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Bosongo S, Belrhiti Z, Ekofo J, Kabanga C, Chenge F, Criel B, Marchal B. How capacity building of district health managers has been designed, delivered and evaluated in sub-Saharan Africa: a scoping review and best fit framework analysis. BMJ Open 2023; 13:e071344. [PMID: 37532484 PMCID: PMC10401232 DOI: 10.1136/bmjopen-2022-071344] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVES We aimed to understand how capacity building programmes (CBPs) of district health managers (DHMs) have been designed, delivered and evaluated in sub-Saharan Africa. We focused on identifying the underlying assumptions behind leadership and management CBPs at the district level. DESIGN Scoping review. DATA SOURCES We searched five electronic databases (MEDLINE, Health Systems Evidence, Wiley Online Library, Cochrane Library and Google Scholar) on 6 April 2021 and 13 October 2022. We also searched for grey literature and used citation tracking. ELIGIBILITY CRITERIA We included all primary studies (1) reporting leadership or management capacity building of DHMs, (2) in sub-Saharan Africa, (3) written in English or French and (4) published between 1 January 1987 and 13 October 2022. DATA EXTRACTION AND SYNTHESIS Three independent reviewers extracted data from included articles. We used the best fit framework synthesis approach to identify an a priori framework that guided data coding, analysis and synthesis. We also conducted an inductive analysis of data that could not be coded against the a priori framework. RESULTS We identified 2523 papers and ultimately included 44 papers after screening and assessment for eligibility. Key findings included (1) a scarcity of explicit theories underlying CBPs, (2) a diversity of learning approaches with increasing use of the action learning approach, (3) a diversity of content with a focus on management rather than leadership functions and (4) a diversity of evaluation methods with limited use of theory-driven designs to evaluate leadership and management capacity building interventions. CONCLUSION This review highlights the need for explicit and well-articulated programme theories for leadership and management development interventions and the need for strengthening their evaluation using theory-driven designs that fit the complexity of health systems.
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Affiliation(s)
- Samuel Bosongo
- Faculté de Médecine et Pharmacie, Département de Santé Publique, Université de Kisangani, Kisangani, Congo (the Democratic Republic of the)
- Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa, Congo (the Democratic Republic of the)
| | - Zakaria Belrhiti
- Département santé publique and management, Ecole Internationale de Santé Publique, Université Mohammed VI des Sciences de la Santé, Casablanca, Morocco
- Centre Mohammed VI de la recherche et Innovation (CM6), Rabat, Morocco
| | - Joël Ekofo
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa, Congo (the Democratic Republic of the)
| | - Chrispin Kabanga
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa, Congo (the Democratic Republic of the)
| | - Faustin Chenge
- Faculté de Médecine et Pharmacie, Département de Santé Publique, Université de Kisangani, Kisangani, Congo (the Democratic Republic of the)
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa, Congo (the Democratic Republic of the)
- Ecole de Santé Publique, Université de Lubumbashi, Lubumbashi, Congo (the Democratic Republic of the)
| | - Bart Criel
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Corvino I, D'Andrea F. Èquipe, community, traditional values, and reproductive rights. FRONTIERS IN SOCIOLOGY 2023; 7:1043241. [PMID: 36714360 PMCID: PMC9875324 DOI: 10.3389/fsoc.2022.1043241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/20/2022] [Indexed: 06/18/2023]
Abstract
Gender stereotypes still surround women's reproductive health for several reasons. Moreover, in the last 20 years, women's access to essential reproductive healthcare is becoming an issue contributing to inequality and exacerbating different kinds of violence (cultural and structural). The patriarchal system, intimate partner violence, and traditional cultural and conservative values have a huge impact on women's access to contraceptive information, services, and induced abortion. Gender-based human rights violation has a higher impact on those women who are part of a minority or suffer a marginalized social or economic condition. In the present article, the behavior of migrant women's networks is examined as a case study when they come into contact with the health and care sector with the aim to highlight how, in the context of childbirth, they can suffer discriminatory and violent treatment by the community and groups that defend conservative and traditional values due to the exercise of reproductive rights. The investigated context was the Careggi Hospital in Florence, Italy, but in further investigation, the research will take place in different medium-sized cities such as Terni and Perugia. The chosen methodology was that of second-level sources and qualitative interviews with the health personnel who usually deals with these women (two focus groups involving 11 persons of the hospital équipe). This article has two aims: (1) to present the conflict between community behavior and the right to reproductive health and (2) to discuss aspects of IPV as degrading or violent treatment due to the exercise of reproductive rights. The main finding underlined the importance of considering the link between rights, identity, culture, and relationships with the community.
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Tabrizi JS, Aghdash SA, Nouri M. Countries' experiences in reforming hospital administration structure based on the Parker and Harding model: A systematic review study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:315. [PMID: 34667815 PMCID: PMC8459866 DOI: 10.4103/jehp.jehp_1649_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/05/2021] [Indexed: 06/13/2023]
Abstract
In recent years, many reforms have been made on the structure of hospital administration, most of which are proposed by Parker-Harding models. Therefore, the purpose of this study is to systematically review global relevant experiences in reforming the hospital governance structure with emphasis on the Parker-Harding model. Required information was collected using keywords autonomization, corporatization, privatization, decentralization, reform, hospital autonomy, governance model, and structural reform in databases such as EMBASE, PubMed, Scopus, SID, MagIran, and other resources. Information on the subjects under study was collected from 1990 to 2020. The content extraction method was used for data extraction and data analysis. Thirty-nine sources were included in the study. Results of searching for relevant evidence on a variety of hospital governance models (government, board, corporate, and private) based on the Parker-Harding model in four categories including strengths (31), weaknesses (30), outcomes (26), and interventions (21) are outlined. In this study, strengths, weaknesses, outcomes, and corrective interventions were presented for different models of hospital administration that could be used by healthcare policymakers. Also, According to the results of this study, governmental model less recommended.
