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The role of care as a critical influence on child nutrition, health, and development has received increasing attention in the last decade. While the role of care has been well elaborated at a conceptual level, we still lack simple valid and reliable tools to measure many aspects of care. Psychosocial care includes the behaviors and practices that support children's healthy growth and psychosocial development. The research presented here constitutes one of the first attempts to quantify some of the various dimensions of child‐care practices (namely type, quality, and frequency) and to summarize the information into a composite, age‐specific index of child‐care practices. The main purpose of this research is to examine, specifically within the context of Pakistan, which of the maternal and household characteristics constituted more severe constraints to the provision of good child care. The main findings of this research have important policy implications. They suggest that specific training in child feeding and the use of preventive health services for poor mothers with little formal education could have a large impact on the growth of children living in impoverished environments.

This paper is concerned with strategic planning in the public services, in particular that sector where no market price exists and where the community expresses some demands. The National Health Service, the Social Services, Education Authorities or Local Authorities are examples. Because the consumer does not directly pay for the service at the point of consumption, demand cannot be expressed in monetary terms. The supply of services is some reflection of community need tempered by its willingness to provide the resources of people, equipment, facilities and money to satisfy that need. Strategic planning or policy making is a complex not to say emotive process, because no obvious measure of success or of community satisfaction exists. It is often difficult to measure satisfaction of a single need, let alone define a policy which “best” satisfies the conglomerate of often conflicting community needs. Nevertheless, this is the task confronting policy makers in the public sector services. The quantity and allocation of these services are not usually directly determined by the community itself but by some section of the community; commonly politicians, economists, planners and occasionally representatives of the community. Within these planning bodies each individual conception of the “best” policy is in conflict with all others. It is not possible to resolve this conflict by deriving a policy which maximises the satisfaction and, hence, minimising the regret of the policy making body. Yet a compromise, or at least a single, policy must be reached. The aim of this paper is to suggest a method of arriving at the most acceptable single policy without making assumptions or deriving definitions of where that compromise ought to lie given the initial postures of the policy makers. The paper is in two sections. The first describes the method in general terms. The second demonstrates, through a small model of the maternity services, its use in practice. The community or surrogate of the community is referred to throughout as the decision makers, policy makers or planning body.

The purpose of this paper is to measure the technical and scale efficiency of health centres; to evaluate changes in productivity; and to highlight possible policy implications of the results for policy makers.

Data envelopment analysis (DEA) is employed to assess the technical and scale efficiency, and productivity change over a four‐year period among 17 public health centres.

During the period of study, the results suggest that the public health centres in Seychelles have exhibited mean overall or technical efficiency of above 93 per cent. It was also found that the overall productivity increased by 2.4 per cent over 2001‐2004.

Further research can be undertaken to gather data on the prices of the various inputs to facilitate an estimation of the allocative efficiency of clinics. If such an exercise were to be undertaken, researchers may also consider collecting data on quantities and prices of paramedical, administrative and support staff to ensure that the analysis is more comprehensive than the study reported in this paper. Institutionalization of efficiency monitoring would help to enhance further the already good health sector stewardship and governance.

This paper provides new empirical evidence on a four‐year trend in the efficiency and productivity of health centres in Seychelles.

To underscore the significance of international health care management, we focus on three themes: the problem of global blindness; global health care challenges and opportunities; and learning from international health care management. The problem of global blindness highlights how health care managers’ inattentional blindness to competitors’ operational performance and market strategies lead to avoidable and expensive failures. To address global challenges and opportunities, health care organizations are employing two different strategies: (1) building and marketing a world-class health care facility internationally, and (2) organizing and integrating multinational health care operations. The first strategy exploits the medical-tourism market. The second strategy requires either multinational health care networks or transnational health care organizations. One of the lessons to be learned from international health care management is that an organization can create a meta-national competitive advantage. Another lesson is that by examining best practices from around the world, health care organizations can obtain new insights and become more innovative within their home markets. A corollary and third lesson is that while health care organizations can learn a great deal from examining international best clinical practices, sometimes the most important management lessons are lost in clinical translations. The fourth and last lesson is that worst cases – serious international management failures – offer perhaps the most valuable insights into the role of culture, complexity, and leadership for health care organizations.

In a wider debate on defining and measuring quality in health care, there is a particular need for frameworks for understanding and managing quality in specific specialties. This article addresses the definition and measurement of quality in maternity care. It develops a pro forma for monitoring and hence managing midwifery quality.

