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Mutsekwa RN, Campbell KL, Canavan R, Angus RL, McBride LJ, Byrnes JM. Unlocking potential: a qualitative exploration guiding the implementation and evaluation of professional role substitution models in healthcare. Implement Sci Commun 2024; 5:73. [PMID: 38997750 PMCID: PMC11245812 DOI: 10.1186/s43058-024-00611-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 06/28/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND As role substitution models gain prominence in healthcare, understanding the factors shaping their effectiveness is paramount. This study aimed to investigate factors that impact the implementation and performance evaluation of professional role substitution models in healthcare, with a focus on understanding the variables that determine their success or failure in adoption, execution, continuity, and outcomes. METHODS The exploratory qualitative study used semi-structured interviews with key opinion leaders, decision makers, facilitators, recipients, and frontline implementers, who had influence and involvement in the implementation of professional role substitution models. Data analysis was guided by the Consolidated Framework for Implementation Research (CFIR). RESULTS Between November 2022 and April 2023, 39 stakeholders were interviewed. Factors influencing implementation and evaluation of allied health professional role substitution models of care aligned with the five core CFIR domains (innovation, outer setting, inner setting, individuals, implementation process) and outcome domain incorporating implementation and innovation outcomes. The six themes identified within these CFIR domains were, respectively; i) Examining the dynamics of innovation catalysts, evidence, advantages, and disadvantages; ii) Navigating the complex landscape of external factors that influence implementation and evaluation; iii) Impact of internal structural, political, and cultural contexts; iv) The roles and contributions of individuals in the process; v) Essential phases and strategies for effective implementation; and vi) The assessment of outcomes derived from allied health professional role substitution models. CONCLUSIONS The study highlights the complex interplay of contextual and individual factors that influence the implementation and performance evaluation of professional role substitution models. It emphasises the need for collaboration among diverse stakeholders to navigate the challenges and leverage the opportunities presented by expanded healthcare roles. Understanding these multifaceted factors can contribute to the development of an empowered workforce and a healthcare system that is more efficient, effective, safe, and sustainable, ultimately benefiting patients.
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Affiliation(s)
- Rumbidzai N Mutsekwa
- Gold Coast Hospital and Health Service, Nutrition and Food Services, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia.
- Gold Coast Hospital and Health Service, Allied Health Research Team, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia.
- Centre for Applied Health Economics, School of Medicine, Griffith University, Sir Samuel Griffith Centre, 1 Parklands Drive, Nathan, Queensland, 4111, Australia.
| | - Katrina L Campbell
- Centre for Applied Health Economics, School of Medicine, Griffith University, Sir Samuel Griffith Centre, 1 Parklands Drive, Nathan, Queensland, 4111, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, 1 Parklands Drive, Southport, Queensland, 4215, Australia
- Healthcare Excellence and Innovation, Metro North Hospital and Health Service, 153 Campbell Street, Bowen Hills, Queensland, 4029, Australia
| | - Russell Canavan
- Gastroenterology Department, Gold Coast Hospital and Health Service, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Rebecca L Angus
- Gold Coast Hospital and Health Service, Nutrition and Food Services, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, 1 Parklands Drive, Southport, Queensland, 4215, Australia
| | - Liza-Jane McBride
- Department of Health, Clinical Excellence, 15 Butterfield Street, Herston, Queensland, 4006, Australia
| | - Joshua M Byrnes
- Centre for Applied Health Economics, School of Medicine, Griffith University, Sir Samuel Griffith Centre, 1 Parklands Drive, Nathan, Queensland, 4111, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, 1 Parklands Drive, Southport, Queensland, 4215, Australia
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Nthumba PM. Global Surgery: The Challenges and Strategies to Win a War That Must Be Won. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5953. [PMID: 38962157 PMCID: PMC11221857 DOI: 10.1097/gox.0000000000005953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/17/2024] [Indexed: 07/05/2024]
Abstract
Background Modern science has conquered seas, land, and space. Although great strides have been made in technology and infectious diseases, global surgery, which was reborn in 2015, has not made much progress. The burden of surgical disease in low- and middle-income countries remains seemingly unconquerable, and its growth unstoppable. The myriad challenges in meeting the surgical needs of 5 billion people has intrigued the author. Methods The author collected the views of plastic surgeons on sources and impediments to the scale-up of plastic surgery in low- and middle-income countries, as well as potential strategies for overcoming these obstacles. The author then performed a literature search reviewing the topics that arose from those discussions. The author proposes a strategy using plastic surgery as a model surgical discipline. Results A root-cause analysis suggests that the Alma Ata Declaration, with its focus on primary healthcare, is the probable genesis of global surgery (GS) woes. The absence of a clear GS community leader and the fragmented nature of GS advocates who operate in multiple silos, without a clear unified goal, are the primary reasons GS advocates have achieved so little on the ground. Conclusions Global surgery requires a business model to sustainably meet the surgical needs of the 5 billion people globally. The proposed and implemented strategies must meet rigorous criteria to ensure sustainability, as quick-fix solutions are counterproductive. The development of centers of excellence offers a viable solution to problems that must be addressed successfully.
