1
|
Hoffmann IM, Andersen AM, Lund S, Nygaard U, Joshua D, Poulsen A. Smartphone apps hold promise for neonatal emergency care in low-resource settings. Acta Paediatr 2024. [PMID: 39222003 DOI: 10.1111/apa.17410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 08/13/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
AIM Many countries risk failing the Sustainable Development Goal to reduce neonatal mortality to 12 in 1000 live births before 2030, necessitating intervention. This scoping review assesses available evidence from studies implementing smartphone application-based education and clinical decision support in neonatal emergency care in low- and middle-income countries and describes applied assessment tools to highlight gaps in the current literature. METHODS A systematic search on 28 March 2024 of PubMed, Web of Science, and EMBASE identified original research papers published in peer-reviewed journals after 2014 in English. The evaluation was based on Kirkpatrick's framework. RESULTS In total, 20 studies assessing eight different smartphone applications were included. Participants found applications acceptable and feasible in 11 of 14 studies. Knowledge and/or skills were improved in 11 of 12 studies. Behaviour was assessed in 10 studies by tracking app usage. Patient outcome was assessed in four studies, focusing on perinatal mortality, Basic Newborn Care outcomes and correct assessment of newborns. CONCLUSION Data from included studies further strengthens hope that smartphone applications can improve neonatal mortality rates in low- and middle-income countries. However, further research into the effectiveness of these applications is warranted. This review highlights gaps in the current literature and provides guidance for future trials.
Collapse
Affiliation(s)
- Ida Madeline Hoffmann
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, The Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Amalie Middelboe Andersen
- Department of Paediatrics and Adolescent Medicine, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Stine Lund
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, The Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Neonatology, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Department of Neonatology, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Ulrikka Nygaard
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, The Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Daniel Joshua
- Zanzibar Health Research Institute, Zanzibar, Tanzania
| | - Anja Poulsen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, The Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
2
|
Hill E, Gurbutt D, Makuloluwa T, Gordon M, Georgiou R, Roddam H, Seneviratne S, Byrom A, Pollard K, Abhayasinghe K, Chance-Larsen K. Collaborative healthcare education programmes for continuing professional education in low and middle-income countries: A Best Evidence Medical Education (BEME) systematic review. BEME Guide No. 65. MEDICAL TEACHER 2021; 43:1228-1241. [PMID: 34499841 DOI: 10.1080/0142159x.2021.1962832] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Large discrepancies exist between standards of healthcare provision in high-income (HICs) and low and middle-income countries (LMICs). The root cause is often financial, resulting in poor infrastructure and under-resourced education and healthcare systems. Continuing professional education (CPE) programmes improve staff knowledge, skills, retention, and practice, but remain costly and rare in low-resource settings. One potential solution involves healthcare education collaborations between institutions in HICs and LMICs to provide culturally appropriate CPE in LMICs. To be effective, educational partnerships must address the challenges arising from differences in cultural norms, language, available technology and organisational structures within collaborating countries. METHODS Seven databases and other sources were systematically searched on 7 July 2020 for relevant studies. Citations, abstracts, and studies were screened and consensus was reached on which to include within the review. 54 studies were assessed regarding the type of educational programme involved, the nature of HIC/LMIC collaboration and quality of the study design. RESULTS Studies varied greatly regarding the types and numbers of healthcare professionals involved, pedagogical and delivery methods, and the ways in which collaboration was undertaken. Barriers and enablers of collaboration were identified and discussed. The key findings were: 1. The methodological quality of reporting in the studies was generally poor. 2. The way in which HIC/LMIC healthcare education collaboration is undertaken varies according to many factors, including what is to be delivered, the learner group, the context, and the resources available. 3. Western bias was a major barrier. 4. The key to developing successful collaborations was the quality, nature, and duration of the relationships between those involved. CONCLUSION This review provides insights into factors that underpin successful HIC/LMIC healthcare CPE collaborations and outlines inequities and quality issues in reporting.
Collapse
Affiliation(s)
- Elaine Hill
- School of Sport and Health Sciences, UCLan, Preston, UK
| | - Dawne Gurbutt
- Centre for Collaborative Learning, UCLan, Preston, UK
| | - Thamasi Makuloluwa
- Faculty of Medicine, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | | | | | - Hazel Roddam
- School of Sport and Health Sciences, UCLan, Preston, UK
| | - Sujatha Seneviratne
- Department of Nursing and Midwifery, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Anna Byrom
- School of Community Health and Midwifery, UCLan, Preston, UK
| | - Kerry Pollard
- School of Community Health and Midwifery, UCLan, Preston, UK
| | - Kalpani Abhayasinghe
- Department of Nursing and Midwifery, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | | |
Collapse
|
3
|
Mutambo C, Shumba K, Hlongwana KW. Child-Centred Care in HIV Service Provision for Children in Resource Constrained Settings: A Narrative Review of Literature. AIDS Res Treat 2019; 2019:5139486. [PMID: 31885911 PMCID: PMC6899315 DOI: 10.1155/2019/5139486] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 09/05/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Child-centred care approaches are increasingly gaining traction in healthcare; and are being applied in the delivery of HIV care for children in resource constrained settings. However, very little is known about their potential benefits. METHODS We synthesised literature from primary and secondary publications exploring the philosophical underpinnings of the concept of child-centred care, and its application to HIV service delivery for children in resource constrained settings. We concluded the review by suggesting a conceptual framework for mainstreaming and integrating child-centred care approaches in the management of HIV in resource constrained settings. RESULTS The philosophical underpinnings of child-centred care stem from human rights (child-rights), holism, the ecological model, and life-cycle approaches. Although there is no standard definition of child-centred care in the context of HIV, the literature review highlighted several phrases used to describe the "child-centredness" of HIV care for children. These phrases include: (i) Respect for child-healthcare rights. (ii) Using the lifecycle approach to accommodate children of different ages. (iii) Provision of age-appropriate HIV services. (iv) Meaningful participation and inclusion of the child in the healthcare consultation process. (v) Using age-appropriate language to increase the child's understanding during healthcare consultations. (vi) Age-appropriate disclosure. (vii) Primary caregiver (PCG) participation and preparation (equipping the PCGs with information on how to support their children). (viii) Creation of a child-friendly healthcare environment. (ix) Consideration of the child ecological systems to have a holistic understanding of the child. (x) Partnership and collaborative approach between children, PCGs, and healthcare workers (HCWs). CONCLUSION Child-centred care approaches can potentially increase child-participation, promote positive health outcomes and resilience in children living with a communicable, highly stigmatised and chronic condition such as HIV. More evidence from controlled studies is required to provide concrete results to support the application of child-centred care approaches in HIV care services.
Collapse
Affiliation(s)
- Chipo Mutambo
- The Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Kemist Shumba
- The Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Khumbulani W. Hlongwana
- The Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
4
|
Luckett R, Barak T, Anderson S, Kalenga K, Johnson K, Molina RL, Clune E, Mmalane M, Makhema J, Ricciotti HA, Scott J. Promoting Health Equity Through Purposeful Design and Professionalization of Resident Global Health Electives in Obstetrics and Gynecology. JOURNAL OF SURGICAL EDUCATION 2019; 76:1594-1604. [PMID: 31160212 DOI: 10.1016/j.jsurg.2019.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/16/2019] [Accepted: 05/22/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To design an Obstetrics and Gynecology (OBGYN) residency elective in global health that meets ACGME standards and simultaneously promotes health equity. DESIGN A 4-week elective was established for US residents in a high-volume African district hospital that served as a site for OBGYN rotations for the national internship training program. Clear clinical, operative, and teaching requirements were delineated for US OBGYN residents. Resident formal didactic outputs were incorporated into the intern OBGYN curriculum. The program was evaluated through assessment of resident experience and contribution to local training, as well as assessment of intern competency in OBGYN. SETTING Scottish Livingstone Hospital, a public district hospital in Molepolole, Botswana. PARTICIPANTS Second- to fourth-year OBGYN residents from US training programs, working with Batswana medical interns under on-site faculty supervision. RESULTS From May 2016 to June 2018, 18 residents from 9 US OBGYN residency programs participated in the elective. Under supervision, US residents performed 116 major and 77 minor gynecologic surgeries, and teach-assisted Batswana interns and medical officers in 76 cesarean deliveries. Residents led or contributed significantly to 25 didactic education sessions as part of the formal intern OBGYN curriculum. During this period, 24 Batswana interns rotated through the hospital's department of OBGYN, and all 24 trainees met required OBGYN competencies prior to completing their internship. CONCLUSIONS Matching US resident demand for global health experiences to equitable global health programming while maintaining ACGME training guidelines poses a challenge to OBGYN residency training programs. This elective provides a model OBGYN global health elective that addresses host-identified needs, broadens residents' skills, and meets standards for postgraduate OBGYN training. Purposeful global health electives for US residents embedded in longitudinal programs provide an opportunity for residents to contribute to broader global health efforts that promote health equity.
