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Schade AT, Sabawo M, Jaffry Z, Nyamulani N, Mpanga CC, Ngoie LB, Metcalfe AJ, Lalloo DG, Harrison WJ, Leather A, MacPherson P. Improving the management of open tibia fractures, Malawi. Bull World Health Organ 2024; 102:255-264. [PMID: 38562195 PMCID: PMC10976873 DOI: 10.2471/blt.23.290755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/21/2023] [Accepted: 01/10/2024] [Indexed: 04/04/2024] Open
Abstract
Objective To assess the impact of an open fracture intervention bundle on clinical management and patient outcomes of adults in Malawi with open tibia fractures. Methods We conducted a before-and-after implementation study in Malawi in 2021 and 2022 to assess the impact of an open fracture intervention bundle, including a national education course for clinical officers and management guidelines for open fractures. We recruited 287 patients with open tibia fractures. The primary outcome was a before-and-after comparison of the self-reported short musculoskeletal function assessment score, a measure of patient function. Secondary outcomes included clinical management; and clinician knowledge and implementation evaluation outcomes of 57 health-care providers attending the course. We also constructed multilevel regression models to investigate associations between clinical knowledge, patient function, and implementation evaluation before and after the intervention. Findings The median patient function score at 1 year was 6.8 (interquartile range, IQR: 1.5 to 14.5) before intervention and 8.4 (IQR: 3.8 to 23.2) after intervention. Compared with baseline scores, we found clinicians' open fracture knowledge scores improved 1 year after the intervention was implemented (mean posterior difference: 1.6, 95% highest density interval: 0.9 to 2.4). However, we found no difference in most aspects of clinicians' open fracture management practice. Conclusion Despite possible improvement in clinician knowledge and positive evaluation of the intervention implementation, our study showed that there was no overall improvement in clinical management, and weak evidence of worsening patient function 1 year after injury, after implementation of the open fracture intervention bundle.
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Affiliation(s)
- Alexander Thomas Schade
- Public Health Department, Malawi-Liverpool-Wellcome Trust, Queen Elizabeth Central Hospital, P.O. Box 30096, Blantyre, Malawi
| | - Maureen Sabawo
- Department of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Zahra Jaffry
- Trauma and Orthopaedic Department, Bart’s Health NHS Trust, London, England
| | - Nohakhelha Nyamulani
- Trauma and Orthopaedic Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | - Leonard Banza Ngoie
- Trauma and Orthopaedic Department, Kamuzu Central Hospital, Lilongwe, Malawi
| | | | | | | | - Andrew Leather
- King's Global Health Partnerships, King’s College London, London, England
| | - Peter MacPherson
- School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
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Mahmoudian P, Jafari M, De Roodenbeke E, Maleki M. Dimensions of Health Care Management Professionalization: A Scoping Review. Med J Islam Repub Iran 2023; 37:127. [PMID: 38318409 PMCID: PMC10843347 DOI: 10.47176/mjiri.37.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Indexed: 02/07/2024] Open
Abstract
Background Within the public sector, health managers occupy positions that are typically filled by individuals with a medical, clinical, or nursing experience who are entrusted with assuming an additional role. The primary objective of this study was to employ a scoping review methodology to ascertain a cluster of prevalent subjects encompassing the development of a proficient health care manager. Methods The purpose of this scoping review study was to identify critical components in the field of management professionalization, as described by Arksey and O'Malley. A total of 13 studies, characterized by predefined keywords, were meticulously culled from Scopus, Web of Science, PubMed, and Embase, Magiran, and SID databases. The inclusion and exclusion criteria considered factors such as language, temporal relevance, redundancy, thematic alignment with the professionalization domain, and congruence with the overarching objectives and methodologies of the present investigation. Subsequently, the contents of the selected studies were subjected to rigorous thematic analysis and judicious categorization using a framework analysis approach. Results From a total of 10,117 articles, a rigorous selection process yielded 13 articles to be included in this study. The identified dimensions are classified and elucidated across 6 overarching domains; namely, the science of management, educational trajectory, and curriculum, cultural infrastructure and ideologies, standards, professional institutions and associations, and licenses and certifications. Conclusion To enhance the efficacy of health management, policymakers and planners ought to adeptly incorporate these dimensions within the framework of the country's health system.
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Affiliation(s)
- Payam Mahmoudian
- Department of Health Service Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Jafari
- Department of Health Service Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mohammadreza Maleki
- Department of Health Service Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Ayorinde AA, Williams I, Mannion R, Song F, Skrybant M, Lilford RJ, Chen YF. Publication and related bias in quantitative health services and delivery research: a multimethod study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Bias in the publication and reporting of research findings (referred to as publication and related bias here) poses a major threat in evidence synthesis and evidence-based decision-making. Although this bias has been well documented in clinical research, little is known about its occurrence and magnitude in health services and delivery research.
Objectives
To obtain empirical evidence on publication and related bias in quantitative health services and delivery research; to examine current practice in detecting/mitigating this bias in health services and delivery research systematic reviews; and to explore stakeholders’ perception and experiences concerning such bias.
Methods
The project included five distinct but interrelated work packages. Work package 1 was a systematic review of empirical and methodological studies. Work package 2 involved a survey (meta-epidemiological study) of randomly selected systematic reviews of health services and delivery research topics (n = 200) to evaluate current practice in the assessment of publication and outcome reporting bias during evidence synthesis. Work package 3 included four case studies to explore the applicability of statistical methods for detecting such bias in health services and delivery research. In work package 4 we followed up four cohorts of health services and delivery research studies (total n = 300) to ascertain their publication status, and examined whether publication status was associated with statistical significance or perceived ‘positivity’ of study findings. Work package 5 involved key informant interviews with diverse health services and delivery research stakeholders (n = 24), and a focus group discussion with patient and service user representatives (n = 8).
