Background: Despite the Integrated Management of Childhood Illness (IMCI) implemented at primary health centres (PHC) level, under-5 mortality remains high in sub-Saharan Africa. To improve the diagnosis and management of severe hypoxaemia, the AIRE project implemented the systematic use of pulse oximeters (PO) into IMCI consultations in PHCs in Burkina Faso, Guinea, Mali and Niger. We described the intervention sites, and measure their capacity to offer IMCI-care prior to project implementation. Methods: A cross-sectional quantitative survey was conducted in all the PHCs and their district hospital (DH) of the AIRE project from March to July 2020. Results: Overall, 215 PHCs and 8 DH were surveyed. Almost all the PHCs were public structures mainly managed by nurses. The IMCI strategy was in force in all PHCs with at least one IMCI-trained agent in more than 99% of the PHCs. At baseline, PO was available in only 2/215 (1%) PHCs and 4/8 (50%) DH. Overall, 35/215 (16%) PHCs have functional ambulance for managing referrals to DH, including two with mobile oxygen. IMCI consultations were free-of-fees in Burkina Faso and Niger, but charged for in Guinea and Mali (from US$0.5 to US$1). All the DH had capacities to provide specialised paediatric care for children under-5 years of age, although the use of PO was not systematic. Oxygen was available at all DH except one. Parents of children requiring hospitalisation had to pay out of pocket costs ranging from US$1.7 to US$8.4 per day. Conclusions: This study revealed the absence of POs at PHC level and their low use at hospital level, as well as difficulties in managing referral to hospital of severe cases and access to mobile oxygen. It has guided the reasoned choice of the AIRE research sites, and the upgrading of PHCs including IMCI training before the project implementation. Study registration number: PACTR202206525204526 registered on 06/15/2022. Keywords: Healthcare system, West Africa, pulse oximetry, oxygen, primary health care ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement The AIRE project is funded by UNITAID, with in-kind support from Inserm and IRD. UNITAID was not involved in the design of the study, the collection, analysis and interpretation of the data, nor in the writing of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was conducted using programmatic data collected routinely with each MOH authorization. No patient was involved in the study. Patients did not contribute to the writing or editing of this manuscript I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors
Following on from two experimental legislative measures successively introduced by social security funding laws and repealed before they had even got off the ground, the draft law on improving access to care, known as the Rist law, will authorise primary prescribing and direct access to advanced practice nurses. Future implementing legislation will require political consultation between all the parties involved, and promises to lead to lively and exciting debates.
Les relations internationales du Québec dans le contexte du droit international. Un article de la revue Revue québécoise de droit international / Quebec Journal of International Law / Revista quebequense de derecho internacional (Volume 6, numéro 2, 1989, p. 105-198) diffusée par la plateforme Érudit.
L’organisation d’un hôpital peut être considérée comme un système complexe sur le plan managérial. De nombreux facteurs expliquent l’émergence de conflits qui correspondent à une situation de perte de sens ou une menace de rupture dans l’organisation. Avant la création du système de médiation dans les établissements publics de santé et médico-sociaux par le décret du 28 août 2019, la gestion de ces conflits était assurée par le Centre national de gestion (CNG), notamment lorsque des praticiens étaient impliqués. En août 2017, la ministre de la Santé confie à Édouard Couty une mission pour préfigurer un service de médiation pour les personnels des établissements de santé et médico-sociaux publics. L’objectif principal du présent article est de proposer une analyse des missions de médiations effectuées pendant la phase de préfiguration entre 2017 et 2020, ainsi que celles effectuées en 2021 et 2022, et ce, à partir des rapports effectués par le service de médiation du ministère de la Santé et des Solidarités. L’objectif secondaire est de préciser les caractéristiques de la médiation, ses avantages et ses limites dans le cadre de la résolution des conflits. Pendant la phase de préfiguration (2017–2019), 236 dossiers ont été enregistrés avec un taux de résolution de 52 % par un processus de médiation (136 médiations). Les accords issus de la médiation sont plus durables s’ils intègrent les besoins, intérêts, ressentis et ressources des personnes concernées ; ils sont ressentis comme plus équitables si les parties contribuent conjointement à leur élaboration.