Collapse
Affiliation(s)
- Rebecca Luckett
- Botswana Harvard AIDS Initiative Partnership, Gaborone, Botswana; Scottish Livingstone Hospital, Molepolole, Botswana; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana.
| | - Tomer Barak
- Botswana Harvard AIDS Initiative Partnership, Gaborone, Botswana; Scottish Livingstone Hospital, Molepolole, Botswana; Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana; Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | - Katherine Johnson
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Rose L Molina
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ed Clune
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mompati Mmalane
- Botswana Harvard AIDS Initiative Partnership, Gaborone, Botswana
| | - Joe Makhema
- Botswana Harvard AIDS Initiative Partnership, Gaborone, Botswana
| | - Hope A Ricciotti
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jen Scott
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| |
Collapse
|
5
|
Philibert I. The International Literature on Teaching Faculty Development in English-Language Journals: A Scoping Review and Recommendations for Core Topics. J Grad Med Educ 2019; 11:47-63. [PMID: 31428259 PMCID: PMC6697281 DOI: 10.4300/jgme-d-19-00174] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/01/2019] [Accepted: 05/23/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND With increasing physician mobility, there is interest in how medical schools and postgraduate medical education institutions across the world develop and maintain the competence of medical teachers. Published reviews of faculty development (FD) have predominantly included studies from the United States and Canada. OBJECTIVE We synthesized the international FD literature (beyond the US and Canada), focusing on FD type, intended audience, study format, effectiveness, differences among countries, and potential unique features. METHODS We identified English-language publications that addressed FD for medical faculty for teaching and related activities, excluding US and Canadian publications. RESULTS A search of 4 databases identified 149 publications, including 83 intervention studies. There was significant growth in international FD publications for the most recent decade, and a sizable number of studies were from developing economies and/or resulted from international collaborations. Focal areas echo those in earlier published reviews, suggesting the international FD literature addresses similar faculty needs and organizational concerns. CONCLUSIONS The growth in publications in recent years and a higher proportion of reporting on participant reactions, coupled with less frequent reporting of results, transfer to practice, and impact on learners and the organization, suggest this is an evolving field. To enhance international FD, educators and researchers should focus on addressing common needs expressed by faculty, including curriculum design and evaluation, small group teaching, assessing professionalism and providing feedback. Future research should focus on approaches for developing comprehensive institutional FD programs that include communities of learning and practice and evaluating their impact.
Collapse
|
6
|
Increased Rwandan Access to Obstetrician–Gynecologists Through a U.S.–Rwanda Academic Training Partnership. Obstet Gynecol 2019; 134:149-156. [DOI: 10.1097/aog.0000000000003317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
7
|
Cancedda C, Binagwaho A, Kerry V. It is time for academic institutions to align their strategies and priorities with the Sustainable Development Goals. BMJ Glob Health 2019; 3:e001067. [PMID: 30613425 PMCID: PMC6304100 DOI: 10.1136/bmjgh-2018-001067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/27/2018] [Accepted: 11/06/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Corrado Cancedda
- Center for Global Health, Division of Infectious Disease/Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Vanessa Kerry
- Center for Global Health, Massachusetts General Hospital, Harvard Medical School, Seed Global Health, Boston, Massachusetts, USA
| |
Collapse
|
8
|
Abebe L, Bender A, Pittini R. Building the Case for Nurses' Continuous Professional Development in Ethiopia: A Qualitative Study of the Sick Kids-Ethiopia Paediatrics Perioperative Nursing Training Program. Ethiop J Health Sci 2019; 28:607-614. [PMID: 30607076 PMCID: PMC6308780 DOI: 10.4314/ejhs.v28i5.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background This study describes the in-service training experience of perioperative nurses from the SickKids-Ethiopia Paediatrics Perioperative Nursing Training Program in Addis Ababa, Ethiopia. The study emphasizes specifically how nurses applied the knowledge and skills gained from the Paediatrics Perioperative Nursing Training program in their subsequent practice and consider the situational factors that facilitated or hindered implementing these new knowledge and skills. Methods The first author led qualitative in-depth interviews with nine perioperative nurses who participated in training in September 2016, and systematically developed descriptive codes and themes to analyze the data. Results The authors found that participants experienced improved knowledge, skills, confidence, and job retention related to perioperative nursing practice after participating in Paediatrics Perioperative Nursing Training. Participants also stressed key challenges including lack of access to ongoing perioperative in-service training and problematic staffing policies that impact perioperative nurses' ability to fully utilize and share new knowledge gained during CPD training. Conclusion The findings highlighted the value of specialized perioperative CPD training for Ethiopian nurses, yet also pointed to multidimensional challenges for knowledge translation and sustainability of best practices. The authors offer recommendations for individual and institutional strategies to address some of them.
Collapse
Affiliation(s)
- Leyouget Abebe
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Amy Bender
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto
| | | |
Collapse
|
9
|
Ramirez AG, Nuradin N, Byiringiro F, Ntakiyiruta G, Giles AE, Riviello R. General Thoracic Surgery in Rwanda: An Assessment of Surgical Volume and of Workforce and Material Resource Deficits. World J Surg 2019; 43:36-43. [PMID: 30132227 PMCID: PMC6318006 DOI: 10.1007/s00268-018-4771-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Benchmarking operative volume and resources is necessary to understand current efforts addressing thoracic surgical need. Our objective was to examine the impact on thoracic surgery volume and patient access in Rwanda following a comprehensive capacity building program, the Human Resources for Health (HRH) Program, and thoracic simulation training. METHODS A retrospective cohort study was conducted of operating room registries between 2011 and 2016 at three Rwandan referral centers: University Teaching Hospital of Kigali, University Teaching Hospital of Butare, and King Faisal Hospital. A facility-based needs assessment of essential surgical and thoracic resources was performed concurrently using modified World Health Organization forms. Baseline patient characteristics at each site were compared using a Pearson Chi-squared test or Kruskal-Wallis test. Comparisons of operative volume were performed using paired parametric statistical methods. RESULTS Of 14,130 observed general surgery procedures, 248 (1.76%) major thoracic cases were identified. The most common indications were infection (45.9%), anatomic abnormalities (34.4%), masses (13.7%), and trauma (6%). The proportion of thoracic cases did not increase during the HRH program (2.07 vs 1.78%, respectively, p = 0.22) or following thoracic simulation training (1.95 2013 vs 1.44% 2015; p = 0.15). Both university hospitals suffer from inadequate thoracic surgery supplies and essential anesthetic equipment. The private hospital performed the highest percentage of major thoracic procedures consistent with greater workforce and thoracic-specific material resources (0.89% CHUK, 0.67% CHUB, and 5.42% KFH; p < 0.01). CONCLUSIONS AND RELEVANCE Lack of specialist providers and material resources limits thoracic surgical volume in Rwanda despite current interventions. A targeted approach addressing barriers described is necessary for sustainable progress in thoracic surgical care.
Collapse
Affiliation(s)
- Adriana G Ramirez
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA, USA.
- University of Virginia Medical Center, P.O. Box 800681, Charlottesville, VA, 22908-0709, USA.
| | - Nebil Nuradin
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Fidele Byiringiro
- Department of Surgery, School of Medicine, University of Rwanda, Kigali, Rwanda
| | | | - Andrew E Giles
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Robert Riviello
- Center for Surgery and Public Health, Women and Brigham Hospital, Harvard University, Boston, MA, USA
| |
Collapse
|
10
|
Bolan NE, Sthreshley L, Ngoy B, Ledy F, Ntayingi M, Makasy D, Mbuyi MC, Lowa G, Nemeth L, Newman S. mLearning in the Democratic Republic of the Congo: A Mixed-Methods Feasibility and Pilot Cluster Randomized Trial Using the Safe Delivery App. GLOBAL HEALTH: SCIENCE AND PRACTICE 2018; 6:693-710. [PMID: 30591577 PMCID: PMC6370362 DOI: 10.9745/ghsp-d-18-00275] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 11/06/2018] [Indexed: 11/15/2022]
Abstract
Health worker knowledge and self-confidence in basic emergency obstetric and newborn care (BEmONC) increased significantly 3 months after introduction of the Safe Delivery App in intervention facilities compared with controls. Background: Substandard delivery care has been widely documented as a major cause of maternal mortality in health facilities globally. Health worker learning via mobile devices is increasing rapidly; however, there is little evidence of mLearning effectiveness. This study sought to determine the feasibility, acceptability, and potential effect of the Safe Delivery App (SDA) on health workers' practices in basic emergency obstetric and newborn care (BEmONC) in the Democratic Republic of the Congo (DRC). The Theoretical Domains Framework was used to guide this research. Methods: Eight BEmONC facilities in central DRC were randomized to either an mLearning intervention or to standard practice (control). Maternal and newborn health workers in intervention facilities (n=64) were trained on the use of smartphones and the French version of the SDA. The SDA is an evidence-based BEmONC training resource with visual guidance using animated videos and clinical management instructions developed by the Maternity Foundation and the Universities of Copenhagen and Southern Denmark. Knowledge on postpartum hemorrhage (PPH) and neonatal resuscitation (NR) and self-confidence in performing 12 BEmONC procedures were assessed at baseline and at 3 months post-intervention. Eighteen qualitative interviews were conducted with app users and key stakeholders to assess feasibility and acceptability of mLearning and the use of the SDA. Maternal mortality was compared in intervention and control facilities using a smartphone-based Open Data Kit (ODK) data application. One smartphone with SDA and ODK was entrusted to intervention facilities for the study period, whereas control facilities received smartphones with ODK only. Results: The analysis included 62 heath workers. Knowledge scores on postpartum hemorrhage and neonatal resuscitation increased significantly from baseline among intervention participants compared with controls at 3 months post-intervention (mean difference for PPH knowledge, 17.4 out of 100; 95% confidence interval [CI]=10.7 to 24.0 and 19.4 for NR knowledge; 95% CI=11.4 to 27.4), as did self-confidence scores on 12 essential BEmONC procedures (mean difference, 4.2 out of 48; CI=0.7 to 7.7). Increases were unaffected by health worker cadre and previous smartphone use. Qualitative interviews supported the feasibility and acceptability of the SDA and mLearning, and the potential for it to impact maternal and neonatal mortality in the DRC. Conclusion: Use of the Safe Delivery App supported increased health worker knowledge and self-confidence in the management of obstetric and newborn emergencies after 3 months. SDA and mLearning were found to be feasible and acceptable to health workers and key stakeholders in the DRC.