Results
We identified only four studies that set out to investigate publication and related bias in health services and delivery research in work package 1. Three of these studies focused on health informatics research and one concerned health economics. All four studies reported evidence of the existence of this bias, but had methodological weaknesses. We also identified three health services and delivery research systematic reviews in which findings were compared between published and grey/unpublished literature. These reviews found that the quality and volume of evidence and effect estimates sometimes differed significantly between published and unpublished literature. Work package 2 showed low prevalence of considering/assessing publication (43%) and outcome reporting (17%) bias in health services and delivery research systematic reviews. The prevalence was lower among reviews of associations than among reviews of interventions. The case studies in work package 3 highlighted limitations in current methods for detecting these biases due to heterogeneity and potential confounders. Follow-up of health services and delivery research cohorts in work package 4 showed positive association between publication status and having statistically significant or positive findings. Diverse views concerning publication and related bias and insights into how features of health services and delivery research might influence its occurrence were uncovered through the interviews with health services and delivery research stakeholders and focus group discussion conducted in work package 5.
Conclusions
This study provided prima facie evidence on publication and related bias in quantitative health services and delivery research. This bias does appear to exist, but its prevalence and impact may vary depending on study characteristics, such as study design, and motivation for conducting the evaluation. Emphasis on methodological novelty and focus beyond summative assessments may mitigate/lessen the risk of such bias in health services and delivery research. Methodological and epistemological diversity in health services and delivery research and changing landscape in research publication need to be considered when interpreting the evidence. Collection of further empirical evidence and exploration of optimal health services and delivery research practice are required.
Study registration
This study is registered as PROSPERO CRD42016052333 and CRD42016052366.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 33. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Abimbola A Ayorinde
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Iestyn Williams
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Russell Mannion
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Fujian Song
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Magdalena Skrybant
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Richard J Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Yen-Fu Chen
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Kohli-Lynch M, Ponce Hardy V, Bernal Salazar R, Bhopal SS, Brentani A, Cavallera V, Goh E, Hamadani JD, Hughes R, Manji K, Milner KM, Radner J, Sharma S, Silver KL, Lawn JE, Tann CJ. Human resources and curricula content for early child development implementation: multicountry mixed methods evaluation. BMJ Open 2020; 10:e032134. [PMID: 32341042 PMCID: PMC7204990 DOI: 10.1136/bmjopen-2019-032134] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 02/13/2020] [Accepted: 03/12/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The WHO recommends responsive caregiving and early learning (RCEL) interventions to improve early child development (ECD), and to achieve the Sustainable Development Goals' vision of a world where all children thrive. Implementation of RCEL programmes in low and middle-income countries (LMIC) requires evidence to inform decisions about human resources and curricula content. We aimed to describe human resources and curricula content for implementation of RCEL projects across diverse LMICs, using data from the Grand Challenges Canada Saving Brains ECD portfolio. SETTING We evaluated 32 RCEL projects across 17 LMICs on four continents. PARTICIPANTS Overall, 2165 workers delivered ECD interventions to 25 909 families. INTERVENTION Projects were either stand-alone RCEL or RCEL combined with health and nutrition, and/or safety and security. PRIMARY AND SECONDARY OUTCOMES We undertook a mixed methods evaluation of RCEL projects within the Saving Brains portfolio. Quantitative data were collected through standardised reporting tools. Qualitative data were collected from ECD experts and stakeholders and analysed using thematic content analysis, informed by literature review. RESULTS Major themes regarding human resources included: worker characteristics, incentivisation, retention, training and supervision, and regarding curricula content: flexible adaptation of content and delivery, fidelity, and intervention duration and dosage. Lack of an agreed standard ECD package contributed to project heterogeneity. Incorporation of ECD into existing services may facilitate scale-up but overburdened workers plus potential reductions in service quality remain challenging. Supportive training and supervision, inducement, worker retention, dosage and delivery modality emerged as key implementation decisions. CONCLUSIONS This mixed methods evaluation of a multicountry ECD portfolio identified themes for consideration by policymakers and programme leaders relevant to RCEL implementation in diverse LMICs. Larger studies, which also examine impact, including high-quality process and costing evaluations with comparable data, are required to further inform decisions for implementation of RCEL projects at national and regional scales.
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Affiliation(s)
- Maya Kohli-Lynch
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Victoria Ponce Hardy
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Raquel Bernal Salazar
- Economics Department, Universidad de Los Andes, Bogota, Colombia
- Centro de Estudios de Desarrollo Economico (CEDE), Universidad de Los Andes, Bogota, Colombia
| | - Sunil S Bhopal
- Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London, UK
- Northern School of Paediatrics, Newcastle upon Tyne, UK
| | - Alexandra Brentani
- Departamento do Pediatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Vanessa Cavallera
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Esther Goh
- Bernard Van Leer Foundation, The Hague, Netherlands
| | - Jena D Hamadani
- Maternal and Child Health Division, ICDDR,B, Dhaka, Bangladesh
| | - Rob Hughes
- Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London, UK
- Children's Investment Fund Foundation, London, United Kingdom
| | - Karim Manji
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kate M Milner
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - James Radner
- Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Ontario, Canada
- Center on the Developing Child, Harvard University, Cambridge, Massachusetts, USA
| | | | | | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Cally J Tann
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
- Neonatal Medicine, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Social Aspects of Health across the Life Course, MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
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Heerdegen ACS, Aikins M, Amon S, Agyemang SA, Wyss K. Managerial capacity among district health managers and its association with district performance: A comparative descriptive study of six districts in the Eastern Region of Ghana. PLoS One 2020; 15:e0227974. [PMID: 31968010 PMCID: PMC6975551 DOI: 10.1371/journal.pone.0227974] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 01/03/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION District health managers play a pivotal role in the delivery of basic health services in many countries, including Ghana, as they are responsible for converting inputs and resources such as, staff, supplies and equipment into effective services that are responsive to population needs. Weak management capacity among local health managers has been suggested as a major obstacle for responsive health service delivery. However, evidence on district health managers' competencies and its association with health system performance is scarce. AIM To examine managerial capacity among district health managers and its association with health system performance in six districts in the Eastern Region of Ghana. METHODS Fifty-nine district health managers' in six different performing districts in the Eastern Region of Ghana completed a self-administered questionnaire measuring their management competencies and skills. In addition, the participants provided information on their socio-demographic background; previous management experience and training; the extent of available management support systems, and the dynamics within their district health management teams. A non-parametric one-way analysis was applied to test the association between management capacity and district performance, which was measured by 17 health indicators. RESULTS Shortcomings within different aspects of district management were identified, however there were no significant differences observed in the availability of support systems, characteristics and qualifications of district health managers across the different performing districts. Overall management capacity among district health managers were significantly higher in high performing districts compared with lower performing districts (p = 0.02). Furthermore, district health managers in better performing districts reported a higher extent of teamwork (p = 0.02), communication within their teams (p<0.01) and organizational commitment (p<0.01) compared with lower performing districts. CONCLUSION The findings demonstrate individual and institutional capacity needs, and highlights the importance of developing management competencies and skills as well as positive team dynamics among health managers at district level.