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Affiliation(s)
- Jafar Sadegh Tabrizi
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saber Azami Aghdash
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahdi Nouri
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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Feyissa GT, Balabanova D, Woldie M. How Effective are Mentoring Programs for Improving Health Worker Competence and Institutional Performance in Africa? A Systematic Review of Quantitative Evidence. J Multidiscip Healthc 2019; 12:989-1005. [PMID: 31824166 PMCID: PMC6901118 DOI: 10.2147/jmdh.s228951] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/27/2019] [Indexed: 02/02/2023] Open
Abstract
Introduction Mentoring programs are frequently recommended as innovative and low-cost solutions, and these have been implemented in many healthcare institutions to tackle multiple human resource-related challenges. This review sought to locate, appraise and describe the literature reporting on mentorship programs that were designed to improve healthcare worker competence and institutional performance in Africa. Methods This review searched and synthesized reports from studies that assessed the effectiveness of mentorship programs among healthcare workers in Africa. We searched for studies reported in the English language in EMBASE, CINAHL, COCHRANE and MEDLINE. Additional search was conducted in Google Scholar. Results We included 30 papers reporting on 24 studies. Diverse approaches of mentorship were reported: a) placing a mentor in health facility for a period of time (embedded mentor), b) visits by a mobile mentor, c) a mentoring approach involving a team of mobile multidisciplinary mentors, d) facility twinning, and e) within-facility mentorship by a focal person or a manager. Implication for practice Mentoring interventions were effective in improving the clinical management of infectious diseases, maternal, neonatal and childhood illnesses. Mentoring interventions were also found to improve managerial performance (accounting, human resources, monitoring and evaluation, and transportation management) of health institutions. Additionally, mentoring had improved laboratory accreditation scores. Mentoring interventions may be used to increase adherence of health professionals to guidelines, standards, and protocols. While different types of interventions (embedded mentoring, visits by mobile mentors, facility twinning and within-facility mentorship by a focal person) were reported to be effective, there is no evidence to recommend one model of mentoring over other types of mentoring. Implications for research Further research—experimental methods measuring the impact of different mentoring formats and longitudinal studies establishing their long-term effectiveness—is required to compare the effectiveness and cost-effectiveness of different models of mentoring. Further studies are needed to explore why and how different mentoring programs succeed and the meaningfulness of mentoring programs for the different stakeholders are also required.
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Affiliation(s)
- Garumma Tolu Feyissa
- Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia.,Ethiopian Evidence Based Healthcare: JBI Center of Excellence, Jimma University, Jimma, Ethiopia
| | - Dina Balabanova
- Department of Health Policy and Management, London School of Hygiene and Tropical Medicine, London, UK
| | - Mirkuzie Woldie
- Ethiopian Evidence Based Healthcare: JBI Center of Excellence, Jimma University, Jimma, Ethiopia.,Department of Global Health and Population, T.H. Chan Harvard School of Public Health, Addis Ababa, Ethiopia
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Bigelow B, Desalegn DN, Salomon JA, Verguet S. Modelling hospital operations: insight from using data from paper registries in the obstetrics ward at a hospital in Addis Ababa, Ethiopia. BMJ Glob Health 2019; 4:e001281. [PMID: 31179031 PMCID: PMC6528765 DOI: 10.1136/bmjgh-2018-001281] [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: 11/05/2018] [Revised: 03/21/2019] [Accepted: 03/30/2019] [Indexed: 11/17/2022] Open
Abstract
In the Ethiopian health system, operations management techniques have been underutilised. Although previous research has outlined limitations of paper-based patient records, few studies have examined their potential utility for improving management of hospital operations. In this paper, we used data collected from paper registries in an Ethiopian obstetrics ward at Addis Ababa’s Tikur Anbessa Specialized Hospital, Ethiopia’s largest university hospital, to model the ward’s operations. First, we attempted to identify predictors of lengthy stays and readmissions among women giving birth: few predictors were deemed significant. Second, time series methods for demand forecasting were applied to the data and evaluated with several error metrics, and these forecasts were improvements over baseline methods. We conclude with recommendations on how the obstetrics ward could incorporate our modelling approaches into their daily operations.