Collapse
Affiliation(s)
- Nancy E Bolan
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA.
| | | | - Bernard Ngoy
- IMA World Health, Kinshasa, Democratic Republic of the Congo
| | - Faustin Ledy
- IMA World Health, Kinshasa, Democratic Republic of the Congo
| | - Mano Ntayingi
- IMA World Health, Kinshasa, Democratic Republic of the Congo
| | - Davis Makasy
- IMA World Health, Kinshasa, Democratic Republic of the Congo
| | | | - Gisele Lowa
- IMA World Health, Kinshasa, Democratic Republic of the Congo
| | - Lynne Nemeth
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Susan Newman
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
11
|
Ridge LJ, Klar RT, Stimpfel AW, Squires A. The meaning of "capacity building" for the nurse workforce in sub-Saharan Africa: An integrative review. Int J Nurs Stud 2018; 86:151-161. [PMID: 30029056 DOI: 10.1016/j.ijnurstu.2018.04.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 04/27/2018] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND "Capacity building" is an international development strategy which receives billions of dollars of investment annually and is utilized by major development agencies globally. However, there is a lack of consensus around what "capacity building", or even "capacity" itself, means. Nurses are the frequent target of capacity building programming in sub-Saharan Africa as they provide the majority of healthcare in that region. OBJECTIVES This study explored how "capacity" was conceptualized and operationalized by capacity building practitioners working in sub-Saharan Africa to develop its nursing workforce, and to assess Grindle and Hilderbrand's (1995) "Dimensions of Capacity" model was for fit with "capacity's" definition in the field. DESIGN An integrative review of the literature using systematic search criteria. DATA SOURCES SEARCHED INCLUDED PubMed, the Cumulative Index for Nursing and Allied Health Literature Plus, the Excerpt Medica Database, and Web of Science. REVIEW METHODS This review utilized conventional content analysis to assess how capacity building practitioners working in sub-Saharan Africa utilize the term "capacity" in the nursing context. Content analysis was conducted separately for how capacity building practitioners described "capacity" versus how their programs operationalized it. Identified themes were then assessed for fit with Grindle and Hilderbrand's (1995) "Dimensions of Capacity" model. RESULTS Analysis showed primary themes for conceptualization of capacity building of nurses by practitioners included: human resources for health, particularly pre- and post- nursing licensure training, and human (nursing) resource retention. Other themes included: management, health expenditure, and physical resources. There are several commonly used metrics for human resources for health, and a few for health expenditures, but none for management or physical resources. Overlapping themes of operationalization include: number of healthcare workers, post-licensure training, and physical resources. The Grindle and Hilderbrand (1995) model was a strong fit with how capacity is defined by practitioners working on nursing workforce issues in sub-Saharan Africa. CONCLUSIONS This review indicates there is significant informal consensus on the definition of "capacity" and that the Grindle and Hilderbrand (1995) framework is a good representation of that consensus. This framework could be utilized by capacity building practitioners and researchers as those groups plan, execute, and evaluate nursing capacity building programming.
Collapse
Affiliation(s)
- Laura Jean Ridge
- New York University, 433 First Avenue, New York, NY 10010, United States.
| | - Robin Toft Klar
- New York University, 433 First Avenue, New York, NY 10010, United States
| | | | - Allison Squires
- New York University, 433 First Avenue, New York, NY 10010, United States
| |
Collapse
|
12
|
Lin Y, Scott JW, Yi S, Taylor KK, Ntakiyiruta G, Ntirenganya F, Banguti P, Yule S, Riviello R. Improving Surgical Safety and Nontechnical Skills in Variable-Resource Contexts: A Novel Educational Curriculum. JOURNAL OF SURGICAL EDUCATION 2018; 75:1014-1021. [PMID: 29074364 DOI: 10.1016/j.jsurg.2017.09.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 09/03/2017] [Accepted: 09/12/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE A substantial proportion of adverse intraoperative events are attributed to failures in nontechnical skills. To strengthen these skills and improve surgical safety, the Non-Technical Skills for Surgeons (NOTSS) taxonomy was developed as a common framework. The NOTSS taxonomy was adapted for low- and middle-income countries, where variable resources pose a significant challenge to safe surgery. The NOTSS for variable-resource contexts (VRC) curriculum was developed and implemented in Rwanda, with the aim of enhancing knowledge and attitudes about nontechnical skills and promoting surgical safety. DESIGN The NOTSS-VRC curriculum was developed through a rigorous process of integrating contextually appropriate values. It was implemented as a 1-day training course for surgical and anesthesia postgraduate trainees. The curriculum comprises lectures, videos, and group discussions. A pretraining and posttraining questionnaire was administered to compare knowledge and attitudes regarding nontechnical skills, and their potential to improve surgical safety. SETTING The setting of this study was in the tertiary teaching hospital of Kigali, Rwanda. PARTICIPANTS Participants were residents of the University of Kigali. A total of 55 residents participated from general surgery (31.4%), obstetrics (25.5%), anesthesia (17.6%), and other surgical specialties (25.5%). RESULTS In a paired analysis, understanding of NOTSS improved significantly (55.6% precourse, 80.9% postcourse, p<0.01). All residents reported that the course would improve their ability to provide safer patient care, and 97.4% believed developing nontechnical skills would improve patient outcomes. CONCLUSIONS Nontechnical skills must be highlighted in surgical training in low- and middle-income countries. The NOTSS-VRC curriculum can be implemented without additional technology or significant financial cost. Its deliberate design for resource-constrained settings allows it to be used both as an educational course and a quality improvement strategy. Our research demonstrates it is feasible to improve knowledge and attitudes about NOTSS through a 1-day course, and represents a novel approach to improving global surgical safety.
Collapse
Affiliation(s)
- Yihan Lin
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts; Department of Surgery, University of Colorado School of Medicine, Denver, Colorodo.
| | - John W Scott
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sojung Yi
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
| | - Kathryn K Taylor
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
| | - Georges Ntakiyiruta
- Department of Surgery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Faustin Ntirenganya
- Department of Surgery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Paulin Banguti
- Department of Anesthesia, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Steven Yule
- Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; STRATUS Center for Medical Simulation, Brigham & Women's Hospital, Boston, Massachusetts
| | - Robert Riviello
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda; STRATUS Center for Medical Simulation, Brigham & Women's Hospital, Boston, Massachusetts
| |
Collapse
|
13
|
Mastellos N, Tran T, Dharmayat K, Cecil E, Lee HY, Wong CCP, Mkandawire W, Ngalande E, Wu JTS, Hardy V, Chirambo BG, O’Donoghue JM. Training community healthcare workers on the use of information and communication technologies: a randomised controlled trial of traditional versus blended learning in Malawi, Africa. BMC MEDICAL EDUCATION 2018; 18:61. [PMID: 29609596 PMCID: PMC5879741 DOI: 10.1186/s12909-018-1175-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 03/20/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Despite the increasing uptake of information and communication technologies (ICT) within healthcare services across developing countries, community healthcare workers (CHWs) have limited knowledge to fully utilise computerised clinical systems and mobile apps. The 'Introduction to Information and Communication Technology and eHealth' course was developed with the aim to provide CHWs in Malawi, Africa, with basic knowledge and computer skills to use digital solutions in healthcare delivery. The course was delivered using a traditional and a blended learning approach. METHODS Two questionnaires were developed and tested for face validity and reliability in a pilot course with 20 CHWs. Those were designed to measure CHWs' knowledge of and attitudes towards the use of ICT, before and after each course, as well as their satisfaction with each learning approach. Following validation, a randomised controlled trial was conducted to assess the effectiveness of the two learning approaches. A total of 40 CHWs were recruited, stratified by position, gender and computer experience, and allocated to the traditional or blended learning group using block randomisation. Participants completed the baseline and follow-up questionnaires before and after each course to assess the impact of each learning approach on their knowledge, attitudes, and satisfaction. Per-item, pre-post and between-group, mean differences for each approach were calculated using paired and unpaired t-tests, respectively. Per-item, between-group, satisfaction scores were compared using unpaired t-tests. RESULTS Scores across all scales improved after attending the traditional and blended learning courses. Self-rated ICT knowledge was significantly improved in both groups with significant differences between groups in seven domains. However, actual ICT knowledge scores were similar across groups. There were no significant differences between groups in attitudinal gains. Satisfaction with the course was generally high in both groups. However, participants in the blended learning group found it more difficult to follow the content of the course. CONCLUSIONS This study shows that there is no difference between blended and traditional learning in the acquisition of actual ICT knowledge among community healthcare workers in developing countries. Given the human resource constraints in remote resource-poor areas, the blended learning approach may present an advantageous alternative to traditional learning.
