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A toolkit for costing environmental health services in healthcare facilities.

ABSTRACT: Environmental health services (EHS) are critical for safe and functional healthcare facilities (HCFs). Understanding costs is important for improving and sustaining access to EHS in HCFs, yet the understanding of costs is poor and no tools exist to specifically support costing EHS in HCFs in low- and middle-income countries. We developed a toolkit to guide the following steps of costing EHS in HCFs: defining costing goals, developing and executing a data collection plan, calculating costs, and disseminating findings. The costing toolkit is divided into eight step-by-step modules with instructions, fillable worksheets, and guidance for effective data collection. It is designed for use by diverse stakeholders involved in funding, implementation, and management of EHS in HCFs and can be used by stakeholders with no prior costing experience. This paper describes the development, structure, and functionality of the toolkit; provides guidance for its application; and identifies good practices for costing, including pilot testing data collection tools and iterating the data collection process, involving diverse stakeholders, considering long-term costs, and disaggregating environmental costs in records to facilitate future costing. The toolkit itself is provided in the Supplementary Material.

SUBMITTER: Anderson DM

PROVIDER: S-EPMC8411608 | biostudies-literature | 2021 Jul

REPOSITORIES: biostudies-literature

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A toolkit for costing environmental health services in healthcare facilities.

Anderson Darcy M DM Wren Tracy J J Cronk Ryan R Schram Hayley H Behnke Nikki N Bartram Jamie J

Journal of water, sanitation, and hygiene for development : a journal of the International Water Association 20210604 4

Environmental health services (EHS) are critical for safe and functional healthcare facilities (HCFs). Understanding costs is important for improving and sustaining access to EHS in HCFs, yet the understanding of costs is poor and no tools exist to specifically support costing EHS in HCFs in low- and middle-income countries. We developed a toolkit to guide the following steps of costing EHS in HCFs: defining costing goals, developing and executing a data collection plan, calculating costs, and d ...[more]

PMID: 34484657

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Project description:BackgroundEnvironmental health services (EHS) in healthcare facilities (HCFs) are critical for providing a safe, functional healthcare environment, but little is known about their costs. Poor understanding of costs impedes progress towards universal access of EHS in HCFs. We developed frameworks of essential expenses required to provide EHS and conducted an ex-post financial analysis of EHS in a network of medical research and training facilities in Lilongwe, Malawi, serving an estimated 42,000 patients annually through seven outpatient buildings.MethodsWe estimated the cost of providing the following EHS: water, sanitation, hygiene, personal protective equipment use at the point of care, waste management, cleaning, laundry, and vector control. We developed frameworks of essential outputs and inputs for each EHS through review of international guidelines and standards, which we used to identify expenses required for EHS delivery and evaluate the completeness of costs data in our case study. For costing, we use a mixed-methods approach, applying qualitative interviews to understand facility context and review of electronic records to determine costs. We calculated initial costs to establish EHS and annual operations and maintenance.ResultsAvailable records contained little information on the upfront, capital costs associated with establishing EHS. Annual operations and maintenance totaled USD 220,427 for all EHS across all facilities (USD 5.21 per patient encounter), although costs of many essential inputs were missing from records. Annual operations and maintenance costs were highest for cleaning (USD 69,372) and waste management (USD 46,752).DiscussionMissing expenses suggests that documented costs are substantial underestimates. Costs to establish services were missing predominantly because purchases pre-dated electronic records. Annual operations and maintenance costs were incomplete primarily because administrative records did not record sufficient detail to disaggregate and attribute expenses.ConclusionsElectronic health information systems have potential to support efficient data collection. However, we found that existing records systems were decentralized and poorly suited to identify EHS costs. Our research suggests a need to better code and disaggregate EHS expenses to properly leverage records for costing. Frameworks developed in this study are a potential tool to develop more accurate estimates of the cost of providing EHS in HCFs.