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Affiliation(s)
- Benjamin Bigelow
- Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Dawit N Desalegn
- Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Center for Medical Ethics and Priority Setting, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Joshua A Salomon
- Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Stéphane Verguet
- Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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Linnander EL, Mantopoulos JM, Allen N, Nembhard IM, Bradley EH. Professionalizing Healthcare Management: A Descriptive Case Study. Int J Health Policy Manag 2017; 6:555-560. [PMID: 28949471 PMCID: PMC5627783 DOI: 10.15171/ijhpm.2017.40] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/18/2017] [Indexed: 11/29/2022] Open
Abstract
Despite international recognition of the importance of healthcare management in the development of high-performing systems, the path by which countries may develop and sustain a professional healthcare management workforce has not been articulated. Accordingly, we sought to identify a set of common themes in the establishment of a professional workforce of healthcare managers in low- and middle-income country (LMIC) settings using a descriptive case study approach. We draw on a historical analysis of the development of this profession in the United States and Ethiopia to identify five common themes in the professionalization of healthcare management: (1) a country context in which healthcare management is demanded; (2) a national framework that elevates a professional management role; (3) standards for healthcare management, and a monitoring function to promote adherence to standards; (4) a graduatelevel educational path to ensure a pipeline of well-prepared healthcare managers; and (5) professional associations to sustain and advance the field. These five components can to inform the creation of a long-term national strategy for the development of a professional cadre of heathcare managers in LMIC settings.
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Affiliation(s)
- Erika L Linnander
- Yale School of Public Health, Yale University, New Haven, CT, USA.,Yale Global Health Leadership Institute, Yale University, New Haven, CT, USA
| | - Jeannie M Mantopoulos
- Yale School of Public Health, Yale University, New Haven, CT, USA.,Yale Global Health Leadership Institute, Yale University, New Haven, CT, USA
| | - Nikole Allen
- Yale School of Public Health, Yale University, New Haven, CT, USA.,Yale Global Health Leadership Institute, Yale University, New Haven, CT, USA
| | - Ingrid M Nembhard
- Yale School of Public Health, Yale University, New Haven, CT, USA.,Yale Global Health Leadership Institute, Yale University, New Haven, CT, USA
| | - Elizabeth H Bradley
- Yale School of Public Health, Yale University, New Haven, CT, USA.,Yale Global Health Leadership Institute, Yale University, New Haven, CT, USA
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Roman TE, Cleary S, McIntyre D. Exploring the Functioning of Decision Space: A Review of the Available Health Systems Literature. Int J Health Policy Manag 2017; 6:365-376. [PMID: 28812832 PMCID: PMC5505106 DOI: 10.15171/ijhpm.2017.26] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 02/18/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The concept of decision space holds appeal as an approach to disaggregating the elements that may influence decision-making in decentralized systems. This narrative review aims to explore the functioning of decision space and the factors that influence decision space. METHODS A narrative review of the literature was conducted with searches of online databases and academic journals including PubMed Central, Emerald, Wiley, Science Direct, JSTOR, and Sage. The articles were included in the review based on the criteria that they provided insight into the functioning of decision space either through the explicit application of or reference to decision space, or implicitly through discussion of decision-making related to organizational capacity or accountability mechanisms. RESULTS The articles included in the review encompass literature related to decentralisation, management and decision space. The majority of the studies utilise qualitative methodologies to assess accountability mechanisms, organisational capacities such as finance, human resources and management, and the extent of decision space. Of the 138 articles retrieved, 76 articles were included in the final review. CONCLUSION The literature supports Bossert's conceptualization of decision space as being related to organizational capacities and accountability mechanisms. These functions influence the decision space available within decentralized systems. The exact relationship between decision space and financial and human resource capacities needs to be explored in greater detail to determine the potential influence on system functioning.
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Linnander E, McNatt Z, Sipsma H, Tatek D, Abebe Y, Endeshaw A, Bradley EH. Use of a national collaborative to improve hospital quality in a low-income setting. Int Health 2016; 8:148-53. [PMID: 26796023 PMCID: PMC4778631 DOI: 10.1093/inthealth/ihv074] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/14/2015] [Indexed: 11/27/2022] Open
Abstract
Background Quality improvement collaboratives are a widely used mechanism to improve hospital performance in high-income settings, but we lack evidence about their effectiveness in low-income settings. Methods We conducted cross-sectional and longitudinal analysis of data from the Ethiopian Hospital Alliance for Quality, a national collaborative sponsored by Ethiopia's Federal Ministry of Health. We identified hospital strategies associated with more positive patient satisfaction using linear regression and assessed changes in patient experience over a 3-year period (2012–2014) using matched t-tests. Results A total of 68 hospitals (response rate 68/120, 56.7%) were included in cross-sectional analysis. Four practices were significantly associated with more positive patient satisfaction (p<0.05): posting a record of cleaning activity in toilets and in patient wards, distributing leaflets in the local language with each prescription, and sharing ideas about patient experience across the hospital. Among hospitals that had complete data for longitudinal analysis (44/68, 65%), we found a 10% improvement in a 10-point measure of patient satisfaction (7.7 vs 8.4, p<0.01) from the start to the end of the study period. Conclusions Quality improvement collaboratives can be useful at scale in low-income settings in sub-Saharan Africa, particularly for hospitals that adopt strategies associated with patient satisfaction.