Collapse
Affiliation(s)
- Nikolaos Mastellos
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, Reynolds Building, London, W6 8RP UK
| | - Tammy Tran
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, Reynolds Building, London, W6 8RP UK
| | - Kanika Dharmayat
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, Reynolds Building, London, W6 8RP UK
| | - Elizabeth Cecil
- Dr Foster Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | | | - Cybele C. Peng Wong
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, Reynolds Building, London, W6 8RP UK
| | | | - Emmanuel Ngalande
- Department of Information and Communication Technology, Mzuzu University, Mzuzu, Malawi
| | | | - Victoria Hardy
- Department of Family Medicine, University of Washington, Seattle, WA USA
| | | | - John Martin O’Donoghue
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, Reynolds Building, London, W6 8RP UK
| |
Collapse
|
14
|
Ruhumuriza J, Odhiambo J, Riviello R, Lin Y, Nkurunziza T, Shrime M, Maine R, Omondi JM, Mpirimbanyi C, de la Paix Sebakarane J, Hagugimana P, Rusangwa C, Hedt-Gauthier B. Assessing the cost of laparotomy at a rural district hospital in Rwanda using time-driven activity-based costing. BJS Open 2018; 2:25-33. [PMID: 29951626 PMCID: PMC5952380 DOI: 10.1002/bjs5.35] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/09/2017] [Indexed: 01/09/2023] Open
Abstract
Background In low‐ and middle‐income countries, the majority of patients lack access to surgical care due to limited personnel and infrastructure. The Lancet Commission on Global Surgery recommended laparotomy for district hospitals. However, little is known about the cost of laparotomy and associated clinical care in these settings. Methods This costing study included patients with acute abdominal conditions at three rural district hospitals in 2015 in Rwanda, and used a time‐driven activity‐based costing methodology. Capacity cost rates were calculated for personnel, location and hospital indirect costs, and multiplied by time estimates to obtain allocated costs. Costs of medications and supplies were based on purchase prices. Results Of 51 patients with an acute abdominal condition, 19 (37 per cent) had a laparotomy; full costing data were available for 17 of these patients, who were included in the costing analysis. The total cost of an entire care cycle for laparotomy was US$1023·40, which included intraoperative costs of US$427·15 (41·7 per cent) and preoperative and postoperative costs of US$596·25 (58·3 per cent). The cost of medicines was US$358·78 (35·1 per cent), supplies US$342·15 (33·4 per cent), personnel US$150·39 (14·7 per cent), location US$89·20 (8·7 per cent) and hospital indirect cost US$82·88 (8·1 per cent). Conclusion The intraoperative cost of laparotomy was similar to previous estimates, but any plan to scale‐up laparotomy capacity at district hospitals should consider the sizeable preoperative and postoperative costs. Although lack of personnel and limited infrastructure are commonly cited surgical barriers at district hospitals, personnel and location costs were among the lowest cost contributors; similar location‐related expenses at tertiary hospitals might be higher than at district hospitals, providing further support for decentralization of these services.
Collapse
Affiliation(s)
- J Ruhumuriza
- Partners In Health/Inshuti Mu Buzima University of Rwanda Kigali Rwanda
| | - J Odhiambo
- Partners In Health, Harvard Medical School Boston Massachusetts USA
| | - R Riviello
- College of Medicine and Health Sciences University of Rwanda Kigali Rwanda.,Department of Global Health and Social Medicine, Harvard Medical School Boston Massachusetts USA.,Program in Global Surgery and Social Change, Harvard Medical School Boston Massachusetts USA.,Center for Surgery and Public Health, Brigham and Women's Hospital Boston Massachusetts USA
| | - Y Lin
- Department of Global Health and Social Medicine, Harvard Medical School Boston Massachusetts USA.,Department of Surgery University of Colorado Denver Colorado USA
| | - T Nkurunziza
- Partners In Health/Inshuti Mu Buzima University of Rwanda Kigali Rwanda
| | - M Shrime
- Department of Global Health and Social Medicine, Harvard Medical School Boston Massachusetts USA.,Office of Surgery and Health, Massachusetts Eye and Ear Infirmary Boston Massachusetts USA
| | - R Maine
- Department of Surgery University of Washington Seattle Washington USA
| | - J M Omondi
- Partners In Health/Inshuti Mu Buzima University of Rwanda Kigali Rwanda.,Ministry of Health, Butaro District Hospital Burera Rwanda
| | - C Mpirimbanyi
- College of Medicine and Health Sciences University of Rwanda Kigali Rwanda
| | | | - P Hagugimana
- Ministry of Health, Butaro District Hospital Burera Rwanda
| | - C Rusangwa
- Partners In Health/Inshuti Mu Buzima University of Rwanda Kigali Rwanda
| | - B Hedt-Gauthier
- Partners In Health/Inshuti Mu Buzima University of Rwanda Kigali Rwanda.,Department of Global Health and Social Medicine, Harvard Medical School Boston Massachusetts USA
| |
Collapse
|
15
|
Oleribe OO, Salako BL, Akpalu A, Anteyi E, Ka MM, Deen G, Akande T, Abellona U MR, Lemoine M, McConnochie M, Foster M, Walker R, Taylor-Robinson SD, Jawad A. Public private partnership in in-service training of physicians: the millennium development goal 6-partnership for African clinical training (M-PACT) approach. Pan Afr Med J 2018; 29:77. [PMID: 29875958 PMCID: PMC5987109 DOI: 10.11604/pamj.2018.29.77.14480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 01/06/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction in-service training of healthcare workers is essential for improving healthcare services and outcome. Methods The Millennium Development Goal (MDG) 6 Partnership for African Clinical Training (M-PACT) program was an innovative in-service training approach designed and implemented by the Royal College of Physicians (RCP) and West African College of Physicians (WACP) with funding from Eco Bank Foundation. The goal was to develop sustainable capacity to tackle MDG 6 targets in West Africa through better postgraduate medical education. Five training centres were establised: Nigeria (Abuja, Ibadan), Ghana (Accra), Senegal (Dakar) and Sierra Leone (Freetown) for training 681 physicians from across West Africa. A curriculum jointly designed by the RCP-WACP team was used to deliver biannual 5-day training courses over a 3-year period. Results Of 602 trained in clinical medicine, 358 (59.5%) were males and 535 (88.9%) were from hosting countries. 472 (78.4%) of participants received travel bursaries to participate, while 318 (52.8%) were residents in Internal Medicine in the respective institutions. Accra had the highest number of participants (29.7%) followed by Ibadan, (28.7%), Dakar, (24.9%), Abuja, (11.0%) and Freetown, (5.6%). Pre-course clinical knowledge scores ranged from 35.1% in the Freetown Course to 63.8% in Accra Course 1; whereas post-course scores ranged from 50.5% in the Freetown course to 73.8% in Accra course 1. Conclusion M-PACT made a positive impact to quality and outcome of healthcare services in the region and is a model for continued improvement for healthcare outcomes, e.g malaria, HIV and TB incidence and mortality in West Africa.