Five‐S, a simple tool was utilized as the initial step towards total quality management activities at a public hospital in Sri Lanka. This paper introduces the system improvement activities at the hospital which won several awards for quality of service at national level. Though there are multiple reasons for the significant improvement of performance at the hospital, the study team observes that Five‐S has contributed heavily towards the success. The unique feature observed was that Five‐S activity reorganizes the system radically compared to most of the continuous quality improvement (CQI) approaches which depend on problem solving. In the hospitals of developing countries, in which even the basic processes are unsatisfactory, Five‐S approach may be suited for the initiation of the CQI process. Further research is needed to evaluate the quality improvement activity based on standardized criteria and to assess the factors which influenced the process.

A workshop on the evaluation of a controversial plan to integrate preventive and curative mother‐and‐child services in Jerusalem was conducted by the Hebrew University — Hadassah School of Public Health and Community Medicine. An extensive field study, conducted by second‐year MPH students led to a better understanding of community problems and needs, and to the formulation of recommendations for closer co‐ordination, rather than integration, between the municipal preventive health services and the curative clinics operated by the sick funds. This paper shows how these recommendations affected the decision‐making process in Jerusalem, and discusses the implications of these and other policy interventions on attaining the various goals of public health academicians.

The purpose of this paper is to investigate the relationship between levels of socioeconomic development and subsequent trends in fertility among the states of India. Based on the Theory of Demographic Transition, this study tests the hypothesis: The higher the level of socioeconomic development in 1993, the greater the subsequent percentage of decrease in fertility rates between 1999 and 2006 among the states of India.

The study utilizes Pearson's r correlation and linear multiple regression analysis on three National Family Health Surveys data to predict two measures of decline in fertility from socioeconomic indicators.

The findings support the theory of demographic transition in large measure revealing that the overall level of socioeconomic development is directly related to subsequent declines in fertility among the states of India.

Correlations between state‐wide indicators are based on sample data of which margins of error and response rates are unknown.

The study suggests that the empowerment of women through education, employment opportunities and exposure to the mass media reduces fertility.

Population control in India is extremely important for the future welfare of all of its society members.

Although previous research has shown cross‐sectional correlations between fertility and socioeconomic development, this is the first time correlations between socioeconomic development and subsequent trends in fertility have been measured. This is methodologically important because Demographic Transition Theory hypothesizes a lag between modernization and fertility decline. Rather than correlating level of economic development with current fertility, this study correlates level of economic development with the subsequent dynamic changes in fertility.

This study examines key adaptations that occurred in the Zimbabwean Results-Based Financing (RBF) programme between 2010 and 2017, locating the endogenous and exogenous factors that required adaptive response and the processes from which changes were made.

The study is based on a desk review and thematic analysis of 64 policy and academic literatures supplemented with 28 multi-stakeholder interviews.

The programme experienced substantive adaption between 2010 and 2017, demonstrating a significant level of responsiveness towards increasing efficiency as well as to respond to unforeseen factors that undermined RBF mechanisms. The programme was adaptive due to its phased design, which allowed revision competencies and responsive adaptation, which provide useful insights for other low-and-middle income countries (LMICs) settings where graduated scale-up might better meet contextualised needs. However, exogenous factors were often not systematically examined or reported in RBF evaluations, demonstrating that adaptation could have been better anticipated, planned, reported and communicated, especially if RBF is to be a more effective health system reform tool.

RBF is an increasingly popular health system reform tool in LMICs. However, there are questions about how exogenous factors affect RBF performance and acknowledgement that unforeseen endogenous programme design and implementation factors also greatly affect the performance of RBF. As a result, a better understanding of how RBF operates and adapts to programme level (endogenous) and exogenous (external) factors in LMICs is necessary.

Similar to many business processes, waiting times are also essential for health care processes, especially in obstetrics and gynecology outpatient department (GOD), because pregnant women may be affected by long waiting times. Since creating process models manually presents subjective and nonrealistic flows, this study aims to meet the need of an objective and realistic method.

In this study, the authors investigate time-related bottlenecks in both departments for different doctors by process mining. Process mining is a pragmatic analysis to obtain meaningful insights through event logs. It applies data mining techniques to business process management with more comprehensive perspectives. Process mining in this study enables to automatically create patient flows to compare considering each department and doctor.

The study concludes that average waiting times in the GOD are higher than obstetrics outpatient department. However, waiting times in departments can change inversely for different doctors.

The event log was created by expert opinions because activities in the processes had just starting timestamp. The ending time of activity was computed by considering the average duration of the corresponding activity under a normal distribution.

This study focuses on administrative (nonclinical) health processes in obstetrics and GOD. It uses a parallel activity log inference algorithm (PALIA) to produce process trees by handling duplicate activities. Infrequent information in health processes can have critical information about the patient. PALIA considers infrequent activities in the event log to extract meaningful information, in contrast to many discovery algorithms.