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Affiliation(s)
- Erika Linnander
- Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, 06520-8034, CT, USA
| | - Zahirah McNatt
- Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, 06520-8034, CT, USA
| | - Heather Sipsma
- Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, 06520-8034, CT, USA
| | - Dawit Tatek
- Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, 06520-8034, CT, USA
| | | | | | - Elizabeth H Bradley
- Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, 06520-8034, CT, USA
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Costa LBM, Filho MG, Rentes AF, Bertani TM, Mardegan R. Lean healthcare in developing countries: evidence from Brazilian hospitals. Int J Health Plann Manage 2015; 32:e99-e120. [PMID: 26681656 DOI: 10.1002/hpm.2331] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 11/12/2015] [Accepted: 11/13/2015] [Indexed: 11/11/2022] Open
Abstract
The present study evaluates how five sectors of two Brazilian hospitals have implemented lean healthcare concepts in their operations. The main characteristics of the implementation process are analyzed in the present study: the motivational factor for implementation, implementation time, form (consultancy or internal), team (hospital and consultants), lean implementation continuity/sustainability, lean healthcare tools and methods implemented, problems/improvement opportunities, lean healthcare barriers faced during the implementation process, and critical factors that affected the implementation and the results obtained in each case. The case studies indicate that reducing patient lead times and costs and making financial improvements were the primary factors that motivated lean healthcare implementation in the hospitals studied. Several tools and methods were used in the cases studied, especially value stream mapping and DMAIC. The barriers found in both hospitals are primarily associated with the human factor. Additionally, the results obtained after implementation were analyzed and improvements in financial aspects, productivity and capacity, and lead time reduction of the analyzed sectors were observed. Further, this study also exhibited four propositions elaborated from the results obtained from the cases that highlighted barriers and challenges to lean healthcare implementation in developing countries. Two of these barriers are hospital organizational structure (and, consequently, how the senior management works with medical staff), and outsourcing hospital activities. This study also concluded that the initialization and maintenance of lean healthcare implementation rely heavily on external support because lean healthcare subject knowledge is not yet available in the healthcare organization, which represents a challenge. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Moacir Godinho Filho
- Department of Industrial Engineering, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Antonio Freitas Rentes
- Department of Industrial Engineering, University of São Paulo (USP), São Carlos, São Paulo, Brazil
| | - Thiago Moreno Bertani
- Department of Industrial Engineering, University of São Paulo (USP), São Carlos, São Paulo, Brazil
| | - Ronaldo Mardegan
- Department of Industrial Engineering, University of São Paulo (USP), São Carlos, São Paulo, Brazil
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McNatt Z, Linnander E, Endeshaw A, Tatek D, Conteh D, Bradley EH. A national system for monitoring the performance of hospitals in Ethiopia. Bull World Health Organ 2015; 93:719-726. [PMID: 26600614 PMCID: PMC4645435 DOI: 10.2471/blt.14.151399] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 06/22/2015] [Accepted: 06/23/2015] [Indexed: 11/27/2022] Open
Abstract
Many countries struggle to develop and implement strategies to monitor hospitals nationally. The challenge is particularly acute in low-income countries where resources for measurement and reporting are scarce. We examined the experience of developing and implementing a national system for monitoring the performance of 130 government hospitals in Ethiopia. Using participatory observation, we found that the monitoring system resulted in more consistent hospital reporting of performance data to regional health bureaus and the federal government, increased transparency about hospital performance and the development of multiple quality-improvement projects. The development and implementation of the system, which required technical and political investment and support, would not have been possible without strong hospital-level management capacity. Thorough assessment of the health sector’s readiness to change and desire to prioritize hospital quality can be helpful in the early stages of design and implementation. This assessment may include interviews with key informants, collection of data about health facilities and human resources and discussion with academic partners. Aligning partners and donors with the government’s vision for quality improvement can enhance acceptability and political support. Such alignment can enable resources to be focused strategically towards one national effort – rather than be diluted across dozens of potentially competing projects. Initial stages benefit from having modest goals and the flexibility for continuous modification and improvement, through active engagement with all stakeholders.
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Affiliation(s)
- Zahirah McNatt
- Yale School of Public Health, 60 College Street, PO Box 208034, New Haven, CT 06520-8034, United States of America
| | - Erika Linnander
- Yale School of Public Health, 60 College Street, PO Box 208034, New Haven, CT 06520-8034, United States of America
| | | | - Dawit Tatek
- Yale School of Public Health, 60 College Street, PO Box 208034, New Haven, CT 06520-8034, United States of America
| | - David Conteh
- Clinton Health Access Initiative, Addis Ababa, Ethiopia
| | - Elizabeth H Bradley
- Yale School of Public Health, 60 College Street, PO Box 208034, New Haven, CT 06520-8034, United States of America
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Yao K, Maruta T, Luman ET, Nkengasong JN. The SLMTA programme: Transforming the laboratory landscape in developing countries. Afr J Lab Med 2014; 3. [PMID: 26752335 PMCID: PMC4703335 DOI: 10.4102/ajlm.v3i2.194] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Efficient and reliable laboratory services are essential to effective and well-functioning health systems. Laboratory managers play a critical role in ensuring the quality and timeliness of these services. However, few laboratory management programmes focus on the competencies required for the daily operations of a laboratory in resource-limited settings. This report provides a detailed description of an innovative laboratory management training tool called Strengthening Laboratory Management Toward Accreditation (SLMTA) and highlights some challenges, achievements and lessons learned during the first five years of implementation (2009–2013) in developing countries. Programme SLMTA is a competency-based programme that uses a series of short courses and work-based learning projects to effect immediate and measurable laboratory improvement, while empowering laboratory managers to implement practical quality management systems to ensure better patient care. A SLMTA training programme spans from 12 to 18 months; after each workshop, participants implement improvement projects supported by regular supervisory visits or on-site mentoring. In order to assess strengths, weaknesses and progress made by the laboratory, audits are conducted using the World Health Organization’s Regional Office for Africa (WHO AFRO) Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist, which is based on International Organization for Standardization (ISO) 15189 requirements. These internal audits are conducted at the beginning and end of the SLMTA training programme. Conclusion Within five years, SLMTA had been implemented in 617 laboratories in 47 countries, transforming the laboratory landscape in developing countries. To our knowledge, SLMTA is the first programme that makes an explicit connection between the performance of specific management behaviours and routines and ISO 15189 requirements. Because of this close relationship, SLMTA is uniquely positioned to help laboratories seek accreditation to ISO 15189.