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Affiliation(s)
- Anne Christine Stender Heerdegen
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Moses Aikins
- School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Samuel Amon
- School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Samuel Agyei Agyemang
- School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Kaspar Wyss
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Ranjbar M, Neishabouri M, Gorji MAH. Exploring the Human Factors Affecting Health Service Managers: A Qualitative Study. Open Access Maced J Med Sci 2019; 7:2017-2023. [PMID: 31406548 PMCID: PMC6684413 DOI: 10.3889/oamjms.2019.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND In recent decades, managing health-service systems has faced multiple challenges. Identifying and resolving these challenges promote the efficiency and effectiveness of hospital activities. AIM The present study aimed to explore the human factors affecting health service managers. MATERIAL AND METHODS In this qualitative study, in-depth unstructured interviews were conducted with 29 employees who were in close contact with the health service managers. All the interviews were transcribed verbatim. Data were collected using purposeful sampling and were analysed using conventional content analysis via MAXQDA software. RESULTS A group of 29 participants were interviewed (male 65.5%, female 34.4%). "Managing managers" has been identified as the primary theme with four supporting secondary themes including the inappropriate appointment of managers, the impact of human and social needs of managers, influential employees, and disrupting organisational communications. These are the challenges faced by managers in managing human resources in health-service organisations. CONCLUSION Results showed that employees manage their managers within the organisation so that they can prevent managers from concentrating on their management affairs and tasks resulting in the distortion of management practices. The results of this study can help the key policy makers and planners in health-service organisations to guide the organisation to pursue its goals through appointing appropriate managers and identifying influential employees.
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Affiliation(s)
- Mansour Ranjbar
- Educational Development Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Masoumeh Neishabouri
- Department of Medical-Surgical Nursing, Nasibeh School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Ali Heidari Gorji
- Department of Medical-Surgical Nursing, Nasibeh School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
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Munabi-Babigumira S, Glenton C, Willcox M, Nabudere H. Ugandan health workers' and mothers' views and experiences of the quality of maternity care and the use of informal solutions: A qualitative study. PLoS One 2019; 14:e0213511. [PMID: 30856217 PMCID: PMC6411106 DOI: 10.1371/journal.pone.0213511] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 02/22/2019] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Although the coverage of maternity services in some low and middle-income countries (LMIC) has greatly improved, the quality of maternity care remains poor, and maternal mortality rates are high. In this study, we describe the meaning and determinants of maternity care quality from the perspective of health workers and mothers in Uganda, the informal solutions used by health workers to manage their daily challenges, and we suggest ways in which maternal care quality can be improved. METHODS We conducted a qualitative study in the Mpigi and Rukungiri districts of Uganda. Twenty-eight health workers based at selected health centres participated in structured interviews. Thirty-six mothers, half of whom had delivered at health facilities, participated in focus group discussions. Data were analysed thematically, and informed by the WHO framework on quality of care for maternal and newborn health and by Lipsky's street level bureaucracy concept. RESULTS According to health workers, knowledge of clinical standards and processes, timeliness, and women's choice during labour, as well as resources, physical infrastructure; collaboration with mothers, professionals and community health workers; were important aspects of good quality care. Mothers' perceptions of good quality care were largely similar to health workers' views, though mothers were more concerned about health workers' interaction skills. Structural challenges sometimes led health workers to develop informal solutions such as asking mothers to purchase their own supplies with variable implications on the quality of care. While several of these informal solutions were useful in addressing bottlenecks in the health system, they sometimes placed additional burdens and personal costs on health workers, created mistrust, inequity in care and negative experiences among mothers who could not afford the extra costs. CONCLUSIONS Health system structural factors; including technical, interpersonal, resource and infrastructural factors; impede the provision and experience of good quality maternity care at health centres in Uganda. Improving the quality of care will require strategies that address these core problems in the health system structure. Such structural reforms will require political support to commit resources, skilful management and leadership that seek to change organisational behaviour and build trust through good quality, woman-centred maternity care.
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Affiliation(s)
- Susan Munabi-Babigumira
- Global Health Unit, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Claire Glenton
- Global Health Unit, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
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Michaux G, Mwembo-Tambwe A, Belrhiti Z, Monet F, Criel B. Développement des Zones de Santé d'Apprentissage et de Recherche en République Démocratique du Congo : enseignements utiles d'une évaluation qualitative des expériences antérieures en Afrique Subsaharienne. Glob Health Promot 2018; 27:139-148. [PMID: 30319019 DOI: 10.1177/1757975918784537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Trois Zones d'Apprentissage et de Recherche (ZAR) sont développées par le programme RIPSEC en République Démocratique duCongo (RDC). Cette stratégie consiste à utiliser un district sanitaire comme substrat pour former des managers des districts de santé et mener des recherches sur les systèmes de santé. L'objet de cet article est d'explorer les principes, les effets et les conditions de succès de cette stratégie à travers une évaluation qualitative des expériences ZAR antérieures en Afrique Subsaharienne. Elle concerne quatre expériences, deux menées au Niger, une en RDC et une au Congo-Brazzaville. Les données proviennent des témoignages de responsables du développement des expériences, présentés dans un séminaire en 2014 et approfondis par des entretiens en 2015, et des publications traitant des expériences. Les faits communs aux quatre expériences sont la diffusion nationale et souvent internationale des bonnes pratiques et des modèles organisationnels, leur développement inscrit dans le long-terme et l'implication des managers des ZAR dans tous les volets de leur transformation. Le centrage de la recherche sur les problèmes de la ZAR et la promotion de la réflexivité dans les décisions managériales sont importants pour cette transformation. L'utilisation des résultats par le programme RIPSEC, les logiques imbriquées dans le concept ZAR et l'apport potentiel de l'implication d'écoles de santé publiques nationales dans leur développement sont ensuite discutés. La validité de l'étude est limitée mais renforcer le leadership des managers des districts sanitaires est un défi fréquent pour les systèmes de santé aux ressources limitées. Cet article peut aider à développer une stratégie pour le renforcer.