Collapse
Affiliation(s)
- Obinna Ositadimma Oleribe
- Excellence and Friends Management Care Centre (EFMC), Dutse Abuja FCT, Nigeria.,Royal College of Physicians of London, 11 St Andrews Place, Regent's Park, London NW1 4LE, United Kingdom.,West African College of Physicians (WACP), 6 Taylor Drive, Off Edmond Crescent, Yaba Lagos Nigeria
| | - Babatunde Lawal Salako
- West African College of Physicians (WACP), 6 Taylor Drive, Off Edmond Crescent, Yaba Lagos Nigeria.,Department of Medicine, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Oyo State, Nigeria
| | - Albert Akpalu
- West African College of Physicians (WACP), 6 Taylor Drive, Off Edmond Crescent, Yaba Lagos Nigeria.,Korle Bu Teaching Hospital, Accra, Ghana
| | - Emmanuel Anteyi
- West African College of Physicians (WACP), 6 Taylor Drive, Off Edmond Crescent, Yaba Lagos Nigeria.,National Hospital, Abuja, Nigeria
| | - Mamadou Mourtalla Ka
- West African College of Physicians (WACP), 6 Taylor Drive, Off Edmond Crescent, Yaba Lagos Nigeria.,University of Thiès, Region of Thiès, Senegal
| | - Gibrilla Deen
- West African College of Physicians (WACP), 6 Taylor Drive, Off Edmond Crescent, Yaba Lagos Nigeria.,University of Sierra Leone Teaching Hospitals Complex-Connaught Hospital, Freetown, Senegal
| | - Temilola Akande
- West African College of Physicians (WACP), 6 Taylor Drive, Off Edmond Crescent, Yaba Lagos Nigeria.,Department of Medicine, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Oyo State, Nigeria
| | - Mei Ran Abellona U
- Department of Surgery and Cancer, Imperial College London, Exhibition Road, London SW7 2AZ, United Kingdom
| | - Maud Lemoine
- Royal College of Physicians of London, 11 St Andrews Place, Regent's Park, London NW1 4LE, United Kingdom
| | - Mairi McConnochie
- Royal College of Physicians of London, 11 St Andrews Place, Regent's Park, London NW1 4LE, United Kingdom
| | - Matthew Foster
- Royal College of Physicians of London, 11 St Andrews Place, Regent's Park, London NW1 4LE, United Kingdom
| | - Richard Walker
- Royal College of Physicians of London, 11 St Andrews Place, Regent's Park, London NW1 4LE, United Kingdom.,Department of Medicine, North Tyneside General Hospital, Tyne & Wear, NE29 8NH, United Kingdom
| | - Simon David Taylor-Robinson
- Hepatology Unit, Imperial College London, 10 Floor, QEQM Building, St Mary's Hospital Campus, South Wharf Road, W2 1NY, London, United Kingdom
| | - Ali Jawad
- Royal College of Physicians of London, 11 St Andrews Place, Regent's Park, London NW1 4LE, United Kingdom
| |
Collapse
|
16
|
Manzi A, Hirschhorn LR, Sherr K, Chirwa C, Baynes C, Awoonor-Williams JK. Mentorship and coaching to support strengthening healthcare systems: lessons learned across the five Population Health Implementation and Training partnership projects in sub-Saharan Africa. BMC Health Serv Res 2017; 17:831. [PMID: 29297323 PMCID: PMC5763487 DOI: 10.1186/s12913-017-2656-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Despite global efforts to increase health workforce capacity through training and guidelines, challenges remain in bridging the gap between knowledge and quality clinical practice and addressing health system deficiencies preventing health workers from providing high quality care. In many developing countries, supervision activities focus on data collection, auditing and report completion rather than catalyzing learning and supporting system quality improvement. To address this gap, mentorship and coaching interventions were implemented in projects in five African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) as components of health systems strengthening (HSS) strategies funded through the Doris Duke Charitable Foundation’s African Health Initiative. We report on lessons learned from a cross-country evaluation. Methods The evaluation was designed based on a conceptual model derived from the project-specific interventions. Semi-structured interviews were administered to key informants to capture data in six categories: 1) mentorship and coaching goals, 2) selection and training of mentors and coaches, 3) integration with the existing systems, 4) monitoring and evaluation, 5) reported outcomes, and 6) challenges and successes. A review of project-published articles and technical reports from the individual projects supplemented interview information. Results Although there was heterogeneity in the approaches to mentorship and coaching and targeted areas of the country projects, all led to improvements in core health system areas, including quality of clinical care, data-driven decision making, leadership and accountability, and staff satisfaction. Adaptation of approaches to reflect local context encouraged their adoption and improved their effectiveness and sustainability. Conclusion We found that incorporating mentorship and coaching activities into HSS strategies was associated with improvements in quality of care and health systems, and mentorship and coaching represents an important component of HSS activities designed to improve not just coverage, but even further effective coverage, in achieving Universal Health Care.
Collapse
Affiliation(s)
- Anatole Manzi
- Partners In Health, Kigali, Rwanda. .,Partners In Health, 800 Boylston Street, Suite 300, Boston, MA, 02199, USA. .,College of Medicine and Health Sciences, School of Public Health, University of Rwanda, Kigali, Rwanda.
| | - Lisa R Hirschhorn
- Partners In Health, Kigali, Rwanda.,Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA, USA.,Health Alliance International, Beira, Mozambique
| | - Cindy Chirwa
- Primary Care and Health Systems Department, Center for Infectious Disease Research, Lusaka, Zambia
| | - Colin Baynes
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA.,Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | | |
Collapse
|
17
|
Chan Seay R, Koroma AP, Coleman J, Sampson J, Koroma L, Ugwa EA, Anderson J. Post-Ebola situational assessment of opportunities for capacity building at the national obstetrics and gynecology referral hospital in Sierra Leone. Int J Gynaecol Obstet 2017; 141:74-79. [PMID: 29094370 DOI: 10.1002/ijgo.12374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 09/05/2017] [Accepted: 10/31/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To describe a site assessment of the Princess Christian Maternity Hospital (PCMH; Freetown, Sierra Leone), the national referral center for reproductive, maternal, newborn, child and adolescent health (RMNCAH) services and logical site for focused efforts to train and expand the RMNCAH workforce in Sierra Leone. METHODS In April 2016, a mixed-methods assessment approach was used involving facility observation and staff interviews using the WHO's Service Availability and Readiness Assessment (SARA) tool. Quantitative and qualitative data were obtained. RESULTS PCMH had 150 inpatient beds and provided care for more than 4600 deliveries in 2015. The number of maternal deaths increased at a rate of approximately 40% per month from January 2015 to June 2016 (P=0.005). Key factors requiring attention were identified in the categories of infrastructure and supplies, RMNCAH services, and human resources. CONCLUSION SARA provided a framework for identifying strengths and weaknesses in infrastructure and supplies, RMNCAH services, and human resources. The process described might serve as a model for evaluating obstetrics and gynecology training facilities in low- and middle-income countries. Human resources are currently insufficient for the volume and complexity of patients at PCMH. Numerous opportunities exist for strengthening healthcare services and capacity building in Sierra Leone.
Collapse
Affiliation(s)
- Rachel Chan Seay
- Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, Baltimore, MD, USA
| | | | - Jenell Coleman
- Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, Baltimore, MD, USA
| | - John Sampson
- Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, MD, USA
| | - Lucy Koroma
- Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, Baltimore, MD, USA
| | - Emmanuel A Ugwa
- Jhpiego/Nigeria, an affiliate of Johns Hopkins University, Abuja, Nigeria
| | - Jean Anderson
- Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, Baltimore, MD, USA.,Jhpiego, an affiliate of Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
18
|
Steenhoff AP, Crouse HL, Lukolyo H, Larson CP, Howard C, Mazhani L, Pak-Gorstein S, Niescierenko ML, Musoke P, Marshall R, Soto MA, Butteris SM, Batra M. Partnerships for Global Child Health. Pediatrics 2017; 140:peds.2016-3823. [PMID: 28931576 DOI: 10.1542/peds.2016-3823] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2017] [Indexed: 11/24/2022] Open
Abstract
Child mortality remains a global health challenge and has resulted in demand for expanding the global child health (GCH) workforce over the last 3 decades. Institutional partnerships are the cornerstone of sustainable education, research, clinical service, and advocacy for GCH. When successful, partnerships can become self-sustaining and support development of much-needed training programs in resource-constrained settings. Conversely, poorly conceptualized, constructed, or maintained partnerships may inadvertently contribute to the deterioration of health systems. In this comprehensive, literature-based, expert consensus review we present a definition of partnerships for GCH, review their genesis, evolution, and scope, describe participating organizations, and highlight benefits and challenges associated with GCH partnerships. Additionally, we suggest a framework for applying sound ethical and public health principles for GCH that includes 7 guiding principles and 4 core practices along with a structure for evaluating GCH partnerships. Finally, we highlight current knowledge gaps to stimulate further work in these areas. With awareness of the potential benefits and challenges of GCH partnerships, as well as shared dedication to guiding principles and core practices, GCH partnerships hold vast potential to positively impact child health.