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Affiliation(s)
- Katy Yao
- International Laboratory Branch, Division of Global HIV/AIDS, US Centers for Disease Control and Prevention (CDC), Atlanta, United States
| | - Talkmore Maruta
- African Society for Laboratory Medicine (ASLM), Addis Ababa, Ethiopia
| | - Elizabeth T Luman
- International Laboratory Branch, Division of Global HIV/AIDS, US Centers for Disease Control and Prevention (CDC), Atlanta, United States
| | - John N Nkengasong
- International Laboratory Branch, Division of Global HIV/AIDS, US Centers for Disease Control and Prevention (CDC), Atlanta, United States
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Choo S, Papandria D, Goldstein SD, Perry H, Hesse AAJ, Abatanga F, Abdullah F. Quality Improvement Activities for Surgical Services at District Hospitals in Developing Countries and Perceived Barriers to Quality Improvement: Findings From Ghana and the Scientific Literature. World J Surg 2013; 37:2512-9. [DOI: 10.1007/s00268-013-2169-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Basson HA, Roets L. Workplace wellness for HIV/AIDS-affected nurses in South Africa. ACTA ACUST UNITED AC 2013; 22:38-44. [PMID: 23299210 DOI: 10.12968/bjon.2013.22.1.38] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The development of a framework for a workplace wellness programme for HIV/AIDS infected and/or affected nurses in South Africa, who comprise registered nurses and midwives, enrolled staff nurses and auxiliary nurses. RESEARCH OBJECTIVES To identify and describe components for a framework of a workplace wellness programme. BACKGROUND Registered nurses and midwives, enrolled staff nurses and auxiliary nurses (referred to as nurses) in the South African nursing workforce are confronted daily with HIV/AIDS in the workplace due to the high HIV/AIDS prevalence rate among sexually and economically active adult women between 15-49 years of age. The research explains how health and wellness could be promoted by instituting a workplace wellness programme. RESEARCH DESIGN Quantitative descriptive research. FINDINGS The nurses emphasised the threat of HIV/AIDS and considered a workplace wellness programme a priority. CONCLUSION A logic model underpinned the workplace wellness programme framework.
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Jack H, Canavan M, Ofori-Atta A, Taylor L, Bradley E. Recruitment and retention of mental health workers in Ghana. PLoS One 2013; 8:e57940. [PMID: 23469111 PMCID: PMC3585225 DOI: 10.1371/journal.pone.0057940] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 01/29/2013] [Indexed: 11/05/2022] Open
Abstract
Introduction The lack of trained mental health workers is a primary contributor to the mental health treatment gap worldwide. Despite the great need to recruit and retain mental health workers in low-income countries, little is known about how these workers perceive their jobs and what drives them to work in mental health care. Using qualitative interviews, we aimed to explore factors motivating mental health workers in order to inform interventions to increase recruitment and retention. Methods We conducted 28 in-depth, open-ended interviews with staff in Ghana’s three public psychiatric hospitals. We used the snowballing method to recruit participants and the constant comparative method for qualitative data analysis, with multiple members of the research team participating in data coding to enhance the validity and reliability of the analysis. The use of qualitative methods allowed us to understand the range and depth of motivating and demotivating factors. Results Respondents described many factors that influenced their choice to enter and remain in mental health care. Motivating factors included 1) desire to help patients who are vulnerable and in need, 2) positive day-to-day interactions with patients, 3) intellectual or academic interest in psychiatry or behavior, and 4) good relationships with colleagues. Demotivating factors included 1) lack of resources at the hospital, 2) a rigid supervisory hierarchy, 3) lack of positive or negative feedback on work performance, and 4) few opportunities for career advancement within mental health. Conclusions Because many of the factors are related to relationships, these findings suggest that strengthening the interpersonal and team dynamics may be a critical and relatively low cost way to increase worker motivation. The data also allowed us to highlight key areas for resource allocation to improve both recruitment and retention, including risk pay, adequate tools for patient care, improved hospital work environment, and stigma reduction efforts.