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Affiliation(s)
- Geneviève Michaux
- Instituut voor Tropische Geneeskunde, Public Health, Antwerpen, Belgique
| | - Albert Mwembo-Tambwe
- Université de Lubumbashi, Département de Gynécologie et Obstétrique, Lubumbashi, République Démocratique du Congo
| | | | - Francis Monet
- Instituut voor Tropische Geneeskunde, Public Health, Antwerpen, Belgique
| | - Bart Criel
- Institut de Médecine Tropicale Prince Leopold, Santé Publique, Anvers, Flandre, Belgique
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9
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Tetui M, Zulu JM, Hurtig AK, Ekirapa-Kiracho E, Kiwanuka SN, Coe AB. Elements for harnessing participatory action research to strengthen health managers' capacity: a critical interpretative synthesis. Health Res Policy Syst 2018; 16:33. [PMID: 29673346 PMCID: PMC5907405 DOI: 10.1186/s12961-018-0306-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 04/02/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Health managers play a key role in ensuring that health services are responsive to the needs of the population. Participatory action research (PAR) is one of the approaches that have been used to strengthen managers' capacity. However, collated knowledge on elements for harnessing PAR to strengthen managers' capacity is missing. This paper bridges this gap by reviewing existing literature on the subject matter. METHODS A critical interpretive synthesis method was used to interrogate eight selected articles. These articles reported the use of PAR to strengthen health managers' capacity. The critical interpretive synthesis method's approach to analysis guided the synthesis. Here, the authors interpretively made connections and linkages between different elements identified in the literature. Finally, the Atun et al. (Heal Pol Plann, 25:104-111, 2010) framework on integration was used to model the elements synthesised in the literature into five main domains. RESULTS Five elements with intricate bi-directional interactions were identified in the literature reviewed. These included a shared purpose, skilled facilitation and psychological safety, activity integration into organisational procedures, organisational support, and external supportive monitoring. A shared purpose of the managers' capacity strengthening initiative created commitment and motivation to learn. This purpose was built upon a set of facilitation skills that included promoting participation, self-efficacy and reflection, thereby creating a safe psychological space within which the managers interacted and learnt from each other and their actions. Additionally, an integrated intervention strengthened local capacity and harnessed organisational support for learning. Finally, supportive monitoring from external partners, such as researchers, ensured quality, building of local capacity and professional safety networks essential for continued learning. CONCLUSIONS The five elements identified in this synthesis provide a basis upon which the use of PAR can be harnessed, not only to strengthen health managers' capacity, but also to foster other health systems strengthening initiatives involving implementation research. In addition, the findings demonstrated the intricate and complex relations between the elements, which further affirms the need for a systems thinking approach to tackling health systems challenges.
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Affiliation(s)
- Moses Tetui
- Makerere University College of Health Sciences, School of Public Health (MakCHS-SPH), New Mulago Complex, P.O. B0X 7072, Kampala, Uganda
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden
| | - Joseph Mumba Zulu
- School of Public Health, University of Zambia, P.O. Box 50110, Lusaka, Zambia
| | - Anna-Karin Hurtig
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden
| | - Elizabeth Ekirapa-Kiracho
- Makerere University College of Health Sciences, School of Public Health (MakCHS-SPH), New Mulago Complex, P.O. B0X 7072, Kampala, Uganda
| | - Suzanne N. Kiwanuka
- Makerere University College of Health Sciences, School of Public Health (MakCHS-SPH), New Mulago Complex, P.O. B0X 7072, Kampala, Uganda
| | - Anna-Britt Coe
- Sociology Department, Umeå University, 901 87 Umeå, Sweden
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Gholipour K, Tabrizi JS, Farahbakhsh M, Iezadi S, Ghiasi A, Jahanbin H. Evaluation of the district health management fellowship training programme: a case study in Iran. BMJ Open 2018; 8:e020603. [PMID: 29525773 PMCID: PMC5855189 DOI: 10.1136/bmjopen-2017-020603] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate the district health management fellowship training programme in the north-west of Iran. DATA SOURCES/STUDY SETTING The programme was introduced to build the managerial capacity of district health managers in Iran. Eighty-nine heads of units in the province's health centre, district health managers and the health deputies of the district health centres in the north-west provinces of Iran had registered for the district health management fellowship training programme in Tabriz in 2015-2016. STUDY DESIGN This was an educational evaluation study to evaluate training courses to measure participants' reactions and learning and, to a lesser extent, application of training to their job and the organisational impact. DATA COLLECTION/EXTRACTION METHODS Valid and reliable questionnaires were used to assess learning techniques and views towards the fellowship, and self-assessment of health managers' knowledge and skills. Also, pretest and post-test examinations were conducted in each course and a portfolio was provided to the trainees to be completed in their work settings. PRINCIPAL FINDINGS About 63% of the participants were medical doctors and 42.3% of them had over 20 years of experience. Learning by practice (scored 18.37 out of 20) and access to publications (17.27) were the most useful methods of training in health planning and management from the participants' perspective. Moreover, meeting peers from other districts and the academic credibility of teachers were the most important features of the current programme. Based on the managers' self-assessment, they were most skilful in quality improvement, managing, planning and evaluation of the district. The results of the post-test analysis on data collected from district health managers showed the highest scores in managing the district (77 out of 100) and planning and evaluation (69) of the courses. CONCLUSION The results of this study indicated that training courses, methods and improvement in managers' knowledge about the health system and the skills necessary to manage their organisation were acceptable.
