Peru’s COVID-19 pandemic response and preparedness (i.e., with vaccine procurement and distribution, emergency health innovations, and community responses). Ethics approval was received from the Duke University Campus Institutional Review Board. Written and verbal consent was obtained from participants before each interview. A qualitative content analysis is currently being done on the interview transcripts. Afterwards a force field analysis will be applied to understand which factors most negatively and positively impacted Peru’s pandemic response capacity. Results: Preliminary findings from the 31 interviews indicate political instability, cross-sector competition, a fragmented health system, and limited medical resource manufacturing and regulations limited Peru’s pandemic response. However, previous experience with vaccination campaigns, community-based support, and cross-sector collaboration influenced effective COVID vaccine distribution and vaccination levels. Conclusion: Peru experienced some small-scale effective COVID response measures, but these were overshadowed by large-scale systemic and political issues, hindering Peru’s pandemic response. This study explores economic, cultural, political, and social factors that impacted Peru’s COVID response, and includes diverse perspectives from various sectors and geographies, increasing the validity and generalizability of findings. However, future studies should include equal representation of sectors and geographies, as most participants represent the public sector and worked in Lima.

Background: In Kenya, timely antenatal care, postnatal family planning, breastfeeding and maternal health literacy impact maternal and child health. mHealth interventions such as chatbots offer novel ways to address health literacy and other health determinants. A chatbot is a computer software that can simulate a human conversation. Identifying the feasibility of chatbots in Kenya for pregnancy support within Facebook’s social media platform is uncharted. To map the feasibility of a chatbot for pregnancy support, questions surrounding the current utilization of health resources and attitudes matter.

Methods: Phase 1 used focus group discussions (FGDs) to understand health resource usage, attitudes and preferences towards a chatbot application for pregnancy. Participant input was used to develop the chatbot in Phase 2. Phase 3 focused on the experience of those using the chatbot to inform feasibility and acceptability of the chatbot developed. Post-intervention we conducted FGDs and interviews, surveyed the sample and analyzed app usage data.

Results: Participants described unsatisfying relationships with health resources including health care providers. These experiences led to mistrust. Participants identified criteria that a chatbot for pregnancy support should have. After making these adaptations to the chatbot developed in Phase 2, the chatbot was tested during Phase 3. Results from Phase 3 indicate positive attitudes towards the chatbot experience and engagement.

Conclusions: The current context of Kenya regarding patient provider relationships, internet access and Facebook have proven beneficial for the feasibility of this innovation. Participant experiences were positive and relate to the use of Human Centered Design, Innovation Diffusion Theory and trust.

As the burden of non-communicable diseases increases worldwide, it is imperative that health systems adopt delivery approaches that will enable them to provide accessible, high-quality, and low-cost care to patients that need consistent management of their lifelong conditions. This is especially true in low- and middle-income country settings, such as India, where the disease burden is high and the health sector resources to address it are limited. The subscription-based, managed care model that SughaVazhvu Healthcare—a non-profit social enterprise operating in rural Thanjavur, Tamil Nadu—has deployed demonstrates potential for ensuring continuity of care among chronic care patients in resource-strained areas. However, its effectiveness and sustainability will depend on its ability to positively impact patient health status and patient satisfaction with the care management they are receiving. Therefore, this study is not only a program appraisal to aid operational quality improvement of the SughaVazhvu Healthcare model, but also an attempt to identify the factors that affect patient satisfaction among individuals with chronic conditions actively availing services.

Crises like Covid-19 pandemic have proved that even strong health systems can collapse without strategic preparation for pandemic emergencies. India’s private sector is integral in having control over the Covid-19 pandemic through various Public-Private Partnerships (PPPs). Knowing it is crucial to understand that how India is handling the Covid-19 crisis, we looked at great examples of PPPs in India in response to Covid-19 and conducted a qualitative study with 10 key informant interviews with several key stakeholders from notable private organizations to gain insights from their experiences on those partnerships. The pandemic was described by participants as an unprecedented tragedy at the start, but it was also seen as an opportunity for reform the weak healthcare system, for growth in innovations and addressing long standing health problems. There is a need for direct communication between policy makers and ground level implementers for clear and concise feedback and understanding of the policies. Also, challenges from dealing with different systems within private health sector prompted to have strong regulatory body for fragmented private health sector. For future pandemic preparation, it was suggested by participants that the government must have a designated crisis response team/taskforce with integrated surveillance system with the private sector. India has been successful in leveraging the use of innovations, digital technology, pharmaceutical and startup workforces, and its robust PPPs to combat the pandemic. However, there were also a lot of lessons learned from hasty policies to management mishaps which can be improved through effective engagement with the private sector.

