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Sunday, October 14, 2018

Health Crisis in Syria

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According to WHO, attack rate on the health sector in Syria has continued to increase over the past years. There has been 67 verfied attacks on the health facilities, workers and infrastructure within the first two of 2018, and about 50% of verified attacks in the year of 2017.  

Dr. Tedros Adhanm Ghebreyesus General Director of WHO, stated that “this health tragedy must come to an end”. “Every attack shatter communities and ripples through health systems, damaging infrastructure and reducing access to health for vulnerable people. WHO calls on all parties to the conflict in Syria to immediately halt attacks on health workers, their means of transport and equipment, hospitals and other medical facilities.” 

The attacks on the health system occurs in the most needed places for medical attention. An estimate of 2.9 million Syrians is living in the UN-declared hard-to-reach and besieged locations, with the collaboration of the World Health Organization providing health services to the areas that lacks access to healthcare.  

About 400,000 individuals are living under siege for half a decade in East Ghouta, running out of the most basic health supplies in the area, with at least 1000 people in urgent need of medical evacuation. “It is unacceptable that children, women, and men are dying from injuries and illnesses that are easily treatable and preventable,” said Dr Tedros. 

70% of health supplies provided by the WHO aimed to reach East Ghouta were restrained by the authorities and sent back to the warehouse of the World Health Organization. The confiscated items were desperately needed to save the lives of the population, as well as decrease the suffering rate. The medical supplies are also routinely removed from the inter-agency convoys to the hard-to-reach and besieged locations.  

Seven years of conflict has affected the healthcare system in Syria. At least half of the country’s public hospitals and healthcare centres are shot down or in bad conditions to function. More than 11.3 million people are seeking for the immediate health assistance possible, with 3 million injured and disabled people.  

WHO ensures that the people in Syria have access to the essential supplies, life-saving healthcare and has delivered more than 14 million treatments and medications in the country, which includes cross-border and cross-line services.  

“The suffering of the people of Syria must stop. We urge all parties to the conflict to end attacks on health, to provide access to all those in Syria who need health assistance, and, above all, to end this devastating conflict,” said Dr Tedros. 

Sunday, October 7, 2018

The Next Step In Improving The Nigerian Health Care Services: Co-Financing With Multi Stakeholders

Some of the Nigerian health indicators have been proven to be the worst in Africa. Nigeria has the most population growth around the world with a range of 5.5 live births per woman and an annual growth rate of 3.2. It has been estimated that by 2050, Nigeria will reach a peak of 440 million individuals. Its increase in population and its developing challenges, the country will drag the socioeconomic indicators down in the whole of Africa.  

The government of Nigeria and the Global Financing Facility (GFF) made an announcement on the 15th of August, 2018, of a multi-stakeholder partnership, investing $20 million to improve and the strengthen the primary health care of Nigeria, beginning with three states, with the aim of targeting the less privilege and the most underserved individuals within the entire country. The Nigerian Government is linking the financing investment to a sum of $150 million, which is equivalent its yearly budget. This is implemented as a part of the Basic Healthcare Provision Fund (BHCPF) of the National Health Act. The provided resources and prioritization of the services will contribute the financing of the health and nutritional needs of women, children and adolescents.

“The Government of Nigeria is committed to ensuring that all Nigerians—particularly the women, children and adolescents facing some of the most challenging circumstances, in the most challenging places—have access to the basic health and nutrition services that they need, without becoming poorer by paying for them,” said Professor Isaac F. Adewole, Minister of Health of Nigeria. “The Global Financing Facility has created a new sense of awareness that we must put our money on the table for these essential investments in our people, and use them in even smarter ways—and that is something that hasn’t been done before.” 

The challenges Nigeria undergoes has outpaced the government spending on health and nutrition, in particular within the recent years, yet, unable to offer medical coverage to those who seeks it most, doing little decline the high and Impoverishing-out-of-pocket spending on the health by the poor Nigerians. With the recent advocacy and support of the GFF, the World Bank, the Bill & Melinda Gates Foundation, Global Affairs Canada, Norwegian Ministry of Foreign Affairs, the U.S. Agency for International Development, the UK Department for International Development and other partners, the Government of Nigeria has begun implementing the National Health Act, which was enacted in 2014 and established the BHCPF for the first time in 2018. Through the BHCPF the Nigerian Government is expanding its fiscal space for health to the tune of US$150million or NGN 55.1 billion for primary health care strengthening and service delivery. 