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Affiliation(s)
- Helen Jack
- School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Maureen Canavan
- School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | | | - Lauren Taylor
- School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Elizabeth Bradley
- School of Public Health, Yale University, New Haven, Connecticut, United States of America
- * E-mail:
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Syed SB, Dadwal V, Rutter P, Storr J, Hightower JD, Gooden R, Carlet J, Nejad SB, Kelley ET, Donaldson L, Pittet D. Developed-developing country partnerships: benefits to developed countries? Global Health 2012; 8:17. [PMID: 22709651 PMCID: PMC3459713 DOI: 10.1186/1744-8603-8-17] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 05/29/2012] [Indexed: 11/10/2022] Open
Abstract
Developing countries can generate effective solutions for today's global health challenges. This paper reviews relevant literature to construct the case for international cooperation, and in particular, developed-developing country partnerships. Standard database and web-based searches were conducted for publications in English between 1990 and 2010. Studies containing full or partial data relating to international cooperation between developed and developing countries were retained for further analysis. Of 227 articles retained through initial screening, 65 were included in the final analysis. The results were two-fold: some articles pointed to intangible benefits accrued by developed country partners, but the majority of information pointed to developing country innovations that can potentially inform health systems in developed countries. This information spanned all six WHO health system components. Ten key health areas where developed countries have the most to learn from the developing world were identified and include, rural health service delivery; skills substitution; decentralisation of management; creative problem-solving; education in communicable disease control; innovation in mobile phone use; low technology simulation training; local product manufacture; health financing; and social entrepreneurship. While there are no guarantees that innovations from developing country experiences can effectively transfer to developed countries, combined developed-developing country learning processes can potentially generate effective solutions for global health systems. However, the global pool of knowledge in this area is virgin and further work needs to be undertaken to advance understanding of health innovation diffusion. Even more urgently, a standardized method for reporting partnership benefits is needed--this is perhaps the single most immediate need in planning for, and realizing, the full potential of international cooperation between developed and developing countries.
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Affiliation(s)
- Shamsuzzoha B Syed
- African Partnerships for Patient Safety, WHO Patient Safety, WHO Headquarters, Avenue Appia, 1211, Geneva 27, Switzerland
| | - Viva Dadwal
- African Partnerships for Patient Safety, WHO Patient Safety, WHO Headquarters, Avenue Appia, 1211, Geneva 27, Switzerland
| | - Paul Rutter
- African Partnerships for Patient Safety, WHO Patient Safety, WHO Headquarters, Avenue Appia, 1211, Geneva 27, Switzerland
| | - Julie Storr
- African Partnerships for Patient Safety, WHO Patient Safety, WHO Headquarters, Avenue Appia, 1211, Geneva 27, Switzerland
| | - Joyce D Hightower
- African Partnerships for Patient Safety, WHO Patient Safety, WHO Headquarters, Avenue Appia, 1211, Geneva 27, Switzerland
| | - Rachel Gooden
- African Partnerships for Patient Safety, WHO Patient Safety, WHO Headquarters, Avenue Appia, 1211, Geneva 27, Switzerland
| | - Jean Carlet
- African Partnerships for Patient Safety, WHO Patient Safety, WHO Headquarters, Avenue Appia, 1211, Geneva 27, Switzerland
| | - Sepideh Bagheri Nejad
- African Partnerships for Patient Safety, WHO Patient Safety, WHO Headquarters, Avenue Appia, 1211, Geneva 27, Switzerland
| | - Edward T Kelley
- African Partnerships for Patient Safety, WHO Patient Safety, WHO Headquarters, Avenue Appia, 1211, Geneva 27, Switzerland
| | - Liam Donaldson
- African Partnerships for Patient Safety, WHO Patient Safety, WHO Headquarters, Avenue Appia, 1211, Geneva 27, Switzerland
- National Patient Safety Agency, 4-8 Maple Street, London, W1T 5HD, United Kingdom
| | - Didier Pittet
- African Partnerships for Patient Safety, WHO Patient Safety, WHO Headquarters, Avenue Appia, 1211, Geneva 27, Switzerland
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland
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Kebede S, Mantopoulos J, Ramanadhan S, Cherlin E, Gebeyehu M, Lawson R, Bradley EH. Educating leaders in hospital management: a pre-post study in Ethiopian hospitals. Glob Public Health 2011; 7:164-74. [PMID: 21259143 DOI: 10.1080/17441692.2010.542171] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite recent focus on health systems strengthening, few studies report large-scale efforts to improve hospital management capacity in low-income countries, a central component of improving health care delivery. We sought to assess the contributions of a systems-based approach, the Ethiopian Hospital Management Initiative (EHMI), which established hospital chief executive officers (CEOs) trained through a Masters of Healthcare and Hospital Administration (MHA) degree programme in Ethiopia. We conducted a pre-post study of 24 hospitals that are managed by CEOs in the MHA programme. We measured changes in hospital functioning based on adherence to a set of 86 hospital performance standards across 12 management domains published in the Standards for Hospital Management in Ethiopia. We found that adherence to hospital performance standards increased significantly during the one-year follow-up (27% compared with 51% of standards met at baseline and follow-up, respectively; P-value < 0.001); overall improvement was driven by improvement in seven of the 12 management domains. The EHMI is an example of health systems strengthening with focus on building hospital management capacity. Early evidence suggests that the establishment of hospital CEOs and MHA training to equip them with management skills may promote scalable improvements in health facility functioning.