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Affiliation(s)
- Peter M. Nthumba
- From Department of Plastic Surgery, AIC Kijabe Hospital, Kijabe, Kenya
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tenn
- Department of Plastic Surgery, Baylor College of Medicine, Temple, Tex
- EACH Research, Kijabe, Kenya
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Nyondo-Mipando AL, Chirwa M, Salimu S, Kumitawa A, Chinkonde JR, Chimuna TJ, Dohlsten M, Chikwapulo B, Senbete M, Gohar F, Hailegebriel TD, Jackson D. Exploring and prioritising strategies for improving uptake of postnatal care services in Thyolo, Malawi: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002992. [PMID: 38446818 PMCID: PMC10917263 DOI: 10.1371/journal.pgph.0002992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/12/2024] [Indexed: 03/08/2024]
Abstract
Although postnatal care services form a critical component of the cascade of care in maternal, newborn, and child health the uptake of these services has remained low worldwide. This study explored and prioritised the strategies for optimising the uptake of postnatal care (PNC) services in Malawi. A qualitative descriptive study followed by nominal group techniques was conducted at three health facilities in Malawi from July to December 2020 and in October 2021. We conducted focus group discussions among postnatal mothers, fathers, healthcare workers, elderly women, and grandmothers. We conducted in-depth interviews with midwives and key health managers. Nominal group techniques were used to prioritise the main strategies for the provision of PNC. The demand strategies include appointment date reminders, provision of free health passport books, community awareness campaigns, and involvement of men in the services. The supply strategies included training health providers, improving clinic operations: task-shifting and hours of operation, having infrastructure for the services, and linkage to other services. Having services delivered near end-user residences was a crosscutting strategy. Refresher training and improvement in the clinic operations especially on hours of operation, appointment date reminders, and linkage to care were the prioritised strategies. There is a need to use acceptable and contextualised strategies to optimise the uptake and delivery of postnatal care services. Educating the healthcare workers and the community on postnatal services is key to increasing the demand and supply of the services.