The grant from the GFF co-finances with the early implementation of the BHCPF with the mobilized funds from the government and other contributors, starting from Abia, Niger and Osun state. 

“The Government of Nigeria will make an enormous difference in the lives of millions of Nigerians by making a lasting investment in the health and nutrition of women, children and adolescents, the foundation of society and the economy,” said Mariam Claeson, Director of the Global Financing Facility“Nigeria’s commitment to sustainably financing health and nutrition is a beacon for other countries, as they work closely with the Global Financing Facility to make sure that the investments they make today last for years to come.”

Monday, July 9, 2018

Innovation To Patient's Satisfaction In The Romanian Healthcare

Image result for patients satisfactionThe word is evolving since the 1980s with many influential forces. For instance, globalization, technology innovations or demographic changes have contributed to the economic, political and social transformation worldwide. Globalization represents a multi-faceted phenomenon today in the modern society that has an impact on the global healthcare system(Burcea, Toma and Papuc, 2014). This is considered an important topic in a health care system because it constitutes to the fact that some of its effects such as; disparities among the health infrastructure in different countries, the free movement of doctors, the increase rate of disease burden and the medical tourism have raised governmental difficulties all over the world (Azevedo and Johnson, 2011)

The healthcare service is a market that is confronted with many challenges and competition in the sense of the development of the private medical providers. Meanwhile, the patients have become increasingly more informed of the various options of treatment because of the availability of the medical information provided by many online platforms. This results in high expectations of patients towards their physicians to be able to provide the necessary information which is suitable to answer the questions of the patients. They as well expect politeness, empathy and attention from their doctors which brings them very close to the traditional meaning of consumer profile (Coțiu and Sabou, 2017).
Gradually, the healthcare system has become more of a complex political, social and economic environment in the recent globalized world. It undergoes pressures (for example; financial, demographic and technological) in order to deliver good quality services to the patients. As a consequence, the protection of patients’ rights has evolved within the key aspect of the agenda of the new global health (Ahoobim et al., 2012). The national public health organizations, health promotion agencies, health service providers, scientific research institutions and consumers association have put significant efforts to promote and support the patients’ rights protection around the world. In the last decades, researchers have conducted analysis on the rights of patients, their protection and its direct/indirect link with the healthcare quality and its improvement(Green et al., 2012).

There are studies that indicate the importance of customer expectations in the healthcare system. This is described as a means of desires to seek for the assistance from the doctor, demands or wants and preferences. Expectations from patients is important because it implies their involvement and creates the possibilities to better access of health services. Patients expectations from the Romanian healthcare providers are based on, firstly the model on active passivity which describes the physician-patient relationship in Romania. Within years of passivity, the Romanian system has moved to a more democratic approach. This is a new approach that focuses on the call for more client-centred orientation in the healthcare services. Therefore, the knowledge and awareness are expected to meet the needs of the patients. Secondly, patients measure their expectations based on their level of satisfaction with the healthcare services. This is mostly used as an indicator of the medical care outcome. Thirdly, the first step to prevent dissatisfied patients is through the knowledge of the patients’ needs, because this may result to discontinuity of care and cost ineffectiveness of the healthcare(Ionilã, Ana-Claudia, A-C Bara, WJA van den Heuvel, 200AD).