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Affiliation(s)
- Sosena Kebede
- Yale University School of Public Health, New Haven, CT 06520-8034, USA
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Ramanadhan S, Kebede S, Mantopoulos J, Bradley EH. Network-based social capital and capacity-building programs: an example from Ethiopia. HUMAN RESOURCES FOR HEALTH 2010; 8:17. [PMID: 20594321 PMCID: PMC2906407 DOI: 10.1186/1478-4491-8-17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 07/01/2010] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Capacity-building programs are vital for healthcare workforce development in low- and middle-income countries. In addition to increasing human capital, participation in such programs may lead to new professional networks and access to social capital. Although network development and social capital generation were not explicit program goals, we took advantage of a natural experiment and studied the social networks that developed in the first year of an executive-education Master of Hospital and Healthcare Administration (MHA) program in Jimma, Ethiopia. CASE DESCRIPTION We conducted a sociometric network analysis, which included all program participants and supporters (formally affiliated educators and mentors). We studied two networks: the Trainee Network (all 25 trainees) and the Trainee-Supporter Network (25 trainees and 38 supporters). The independent variable of interest was out-degree, the number of program-related connections reported by each respondent. We assessed social capital exchange in terms of resource exchange, both informational and functional. Contingency table analysis for relational data was used to evaluate the relationship between out-degree and informational and functional exchange. DISCUSSION AND EVALUATION Both networks demonstrated growth and inclusion of most or all network members. In the Trainee Network, those with the highest level of out-degree had the highest reports of informational exchange, chi2 (1, N = 23) = 123.61, p < 0.01. We did not find a statistically significant relationship between out-degree and functional exchange in this network, chi2(1, N = 23) = 26.11, p > 0.05. In the Trainee-Supporter Network, trainees with the highest level of out-degree had the highest reports of informational exchange, chi2 (1, N = 23) = 74.93, p < 0.05. The same pattern held for functional exchange, chi2 (1, N = 23) = 81.31, p < 0.01. CONCLUSIONS We found substantial and productive development of social networks in the first year of a healthcare management capacity-building program. Environmental constraints, such as limited access to information and communication technologies, or challenges with transportation and logistics, may limit the ability of some participants to engage in the networks fully. This work suggests that intentional social network development may be an important opportunity for capacity-building programs as healthcare systems improve their ability to manage resources and tackle emerging problems.
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Affiliation(s)
- Shoba Ramanadhan
- Center for Community-Based Research, Dana-Farber Cancer Institute, 44 Binney St., LW 703, Boston, MA 02115 USA
| | - Sosena Kebede
- Division of Health Policy and Administration, Yale School of Public Health, 60 College St. P.O. Box 208034, New Haven, CT 06520 USA
| | - Jeannie Mantopoulos
- Division of Health Policy and Administration, Yale School of Public Health, 60 College St. P.O. Box 208034, New Haven, CT 06520 USA
| | - Elizabeth H Bradley
- Division of Health Policy and Administration, Yale School of Public Health, 60 College St. P.O. Box 208034, New Haven, CT 06520 USA
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Rabbani F, Jafri SMW, Abbas F, Shah M, Azam SI, Shaikh BT, Brommels M, Tomson G. Designing a balanced scorecard for a tertiary care hospital in Pakistan: a modified Delphi group exercise. Int J Health Plann Manage 2010; 25:74-90. [PMID: 20191594 DOI: 10.1002/hpm.1004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Balanced Scorecards (BSC) are being implemented in high income health settings linking organizational strategies with performance data. At this private university hospital in Pakistan an elaborate information system exists. This study aimed to make best use of available data for better performance management. Applying the modified Delphi technique an expert panel of clinicians and hospital managers reduced a long list of indicators to a manageable size. Indicators from existing documents were evaluated for their importance, scientific soundness, appropriateness to hospital's strategic plan, feasibility and modifiability. Panel members individually rated each indicator on a scale of 1-9 for the above criteria. Median scores were assigned. Of an initial set of 50 indicators, 20 were finally selected to be assigned to the four BSC quadrants. These were financial (n = 4), customer or patient (n = 4), internal business or quality of care (n = 7) and innovation/learning or employee perspectives (n = 5). A need for stringent definitions, international benchmarking and standardized measurement methods was identified. BSC compels individual clinicians and managers to jointly work towards improving performance. This scorecard is now ready to be implemented by this hospital as a performance management tool for monitoring indicators, addressing measurement issues and enabling comparisons with hospitals in other settings.
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Affiliation(s)
- Fauziah Rabbani
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
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Rowe LA, Brillant SB, Cleveland E, Dahn BT, Ramanadhan S, Podesta M, Bradley EH. Building capacity in health facility management: guiding principles for skills transfer in Liberia. HUMAN RESOURCES FOR HEALTH 2010; 8:5. [PMID: 20298565 PMCID: PMC2850875 DOI: 10.1186/1478-4491-8-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 03/18/2010] [Indexed: 05/19/2023]
Abstract
BACKGROUND Management training is fundamental to developing human resources for health. Particularly as Liberia revives its health delivery system, facility and county health team managers are central to progress. Nevertheless, such management skills are rarely prioritized in health training, and sustained capacity building in this area is limited. We describe a health management delivery program in which a north and south institution collaborated to integrate classroom and field-based training in health management and to transfer the capacity for sustained management development in Liberia. METHODS We developed and implemented a 6-month training program in health management skills (i.e. strategic problem solving, financial management, human resource management and leadership) delivered by Yale University and Mother Patern College from Liberia, with support from the Clinton HIV/AIDS Initiative. Over three 6-month cycles, responsibility for course instruction was transferred from the north institution to the south institution. A self-administered survey was conducted of all participants completing the course to measure changes in self-rated management skills, the degree to which the course was helpful and met its stated objectives, and faculty members' responsiveness to participant needs as the transfer process occurred. RESULTS Respondents (n=93, response rate 95.9%) reported substantial improvement in self-reported management skills, and rated the helpfulness of the course and the degree to which the course met its objectives highly. Levels of improvement and course ratings were similar over the three cohorts as the course was transferred to the south institution. We suggest a framework of five elements for implementing successful management training programs that can be transferred and sustained in resource-limited settings, including: 1) use a short-course format focusing on four key skill areas with practical tools; 2) include didactic training, on-site projects, and on-site mentoring; 3) collaborate with an in-country academic institution, willing and able to scale-up and maintain the training; 4) provide training for the in-country academic faculty; and 5) secure Ministry-level support to ensure participation. CONCLUSION Our findings demonstrate key elements for scaling up and replicating educational initiatives that address management skills essential for long-term health systems strengthening in resource-poor settings.