Collapse
Affiliation(s)
- Andrew P Steenhoff
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania; .,Department of Paediatric and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Heather L Crouse
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Heather Lukolyo
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Charles P Larson
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Cynthia Howard
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Loeto Mazhani
- Department of Paediatric and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Suzinne Pak-Gorstein
- Department of Pediatrics, Seattle Children's Hospital and University of Washington, Seattle, Washington
| | - Michelle L Niescierenko
- Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Philippa Musoke
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - Roseda Marshall
- Department of Pediatrics, Dogliotti School of Medicine, University of Liberia, Monrovia, Liberia
| | - Miguel A Soto
- Department of Pediatrics, Hospital Nacional Pedro Bethancourt, La Antigua, Guatemala; and
| | - Sabrina M Butteris
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Maneesh Batra
- Department of Pediatrics, Seattle Children's Hospital and University of Washington, Seattle, Washington
| | | |
Collapse
|
19
|
Cancedda C, Riviello R, Wilson K, Scott KW, Tuteja M, Barrow JR, Hedt-Gauthier B, Bukhman G, Scott J, Milner D, Raviola G, Weissman B, Smith S, Nuthulaganti T, McClain CD, Bierer BE, Farmer PE, Becker AE, Binagwaho A, Rhatigan J, Golan DE. Building Workforce Capacity Abroad While Strengthening Global Health Programs at Home: Participation of Seven Harvard-Affiliated Institutions in a Health Professional Training Initiative in Rwanda. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:649-658. [PMID: 28328735 DOI: 10.1097/acm.0000000000001638] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A consortium of 22 U.S. academic institutions is currently participating in the Rwanda Human Resources for Health Program (HRH Program). Led by the Rwandan Ministry of Health and funded by both the U.S. Government and the Global Fund to Fight AIDS, Tuberculosis and Malaria, the primary goal of this seven-year initiative is to help Rwanda train the number of health professionals necessary to reach the country's health workforce targets. Since 2012, the participating U.S. academic institutions have deployed faculty from a variety of health-related disciplines and clinical specialties to Rwanda. In this Article, the authors describe how U.S. academic institutions (focusing on the seven Harvard-affiliated institutions participating in the HRH Program-Harvard Medical School, Brigham and Women's Hospital, Harvard School of Dental Medicine, Boston Children's Hospital, Beth Israel Deaconess Medical Center, Massachusetts General Hospital, and Massachusetts Eye and Ear Infirmary) have also benefited: (1) by providing opportunities to their faculty and trainees to engage in global health activities; (2) by establishing long-term, academic partnerships and collaborations with Rwandan academic institutions; and (3) by building the administrative and mentorship capacity to support global health initiatives beyond the HRH Program. In doing this, the authors describe the seven Harvard-affiliated institutions' contributions to the HRH Program, summarize the benefits accrued by these institutions as a result of their participation in the program, describe the challenges they encountered in implementing the program, and outline potential solutions to these challenges that may inform similar future health professional training initiatives.
Collapse
Affiliation(s)
- Corrado Cancedda
- C. Cancedda is associate physician, Division of Global Health Equity, Brigham and Women's Hospital, and instructor in medicine and in global health and social medicine, Harvard Medical School, Boston, Massachusetts. R. Riviello is director of global surgery programs, Center for Surgery and Public Health, associate surgeon, Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, and assistant professor of surgery and of global health and social medicine, Harvard Medical School, Boston, Massachusetts. K. Wilson is associate director, Global Pediatrics Program, and codirector, Global Pediatric Fellowship, Boston Children's Hospital, and assistant professor of pediatrics, Harvard Medical School, Boston, Massachusetts. K.W. Scott is a medical student, Harvard Medical School, and research assistant, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts. M. Tuteja is director for global health and research programs, Brigham and Women's Hospital, Boston, Massachusetts. J.R. Barrow is assistant dean of global and community health, executive director of the initiative to integrate oral health and medicine, and lecturer, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts. B. Hedt-Gauthier is assistant professor of global health and social medicine, Harvard Medical School, Boston, Massachusetts. G. Bukhman is director of the program in global noncommunicable diseases (NCDs) and social change, Harvard Medical School, cardiologist, Cardiovascular Division and the Division of Global Health Equity, Brigham and Women's Hospital, senior health and policy advisor on NCDs, Partners In Health, and assistant professor of medicine and assistant professor of global health and social medicine, Harvard Medical School, Boston, Massachusetts. G. Bukhman is also co-chair, Lancet Commission on Reframing Noncommunicable Diseases and Injuries for the Poorest Billion. J. Scott is faculty, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, associate scientist, Division of Women's Health, Brigham and Women's Hospital, and instructor, Harvard Medical School, Boston, Massachusetts. D. Milner is associate medical director of microbiology, Brigham and Women's Hospital, and associate professor, Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. G. Raviola is assistant professor of psychiatry and assistant professor of global health and social medicine, Harvard Medical School, and director of the psychiatry quality programs, Boston Children's Hospital, Boston, Massachusetts. B. Weissman is vice chair emeritus of radiology, Brigham and Women's Hospital, and professor in radiology, Harvard Medical School, Boston, Massachusetts. S. Smith is chief and Distinguished Barbara N. Weissman Chair, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, radiology lead, Rwanda Human Resources for Health Program, associate residency training director, Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, co-medical director, Orthopaedic and Arthritis Center, Brigham and Women's Hospital, assistant director, Neil and Elise Wallace STRATUS Center for Medical Simulation, Brigham and Women's Hospital, and associate professor, Harvard Medical School, Boston, Massachusetts. T. Nuthulaganti is director, Health Workforce, Clinton Health Access Initiative, Boston, Massachusetts. C.D. McClain is senior associate in perioperative anesthesia, Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, and assistant professor of anesthesia, Harvard Medical School, Boston, Massachusetts. B.E. Bierer is senior physician, Brigham and Women's Hospital, professor of medicine (pediatrics), Harvard Medical School, and faculty director, Multi-Regional Clinical Trials Center, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. P.E. Farmer is Kolokotrones University Professor of Global Health and Social Medicine, Harvard University, chair, Department of Global Health and Social Medicine, Harvard Medical School, and chief, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts. A.E. Becker is Maude and Lillian Presley Professor of Global Health and Social Medicine, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts. A. Binagwaho is former Minister of Health of Rwanda, Kigali, Rwanda, and is currently senior lecturer, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, professor of pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, and professor of the practice of global health delivery, University of Global Health Equity, Kigali, Rwanda. J. Rhatigan is associate professor of medicine and associate professor of global health and social medicine, Harvard Medical School, associate chief, Division of Global Health Equity, and director, Hiatt Global Health Equity Residency Program, Brigham and Women's Hospital, Boston, Massachusetts. D.E. Golan is dean for basic science and graduate education, special advisor for global programs, George R. Minot Professor of Medicine, and professor of biological chemistry and molecular pharmacology, Harvard Medical School, and senior physician, Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Vermund SH. The Vital Case for Global Health Investments by the US Government. Clin Infect Dis 2017; 64:707-710. [PMID: 28158519 PMCID: PMC10941300 DOI: 10.1093/cid/cix048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Sten H Vermund
- Vanderbilt Institute for Global Health and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| |
Collapse
|
21
|
Adams LV, Wagner CM, Nutt CT, Binagwaho A. The future of global health education: training for equity in global health. BMC MEDICAL EDUCATION 2016; 16:296. [PMID: 27871276 PMCID: PMC5117699 DOI: 10.1186/s12909-016-0820-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 11/09/2016] [Indexed: 05/21/2023]
Abstract
BACKGROUND Among academic institutions in the United States, interest in global health has grown substantially: by the number of students seeking global health opportunities at all stages of training, and by the increase in institutional partnerships and newly established centers, institutes, and initiatives to house global health programs at undergraduate, public health and medical schools. Witnessing this remarkable growth should compel health educators to question whether the training and guidance that we provide to students today is appropriate, and whether it will be applicable in the next decade and beyond. Given that "global health" did not exist as an academic discipline in the United States 20 years ago, what can we expect it will look like 20 years from now and how can we prepare for that future? DISCUSSION Most clinicians and trainees today recognize the importance of true partnership and capacity building in both directions for successful international collaborations. The challenge is in the execution of these practices. There are projects around the world where this is occurring and equitable partnerships have been established. Based on our experience and observations of the current landscape of academic global health, we share a perspective on principles of engagement, highlighting instances where partnerships have thrived, and examples of where we, as a global community, have fallen short. CONCLUSIONS As the world moves beyond the charity model of global health (and its colonial roots), it is evident that the issue underlying ethical global health practice is partnership and the pursuit of health equity. Thus, achieving equity in global health education and practice ought to be central to our mission as educators and advisors when preparing trainees for careers in this field. Seeking to eliminate health inequities wherever they are ingrained will reveal the injustices around the globe and in our own cities and towns.