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Affiliation(s)
- Kamal Gholipour
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jafar Sadegh Tabrizi
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mostafa Farahbakhsh
- Road Traffic Injury Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shabnam Iezadi
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akbar Ghiasi
- Department of Health Services Administration, School of Health Professions, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Hasan Jahanbin
- East Azerbaijan Provincial Health Centre, Tabriz University of Medical Sciences, Tabriz, Iran
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Sebuliba I, Lindan C, Baryamutuma R, Kyomugisha C, Muhumuza S, Bazeyo W, Akello E. Improving the ability of districts in Uganda to monitor their HIV programs. EAST AFRICAN JOURNAL OF APPLIED HEALTH MONITORING AND EVALUATION 2018; 2018:http://eajahme.com/wp-content/uploads/2018/03/Sebuliba_FINAL.pdf. [PMID: 30918924 PMCID: PMC6433397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Although district health teams (DHT) in Uganda are supposed to monitor and support facilities to ensure quality HIV data collection, reporting and use, they are often ill-equipped to do so. We implemented a program designed to build the capacity of districts to manage and use their own HIV-related program data and to assist facilities to collect and evaluate their own data. METHODS We conducted a baseline assessment of the monitoring and evaluation (M&E) capacity of 38 districts. In the 10 worst-performing districts, we identified and trained district-level staff to become M&E mentors who in turn trained and supervised facility-level staff. We collected information on action plans developed by facilities to address major issues of concern. Following the intervention, we reassessed M&E capacity of the 10 targeted districts. RESULTS Among the 38 districts assessed, one-half did not have a biostatistician, less than one-quarter had staff trained in the basics of M&E or data analysis, and less than one-quarter had an M&E plan. The main concerns of facilities included lack of updated data collection tools, lack of supervision, inaccurate data recording, and limited ability to analyze and use data. In the 10 targeted districts, comparison before and after the intervention showed that the number of districts with trained M&E staff increased (4 to 9), the number of M&E plans increased (3 to 6), and the number using data for programming increased (4 to 8). Implementation of action plans by facilities successfully addressed many issues and led to improved programming. CONCLUSION Challenges of district M&E in Uganda mainly result from a lack of skilled human resources. On-the-job training and direct involvement of district staff to provide support to facilities can lead to improvements in data quality and use.
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Affiliation(s)
- Isaac Sebuliba
- Makerere University School of Public Health, Kampala, Uganda
| | - Christina Lindan
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | | | | | - Simon Muhumuza
- Makerere University School of Public Health, Kampala, Uganda
| | - William Bazeyo
- Makerere University School of Public Health, Kampala, Uganda
| | - Evelyn Akello
- Makerere University School of Public Health, Kampala, Uganda
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Herrera CA, Lewin S, Paulsen E, Ciapponi A, Opiyo N, Pantoja T, Rada G, Wiysonge CS, Bastías G, Garcia Marti S, Okwundu CI, Peñaloza B, Oxman AD. Governance arrangements for health systems in low-income countries: an overview of systematic reviews. Cochrane Database Syst Rev 2017; 9:CD011085. [PMID: 28895125 PMCID: PMC5618451 DOI: 10.1002/14651858.cd011085.pub2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Governance arrangements include changes in rules or processes that determine authority and accountability for health policies, organisations, commercial products and health professionals, as well as the involvement of stakeholders in decision-making. Changes in governance arrangements can affect health and related goals in numerous ways, generally through changes in authority, accountability, openness, participation and coherence. A broad overview of the findings of systematic reviews can help policymakers, their technical support staff and other stakeholders to identify strategies for addressing problems and improving the governance of their health systems. OBJECTIVES To provide an overview of the available evidence from up-to-date systematic reviews about the effects of governance arrangements for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on governance arrangements and informing refinements of the framework for governance arrangements outlined in the overview. METHODS We searched Health Systems Evidence in November 2010 and PDQ Evidence up to 17 December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of governance arrangements on patient outcomes (health and health behaviours), the quality or utilisation of healthcare services, resource use (health expenditures, healthcare provider costs, out-of-pocket payments, cost-effectiveness), healthcare provider outcomes (such as sick leave), or social outcomes (such as poverty, employment) and that were published after April 2005. We excluded reviews with limitations that were important enough to compromise the reliability of the findings of the review. Two overview authors independently screened reviews, extracted data and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence) and assessments of the relevance of findings to low-income countries. MAIN RESULTS We identified 7272 systematic reviews and included 21 of them in this overview (19 primary reviews and 2 supplementary reviews). We focus here on the results of the 19 primary reviews, one of which had important methodological limitations. The other 18 were reliable (with only minor limitations).We grouped the governance arrangements addressed in the reviews into five categories: authority and accountability for health policies (three reviews); authority and accountability for organisations (two reviews); authority and accountability for commercial products (three reviews); authority and accountability for health professionals (seven reviews); and stakeholder involvement (four reviews).Overall, we found desirable effects for the following interventions on at least one outcome, with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects. Decision-making about what is covered by health insurance- Placing restrictions on the medicines reimbursed by health insurance systems probably decreases the use of and spending on these medicines (moderate-certainty evidence). Stakeholder participation in policy and organisational decisions- Participatory learning and action groups for women probably improve newborn survival (moderate-certainty evidence).- Consumer involvement in preparing patient information probably improves the quality of the information and patient knowledge (moderate-certainty evidence). Disclosing performance information to patients and the public- Disclosing performance data on hospital quality to the public probably encourages hospitals to implement quality improvement activities (moderate-certainty evidence).- Disclosing performance data on individual healthcare providers to the public probably leads people to select providers that have better quality ratings (moderate-certainty evidence). AUTHORS' CONCLUSIONS Investigators have evaluated a wide range of governance arrangements that are relevant for low-income countries using sound systematic review methods. These strategies have been targeted at different levels in health systems, and studies have assessed a range of outcomes. Moderate-certainty evidence shows desirable effects (with no undesirable effects) for some interventions. However, there are important gaps in the availability of systematic reviews and primary studies for the all of the main categories of governance arrangements.
