Explore the vast range of titles available.

Background Public-private partnerships (PPPs) are an alternative global financing strategy. It emerged as a key driving strategy in the previous century, coinciding with a global health direction that focused on risk sharing. Exploring the readiness and preferences of Palestinian stakeholders toward partnerships offers important perspectives for shaping the future adoption of PPPs. Methods This study employed qualitative methodology, including semi-structured interviews, to gain insight into decision-maker perceptions. Seventeen participants were interviewed, including three from the public sector, eight KIs from non-profit organizations, and six health care providers from the private sector or for-profit organizations. The thematic analysis method was used to analyze data at each stage. Data was transcribed and analyzed descriptively using Braun and Clarke’s (2006) thematic analysis approach. Results Four key themes emerged from the in-depth interviews conducted with a diverse group of decision-makers in the Palestinian healthcare sector: (1) The importance of conducting feasibility studies and economic evaluations prior to the decision to adopt PPPs (2) The investment environment and clarity of healthcare provider role(s) in the partnership (3) The strategic direction in implementing effective PPPs in the healthcare system (4) Operational challenges related to partnership patterns and structure. The decision to adopt PPPs in the Palestinian healthcare sector offers a promising avenue to enhance service delivery, improve financial sustainability, and address gaps in healthcare provision that might lead to advancing universal health coverage. However, the success of these partnerships is contingent upon a thorough understanding of the local context, including the economic, cultural, and political factors that influence healthcare delivery. Policymakers should prioritize feasibility assessments, establish clear governance structures, and design partnerships with social responsibility at their core.

Background Telemedicine is widely adopted in developed countries, but it remains a relatively novel concept in developing countries. This study aimed to assess the willingness of physicians to adopt telemedicine in governmental primary healthcare (PHC) centers in Palestine and identify key influencing factors. Methods A cross-sectional study was conducted at PHC centers between May and July 2024 using a self-administered online questionnaire distributed via WhatsApp. Descriptive statistics were calculated, including percentages, means, and standard deviations. Independent t-tests, ANOVA, and Pearson correlation assessed variable relationships, and a multivariate linear regression model identified factors influencing telemedicine adoption. Results Among 273 participating physicians, most had limited prior experience with telemedicine but held positive perceptions of its potential to save time and reduce costs, particularly for real-time procedural observation. The most frequently cited barrier was inadequate and inconsistent training. Multivariate analysis identified several factors significantly associated with higher willingness to adopt telemedicine, including perceived usefulness (B = 0.206, 95% CI: 0.059–0.352, β = 0.126, aP = 0.006), behavioral intention to use telemedicine (B = 0.181, 95% CI: 0.079–0.273, β = 0.215, aP < 0.001), and a positive general perception of telemedicine (B = 0.348, 95% CI: 0.269– 0.441, β = 0.450, aP < 0.001). Demographic factors such as older age (B = 0.639, 95% CI: 0.133–1.16, β = 0.138. aP = 0.014), and female gender (B = 0.714, 95% CI: 0.134–1.30, β = 0.105, aP = 0.016) were also positively associated. Conclusion Physician willingness is essential for the successful integration of telemedicine into Palestinian primary care. To promote adoption, policymakers and healthcare managers should develop targeted interventions that address critical barriers, particularly the lack of capacity building related to telemedicine, while highlighting the perceived benefits of telemedicine. Clinical trial number Not applicable.

