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Doumbia I, Seydou F, Diakalia K, Bennis I. The provider's checklist to improve pregnant women coverage by intermittent preventive malaria treatment in Mali: a pilot implementation study. Malar J 2021; 20:402. [PMID: 34656113 PMCID: PMC8520273 DOI: 10.1186/s12936-021-03940-7] [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: 01/06/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022] Open
Abstract
Background Intermittent preventive treatment of malaria in pregnancy (IPTp) is a comprehensive treatment protocol of anti-malarial drugs administered to pregnant women to prevent malaria, started at the fourth pregnancy month, with at least three doses of sulfadoxine–pyrimethamine (SP), taken as directly observed treatment (DOT) every 30 days at intervals until childbirth, in combination with other preventive measures. This paper introduces feasibility and adoption concepts as implementation research outcomes (IRO), allowing after a defined intervention, to assess the coverage improvement by IPTp for women attending a reference district hospital in Mali. Specifically, the purpose is to evaluate the feasibility of a reminder tool (provider checklist) to enhance pregnant women’s adoption of information about IPTp-SP uptake as immediate and sustained women practices. Methods The implementation strategy used a reminder checklist about malaria knowledge and the recommended preventive tools. Then, the checklist feasibility was assessed during routine practices with the adoption-level about pregnant women’ knowledge. Quantitative data were collected through a questionnaire distributed to a non-probability purposive sampling targeting 200 pregnant women divided into two groups before and after the checklist intervention. In contrast, the qualitative data were based on in-depth face-to-face gynaecologists’ interviews. Results Both the IROs (feasibility and adoption) were satisfactory. The gynaecologists agreed to the use of this checklist during routine practice with a recommendation to generalize it to other health providers. After a gynaecologist visit, a significant increase of the adoption-level about prior knowledge and preventive tools was noticed. A total of 83% of participants were not knowledgeable about malaria disease before checklist use versus 15% after. Similarly, coverage of women’s SP DOT rose from 0 to 59% after introducing the checklist and the IPTp-SP uptake after the visit was highly significant in the second group. The latter reached 95% of pregnant women with 4–8 months’ gestational age, that mostly respected all SP future visits as theoretically scheduled. Conclusions Generalizing such a checklist reminder will improve women’s knowledge about malaria prevention. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03940-7.
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Affiliation(s)
- Issa Doumbia
- Human Resources Directorate, Health and Social Development Ministry, Bamako, Mali.
| | - Fomba Seydou
- National Malaria Control Program Directorate, Health and Social Development Ministry, Bamako, Mali
| | - Koné Diakalia
- National Control Program Malaria Directorate, Health and Social Development Ministry, Bamako, Mali
| | - Issam Bennis
- Regional Directorate of the Ministry of Health and Social Protection, Fez, Morocco
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Osei Afriyie D, Hooley B, Mhalu G, Tediosi F, Mtenga SM. Governance factors that affect the implementation of health financing reforms in Tanzania: an exploratory study of stakeholders' perspectives. BMJ Glob Health 2021; 6:bmjgh-2021-005964. [PMID: 34413077 PMCID: PMC8378361 DOI: 10.1136/bmjgh-2021-005964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/26/2021] [Indexed: 01/24/2023] Open
Abstract
The development of effective and inclusive health financing reforms is crucial for the progressive realisation of universal health coverage in low-income and middle-income countries. Tanzania has been reforming health financing policies to expand health insurance coverage and achieve better access to quality healthcare for all. Recent reforms have included improved community health funds (iCHFs), and others are underway to implement a mandatory national health insurance scheme in order to expand access to services and improve financial risk protection. Governance is a crucial structural determinant for the successful implementation of health financing reforms, however there is little understanding of the governance elements that hinder the implementation of health financing reforms such as the iCHF in Tanzania. Therefore, this study used the perspectives of health sector stakeholders to explore governance factors that influence the implementation of health financing reforms in Tanzania. We interviewed 36 stakeholders including implementers of health financing reforms, policymakers and health insurance beneficiaries in the regions of Dodoma, Dar es Salaam and Kilimanjaro. Normalisation process theory and governance elements guided the structure of the in-depth interviews and analysis. Governance factors that emerged from participants as facilitators included a shared strategic vision for a single mandatory health insurance, community engagement and collaboration with diverse stakeholders in the implementation of health financing policies and enhanced monitoring of iCHF enrolment due to digitisation of registration process. Governance factors that emerged as barriers to the implementation were a lack of transparency, limited involvement of the private sector in service delivery, weak accountability for revenues generated from community level and limited resources due to iCHF design. If stakeholders do not address the governance factors that hinder the implementation of health financing reforms, then current efforts to expand health insurance coverage are unlikely to succeed on their own.