Collapse
Affiliation(s)
- Lisa V. Adams
- Center for Health Equity, Dartmouth’s Geisel School of Medicine, 1 Rope Ferry Road, Room 219, Hanover, NH 03755 USA
| | - Claire M. Wagner
- Union for International Cancer Control, 62 Route de Frontenex, 1207 Geneva, Switzerland
| | - Cameron T. Nutt
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115 USA
| | | |
Collapse
|
22
|
Cancedda C, Davis SM, Dierberg KL, Lascher J, Kelly JD, Barrie MB, Koroma AP, George P, Kamara AA, Marsh R, Sumbuya MS, Nutt CT, Scott KW, Thomas E, Bollbach K, Sesay A, Barrie A, Barrera E, Barron K, Welch J, Bhadelia N, Frankfurter RG, Dahl OM, Das S, Rollins RE, Eustis B, Schwartz A, Pertile P, Pavlopoulos I, Mayfield A, Marsh RH, Dibba Y, Kloepper D, Hall A, Huster K, Grady M, Spray K, Walton DA, Daboh F, Nally C, James S, Warren GS, Chang J, Drasher M, Lamin G, Bangura S, Miller AC, Michaelis AP, McBain R, Broadhurst MJ, Murray M, Richardson ET, Philip T, Gottlieb GL, Mukherjee JS, Farmer PE. Strengthening Health Systems While Responding to a Health Crisis: Lessons Learned by a Nongovernmental Organization During the Ebola Virus Disease Epidemic in Sierra Leone. J Infect Dis 2016; 214:S153-S163. [PMID: 27688219 PMCID: PMC5050485 DOI: 10.1093/infdis/jiw345] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
An epidemic of Ebola virus disease (EVD) beginning in 2013 has claimed an estimated 11 310 lives in West Africa. As the EVD epidemic subsides, it is important for all who participated in the emergency Ebola response to reflect on strengths and weaknesses of the response. Such reflections should take into account perspectives not usually included in peer-reviewed publications and after-action reports, including those from the public sector, nongovernmental organizations (NGOs), survivors of Ebola, and Ebola-affected households and communities. In this article, we first describe how the international NGO Partners In Health (PIH) partnered with the Government of Sierra Leone and Wellbody Alliance (a local NGO) to respond to the EVD epidemic in 4 of the country's most Ebola-affected districts. We then describe how, in the aftermath of the epidemic, PIH is partnering with the public sector to strengthen the health system and resume delivery of regular health services. PIH's experience in Sierra Leone is one of multiple partnerships with different stakeholders. It is also one of rapid deployment of expatriate clinicians and logistics personnel in health facilities largely deprived of health professionals, medical supplies, and physical infrastructure required to deliver health services effectively and safely. Lessons learned by PIH and its partners in Sierra Leone can contribute to the ongoing discussion within the international community on how to ensure emergency preparedness and build resilient health systems in settings without either.
Collapse
Affiliation(s)
- Corrado Cancedda
- Partners In Health Division of Global Health Equity Department of Global Health and Social Medicine, Harvard Medical School
| | | | | | | | - J Daniel Kelly
- Division of Global Health Equity Department of Medicine, University of California-San Francisco School of Medicine Wellbody Alliance
| | - Mohammed Bailor Barrie
- Partners In Health Department of Global Health and Social Medicine, Harvard Medical School Wellbody Alliance
| | | | - Peter George
- Port Loko Government Hospital, Port Loko, Sierra Leone
| | | | | | | | - Cameron T Nutt
- Partners In Health Department of Global Health and Social Medicine, Harvard Medical School
| | - Kirstin W Scott
- Department of Global Health and Social Medicine, Harvard Medical School
| | | | | | | | | | | | | | - John Welch
- Partners In Health Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital
| | - Nahid Bhadelia
- Partners In Health Division of Infectious Diseases, Boston University School of Medicine, Massachusetts
| | | | | | | | | | | | | | | | | | | | - Regan H Marsh
- Partners In Health Department of Emergency Medicine, Brigham and Women's Hospital Department of Global Health and Social Medicine, Harvard Medical School
| | | | | | | | - Karin Huster
- Partners In Health Department of Global Health at the University of Washington, Seattle
| | | | | | | | | | | | | | | | | | | | | | | | - Ann C Miller
- Department of Global Health and Social Medicine, Harvard Medical School
| | | | | | | | - Megan Murray
- Partners In Health Division of Global Health Equity Department of Global Health and Social Medicine, Harvard Medical School
| | - Eugene T Richardson
- Partners In Health Division of Global Health Equity Division of Infectious Diseases, Stanford University School of Medicine Department of Anthropology, Stanford University, Palo Alto, California
| | | | | | - Joia S Mukherjee
- Partners In Health Division of Global Health Equity Department of Global Health and Social Medicine, Harvard Medical School
| | - Paul E Farmer
- Partners In Health Division of Global Health Equity Department of Global Health and Social Medicine, Harvard Medical School
| |
Collapse
|
23
|
Gosselin K, Norris JL, Ho MJ. Beyond homogenization discourse: Reconsidering the cultural consequences of globalized medical education. MEDICAL TEACHER 2016; 38:691-9. [PMID: 26571353 DOI: 10.3109/0142159x.2015.1105941] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Global medical education standards, largely designed in the West, have been promoted across national boundaries with limited regard for cultural differences. This review aims to identify discourses on cultural globalization in medical education literature from non-Western countries. METHODS To explore the diversity of discourses related to globalization and culture in the field of medical education, the authors conducted a critical review of medical education research from non-Western countries published in Academic Medicine, Medical Education and Medical Teacher from 2006 to 2014. Key discourses about globalization and culture emerged from a preliminary analysis of this body of literature. A secondary analysis identified inductive sub-themes. RESULTS Homogenization, polarization and hybridization emerged as key themes in the literature. These findings demonstrate the existence of discourses beyond Western-led homogenization and the co-existence of globalization discourses ranging from homogenization to syncretism to resistance. CONCLUSIONS This review calls attention to the existence of manifold discourses about globalization and culture in non-Western medical education contexts. In refocusing global medical education processes to avoid Western cultural imperialism, it will also be necessary to avoid the pitfalls of other globalization discourses. Moving beyond existing discourses, researchers and educators should work towards equitable, context-sensitive and locally-driven approaches to global medical education.
Collapse
Affiliation(s)
- K Gosselin
- a National Taiwan University College of Medicine , Taiwan
| | - J L Norris
- a National Taiwan University College of Medicine , Taiwan
| | - M-J Ho
- a National Taiwan University College of Medicine , Taiwan
| |
Collapse
|
24
|
|
25
|
Stulac S, Mark Munyaneza RB, Chai J, Bigirimana JB, Nyishime M, Tapela N, Chaffee S, Lehmann L, Shulman LN. Initiating Childhood Cancer Treatment in Rural Rwanda: A Partnership-Based Approach. Pediatr Blood Cancer 2016; 63:813-7. [PMID: 26785111 DOI: 10.1002/pbc.25903] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 12/13/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND More than 85% of pediatric cancer cases and 95% of deaths occur in resource-poor countries that use less than 5% of the world's health resources. In the developed world, approximately 81% of children with cancer can be cured. Models applicable in the most resource-poor settings are needed to address global inequities in pediatric cancer treatment. PROCEDURE Between 2006 and 2011, a cohort of children received cancer therapy using a new approach in rural Rwanda. Children were managed by a team of a Rwandan generalist doctor, Rwandan nurse case manager, Rwanda-based US-trained pediatrician, and US-based pediatric oncologist. Biopsies and staging studies were obtained in-country. Pathologic diagnoses were made at US or European laboratories. Rwanda-based clinicians and the pediatric oncologist jointly generated treatment plans by telephone and email. RESULTS Treatment was provided to 24 patients. Diagnoses included lymphomas (n = 10), sarcomas (n = 9), leukemias (n = 2), and other malignancies (n = 3). Standard chemotherapy regimens included CHOP, ABVD, VA, COP/COMP, and actino-VAC. Thirteen patients were in remission at the completion of data collection. Two succumbed to treatment complications and nine had progressive disease. There were no patients who abandoned treatment. The mean overall survival was 31 months and mean disease-free survival was 18 months. CONCLUSIONS These data suggest that chemotherapy can be administered with curative intent to a subset of cancer patients in this setting. This approach provides a platform for pediatric cancer care models, relying on local physicians collaborating with remote specialist consultants to deliver subspecialty care in resource-poor settings.
Collapse
Affiliation(s)
- Sara Stulac
- Partners In Health, Boston, Massachusetts.,Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Boston Children's Hospital, Boston, Massachusetts
| | | | | | | | | | - Neo Tapela
- Brigham and Women's Hospital, Boston, Massachusetts.,Ministry of Health, Kigali, Rwanda.,Inshuti Mu Buzima, Kigali, Rwanda
| | - Sara Chaffee
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Leslie Lehmann
- Boston Children's Hospital, Boston, Massachusetts.,Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lawrence N Shulman
- Partners In Health, Boston, Massachusetts.,Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Dana-Farber Cancer Institute, Boston, Massachusetts
| |
Collapse
|
26
|
|
27
|
Establishing an Online Continuing and Professional Development Library for Nurses and Midwives in East, Central, and Southern Africa. J Assoc Nurses AIDS Care 2016; 27:297-311. [PMID: 27086190 DOI: 10.1016/j.jana.2016.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 01/25/2016] [Indexed: 11/23/2022]
Abstract
Over the past 4 years, the African Health Profession Regulatory Collaborative for nurses and midwives has supported 12 countries establish national continuing and professional development frameworks and programs, linking continuing education to nursing and midwifery re-licensure through technical assistance and improvement grants. However, lack of electronic media and rural practice sites, differences in priority content, and varying legal frameworks make providing accessible, certifiable, and up-to-date online continuing education content for the more than 300,000 nurses and midwives in the 17 member countries of the East, Central, and Southern Africa College of Nursing a major challenge. We report here on how the East, Central, and Southern Africa College of Nursing, with technical assistance from an Afya Bora Fellow, developed an online continuing professional development library hosted on their Web site using data collected in a survey of nursing and midwifery leaders in the region.