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Affiliation(s)
- Alinane Linda Nyondo-Mipando
- Department of Health Systems and Policy, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Marumbo Chirwa
- Department of Health Systems and Policy, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Sangwani Salimu
- Department of Health Systems and Policy, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Andrew Kumitawa
- Department of Epidemiology and Statistics, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | | | - Martin Dohlsten
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | | | | | | | - Tedbabe D. Hailegebriel
- Health Section, Programme Division, UNICEF Headquarters, New York, NY, United States of America
| | - Debra Jackson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- University of the Western Cape, Cape Town, South Africa
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Moçambique D, Schindele A, Loquiha O, Martins S, Sequene M, Seni A, Macassa E, Samuel L, Mondlane C, Vilanculo A, Epifanio M, Buck WC. Strengthening the Diagnosis and Treatment of Malnutrition Through Increased Nurse Involvement: A Quality Improvement Project From Pediatric Wards in Mozambique. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2300094. [PMID: 38135520 PMCID: PMC10749644 DOI: 10.9745/ghsp-d-23-00094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Childhood acute malnutrition continues to be a serious health problem in many low-resource settings in Africa. On pediatric wards in Mozambique, missed opportunities for timely diagnosis and treatment of malnutrition may lead to poor health outcomes. To improve inpatient nutritional care, a quality improvement (QI) project was implemented that aimed to engage pediatric nurses in inpatient malnutrition diagnosis and treatment. METHODS In 2 Mozambican referral hospitals, for 6 months, the Plan-Do-Study-Act framework for QI was implemented to identify key drivers of the following measures: having complete anthropometric evaluation documented at admission, 3 or more weight measurements per hospitalization week, documentation of nutritional therapy for eligible patients, and documentation of referral for outpatient nutritional rehabilitation after discharge. Clinical data were abstracted from hospital charts and entered into an EpiInfo database, including a 3-month observation period after the project, and analyzed retrospectively. RESULTS A total of 2,208 children from wards other than malnutrition were included in the analysis. Complete anthropometric evaluation at admission improved from 24.4% 2 months before the QI project to 80.1% during and 75.2% in the 3 months after the project (P<.001). The percentage of patients with 3 or more weight measurements per hospitalization week rose from 22.3% to 82.8% during and 75.0% after the project (P<.001). Documentation of nutritional therapy increased from 58.8% before to 67.1% during and 70.6% after the project (P=.54), and documentation of referral for outpatient nutritional rehabilitation after discharge decreased from 55.9% to 54.9% during and increased to 70.6% after the project, (P<.001). CONCLUSION Nurse engagement may lead to important advancements in the diagnosis and treatment of acute malnutrition in pediatric wards other than malnutrition in Mozambique. Task-sharing, particularly nurse engagement, in combination with QI methodology, may be considered for wards in similar settings with a high burden of malnutrition.
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Affiliation(s)
| | | | | | | | | | - Amir Seni
- Hospital Central da Beira, Beira, Mozambique
| | | | - Lara Samuel
- Clinton Health Access Initiative, Maputo, Mozambique
| | | | | | - Matias Epifanio
- Pontifícia Universidade Católica Rio Grande do Sul, Porto Alegre, Brazil
| | - W Chris Buck
- Hospital Central de Maputo, Maputo, Mozambique
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Kagonya VA, Onyango OO, Maina M, Gathara D, English M, Imam A. Characterising support and care assistants in formal hospital settings: a scoping review. HUMAN RESOURCES FOR HEALTH 2023; 21:90. [PMID: 38012737 PMCID: PMC10680191 DOI: 10.1186/s12960-023-00877-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/16/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND A 15 million health workforce shortage is still experienced globally leading to a sub-optimal healthcare worker-to-population ratio in most countries. The use of low-skilled care assistants has been suggested as a cost-saving human resource for health strategy that can significantly reduce the risks of rationed, delayed, or missed care. However, the characterisation, role assignment, regulation, and clinical governance mechanisms for unlicensed assistive workforce remain unclear or inconsistent. The purpose of this study was to map and collate evidence of how care assistants are labelled, utilised, regulated, and managed in formal hospital settings as well as their impact on patient care. METHODS We conducted a scoping review of literature from PUBMED, CINAHL, PsychINFO, EMBASE, Web of Science, Scopus, and Google Scholar. Searches and eligibility screening were conducted using the Participants-Context-Concepts framework. Thematic content analysis guided the synthesis of the findings. RESULTS 73 records from a total of 15 countries were included in the final full-text review and synthesis. A majority (78%) of these sources were from high-income countries. Many titles are used to describe care assistants, and these vary within and across countries. On ascribed roles, care assistants perform direct patient care, housekeeping, clerical and documentation, portering, patient flow management, ordering of laboratory tests, emergency response and first aid duties. Additional extended roles that require higher competency levels exist in the United States, Australia, and Canada. There is a mixture of both positive and negative sentiments on their impact on patient care or nurses' perception and experiences. Clinical and organisational governance mechanisms vary substantially across the 15 countries. Licensure, regulatory mechanisms, and task-shifting policies are largely absent or not reported in these countries. CONCLUSIONS The nomenclature used to describe care assistants and the tasks they perform vary substantially within countries and across healthcare systems. There is, therefore, a need to review and update the international and national classification of occupations for clarity and more meaningful nomenclature for care assistants. In addition, the association between care assistants and care outcomes or nurses' experience remains unclear. Furthermore, there is a dearth of empirical evidence on this topic from low- and middle-income countries.