Project description:BackgroundThe present Malaysian healthcare system is burdened with increasing cases of non-communicable diseases (NCDs) and its risk factors. Health care providers (HCPs) have to provide both treatment and health education to ensure optimal outcome. Health education is a vital component in addressing and managing chronic diseases. This study intends to explore patient's perspective on health education services received from HCPs, focusing at the secondary triage in government primary healthcare facilities.MethodsThis qualitative exploratory study focused on the health education component derived from a complex enhanced primary health care intervention. Participants were purposively selected from patients who attended regular NCD treatment at 8 primary healthcare facilities in rural and urban areas of Johor and Selangor. Data collection was conducted between April 2017 and April 2018. Individual semi-structured interviews were conducted on 4 to 5 patients at each intervention clinic. Interviews were transcribed verbatim, coded and analyzed using a thematic analysis approach.ResultsA total of 35 patients participated. Through thematic analysis, 2 main themes emerged; Perceived Suitability and Preferred HCPs. Under Perceived Suitability theme, increased waiting time and unsuitable location emerged as sub-themes. Under Preferred HCPs, emerging sub-themes were professional credibility, continuity of care, message fatigue, and interpersonal relationship. There are both positive and adverse acceptances toward health education delivered by HCPs. It should be noted that acceptance level for health information received from doctors are much more positively accepted compared to other HCPs.ConclusionPatients are willing to engage with health educators when their needs are addressed. Revision of current location, process and policy of health education delivery is needed to capture patients' attention and increase awareness of healthy living with NCDs. HCPs should continuously enhance knowledge and skills, which are essential to improve development and progressively becoming the expert educator in their respective specialized field.

Project description:IntroductionTo assess the burden of depression, anxiety and suicidality; and to determine the impact of integrated mental health and HIV services on treatment outcomes among Thai adolescents and young adults living with HIV (AYHIV).MethodsA multicentre prospective cohort study was conducted among AYHIV (15 to 25 years), and age- and sex-matched HIV-uninfected adolescents and young adults (HUAY). The Patient Health Questionnaire 9-item (PHQ-9) and Generalized Anxiety Disorder 7-item scales (GAD-7) were used as screening tools for depressive and anxiety symptoms respectively. History of lifetime and recent suicidal ideations/attempts were ascertained. Elevated mental health screening scores were defined as having either significant depressive symptoms (PHQ-9 ≥9), significant anxiety symptoms (GAD-7 ≥10) or suicidality (lifetime; and recent [within two weeks]). Participants meeting these criteria were referred to psychiatrists for confirmatory diagnosis and mental health services. Follow-up assessment with PHQ-9 and GAD-7 was performed one year after psychiatric referral.ResultsFrom February to April 2018, 150 AYHIV and 150 HUAY were enrolled, median age was 19.0 (IQR:16.8 to 21.8) years and 56% lived in urban areas. Among AYHIV, 73% had HIV RNA <50 copies/mL, and median CD4 count was 580 (IQR:376 to 744) cells/mm3 . At enrolment, 31 AYHIV (21%; 95%CI:14% to 28%) had elevated mental health screening scores; 17 (11%) significant depressive symptoms, 11 (7%) significant anxiety symptoms and 21 (14%) suicidality. Seven AYHIV (5%) had all three co-existing conditions. These prevalences were not substantially different from HUAY. Urban living increased risk, whereas older age decreased risk of elevated mental health screening scores (p < 0.05). All AYHIV with elevated mental health screening scores were referred to study psychiatrists, and 19 (13%; 95%CI: 8% to 19%) had psychiatrist-confirmed mental health disorders (MHDs), including adjustment disorder (n = 5), major depression (n = 4), anxiety disorders (n = 2), post-traumatic stress disorder (n = 1) and mixed MHDs (n = 4). One year after psychiatric referral, 42% of AYHIV who received mental health services demonstrated an absence of significant mental health symptoms from the reassessments, and 26% had an improved score.ConclusionsWith the significant burden of MHDs among AYHIV, an integration of mental health services, including mental health screenings, and psychiatric consultation and referral, is critically needed and should be scaled up in HIV healthcare facilities.

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A toolkit for costing environmental health services in healthcare facilities.

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A toolkit for costing environmental health services in healthcare facilities.

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