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Affiliation(s)
- Cristian A Herrera
- Pontificia Universidad Católica de ChileDepartment of Public Health, School of MedicineMarcoleta 434SantiagoChile
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
| | - Simon Lewin
- Norwegian Institute of Public HealthPO Box 4404OsloNorway0403
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
| | | | - Agustín Ciapponi
- Institute for Clinical Effectiveness and Health Policy (IECS‐CONICET)Argentine Cochrane CentreDr. Emilio Ravignani 2024Buenos AiresCapital FederalArgentinaC1414CPV
| | - Newton Opiyo
- CochraneCochrane Editorial UnitSt Albans House, 57‐59 HaymarketLondonUKSW1Y 4QX
| | - Tomas Pantoja
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
- Pontificia Universidad Católica de ChileDepartment of Family Medicine, Faculty of MedicineCentro Medico San Joaquin, Vicuña Mackenna 4686MaculSantiagoChile
| | - Gabriel Rada
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
- Pontificia Universidad Católica de ChileDepartment of Internal Medicine and Evidence‐Based Healthcare Program, Faculty of MedicineLira 44, Decanato Primer pisoSantiagoChile
| | - Charles S Wiysonge
- South African Medical Research CouncilCochrane South AfricaFrancie van Zijl Drive, Parow ValleyCape TownWestern CapeSouth Africa7505
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Gabriel Bastías
- Pontificia Universidad Católica de ChileDepartment of Public Health, School of MedicineMarcoleta 434SantiagoChile
| | - Sebastian Garcia Marti
- Institute for Clinical Effectiveness and Health PolicyBuenos AiresCapital FederalArgentinaC1056ABH
| | - Charles I Okwundu
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Blanca Peñaloza
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
- Pontificia Universidad Católica de ChileDepartment of Family Medicine, Faculty of MedicineCentro Medico San Joaquin, Vicuña Mackenna 4686MaculSantiagoChile
| | - Andrew D Oxman
- Norwegian Institute of Public HealthPO Box 4404OsloNorway0403
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Abstract
INTRODUCTION Health leadership and management capacity are essential for health system strengthening and for attaining universal health coverage by optimising the existing human, technological and financial resources. However, in health systems, health leadership and management training is not widely available. The use of information technology for education (ie, eLearning) could help address this training gap by enabling flexible, efficient and scalable health leadership and management training. We present a protocol for a systematic review on the effectiveness of eLearning for health leadership and management capacity building in improving health system outcomes. METHODOLOGY AND ANALYSIS We will follow the Cochrane Collaboration methodology. We will search for experimental studies focused on the use of any type of eLearning modality for health management and leadership capacity building in all types of health workforce cadres. The primary outcomes of interest will be health outcomes, financial risk protection and user satisfaction. In addition, secondary outcomes of interest include the attainment of health system objectives of improved equity, efficiency, effectiveness and responsiveness. We will search relevant databases of published and grey literature as well as clinical trials registries from 1990 onwards without language restrictions. Two review authors will screen references, extract data and perform risk of bias assessment independently. Contingent on the heterogeneity of the collated literature, we will perform either a meta-analysis or a narrative synthesis of the collated data. ETHICS AND DISSEMINATION The systematic review will aim to inform policy makers, investors, health professionals, technologists and educators about the existing evidence, potential gaps in literature and the impact of eLearning for health leadership and management capacity building on health system outcomes. We will disseminate the review findings by publishing it as a peer-reviewed journal manuscript and conference abstracts. TRIAL REGISTRATION NUMBER PROSPERO CRD42017056998.
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Affiliation(s)
- Lorainne Tudor Car
- Center for Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard, Boston, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard, Boston, USA
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Tetui M, Hurtig AK, Ekirpa-Kiracho E, Kiwanuka SN, Coe AB. Building a competent health manager at district level: a grounded theory study from Eastern Uganda. BMC Health Serv Res 2016; 16:665. [PMID: 27871333 PMCID: PMC5117515 DOI: 10.1186/s12913-016-1918-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 11/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health systems in low-income countries are often characterized by poor health outcomes. While many reasons have been advanced to explain the persistently poor outcomes, management of the system has been found to play a key role. According to a WHO framework, the management of health systems is central to its ability to deliver needed health services. In this study, we examined how district managers in a rural setting in Uganda perceived existing approaches to strengthening management so as to provide a pragmatic and synergistic model for improving management capacity building. METHODS Twenty-two interviews were conducted with district level administrative and political managers, district level health managers and health facility managers to understand their perceptions and definitions of management and capacity building. Kathy Charmaz's constructive approach to grounded theory informed the data analysis process. RESULTS An interative, dynamic and complex model with three sub-process of building a competent health manager was developed. A competent manager was understood as one who knew his/her roles, was well informed and was empowered to execute management functions. Professionalizing health managers which was viewed as the foundation, the use of engaging learning approaches as the inside contents and having a supportive work environment the frame of the model were the sub-processes involved in the model. The sub-processes were interconnected although the respondents agreed that having a supportive work environment was more time and effort intensive relative to the other two sub-processes. CONCLUSIONS The model developed in our study makes four central contributions to enhance the WHO framework and the existing literature. First, it emphasizes management capacity building as an iterative, dynamic and complex process rather than a set of characteristics of competent managers. Second, our model suggests the need for professionalization of health managers at different levels of the health system. Third, our model underscores the benefits that could be accrued from the use of engaging learning approaches through prolonged and sustained processes that act in synergy. Lastly, our model postulates that different resource investments and a varied range of stakeholders could be required at each of the sub-processes.