Patients satisfaction is an important part of the quality assessment of the healthcare system (Williams et al., 1995)

There are two dimensions used to improve the patient satisfaction:- The procedural dimension of the quality of the provided services such as the time spent at the waiting reception before getting the required medical attention, the condition of the accommodation provided according to the needs of the patient, and the doctor or physicians anticipated with the patient’s needs and, The personal dimension of the provided service quality-that is, the physical aspect of cleanness, maintenance of the facility, the attitude of the practitioner towards the patients, the demonstration of the body language between the physician and the patient and the voice tone used to address the patients (Agheorghiesei and Copoeru, 2013)

Over the past 10 years, there are many changes that occurred in the Romanian healthcare system.  These changes include the health insurance system, the role of the general practitioner, the position of hospitals and privatization. It is expected that the consumer satisfaction is related to the general healthcare system because of the significance of the role the primary care plays in the new healthcare reform as it has been shown in the transition of other countries(Bara et al., 2002).
The most used instrument in measuring patient satisfaction is a questionnaire survey which usually applied during the discharge moment of patients from hospitals.  Studies have suggested that the method of satisfaction measurement uses a broad and vague term that results in short, superficial, and affirmative answers without any true meaning. Several researchers have brought to attention the notion of “patient satisfaction”. Although this term is commonly used in evaluating and guiding the delivery of healthcare services, it is likely to be related to the quality of services rather than the quality of care provided. “According to Pomerantz, several changes have occurred within the recent years on the perception healthcare service users on quality care, and he suggested that an increase in the focus of patients’ needs and preferences may help better oriented medical care, compared to the adherence of the standard of care”. 

The most frequent aspect of satisfaction and dissatisfaction in the healthcare services is professionalism among the providers. Professionalism is an area that includes various sub-categories such as, advancement in medical knowledge, improved level of development in clinical competence, strong ethical morals and standards, sharing of honesty and respect as values, and showing empathy, courtesy and kind attitude towards the patients. In economically developed countries such as the Western European countries and USA, the medical orientation act changed from a “predominantly doctor-oriented approach to a patient-centred culture”. This cannot be expressed in Eastern Europe, which is influenced by corruption, informal payments and in need of a new reform 5, 20. Since the 1970s, Eastern European countries are slagging behind Western European countries in terms of healthcare quality because of its communist policy throughout the region. Romanian has the lowest level of patient satisfaction in Europe. Romania is faced with other challenges that are related to the lack of access to health services among the less privileged communities.  The general dissatisfaction and cynicism in Romania are owned by the country’s poor economic performance, which limits the freedom of the individual to explain a greater degree in behavioural and environmental factors(Popa et al., 2017).

INNOVATION FOR IMPROVING PATIENT SATISFACTION(Agency for Healthcare Research and Quality, 2014):

Implementing Staff Training:
It has been brought to attention that most hospital staff such as the physician or the healthcare organizers have expressed their concern to ask patients personal questions that include their race, ethnicity and language. They believe that it may offend the patient. In addition, most physicians may be time-sensitive towards the modern nature of clinical practice and want to ensure the effectiveness of asking questions. For data to be accurate and consistent, healthcare organizations are required to invest in clinical training among all staff levels (health professionals, administrative staff, hospitals and health plan leadership), which includes integrating the significance of the data for detecting and addressing health care needs. For instance, those assigned to the task of asking questions directly to the patients, enrollees can receive a front-line training on the importance of collecting the information, how to use the information and the means of collecting the data, and how to address the concerns of the patients, enrollees and other members.

The training exercise should be based on the context and the methods of collecting and utilizing the data. For example, health plan staff who do not have face-to-face communication with the enrollees can obtain the demographic information through telephone encounters. Therefore, there should a training for “telephone means of collecting data” because pre-registration by telephone can occur before hospital admission or ambulatory care appointments.  Before establishing a formal training session with the medical staff, an assessment should be conducted based on the practices and determine what is currently happening and identify the necessary changes. These changes will be clearly communicated among the staff members during the training session.

Sharing and Collecting of Data Across the Healthcare System:
The health system is a diverse set of a public and private entity that contribute to the collection of data including health surveys, administrative enrollment, billing records and medical records used by different medical departments such as the hospitals, CHCs, physicians and health plan management. The data collected on the patient’s race, language and ethnicity are extended to these entities suggesting that each can collaborate to obtain and sustain the patient’s medical record.  No one of the entities can individually gather the necessary information regarding the population of patients, neither can they collect the health data on an individual patient.  Therefore, it is important to increase the integration of data from other sources within and across the healthcare system.