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Affiliation(s)
- Vincent A Kagonya
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
| | - Onesmus O Onyango
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Michuki Maina
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - David Gathara
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mike English
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, Health Systems Collaborative, University of Oxford, Oxford, United Kingdom
| | - Abdulazeez Imam
- Nuffield Department of Medicine, Health Systems Collaborative, University of Oxford, Oxford, United Kingdom
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Mbau R, Musiega A, Nyawira L, Tsofa B, Mulwa A, Molyneux S, Maina I, Jemutai J, Normand C, Hanson K, Barasa E. Analysing the Efficiency of Health Systems: A Systematic Review of the Literature. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:205-224. [PMID: 36575334 PMCID: PMC9931792 DOI: 10.1007/s40258-022-00785-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/04/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Efficiency refers the use of resources in ways that optimise desired outcomes. Health system efficiency is a priority concern for policy makers globally as countries aim to achieve universal health coverage, and face the additional challenge of an aging population. Efficiency analysis in the health sector has typically focused on the efficiency of healthcare facilities (hospitals, primary healthcare facilities), with few studies focusing on system level (national or sub-national) efficiency. We carried out a thematic review of literature that assessed the efficiency of health systems at the national and sub-national level. METHODS We conducted a systematic search of PubMed and Google scholar between 2000 and 2021 and a manual search of relevant papers selected from their reference lists. A total of 131 papers were included. We analysed and synthesised evidence from the selected papers using a thematic approach (selecting, sorting, coding and charting collected data according to identified key issues and themes). FINDINGS There were more publications from high- and upper middle-income countries (53%) than from low-income and lower middle-income countries. There were also more publications focusing on national level (60%) compared to sub-national health systems' efficiency. Only 6% of studies used either qualitative methods or mixed methods while 94% used quantitative approaches. Data envelopment analysis, a non-parametric method, was the most common methodological approach used, followed by stochastic frontier analysis, a parametric method. A range of regression methods were used to identify the determinants of health system efficiency. While studies used a range of inputs, these generally considered the building blocks of health systems, health risk factors, and social determinants of health. Outputs used in efficiency analysis could be classified as either intermediate health service outputs (e.g., number of health facility visits), single health outcomes (e.g., infant mortality rate) or composite indices of either intermediate outputs of health outcomes (e.g., Health Adjusted Life Expectancy). Factors that were found to affect health system efficiency include demographic and socio-economic characteristics of the population, macro-economic characteristics of the national and sub-national regions, population health and wellbeing, the governance and political characteristics of these regions, and health system characteristics. CONCLUSION This review highlights the limited evidence on health system efficiency, especially in low- and middle-income countries. It also reveals the dearth of efficiency studies that use mixed methods approaches by incorporating qualitative inquiry. The review offers insights on the drivers of the efficiency of national and sub-national health systems, and highlights potential targets for reforms to improve health system efficiency.
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Affiliation(s)
- Rahab Mbau
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Anita Musiega
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Institute of Healthcare Management, Strathmore University, Nairobi, Kenya
| | - Lizah Nyawira
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Benjamin Tsofa
- Health Systems and Research Ethics Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Andrew Mulwa
- County Department of Health, Makueni County Government, Nairobi, Kenya
| | - Sassy Molyneux
- Health Systems and Research Ethics Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield department of Medicine, University of Oxford, Oxford, UK
| | - Isabel Maina
- Health Financing Department, Ministry of Health, Nairobi, Kenya
| | - Julie Jemutai
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College, The University of Dublin, Dublin, Ireland
- Cicely Saunders Institute, Kings College London, London, UK
| | - Kara Hanson
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
- Centre for Tropical Medicine and Global Health, Nuffield department of Medicine, University of Oxford, Oxford, UK.