Background Early childhood caries (ECC) is a major global health issue affecting millions of children. Mitigating this problem requires up-to-date information from reliable surveillance systems. This enables evidence-based decision-making to devise oral health policies. The World Health Organization (WHO) advocates the adoption of mobile technologies in oral disease surveillance because of their efficiency and ease of application. The study describes developing an electronic, oral health surveillance system (EOHSS) for preschoolers in Egypt, using the District Health Information System (DHIS2) open-source platform along with its Android App, and assesses its feasibility in data acquisition. Methods The DHIS2 Server was configured for the DHIS2 Tracker Android Capture App to allow individual-level data entry. The EOHSS indicators were selected in line with the WHO Action Plan 2030. Two modalities for the EOHSS were developed based on clinical data capture: face-to-face and tele/asynchronous. Eight dentists in the pilot team collected 214 events using modality-specific electronic devices. The pilot’s team's feedback was obtained regarding the EOHSS's feasibility in collecting data, and a time-motion study was conducted to assess workflow over two weeks. Independent t-test and Statistical Process Control techniques were used for data analysis. Results The pilot team reported positive feedback on the structure of the EOHSS. Workflow adaptations were made to prioritize surveillance tasks by collecting data from caregivers before acquiring clinical data from children to improve work efficiency. A shorter data capture time was required during face-to-face modality (4.2 ± 0.7 min) compared to telemodality (5.1 ± 0.9 min), p  < 0.001). The acquisition of clinical data accounted for 16.9% and 21.1% of the time needed for both modalities, respectively. The time required by the face-to-face modality showed random variation, and the tele-modality tasks showed a reduced time trend to perform tasks. Conclusions The DHIS2 provides a feasible solution for developing electronic, oral health surveillance systems. The one-minute difference in data capture time in telemodality compared to face-to-face indicates that despite being slightly more time-consuming, telemodality still shows promise for remote oral health assessments that is particularly valuable in areas with limited access to dental professionals, potentially expanding the reach of oral health screening programs.

Background Targeted client communication (TCC) using text messages can inform, motivate and remind pregnant and postpartum women of timely utilization of care. The mixed results of the effectiveness of TCC interventions points to the importance of theory based interventions that are co-design with users. The aim of this paper is to describe the planning, development, and evaluation of a theory led TCC intervention, tailored to pregnant and postpartum women and automated from the Palestinian electronic maternal and child health registry. Methods We used the Health Belief Model to develop interview guides to explore women’s perceptions of antenatal care (ANC), with a focus on high-risk pregnancy conditions (anemia, hypertensive disorders in pregnancy, gestational diabetes mellitus, and fetal growth restriction), and untimely ANC attendance, issues predefined by a national expert panel as being of high interest. We performed 18 in-depth interviews with women, and eight with healthcare providers in public primary healthcare clinics in the West Bank and Gaza. Grounding on the results of the in-depth interviews, we used concepts from the Model of Actionable Feedback, social nudging and Enhanced Active Choice to compose the TCC content to be sent as text messages. We assessed the acceptability and understandability of the draft text messages through unstructured interviews with local health promotion experts, healthcare providers, and pregnant women. Results We found low awareness of the importance of timely attendance to ANC, and the benefits of ANC for pregnancy outcomes. We identified knowledge gaps and beliefs in the domains of low awareness of susceptibility to, and severity of, anemia, hypertension, and diabetes complications in pregnancy. To increase the utilization of ANC and bridge the identified gaps, we iteratively composed actionable text messages with users, using recommended message framing models. We developed algorithms to trigger tailored text messages with higher intensity for women with a higher risk profile documented in the electronic health registry. Conclusions We developed an optimized TCC intervention underpinned by behavior change theory and concepts, and co-designed with users following an iterative process. The electronic maternal and child health registry can serve as a unique platform for TCC interventions using text messages.

Background Health worker compliance with established best-practice clinical and public health guidelines may be enhanced by customized checklists of care and clinical decision support driven by point-of-care data entry into an electronic health registry. The public health system of Palestine is currently implementing a national electronic registry (eRegistry) for maternal and child health. This trial is embedded in the national implementation and aims to assess the effectiveness of the eRegistry’s interactive checklists and clinical decision support, compared with the existing paper based records, on improving the quality of care for pregnant women. Methods This two-arm cluster randomized controlled trial is conducted in the West Bank, Palestine, and includes 120 clusters (primary healthcare clinics) with an average annual enrollment of 60 pregnancies. The intervention tool is the eRegistry’s interactive checklists and clinical decision support implemented within the District Health Information System 2 (DHIS2) Tracker software, developed and customized for the Palestinian context. The primary outcomes reflect the processes of essential interventions, namely timely and appropriate screening and management of: 1) anemia in pregnancy; 2) hypertension in pregnancy; 3) abnormal fetal growth; 4) and diabetes mellitus in pregnancy. The composite primary health outcome encompasses five conditions representing risk for the mother or baby that could have been detected or prevented by high-quality antenatal care: moderate or severe anemia at admission for labor; severe hypertension at admission for labor; malpresentation at delivery undetected during pregnancy; small for gestational age baby at delivery undetected during pregnancy; and large for gestational age baby at delivery. Primary analysis at the individual level taking the design effect of the clustering into account will be performed as intention-to-treat. Discussion This trial, embedded in the national implementation of the eRegistry in Palestine, allows the assessment of process and health outcomes in a large-scale pragmatic setting. Findings will inform the use of interactive checklists and clinical decision support driven by point-of-care data entry into an eRegistry as a health systems-strengthening approach. Trial registration ISRCTN trial registration number, ISRCTN18008445 . Registered on 6 April 2017.

