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      Health System Approaches Are Needed To Expand Telemedicine Use Across Nine Latin American Nations

      1 , 2 , 3 , 4
      Health Affairs
      Health Affairs (Project Hope)

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          E-health in low-and middle-income countries: findings from the Center for Health Market Innovations

          OBJECTIVE: To describe how information communication technology (ICT) is being used by programmes that seek to improve private sector health financing and delivery in low-and middle-income countries, including the main uses of the technology and the types of technologies being used. METHODS: In-country partners in 16 countries directly searched systematically for innovative health programmes and compiled profiles in the Center for Health Market Innovations' database. These data were supplemented through literature reviews and with self-reported data supplied by the programmes themselves. FINDINGS: In many low-and middle-income countries, ICT is being increasingly employed for different purposes in various health-related areas. Of ICT-enabled health programmes, 42% use it to extend geographic access to health care, 38% to improve data management and 31% to facilitate communication between patients and physicians outside the physician's office. Other purposes include improving diagnosis and treatment (17%), mitigating fraud and abuse (8%) and streamlining financial transactions (4%). The most common devices used in technology-enabled programmes are phones and computers; 71% and 39% of programmes use them, respectively, and the most common applications are voice (34%), software (32%) and text messages (31%). Donors are the primary funders of 47% of ICT-based health programmes. CONCLUSION: Various types of ICT are being employed by private organizations to address key health system challenges. For successful implementation, however, more sustainable sources of funding, greater support for the adoption of new technologies and better ways of evaluating impact are required.
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            HITECH Act Drove Large Gains In Hospital Electronic Health Record Adoption

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              Improving the quality of private sector delivery of public health services: challenges and strategies.

              Despite significant successes in controlling a number of communicable diseases in low and middle income countries, important challenges remain, one being that a large proportion of patients with conditions of public health significance, such as tuberculosis, malaria, or sexually transmitted diseases, seek care in the largely unregulated 'for profit' private sector. Private providers (PPs) often offer services which are perceived by users to be more attractive. However, the available evidence suggests that serious deficiencies in technical quality are often present. Evaluations of interventions to promote evidence-based care in high income countries have shown that multi-faceted strategies which increase provider knowledge have had some success in improving service quality. A wider range of factors needs to be considered in low and middle income countries (LMICs), especially factors which contribute to discrepancies between provider knowledge and practice. Studies have shown that PPs, especially, perceive or experience patient and community pressures to provide inappropriate treatments. LMIC governments also lack the capacity to enforce regulatory controls. Context-specific multi-faceted strategies are needed, including the local adaptation and dissemination to providers of relevant evidence, the education of patients and communities to adopt effective treatment-seeking and treatment-taking behaviour, and feasible mechanisms for ensuring and monitoring service quality, which may include a role for self-regulation by provider organizations or provider accreditation. Developing, implementing and evaluating strategies to improve the quality of service provision will depend on the involvement of the key stakeholders, including policy makers and PPs. Focusing on studies from Asia, Africa and Latin America, this paper develops a model for identifying the influences on PPs, mainly private medical practitioners, in their management of conditions of public health significance. Based on this, multi-faceted strategies for improving the quality of treatment provision are suggested. Interventions need to be inexpensive, practical, efficient, effective and sustainable over the medium to long term. Achieving this is a significant challenge.
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                Author and article information

                Journal
                Health Affairs
                Health Affairs
                Health Affairs (Project Hope)
                0278-2715
                1544-5208
                February 2019
                February 2019
                : 38
                : 2
                : 212-221
                Affiliations
                [1 ]Cynthia M. LeRouge () is an associate professor in the Department of Information Systems and Business Analytics, College of Business, Florida International University, in Miami.
                [2 ]Manjul Gupta is an assistant professor in the Department of Information Systems and Business Analytics, College of Business, Florida International University.
                [3 ]Guillaume Corpart is founder and CEO of Global Health Intelligence, in Coral Gables, Florida.
                [4 ]Alejandro Arrieta is an assistant professor in the Department of Health Policy and Management, Robert Stempel College of Public Health and Social Work, Florida International University.
                Article
                10.1377/hlthaff.2018.05274
                30715970
                ade1918e-acd1-48e9-8efa-b321a6d38933
                © 2019
                History

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