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Affiliation(s)
- Doris Osei Afriyie
- Household Economics and Health Systems Research Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Brady Hooley
- Household Economics and Health Systems Research Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland .,University of Basel, Basel, Switzerland
| | - Grace Mhalu
- Health Systems, Impact Evaluation and Policy Group, Ifakara Health Institute, Dar es Salaam, Tanzania, United Republic of
| | - Fabrizio Tediosi
- Household Economics and Health Systems Research Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Sally M Mtenga
- Health Systems, Impact Evaluation and Policy Group, Ifakara Health Institute, Dar es Salaam, Tanzania, United Republic of.,Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Yimgang D, Danhoundo G, Kusi-Appiah E, Sunder V, Campbell S, Yaya S. A scoping review of researchers' involvement in health policy dialogue in Africa. Syst Rev 2021; 10:190. [PMID: 34174957 PMCID: PMC8236190 DOI: 10.1186/s13643-021-01745-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Improving evidence-informed policy dialogue to support the development and implementation of national health policies is vital, but there is limited evidence on researchers' roles in policy dialogue processes in Africa. The objective of this study is to examine researchers' involvement in health policy dialogue in Africa. METHODS The database search of this scoping review was conducted from inception to January 24, 2021, by an expert searcher/librarian to determine the extent of evidence, barriers, and facilitators of researchers' involvement in health policy dialogues in Africa. PROSPERO, Wiley Cochrane Library, OVID Medline, OVID EMBASE, OVID PsycINFO, OVID Global Health, EBSCO CINAHL, BASE (Bielefeld Academic Search Engine), and Google/Google Scholar were searched using key words representing the concepts "policy dialogue", "health", and "Africa". No limits were applied. A narrative summary of results was presented. RESULTS There were 26 eligible studies representing 21 African countries. Significant discrepancies in researchers' involvement existed across countries. In 62% of the countries, there was suboptimal involvement of researchers in policy dialogues due to no or partial participation in policy dialogues. Major barriers included limited funding, lack of evidence in the public health field of interest, and skepticism of policymakers. The presence of an interface for exchange, demand for scientific evidence, and donors' funding were the most reported facilitators. CONCLUSIONS To improve the uptake of evidence in health policy-making processes, an environment of trust and communication between policymakers and researchers must be established. Policymakers need to demonstrate that they value research, by providing adequate funding, promoting knowledge translation activities, and supporting personal and professional development opportunities for researchers.
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Affiliation(s)
| | | | | | | | | | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, 120 University Private, Ottawa, Ontario, K1N 6 N5, Canada. .,The George Institute for Global Health, Imperial College London, London, UK.
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Roman E, Andrejko K, Wolf K, Henry M, Youll S, Florey L, Ferenchick E, Gutman JR. Determinants of uptake of intermittent preventive treatment during pregnancy: a review. Malar J 2019; 18:372. [PMID: 31752868 PMCID: PMC6873519 DOI: 10.1186/s12936-019-3004-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/11/2019] [Indexed: 11/10/2022] Open
Abstract
Malaria in pregnancy (MiP) contributes to devastating maternal and neonatal outcomes. Coverage of intermittent preventive treatment during pregnancy (IPTp) remains alarmingly low. Data was compiled from MiP programme reviews and performed a literature search on access to and determinants of IPTp. National malaria control and reproductive health (RH) policies may be discordant. Integration may improve coverage. Medication stock-outs are a persistent problem. Quality improvement programmes are often not standardized. Capacity building varies across countries. Community engagement efforts primarily focus on promotion of services. The majority of challenges can be addressed at country level to improve IPTp coverage.
