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Background Research has found health system improvement cannot be achieved without continuously engaging patients, their families and all stakeholders in the design, management and delivery of health care services. Following the Alma Ata declaration on Primary Health Care in 1978, the focus of health system improvement has tended to shift from physician or hospital-centric approaches to a more democratic vision of engaging the public and/or patients in the commissioning, planning, organisation, operation and control of the health care system. Thus, patient-public engagement (PPE) has become an important tool in health system improvement particularly for countries with poor health outcomes including countries in sub-Saharan Africa which carries an estimated 24% of the global burden of diseases in both human and financial costs. The aim of this scoping review is to describe and systematically map PPE research in sub-Saharan Africa, and then to synthesise this research in relation to key theories of PPE, identify the key drivers and barriers of PPE and to identify the knowledge gaps that may usefully be addressed by future research. Methods This scoping review will follow Arksey and O'Malley's best guidelines for conducting scoping reviews and also follow the standard guidelines for reporting using the Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews checklist. A systematic search of peer-reviewed English language literature published between January 1999 and December 2019 will be conducted on four databases: Scopus, CINAHL, Medline (Ovid) and Embase. The initial screening of titles and abstracts will be undertaken independently by two reviewers, followed by full text screening involving three independent reviewers. A thematic framework synthesis will be employed in the analysis of data to identify the various PPE interventions, and outcomes mapped to a framework of engagement continuum to understand its overall effect on health system improvement in sub-Saharan Africa. Discussion To our knowledge, this scoping review will be the first to systematically investigate PPE interventions implemented across sub-Saharan Africa, map the outcomes of identified interventions to a framework of engagement continuum and to understand its overall effect on health system improvement. Findings of this review will be published in an open-access peer review journal and disseminated at scientific conferences.

Objectives: To compare the prevalence of disability between migrants and non‐migrants at three and 24 months post‐injury, and to identify key predictors of post‐injury disability among migrants. Methods: Disability among 2,850 injured participants, including 677 migrants to New Zealand, was measured prospectively using the World Health Organization Disability Assessment Schedule. Results: Migrants experienced higher risk of disability than non‐migrants at three months post‐injury (aRR=1.14, 95%CI 1.03–1.26). Both groups had similar disability prevalence, but higher than pre‐injury, at 24 months. For migrants, strong predictors of disability at three months post‐injury were: higher injury severity, pre‐injury obesity, and perceiving the injury as a threat of disability. Having multiple chronic conditions was a predictor of disability at both time points. Conclusions: Disability was persistent for migrants and non‐migrants to 24 months post‐injury. The disability risk at three months was higher for migrants. Certain predictors associated with disability were identified. Implications for public health: Despite having accessed healthcare services for their injury, migrants (compared with non‐migrants) had higher risks of disability at least in the first three months post‐injury. Interventions should be focused during this critical period on identified key predictors to promote faster recovery and reduce disability.

OBJECTIVE: To investigate post-injury disability prevalence and identify pre-injury and injury-related predictors 24 months post-injury among Māori Prospective Outcomes of Injury Study participants. METHODS: Participants were recruited from New Zealand's no-fault injury insurer. Pre-injury and injury-related characteristic information was obtained from participants at three and 24 months post-injury. The World Health Organization Disability Assessment Schedule was used to measure disability. Multivariable models were developed to estimate relative risks of post-injury disability. RESULTS: Of 2,856 participants, 566 were Māori. Analyses were restricted to 374 Māori with pre-injury and 24-month post-injury disability data available. Pre-injury, 9% reported disability compared to 19% 24 months post-injury. Strong predictors of increased risk of disability 24 months post-injury were having ≥2 chronic conditions pre-injury and having trouble accessing healthcare services after injury. Hospitalisation for injury and having inadequate pre-injury household income were other predictors. CONCLUSIONS: Māori experience considerable disability 24 months post-injury. Pre-injury socio-demographic, health and psychosocial, and injury-related characteristics independently predict post-injury disability and provide focus for future research and interventions to improve Māori post-injury outcomes. Implications for public health: Despite having had access to services, injured Māori experienced considerable long-term disability. Pre-injury and injury-related factors predict long-term disability and should be the focus to reduce the post-injury disability burden for Māori.© 2017 The Authors. Language: en

INTRODUCTION Little is known about neurosurgery patient outcomes in Indonesia. Our study sought to describe patient characteristics, health care pathways, health-related quality of life, and health/rehabilitation care needs of patients admitted to, and discharged from, a major neurosurgery department. METHODS Eligible patients were aged ≥18 years admitted to the Neurosurgery Department in a regional referral hospital in Bandung, Indonesia. Baseline data was collected on admission. An in-person interview (in the Indonesian language) was held 1 to 2 days pre-discharge. Sociodemographic along with clinical characteristics, Glasgow Coma Scale (GCS), and EQ-5D-5L data were collected. RESULTS A total of 217 patients were admitted, 37 died before discharge, and a pre-discharge interview was undertaken by 178 (82%). Almost half (48%) were admitted because of injury, 38% brain tumour, 10% acute illness, and 4% other conditions. The mean age was 41 years. On admission, 63% had a mild Glasgow Coma Scale, 31% moderate, and 3% severe. The average hospital stay was 8 days for injury and 24 days for illness patients. Prior to discharge, one-third, or less, of the 178 patients interviewed reported "no problems" in the EQ-5D dimensions of mobility (32%), self-care (27%), usual activities (16%), and pain/discomfort (32%), whereas 70% reported "no problems" with anxiety/depression. CONCLUSION A large proportion of patients are being discharged with considerable levels of difficulty in four of the five EQ-5D dimensions. This stresses the importance of providing good follow-up and support of patients and their families.