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Affiliation(s)
- Laura A Rowe
- Yale School of Public Health, New Haven, CT, USA
| | | | | | | | | | - Mae Podesta
- Clinton Foundation HIV/AIDS Initiative, Monrovia, Liberia
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Kebede S, Abebe Y, Wolde M, Bekele B, Mantopoulos J, Bradley EH. Educating leaders in hospital management: a new model in Sub-Saharan Africa. Int J Qual Health Care 2010; 22:39-43. [PMID: 19951963 PMCID: PMC2803009 DOI: 10.1093/intqhc/mzp051] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2009] [Indexed: 11/13/2022] Open
Abstract
QUALITY ISSUE: The vast majority of health system capacity-building efforts have focused on enhancing medical and public health skills; less attention has been directed at developing hospital managers despite their central role in improving the functioning and quality of health-care systems. Initial ASSESSMENT AND CHOICE OF INTERVENTION: Initial assessment of hospital management systems demonstrated weak functioning in several management areas. In response, we developed with the Ethiopian Ministry of Health (MoH) a novel Master of Hospital Administration (MHA) program, reflecting a collaborative effort of the MoH, the Clinton HIV/AIDS Initiative, Jimma University and Yale University. The MHA is a 2-year executive style educational program to develop a new cadre of hospital leaders, comprising 5% classroom learning and 85% executive practice. IMPLEMENTATION The MHA has been implemented with 55 hospital leaders in the position of chief executive officer within the MoH, with courses taught in collaboration by faculty of the North and the South universities. EVALUATION AND LESSONS LEARNED The program has enrolled two cohorts of hospital leaders and is working in more than half of the government hospitals in Ethiopia. Lessons learned include the need to: (i) balance education in applied, technical skills with more abstract thinking and problem solving, (ii) recognize the interplay between management education and policy reform, (iii) remain flexible as policy changes have direct impact on the project, (iv) be realistic about resource constraints in low-income settings, particularly information technology limitations, and (v) manage the transfer of knowledge for longer term sustainability.
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Affiliation(s)
| | - Yigeremu Abebe
- Clinton Foundation HIV/AIDS Initiative, Addis Ababa, Ethiopia
| | - Mirkuzie Wolde
- Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Biftu Bekele
- Faculty of Public Health, Jimma University, Jimma, Ethiopia
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Bradley E, Hartwig KA, Rowe LA, Cherlin EJ, Pashman J, Wong R, Dentry T, Wood WE, Abebe Y. Hospital quality improvement in Ethiopia: a partnership-mentoring model. Int J Qual Health Care 2008; 20:392-9. [PMID: 18784268 DOI: 10.1093/intqhc/mzn042] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Quality improvement efforts are increasingly common in the United States; however, their use in developing countries is limited. We sought to evaluate the impact of a large-scale intervention on several key management indicators through hospital quality improvement efforts. DESIGN Pre-post-descriptive study of 14 hospitals in Ethiopia. SETTING Six regions and two city administrations in Ethiopia. PARTICIPANTS Hospital leaders and management mentors in participating hospitals. INTERVENTION In collaboration with the Ministry of Health and the Clinton HIV/AIDS Initiative, we implemented a countrywide quality improvement initiative in which 24 mentors with hospital administration experience were placed for 1 year in Ethiopia to work side-by-side with hospital management teams. We also provided a professional development course to enhance quality improvement skills. MAIN OUTCOME MEASURE s) Presence of 75 key management indicators; reported management skills of hospital leaders by the mentors. RESULTS In pre-post analysis, we found improvement in 45 of the 75 (60%) key management indicators between August 2006 and May 2007. The changes reflected a total of 105 management indicators improved across the 14 hospitals, which equates to a per-hospital mean of 7.5 (standard deviation 5.9) improvements. Reported management skills of hospital leaders improved in several management domains, although their reported confidence in these skills remained largely unchanged. CONCLUSIONS Our findings indicate that quality improvement efforts can be effective in improving hospital management in developing countries. Longer follow-up is required to assess the sustainability of the hospital improvements accomplished.
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Affiliation(s)
- Elizabeth Bradley
- School of Public Health, Yale University, 60 College Street, New Heaven, CT 06520, USA
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