Many observed three main issues with patient-reported measures, the feedback provided by the patients may not be conclusive because they acquire little or no formal medical training. “Critics hold that patient-reported measures that include patient satisfaction signify an aspect of happiness” as they consider the process to be subjective among patients, which can be influenced by other factors that is not related to health care. The patient’s experience measures could be confounded by aspects that may not be linked to the quality process of the health services.  For instance, it could be a case where the patient may rate their experiences that is based on their subjective assessment of their health status instead of the experience of the healthcare services provided to them. Finally, the experiences of patients may be reversed to the fulfilment of the actual desire of the patient. For example, “the receipt of a specific medication regardless of its benefit”. These problems may decrease the validity of the patient’s perception(LaVela and Gallan, 2014).

A significant factor that influences the satisfaction of patients is the medical services bounded by the medical personnel. Firstly, the level of information provided by the medical staff on the schemes of new treatment, the appearances of advanced medical equipment for diagnosis and investigation, and the medical process can generate a better result in customer satisfaction and, the behavior and attitude of the medical personnel is considered important because it can improve the communication between the doctors and the patients (Economics, Domain and Thesis, 2015).


 Agency for Healthcare Research and Quality (2014) Improving Data Collection across the Health Care System | Agency for Healthcare Research & Quality, U.S Department of Health and Human Services. Available at: (Accessed: 27 April 2018).

Agheorghiesei, D.-T. and Copoeru, I. (2013) ‘Evaluating Patient Satisfaction – A Matter of Ethics in the Context of the Accreditation Process of the Romanian Hospitals’, Procedia -Social and Behavioral Sciences World Conference on Psychology and Sociology, 82, pp. 404–410. doi: 10.1016/j.sbspro.2013.06.283.

Ahoobim, O. et al. (2012) ‘Council on Foreign Relations The New Global Health Agenda’. Available at: (Accessed: 20 April 2018).

Azevedo, M. J. and Johnson, B. H. (2011) ‘The Impact of Globalization Determinants and the Health of the World’s Population’, INTECH. Available at: (Accessed: 20 April 2018).

Burcea, M., Toma, S.-G. and Papuc, R.-M. (2014) ‘PATIENTS’ SATISFACTION WITH THE HEALTH CARE SYSTEM IN THE AGE OF GLOBALIZATION: THE CASE OF ROMANIA* Marin BURCEA Sorin-George TOMA Răzvan-Mihail PAPUC’, Transylvanian Review of Administrative Sciences, Special Issue, pp. 5–20. Available at: (Accessed: 18 April 2018).

Coțiu, M. A. and Sabou, A. (2017) ‘Patient Satisfaction with Diabetes Care in Romania – An Importance-performance Analysis’, in. Springer, Cham, pp. 297–302. doi: 10.1007/978-3-319-52875-5_62.

Green, S. et al. (2012) ‘Aligning quality improvement to population health’, International Journal for Quality in Health Care, 24(5), pp. 441–442. doi: 10.1093/intqhc/mzs049.

Ionilã, Ana-Claudia, A C Bara, WJA van den Heuvel, J. M. (200AD) ‘The Romanian health care system in transition from the users’ perspective’, Ionilã, Ana-Claudia. Available at: (Accessed: 27 April 2018).

Williams, S. et al. (1995) ‘Patient expectations: What do primary care patients want from the GP and how far does meeting expectations affect patient satisfaction?’, Family Practice. Oxford University Press, 12(2), pp. 193–201. doi: 10.1093/fampra/12.2.193.

Bara, A. C. et al. (2002) ‘Users ’ satisfaction with the Romanian health care system : an evaluation of recent health care reforms’, European Journal of Public Health, 12(4), pp. 39–40.

Economics, F. O. F., Domain, M. and Thesis, D. (2015) ‘Doctoral School in Economics and Business Administration Study Regarding the Measurement of Consumer Satisfaction in Healthcare’.

LaVela, S. and Gallan, A. (2014) ‘Evaluation and Measurement of Patient Experience’, Patient Experience Journal, 1(1), pp. 28–36. Available at:

Popa, D. et al. (2017) ‘Patients’ perceptions of healthcare professionalism - A Romanian experience’, BMC Health Services Research, 17(1). doi: 10.1186/s12913-017-2412-z.