Background: In The Gambia, a woman has a 1/24 lifetime chance of dying during childbirth and there are approximately 706 deaths per every 100,000 births, one of the highest rates of maternal mortality in the world. These high rates of maternal mortality are due to a series of factors including a delay in reaching a health facility. A low quality of care provided at a facility during an institutional delivery can contribute to these high rates as well. A factor in low quality of care is having inadequate resources, such as electricity, in health facilities. More specifically, not having a reliable source of light might impact the quality of care that health workers are able to provide during the night. Along with the greater structural issues and correlations between energy access and wellbeing, energy poverty can have an impact on health facilities and perpetuate poor health outcomes.The We Care Solar Suitcase strives to bridge this gap by providing a reliable source of light in labor wards of health facilities, with the aim of decreasing maternal and infant mortality. This study was conducted in The Gambia, one of the countries where We Care Solar has deployed Solar Suitcases. The study had three aims: 1) to assess the user experience of the We Care Solar Suitcase and its impact on the quality of care delivered by midwives, nurses and traditional birth attendants; 2) to explore the perceived impact of the We Care Solar Suitcase on infant and maternal mortality in rural communities through qualitative methods; and 3) to explore the continuing barriers to providing high quality care that health workers face in The Gambia face during institutional and facility level deliveries. Methods: In depth interviews, focus group discussions and unstructured observations were used as qualitative data collection methods. Participant groups were health workers (including community health workers, nurses and midwives), women who had given birth, key informants and traditional birth attendants. 28 in depth interviews with health workers, 9 in depth interviews with key informants, 2 focus group discussions with women who had given birth, and 1 focus group discussion with traditional birth attendants occurred. The interviews and focus group discussions with health workers sought to gain insight into the quality of care health workers felt they could deliver to women as they were laboring and delivering in the middle of the night with the addition of the Solar Suitcase in their facility. Observations, which occurred at 8 facilties, sought to gain insight into what birth looks like with the light of the Solar Suitcase. At the end of the study period, all data was transcribed. Close reading of the transcripts occurred, followed by memoing, the iterative creation of a codebook, coding and thematic analysis in NVivo 12. Results: Health workers felt that they were able to provide a higher quality of care to women when they are in labor or giving birth with a reliable source of light. The Solar Suitcase was seen to be a mechanism of providing a reliable source of light. Health workers felt they could deliver higher quality of care by having 1) Increases sanitation in facilities; 2) Ability to manage complications more easily; 3) Less referrals to other health centers and 4) Self efficacy and autonomy in their work. In addition, the suitcase was seen as being a motivating factor for women to deliver at a health facility. Continuing barriers to care still exist in facility-level births in The Gambia, but the Solar Suitcase addresses the issue of lack of light. Conclusion: While energy access continues to be a challenge in low resource settings, innovations such as the We Care Solar Suitcase help in bridging the gap between larger infrastructural development and barriers to providing care and therefore facilitate a higher quality of care in institutional deliveries.

Abstract

Background: The Millennium Development Goals (MDG) 4 and 5 of the United Nations has set the target of reducing maternal deaths to 109 per 100,000 live births and infant deaths to 27 per 1000 live births level by 2015 respectively. India reported an MMR 212 per 100,000 live births in 2007-2009 and a neonatal mortality rate (NMR) of 32 per 1000 live births in 2010 accounting for more than 20% of maternal deaths and 25% of neonatal deaths globally respectively. Unless issues such as reduction in delay in reaching the appropriate health facility in time and receiving care for obstetric and neonatal complications before, during and after childbirth such as infections and premature birth, are addressed, India is unlikely to achieve the MMR and NMR reduction targets by 2015 as envisaged in the MDGs. To a large extent the accessibility and utilization of reproductive and child health services play an important role in determining the extent of both maternal and neonatal mortality. More than 80% of maternal and neonatal deaths can be prevented through increasing institutional deliveries and by improving the quality of healthcare provided to the women and the newborn babies. Over the past few decades, reduced government spending on public healthcare services and its consequent deterioration has led to a gradual shift in patient volume towards the rapidly expanding private health services in India. Therefore a highly competitive environment makes it necessary for private healthcare services to measure and respond to patient expectations by incorporating their views into quality of health service assessments. Studies like Alden et al. (2004) among working and lower middle income women in urban reproductive health clinics in Vietnam, found that patient perception of quality of services is positively and significantly associated with both reutilization of services and recommendation of the facility to others. While several studies such as the Rao et. al study (2006) and the Kumari et. al study (2009) in government health facilities in India have identified aspects of patient perception of quality of care that impact patient satisfaction, there has been very little research on aspects of patient perception of quality of reproductive healthcare and its impact on decisions to reutilize services. This study is designed to fill this knowledge gap.