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Affiliation(s)
- Moses Tetui
- Makerere University School of Public Health (MakSPH), Makerere University, New Mulago Complex, P.O. B0X 7072, Kampala, Uganda. .,Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, SE 90185, Sweden.
| | - Anna-Karin Hurtig
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, SE 90185, Sweden
| | - Elizabeth Ekirpa-Kiracho
- Makerere University School of Public Health (MakSPH), Makerere University, New Mulago Complex, P.O. B0X 7072, Kampala, Uganda
| | - Suzanne N Kiwanuka
- Makerere University School of Public Health (MakSPH), Makerere University, New Mulago Complex, P.O. B0X 7072, Kampala, Uganda
| | - Anna-Britt Coe
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, SE 90185, Sweden
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Belrhiti Z, Booth A, Marchal B, Verstraeten R. To what extent do site-based training, mentoring, and operational research improve district health system management and leadership in low- and middle-income countries: a systematic review protocol. Syst Rev 2016; 5:70. [PMID: 27116915 PMCID: PMC4847191 DOI: 10.1186/s13643-016-0239-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/06/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND District health managers play a key role in the effectiveness of decentralized health systems in low- and middle-income countries. Inadequate management and leadership skills often hamper their ability to improve quality of care and effectiveness of health service delivery. Nevertheless, significant investments have been made in capacity-building programmes based on site-based training, mentoring, and operational research. This systematic review aims to review the effectiveness of site-based training, mentoring, and operational research (or action research) on the improvement of district health system management and leadership. Our secondary objectives are to assess whether variations in composition or intensity of the intervention influence its effectiveness and to identify enabling and constraining contexts and underlying mechanisms. METHODS We will search the following databases: MEDLINE, PsycInfo, Cochrane Library, CRD database (DARE), Cochrane Effective Practice and Organisation of Care (EPOC) group, ISI Web of Science, Health Evidence.org, PDQ-Evidence, ERIC, EMBASE, and TRIP. Complementary search will be performed (hand-searching journals and citation and reference tracking). Studies that meet the following PICO (Population, Intervention, Comparison, Outcome) criteria will be included: P: professionals working at district health management level; I: site-based training with or without mentoring, or operational research; C: normal institutional arrangements; and O: district health management functions. We will include cluster randomized controlled trials, controlled before-and-after studies, interrupted time series analysis, quasi-experimental designs, and cohort and longitudinal studies. Qualitative research will be included to contextualize findings and identify barriers and facilitators. Primary outcomes that will be reported are district health management and leadership functions. We will assess risk of bias with the Cochrane Collaboration's tools for randomized controlled trials (RCT) and non RCT studies and Critical Appraisal Skills Programme checklists for qualitative studies. We will assess strength of recommendations with the GRADE tool for quantitative studies, and the CERQual approach for qualitative studies. Synthesis of quantitative studies will be performed through meta-analysis when appropriate. Best fit framework synthesis will be used to synthesize qualitative studies. DISCUSSION This protocol paper describes a systematic review assessing the effectiveness of site-based training (with or without mentoring programmes or operational research) on the improvement of district health system management and leadership. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015032351.
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Affiliation(s)
- Zakaria Belrhiti
- Department of Management and Economy, National School of Public Health, Rabat, Morocco.
| | - Andrew Booth
- School of Health & Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Bruno Marchal
- Health Services Organisation Unit, Institute of Tropical Medicine, Antwerp, Belgium
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Sacks E, Alva S, Magalona S, Vesel L. Examining domains of community health nurse satisfaction and motivation: results from a mixed-methods baseline evaluation in rural Ghana. HUMAN RESOURCES FOR HEALTH 2015; 13:81. [PMID: 26450085 PMCID: PMC4599654 DOI: 10.1186/s12960-015-0082-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 09/28/2015] [Indexed: 05/19/2023]
Abstract
BACKGROUND A strong health system requires a competent and caring workforce. A more satisfied and motivated health workforce should be more willing to serve in difficult areas, have lower turnover, and theoretically provide better care to patients. This paper examines the motivation, satisfaction, and correlation with clinical knowledge, of community health nurses (CHNs), a cadre of provider focused on maternal, newborn and child health in rural Ghana. METHODS This study employed three methods of evaluation. Two quantitative measurements were used: (1) a survey of health worker satisfaction and motivation and (2) a clinical knowledge assessment focusing on maternal, newborn and child health. Both were administered to all rostered CHNs working in the five sampled districts in the Greater Accra and Volta regions in Eastern Ghana (N = 205). Qualitative interviews (N = 29) and focus group discussions (N = 4) were held with selected CHNs in the same districts. These data were analysed using NVivo (Version 10) and Stata (Version 13.0) based on domains of extrinsic and intrinsic motivation including general satisfaction, work environment and access to resources, respect and recognition received and opportunities for advancement. RESULTS CHNs desired more training, especially those who were posted at the community level (a Community-based Health Planning and Services post or "CHPS") versus at a health facility. CHNs working at CHPS believed their work to be more difficult than those posted at health facilities, due to challenges associated with foot travel to visit patients at home, and they were more likely to report having insufficient resources to do their jobs (48% vs 36%). However, CHNs posted at health facilities were more likely to report insufficient opportunities for career advancement than the CHPS nurses (49% vs 33%). CHNs generally reported good relationships with colleagues and being respected by patients but desired more respect from supervisors. The median score on the knowledge assessment was 78%. On average, subgroups of CHNs with different reported levels of satisfaction did not perform differently on the knowledge assessment. CONCLUSIONS CHNs in Ghana were satisfied overall but desired more training, more guidance and supervision, fair pay and opportunities to advance in their career. Improving health worker satisfaction and morale may be important for health worker retention and certain aspects of care but may not have a significant influence on clinical knowledge or performance.
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Affiliation(s)
- Emma Sacks
- Department of International Health, Johns Hopkins School of Public Health, 615 N. Wolfe St., E8011, Baltimore, MD, 21205, USA.
- USAID Maternal and Child Survival Program (MCSP)/ICF International, Washington, DC, USA.