Nepal has seen impressive recent health gains through a successful community-based health program. However, governance challenges remain within the Nepalese primary health care system that include under-staffing and absenteeism, limited health facility opening hours, poor supervision and monitoring, and insufficient financial management. We propose that these be addressed through expanded community engagement and a power shift towards local communities, enhancing skills of community representatives in co-managing health facilities and of service providers to effectively engage the community, increased quality of community participation, and improved documentation of the process and impact of engagement on health outcomes. Copyright © 2015 John Wiley & Sons, Ltd.

Objectives: To: describe pre-injury characteristics of Pacific (n=239) and non-Pacific (n=2,611) participants and compare their outcomes three months after injury. Methods: Participants were New Zealand residents aged 18–64 years referred to the Accident Compensation Corporation's injury entitlement claims register. Univariate and multivariable analyses compared pre-injury and injury-related characteristics of Pacific and non-Pacific people and assessed the unadjusted and adjusted relative risks for selected outcomes. Results: Of the 2,856 participants, 239 identified at least one Pacific ethnicity. Adjusted relative risks (aRR; 95% confidence intervals) for Pacific peoples, with the non-Pacific group as the reference, indicate Pacific peoples were: less likely to have no/lesser problems with disability (aRR=0.82; 0.70,0.95); less likely to have no problems with EQ-5D self-care (aRR=0.88; 0.80,0.98); less likely not to report EQ-5D anxiety/depression (aRR=0.84; 0.76,0.93); and less satisfied with social relationships three months after injury (aRR=0.89; 0.83,0.95). Conclusions: Evidence does not suggest Pacific peoples’ likelihood of paid employment differs from non-Pacific people three months after injury. However, Pacific peoples appear to have an increased likelihood of problems with disability, self-care, anxiety/depression and social relationships. Implications: This study provides information about a range of previously unknown outcomes following injury for Pacific peoples in New Zealand, and suggests areas of possible focus for health and rehabilitation service providers and policy-makers interested in improving outcomes for injured Pacific peoples.

Waiting lists for elective procedures are a characteristic feature of tax-funded universal health systems. New Zealand has gained a reputation for its ‘booking system’ for waiting list management, introduced in the early-1990s. The New Zealand system uses criteria to ‘score’ and then ‘book’ qualifying patients for surgery. This article aims to (i) describe key issues focused on by the media, (ii) identify local strategies and (iii) present evidence of variation. Newspaper sources were searched (2000–2006). A total of 1199 booking system stories were identified. Findings demonstrate, from a national system perspective, the extraordinarily difficult nature of maintaining overall control and coordination. Equity and national consistency are affected when hospitals respond to local pressure by reducing access to elective treatment. Findings suggest that central government probably needs to be closely involved in local-level management and policy adjustments; that through the study period, the New Zealand system appears to have been largely out of the control of government; and that governments elsewhere may need to be cautious when considering developing similar systems. Developing and implementing scoring and booking systems may always be a ‘messy reality’ with unintended consequences and throwing regional differences in service management and access into stark relief. Copyright © 2012 John Wiley & Sons, Ltd.

Background: The proportion of older people receiving dialysis is rapidly increasing. The typical choice for older patients is between home-based peritoneal dialysis (PD) and clinic-based haemodialysis (HD). Some centres have been successful in encouraging all patients – including older patients – to have home-based self-administered PD or HD. Aim: To (i) describe the overall satisfaction with renal services among older patients dialysing, or in training, with HD or PD at home; and (ii) examine the relationship between residential distance from the nephrology unit and satisfaction with home-based dialysis. Methods: Participants were aged 60 years or more; and were either dialysing at home or training for dialysis at home. Two methods of cross-sectional data collection were used: (i) structured quantitative interviews with all participants; and (ii) qualitative interviews with a selected subgroup. Results: Participants comprised 45 patients on dialysis (94% of 48 eligible). Their average age was 68 years. Duration of dialysis averaged 28 months (range 3–150 months). Ratings of ‘very good or excellent’ were reported for dialysis treatment by 40 (89%) patients. Patients on dialysis, despite experiencing frustration with dialysis itself, expressed satisfaction across four categories: staff, information provision, involvement in decision-making and confidence in managing dialysis. Dissatisfaction was infrequent. Conclusion: This pilot study suggests that older patients trained to dialyse at home using PD or HD are highly satisfied with the nephrology service – even when living remote from the nephrology unit. Home-based dialysis is possible in older patients with levels of comorbidity and disease severity as serious as elsewhere.

This article discusses the development and implementation of New Zealand's booking system for publicly funded non-urgent surgical and medical procedures. The ‘booking system’ emerged out of New Zealand's core services debate and the government's desire to remove waiting lists. It was targeted for implementation by mid-1998. However, the booking system remains in an unsatisfactory state and a variety of problems have plagued its introduction. These include a lack of national consistency in the priority access criteria, failure to pilot the system and a shortfall in the levels of funding available to treat the numbers of patients whose priority criteria ‘scores’ deem them clinically eligible for surgery. The article discusses endeavours to address these problems. In conclusion, based on the New Zealand experience, the article provides lessons for policy-makers interested in introducing surgical booking systems. Copyright © 2000 John Wiley & Sons, Ltd.