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Affiliation(s)
| | - Kristin Andrejko
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | - Marianne Henry
- U.S. President's Malaria Initiative, U.S. Agency for International Development, Washington, DC, USA
| | - Susan Youll
- U.S. President's Malaria Initiative, U.S. Agency for International Development, Washington, DC, USA
| | - Lia Florey
- U.S. President's Malaria Initiative, U.S. Agency for International Development, Washington, DC, USA
| | - Erin Ferenchick
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Julie R Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, U.S Centers for Disease Control and Prevention, Atlanta, GA, USA
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Danhoundo G, Nasiri K, Wiktorowicz ME. Improving social accountability processes in the health sector in sub-Saharan Africa: a systematic review. BMC Public Health 2018; 18:497. [PMID: 29653531 PMCID: PMC5899409 DOI: 10.1186/s12889-018-5407-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 04/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social accountability is a participatory process in which citizens are engaged to hold politicians, policy makers and public officials accountable for the services that they provide. In the Fifteenth Ordinary Session of the Assembly of the African Union, African leaders recognized the need for strong, decentralized health programs with linkages to civil society and private sector entities, full community participation in program design and implementation, and adaptive approaches to local political, socio-cultural and administrative environments. Despite the increasing use of social accountability, there is limited evidence on how it has been used in the health sector. The objective of this systematic review was to identify the conditions that facilitate effective social accountability in sub-Saharan Africa. METHODS Electronic databases (MEDLINE, PsycINFO, Sociological Abstracts, Social Sciences Abstracts) were searched for relevant articles published between 2000 and August 2017. Studies were eligible for inclusion if they were peer-reviewed English language publications describing a social accountability intervention in sub-Saharan Africa. Qualitative and quantitative study designs were eligible. RESULTS Fourteen relevant studies were included in the review. The findings indicate that effective social accountability interventions involve leveraging partnerships and building coalitions; being context-appropriate; integrating data and information collection and analysis; clearly defined roles, standards, and responsibilities of leaders; and meaningful citizen engagement. Health system barriers, corruption, fear of reprisal, and limited funding appear to be major challenges to effective social accountability interventions. CONCLUSION Although global accountability standards play an important guiding role, the successful implementation of global health initiatives depend on national contexts.
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Affiliation(s)
- Georges Danhoundo
- Faculty of Health (York University), 435 Health, Nursing & Environmental Studies Bldg, 4700 Keele St., Toronto, ON, M3J 1P3, Canada.
| | - Khalidha Nasiri
- Faculty of Health (York University), 435 Health, Nursing & Environmental Studies Bldg, 4700 Keele St., Toronto, ON, M3J 1P3, Canada
| | - Mary E Wiktorowicz
- Dahdaleh Institute for Global Health Research, Community and Global Health, Health Policy and Management, Faculty of Health, York University, Toronto, Canada
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Danhoundo G, Wiktorowicz ME, Premji SS, Nasiri K. Determinants of bed net policy implementation: A case study of Southern Benin. Int J Health Plann Manage 2017; 33:e279-e292. [DOI: 10.1002/hpm.2465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
| | - Mary E. Wiktorowicz
- Dahdaleh Institute for Global Health Research, Community and Global, Health Policy and Management, Faculty of Nursing; York University; Canada
| | - Shahirose Sadrudin Premji
- UofC, Cumming School of Medicine, Department of Community Health Sciences, Faculty of Nursing; University of Calgary (UofC); Calgary Canada
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