Background This trial evaluates interventions that utilize data entered at point-of-care in the Palestinian maternal and child eRegistry to generate Quality Improvement Dashboards (QID) for healthcare providers and Targeted Client Communication (TCC) via short message service (SMS) to clients. The aim is to assess the effectiveness of the automated communication strategies from the eRegistry on improving attendance and quality of care for pregnant women. Methods This four-arm cluster randomized controlled trial will be conducted in the West Bank and the Gaza Strip, Palestine, and includes 138 clusters (primary healthcare clinics) enrolling from 45 to 3000 pregnancies per year. The intervention tools are the QID and the TCC via SMS, automated from the eRegistry built on the District Health Information Software 2 (DHIS2) Tracker. The primary outcomes are appropriate screening and management of anemia, hypertension, and diabetes during pregnancy and timely attendance to antenatal care. Primary analysis, at the individual level taking the design effect of the clustering into account, will be done as intention-to-treat. Discussion This trial, embedded in the implementation of the eRegistry in Palestine, will inform the use of digital health interventions as a health systems strengthening approach. Trial registration ISRCTN Registry, ISRCTN10520687 . Registered on 18 October 2018

BackgroundRoad traffic casualties and risks are poorly quantified in the West Bank, Palestine. The aim of this study was to provide a first-ever overview of road traffic casualties (RTC) surveillance systems, and to assess the feasibility of establishing an integrated RTC registry in West Bank to provide reliable data to decision makers.MethodsGeneral assessment methodology for surveillance systems and registries (World Health Organisation and CDC, USA) were used. The assessment took place in 2014 in collaboration with the Palestinian Ministry of Health (MoH) and Ministry of Interior. Qualitative methods were used, including semi-structured questionnaires, in-depth interviews and review of grey literature.ResultsAt least five stand-alone surveillance systems operated by different agencies in the West Bank collect data related to road traffic accidents. These systems do not have a common set of indicators, no formal case definitions or standard operating procedures (SOPs). There is a lack of quality assurance systems at all levels. There are large discrepancies in reported casualties: for 2012 the Palestinian Civil Police (PCP) reported 120 fatalities, whereas MoH reported both 34 and 112 from separate sources of data. Privacy concerns hinder some organisations from sharing data. MoH and PCP data are sufficiently complete to support a robust integrated registry.ConclusionsAn integrated registry for RTC is feasible. The establishment should comprise a framework for all essential parts of a registry, including stakeholder relations and a comprehensive quality assurance system. Steps toward technical improvement include establishing a multisectoral working group; developing a common set of indicators and case definitions; revising data collection forms and developing SOPs for the whole continuum of data flow.

Targeted client communication using text messages can inform, motivate, and remind pregnant and postpartum women to use care in a timely way. The mixed results of previous studies of the effectiveness of targeted client communication highlight the importance of theory-based co-design with users. We planned, developed, and tested a theory-based intervention tailored to pregnant and postpartum women, to be automatically distributed via an electronic maternal and child health registry in occupied Palestinian territory. We did 26 in-depth interviews with pregnant women and health-care providers in seven purposively selected public primary health-care clinics in the West Bank and Gaza to include clinics with different profiles. An interview guide was developed using the Health Belief Model to explore women's perceptions of high-risk conditions (anaemia, hypertension, diabetes, and fetal growth restriction) and timely attendance for antenatal care, as predefined by a national expert panel. We did thematic analyses of the interview data. Based on the results, we composed messages for a targeted client communication intervention, applying concepts from the Model of Actionable Feedback, social nudging, and enhanced active choice. We assessed the acceptability and understandability of the messages through unstructured interviews with local health promotion experts, health-care providers, and pregnant women. The recurring themes indicated that most women were aware of the health consequences of anaemia, hypertension, and diabetes, but that they seldom associated these conditions with pregnancy. We identified knowledge gaps and low awareness of susceptibility to and severity of these complications and the benefits of timely antenatal care. The actionable messages were iteratively improved with stakeholder and end-user feedback after presenting the initial draft, and the messages deemed were understandable and acceptable based on reflections during unstructured assessment. Following a stepwise iterative process by a theory-based approach and co-designing the intervention with users, we revealed elements critical to an efficacious targeted client communication intervention. A potential limitation of our study is that conducting in-depth interviews on several health conditions simultaneously might have reduced the depth of information we could have obtained. The strength of our study was that we assessed for, developed, and refined the intervention following recommended theoretical frameworks and best practices. The effectiveness of this intervention is under evaluation in a cluster-randomised trial (ISRCTN10520687). European Research Council and Research Council of Norway.