Methods: This study, descriptive and cross-sectional using a survey methodology was administered in five branches of Life Spring Hospitals, a chain of 12 private, for-profit maternity hospitals providing prenatal, perinatal and postnatal care to women in Hyderabad, India. It examined associations between patient perception of various components of the quality of care and predisposition for using the facility for a future delivery. The specific components of quality of care within facilities included cleanliness, availability of modern diagnostic equipment, technical and interactive skills of doctors and clinic staff. The study also tried to compare these associations between patients presenting for prenatal, perinatal and postnatal care.

Results: 72% of survey respondents were between the age group of 18 to 25 years, 97% had some level of formal education, that is, school level (up to 12th grade) or university level (graduate or beyond), 75% had a household income of less than or equal to10,000 INR per month and 80% of respondents had a previous child, of which, 64% had delivered at LifeSpring Hospitals. The probability of choosing LifeSpring Hospitals for a previous delivery among respondents receiving prenatal care varied significantly by main reason for choice of facility (cost = 66.67%, proximity to home = 50% , facility environment = 15.79%) (p < 0.05*), among respondents receiving postnatal care by age (18 to 25 yrs = 91.30% , = or > 26 yrs = 64.71%) (p < 0.05*). Among overall respondents indicating a predisposition for LifeSpring Hospitals for a future delivery, the mean score of a composite of overall perception factors (facility cum interactive perception factors) (LifeSpring Hospitals = 3.570 and Others = 3.156) (p < 0.05*), facility perception factors (LifeSpring Hospitals = 3.193 and Others = 2.555) (p < 0.05*) and interaction perception factors (LifeSpring Hospitals = 3.793 and Others = 3.517) (p < 0.05*) was significantly higher compared to those who reported a predisposition for other facilities. Among respondents receiving perinatal care, indicating a predisposition for LifeSpring Hospitals for a future delivery, the mean score of a composite of overall perception factors (facility cum interactive perception factors) (LifeSpring Hospitals = 3.636 and Others = 3.313) (p < 0.05*) and facility perception factors (LifeSpring Hospitals = 3.256 and Others = 2.333) (p < 0.05*) was significantly higher compared to those who reported a predisposition for other facilities. Among respondents receiving postnatal care, indicating a predisposition for LifeSpring Hospitals for a future delivery, the mean score of a composite of overall perception factors (facility cum interactive perception factors) was significantly higher compared to those who reported a predisposition for other facilities (LifeSpring Hospitals = 3.531 and Others = 3.078) (p < 0.05*).

Discussion: Age, income level, education level, parity, perception of charges and reasons such as cost, proximity to home and facility environment (including a specific doctor at the facility, treatment by the staff and the quality of equipment available at the facilities) do not appear to be important drivers of patient's decision to deliver at LifeSpring Hospitals in the future. However, patient perception of LifeSpring's facilities (including waiting time, crowding and outpatients hours) and interactive skills of staff (including length of consultation time, explanation of tests, staff dynamics, comfort level with advice and patient inclusion in decision making) appear to be important drivers of women's decision to deliver at LifeSpring Hospitals in the future.

This study explores patients’ needs in rural Thanjavur, southern India through understanding how people with diabetes choose providers and perceive care-seeking experience. To measure perception, the study surveyed people regarding six common barriers to care-seeking behavior, selected from both literature and local expert interview. Ninety-one percent of the sampled population goes to public or private allopathic providers out of the six presented providers. The low socioeconomic group and people with more complications or comorbidities are more likely to go to private allopathic providers. What is more, there is no difference between public and private allopathic providers in patients’ perception of care except for perceived cost. Positive perceptions in both providers are very common except for perceptions in blood-sugar management, distance to facilities, and cost of care. Sixty-six percent of patients perceived their blood-sugar control to fluctuate or have no change versus improved control. Twenty-seven percent of patients perceived the distance to facilities as unreasonable, and sixty-two percent of patients perceived the cost as high for them. The results suggest that cost may affect low socioeconomic people’s choice of care significantly. However, for people in middle and higher socioeconomic groups, cost does not appear to be a major factor. For qualitative text analyses, physician’s behavior and reputation emerge as themes, which require further studies.