Collapse
|
28
|
Li H, Wang Z, Jiang N, Liu Y, Wen D. Lifelong learning of Chinese rural physicians: preliminary psychometrics and influencing factors. BMC MEDICAL EDUCATION 2015; 15:192. [PMID: 26519057 PMCID: PMC4628275 DOI: 10.1186/s12909-015-0460-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 10/09/2015] [Indexed: 05/11/2023]
Abstract
BACKGROUND There are more than 4.9 million rural health workers undertaking the health care need of rural population of over 629 million in China. The lifelong learning of physicians is vital in maintaining up-to-date and qualified health care, but rural physicians in many developing countries lack adequate medical professional developments. There has also been no empirical research focused on the lifelong learning of rural physician populations. The purpose of this study was to investigate the primary levels of lifelong learning of the rural physicians and to analyze group differences. METHODS We conducted a cross-sectional study on 1197 rural physicians using the Jefferson Scale of Physician Lifelong Learning (JSPLL). Cronbach's α coefficient, exploratory factor analysis, independent sample t-test, and one-way ANOVA followed by Student-Newman-Keuls test were performed to analyze the data. RESULTS For Chinese rural physicians, the JSPLL was reliable (Cronbach's α coefficient = 0.872) and valid, with exploratory factor analysis fitting a 3-factor model and accounting for a total of 60.46 % of the variance. The mean lifelong learning score was 45.56. Rural physicians generally performed worse in the technical skills in seeking information domain. Rural physicians with 21-30 working years have a lower score of lifelong learning (P < 0.05) than other phases of working years. Career satisfaction and professional titles had a significantly positive influence on physicians' orientation towards lifelong learning (P < 0.05). The overall lifelong learning scores of physicians who received more training after completion of medical school were higher than those with less additional post-medical school training (P <0.05). CONCLUSIONS The JSPLL is effective for the Chinese rural physician population. In order to cope with impacting factors on rural physicians' lifelong learning, the results of the study reinforced the importance of continuing medical education and career satisfaction for lifelong learning and the need for medical schools and hospitals to provide reasonable strategies and necessary support for rural physicians with different amounts of working years. Providing rural physicians more educational opportunities and helping them access educational resources may be an effective strategy for improving their orientation to lifelong learning.
Collapse
Affiliation(s)
- Honghe Li
- School of Public Health, China Medical University, Shenyang, Liaoning Province, China.
- Research Center for Medical Education, China Medical University, Shenyang, Liaoning Province, China.
| | - Ziwei Wang
- School of Public Health, China Medical University, Shenyang, Liaoning Province, China.
- Research Center for Medical Education, China Medical University, Shenyang, Liaoning Province, China.
| | - Nan Jiang
- Research Center for Medical Education, China Medical University, Shenyang, Liaoning Province, China.
| | - Yang Liu
- School of Public Health, China Medical University, Shenyang, Liaoning Province, China.
| | - Deliang Wen
- School of Public Health, Dalian Medical University, Dalian, Liaoning Province, China.
| |
Collapse
|
29
|
Stulac S, Binagwaho A, Tapela NM, Wagner CM, Muhimpundu MA, Ngabo F, Nsanzimana S, Kayonde L, Bigirimana JB, Lessard AJ, Lehmann L, Shulman LN, Nutt CT, Drobac P, Mpunga T, Farmer PE. Capacity building for oncology programmes in sub-Saharan Africa: the Rwanda experience. Lancet Oncol 2015; 16:e405-13. [DOI: 10.1016/s1470-2045(15)00161-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 08/28/2014] [Accepted: 09/09/2014] [Indexed: 01/30/2023]
|
30
|
Cancedda C, Farmer PE, Kerry V, Nuthulaganti T, Scott KW, Goosby E, Binagwaho A. Maximizing the Impact of Training Initiatives for Health Professionals in Low-Income Countries: Frameworks, Challenges, and Best Practices. PLoS Med 2015; 12:e1001840. [PMID: 26079377 PMCID: PMC4469419 DOI: 10.1371/journal.pmed.1001840] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Corrado Cancedda and colleagues outline a framework for health professional training initiatives in low-income countries.
Collapse
Affiliation(s)
- Corrado Cancedda
- Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Partners In Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Paul E. Farmer
- Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Partners In Health, Boston, Massachusetts, United States of America
| | - Vanessa Kerry
- Harvard Medical School, Boston, Massachusetts, United States of America
- Seed Global Health, Boston, Massachusetts, United States of America
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Tej Nuthulaganti
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
- Harvard University, Cambridge, Massachusetts, United States of America
| | - Kirstin W. Scott
- Harvard University, Cambridge, Massachusetts, United States of America
| | - Eric Goosby
- University of California San Francisco, San Francisco, California, United States of America
| | - Agnes Binagwaho
- Harvard Medical School, Boston, Massachusetts, United States of America
- Ministry of Health of Rwanda, Kigali, Rwanda
- Geisel School of Medicine—Dartmouth, Hanover, New Hampshire, United States of America
| |
Collapse
|
31
|
Feldacker C, Chicumbe S, Dgedge M, Cesar F, Augusto G, Robertson M, Mbofana F, O'Malley G. The effect of pre-service training on post-graduation skill and knowledge retention among mid-level healthcare providers in Mozambique. HUMAN RESOURCES FOR HEALTH 2015; 13:20. [PMID: 25884825 PMCID: PMC4404676 DOI: 10.1186/s12960-015-0011-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 03/25/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Mozambique suffers from critical shortages of healthcare workers including non-physician clinicians, Tecnicos de Medicina Geral (TMGs), who are often senior clinicians in rural health centres. The Mozambique Ministry of Health and the International Training and Education Center for Health, University of Washington, Seattle, revised the national curriculum to improve TMG clinical knowledge and skills. To evaluate the effort, data was collected at graduation and 10 months later from pre-revision (initial) and revised curriculum TMGs to determine the following: (1) Did cohorts trained in the revised curriculum score higher on measurements of clinical knowledge, physical exam procedures, and solving clinical case scenarios than those trained in the initial curriculum; (2) Did TMGs in both curricula retain their knowledge over time (from baseline to follow-up); and (3) Did skills and knowledge retention differ over time by curricula? Post-graduation and over time results are presented. METHODS t-tests examine differences in scores between curriculum groups. Univariate and multivariate linear regression models assess curriculum-related, demographic, and workplace factors associated with scores on each of three evaluation methods at the p < 0.05 level. Paired t-tests examine within-group changes over time. ANOVA models explore differences between Health Training Institutes (HTIs). Generalized estimating equations determine whether change in scores over time differed by curricula. RESULTS Mean scores of initial curriculum TMGs at follow-up were 52.7%, 62.6%, and 40.0% on the clinical cases, knowledge test, and physical exam, respectively. Averages were significantly higher among the revised group for clinical cases (60.2%; p < 0.001) and physical exam (47.6%; p < 0.001). HTI was influential on clinical case and physical exam scores. Between graduation and follow-up, clinical case and physical exam scores decreased significantly for initial curriculum students; clinical case scores increased significantly among revised curriculum TMGs. CONCLUSIONS Although curriculum revision had limited effect, marginal improvements in the revised group show promise that these TMGs may have increased ability to synthesize clinical information. Weaknesses in curriculum and practicum implementation likely compromised the effect of curriculum revision. An improvement strategy that includes strengthened TMG training, greater attention to pre-service clinical practice, and post-graduation mentoring may be more advantageous than curriculum revision, alone, to improve care provided by TMGs.
Collapse
Affiliation(s)
- Caryl Feldacker
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA.
- Department of Global Health, University of Washington, 901 Boren Avenue, Suite 1100, Seattle, 98104, WA, USA.
| | - Sergio Chicumbe
- National Institute of Health, Mozambique Ministry of Health, Maputo, Mozambique.
| | - Martinho Dgedge
- Department of Human Resources, Mozambique Ministry of Health, Maputo, Mozambique.
| | - Freide Cesar
- International Training and Education Center for Health (I-TECH), Maputo, Mozambique.
| | - Gerito Augusto
- International Training and Education Center for Health (I-TECH), Maputo, Mozambique.
| | - Molly Robertson
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA.
| | - Francisco Mbofana
- National Institute of Health, Mozambique Ministry of Health, Maputo, Mozambique.
| | - Gabrielle O'Malley
- International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA.
- Department of Global Health, University of Washington, 901 Boren Avenue, Suite 1100, Seattle, 98104, WA, USA.
| |
Collapse
|
32
|
Sklar DP. The medical education partnership initiative--moving from mumbo jumbo to real understanding. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:1091-1093. [PMID: 25072450 DOI: 10.1097/acm.0000000000000382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|