Estimated dates of delivery have important consequences for clinical decisions during pregnancy and labour. The Electronic Maternal and Child Health Registry (MCH eRegistry) in Palestine includes antenatal care data and birth data from hospitals. Our objective was to compare computed best estimates of gestational age in the MCH eRegistry with the gestational ages recorded by health-care providers in hospital delivery units. We obtained data for pregnant women in the West Bank registered in the MCH eRegistry from Jan 1, 2017 to March 31, 2017. Best estimates of gestational age in the registry are automated and based on a standard pregnancy duration of 280 days and ultrasound-based pregnancy dating before 20 weeks’ gestation or the woman's last menstrual period date. Hospital recorded gestational ages are reported by care providers in delivery units and are rounded to the nearest week. We calculated proportions of gestational ages (with 95% CIs) from both sources that fell into the categories of term, very preterm (24–32 weeks’ gestation), preterm (33–37 weeks), or post-term (>42 weeks). 1924 women were included in the study. The median hospital recorded gestational age was 39 weeks (IQR 38–40 weeks) and according to MCH eRegistry estimates was 39 weeks and 5 days (IQR 38 weeks and 1 day to 40 weeks and 5 days). Proportions of very preterm, preterm, and post-term deliveries were higher based on MCH eRegistry estimates than on hospital recorded gestational ages (very preterm 3%, 95% CI 2–4 vs 2%, 1–2; preterm 6%, 5–7 vs 5%, 3–6 ; post-term 6%, 5–7 vs 1%, 1–2). In addition to clinical care, the proportions of term, very preterm, preterm, and post-term births can have implications for public health monitoring. The proportion of deliveries within the normal range of term gestation was calculated to be higher by care providers in delivery units than by MCH eRegistry estimates. Extending the access of hospitals to information from antenatal care in the MCH e-Registry could improve continuity of data and better care for pregnant women. European Research Council, Research Council of Norway.

Good quality data from health systems can benefit several stakeholders, including policy makers, care providers, clients, and researchers. Conventional data collection methods for maternal and child health, such as household surveys, may not be suitable to assess processes of service delivery. The electronic maternal and child health registry (MCH eRegistry) has been implemented in 182 governmental primary care clinics in Palestine. Here we present the data in the MCH eRegistry. We processed the raw data in the MCH eRegistry from the West Bank, and documented validation rules for crude data points (time of entry, values allowed). Definitions and appropriate categorisations were created for core process indicators. Data from the MCH eRegistry and the electronic health information system in governmental hospitals were linked using statistical software. As per the second quarter of 2018, the MCH eRegistry contained raw data on 69 793 antenatal care visits, 27 304 postpartum care visits and 40 264 newborn care visits. From antenatal care, data on core process indicators were available for screening of anaemia (n=48 542), hypertension (n=66 814), diabetes (n=18 013), asymptomatic bacteriuria (n=31 757), as well as antenatal ultrasound (n=55 453). Distributions of raw data on haemoglobin and blood pressures had no extreme outliers. Links had been established between antenatal care and delivery data in governmental hospitals for 51% of births. The MCH eRegistry contains data from antenatal to postpartum and newborn care. These data have been successfully linked with delivery data, resulting in a large data set on continuity of care and birth outcomes. Furthermore, the data are accessible, of good quality, and can be used for studies of quality of care and maternal and newborn epidemiology, among others. Researchers are invited to use this resource in working towards improving the health system and the health of Palestinians. European Research Council and Research Council of Norway.