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Grobler L, Marais BJ, Mabunda S. Interventions for increasing the proportion of health professionals practising in rural and other underserved areas. Cochrane Database Syst Rev 2015; 2015:CD005314. [PMID: 26123126 PMCID: PMC6791300 DOI: 10.1002/14651858.cd005314.pub3] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The inequitable distribution of health professionals, within countries, poses an important obstacle to the optimal functioning of health services. OBJECTIVES To assess the effectiveness of interventions aimed at increasing the proportion of health professionals working in rural and other underserved areas. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, including specialised register of the Cochrane Effective Practice and Organisation of Care Group; March 2014), MEDLINE (1966 to March 2014), EMBASE (1988 to March 2014), CINAHL (1982 to March 2014), LILACS (February 2014), Science Citation Index and Social Sciences Citation Index (up to April 2014), Global Health (March 2014) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (June 2013). We also searched reference lists of all papers and relevant reviews identified, and contacted authors of relevant papers regarding any further published or unpublished work. SELECTION CRITERIA Randomised trials, non-randomised trials, controlled before-and-after studies and interrupted time series studies evaluating the effects of various interventions (e.g. educational, financial, regulatory or support strategies) on the recruitment or retention, or both, of health professionals in underserved areas. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts and assessed full texts of potentially relevant studies for eligibility. Two review authors independently extracted data from eligible studies. MAIN RESULTS For this first update of the original review, we screened 8945 records for eligibility. We retrieved and assessed the full text of 125 studies. Only one study met the inclusion criteria of the review. This interrupted time series study, conducted in Taiwan, found that the implementation of a National Health Insurance scheme in 1995 was associated with improved equity in the geographic distribution of physicians and dentists. We judged the certainty of the evidence provided by this one study very low. AUTHORS' CONCLUSIONS There is currently limited reliable evidence regarding the effects of interventions aimed at addressing the inequitable distribution of health professionals. Well-designed studies are needed to confirm or refute findings of observational studies of educational, financial, regulatory and supportive interventions that might influence healthcare professionals' decisions to practice in underserved areas. Governments and medical schools should ensure that when interventions are implemented, their impacts are evaluated using scientifically rigorous methods to establish the true effects of these measures on healthcare professional recruitment and retention in rural and other underserved settings.
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Affiliation(s)
- Liesl Grobler
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesPO Box 241TygerbergCape TownWestern CapeSouth Africa8000
| | - Ben J Marais
- University of SydneyMarie Bashir Institute for Infectious Diseases and BiosecuritySydneyAustralia
- University of SydneyChildren’s Hospital at WestmeadSydneyAustralia
| | - Sikhumbuzo Mabunda
- University of Cape Town/Western Cape Department of HealthP.O. Box 768RondeboschSouth Africa7701
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Marrinan H, Firth S, Hipgrave D, Jimenez-Soto E. Let's Take it to the Clouds: The Potential of Educational Innovations, Including Blended Learning, for Capacity Building in Developing Countries. Int J Health Policy Manag 2015; 4:571-3. [PMID: 26340485 DOI: 10.15171/ijhpm.2015.121] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 06/25/2015] [Indexed: 11/09/2022] Open
Abstract
In modern decentralised health systems, district and local managers are increasingly responsible for financing, managing, and delivering healthcare. However, their lack of adequate skills and competencies are a critical barrier to improved performance of health systems. Given the financial and human resource, constraints of relying on traditional face-to-face training to upskill a large and dispersed number of health managers, governments, and donors must look to exploit advances in the education sector. In recent years, education providers around the world have been experimenting with blended learning; that is, amalgamating traditional face-to-face education with web-based learning to reduce costs and enrol larger numbers of students. Access to improved information and communication technology (ICT) has been the major catalyst for such pedagogical innovations. We argue that with many developing countries already improving their ICT systems, the question is not whether but how to employ technology to facilitate the continuous professional development of district and local health managers in decentralised settings.
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Affiliation(s)
- Hannah Marrinan
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Sonja Firth
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - David Hipgrave
- United Nations Children's Fund (UNICEF), New York City, NY, USA
| | - Eliana Jimenez-Soto
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
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Mpofu M, Semo BW, Grignon J, Lebelonyane R, Ludick S, Matshediso E, Sento B, Ledikwe JH. Strengthening monitoring and evaluation (M&E) and building sustainable health information systems in resource limited countries: lessons learned from an M&E task-shifting initiative in Botswana. BMC Public Health 2014; 14:1032. [PMID: 25281354 PMCID: PMC4192275 DOI: 10.1186/1471-2458-14-1032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 09/29/2014] [Indexed: 11/12/2022] Open
Abstract
Background The demand for quality data and the interest in health information systems has increased due to the need for country-level progress reporting towards attainment of the United Nations Millennium Development Goals and global health initiatives. To improve monitoring and evaluation (M&E) of health programs in Botswana, 51 recent university graduates with no experience in M&E were recruited and provided with on-the-job training and mentoring to develop a new cadre of health worker: the district M&E officer. Three years after establishment of the cadre, an assessment was conducted to document achievements and lessons learnt. Methods This qualitative assessment included in-depth interviews at the national level (n = 12) with officers from government institutions, donor agencies, and technical organizations; and six focus group discussions separately with district M&E officers, district managers, and program officers coordinating different district health programs. Results Reported achievements of the cadre included improved health worker capacity to monitor and evaluate programs within the districts; improved data quality, management, and reporting; increased use of health data for disease surveillance, operational research, and planning purposes; and increased availability of time for nurses and other health workers to concentrate on core clinical duties. Lessons learnt from the assessment included: the importance of clarifying roles for newly established cadres, aligning resources and equipment to expectations, importance of stakeholder collaboration in implementation of sustainable programs, and ensuring retention of new cadres. Conclusion The development of a dedicated M&E cadre at the district level contributed positively to health information systems in Botswana by helping build M&E capacity and improving data quality, management, and data use. This assessment has shown that such cadres can be developed sustainably if the initiative is country-led, focusing on recruitment and capacity-development of local counterparts, with a clear government retention plan.
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Affiliation(s)
| | | | | | | | | | | | | | - Jenny H Ledikwe
- International Training and Education Centre for Health (I-TECH), P,O, Box AC46 ACH, Riverwalk, Gaborone, Botswana.
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