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Primary Health Care System Strengthening Project in Sri Lanka: Status and Challenges with Human Resources, Information Systems, Drugs and Laboratory Services. Healthcare (Basel) 2022; 10:healthcare10112251. [PMID: 36360593 PMCID: PMC9691080 DOI: 10.3390/healthcare10112251] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/08/2022] [Accepted: 11/08/2022] [Indexed: 11/12/2022] Open
Abstract
A Primary Healthcare-System-Strengthening Project (PSSP) is implemented by the Ministry of Health, Sri Lanka, with funding support from the World Bank for providing quality care through primary medical care institutions (PMCIs). We used an explanatory mixed-methods study to assess progress and challenges in human resources, drug availability, laboratory services and the health management information system (HMIS) at PMCIs. We conducted a checklist-based assessment followed by in-depth interviews of healthcare workers in one PMCI each in all nine provinces. All PMCIs had medical/nursing officers, but data entry operators (44%) and laboratory technicians (33%) were mostly not available. Existing staff were assigned additional responsibilities in PSSP, decreasing their motivation and efficiency. While 11/18 (61%) essential drugs were available in all PMCIs, buffer stocks were not maintained in >50% due to poor supply chain management and storage infrastructure. Only 6/14 (43%) essential laboratory investigations were available in >50% of PMCIs, non-availability was due to shortages of reagents/consumables and lack of sample collection−transportation system. The HMIS was installed in PMCIs but its usage was sub-optimal due to perceived lack of utility, few trained operators and poor internet connectivity. The PSSP needs to address these bottlenecks as a priority to ensure sustainability and successful scale-up.
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Turpin A, Charest M, Brennan DJ, Griffiths D. Exploring inter- and intra-organisational dynamics supporting task-shifting opportunities in AIDS service organisations: A qualitative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4724-e4734. [PMID: 35698825 DOI: 10.1111/hsc.13879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/05/2022] [Accepted: 05/28/2022] [Indexed: 06/15/2023]
Abstract
Task-shifting of combination sexual health services from clinicians to community workers has been well-studied in low-resource settings, but lacks empirical examination as a response to service inequities in North American community-based AIDS service organisations (ASOs). This study adopts a qualitative exploratory approach to understanding how ASOs may support task-shifting for gay, bisexual and other men who have sex with men (GBMSM), drawing from interviews (n = 33) with clinicians and community workers in southern Ontario. Results include intra-organisational (including resource supports, development of community worker roles, providing task-shifting training, provider representation and inclusive service environment) and inter-organisational (including structure of engagement, streamlining referrals, development of effective partnerships, development of a formal organisational network and increasing awareness) dynamics which, when applied at an organisation level within ASOs, encourage successful and effective task-shifting. Related activities may be used to increase service quality and access for GBMSM. Considerations for application and management practice is provided.
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Gudza-Mugabe M, Sithole K, Sisya L, Zimuto S, Charimari LS, Chimusoro A, Simbi R, Gasasira A. Zimbabwe's emergency response to COVID-19: Enhancing access and accelerating COVID-19 testing as the first line of defense against the COVID-19 pandemic. Front Public Health 2022; 10:871567. [PMID: 35928486 PMCID: PMC9343728 DOI: 10.3389/fpubh.2022.871567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) spreads rapidly, causing outbreaks that grow exponentially within a short period before interventions are sought and effectively implemented. Testing is part of the first line of defense against Corona Virus Disease of 2019 (COVID-19), playing a critical role in the early identification and isolation of cases to slow transmission, provision of targeted care to those affected, and protection of health system operations. Laboratory tests for COVID-19 based on nucleic acid amplification techniques were rapidly developed in the early days of the pandemic, but such tests typically require sophisticated laboratory infrastructure and skilled staff. In March 2020, Zimbabwe confirmed its first case of COVID-19; this was followed by an increase in infection rates as the pandemic spread across the country, thus increasing the demand for testing. One national laboratory was set to test all the country's COVID-19 suspect cases, building pressure on human and financial resources. Staff burnout and longer turnaround times of more than 48 h were experienced, and results were released late for clinical relevance. Leveraging on existing PCR testing platforms, including GeneXpert machines, eased the pressure for a short period before facing the stockout of SARs-CoV-2 cartridges for a long time, leading to work overload at a few testing sites contributing to long turnaround times. On September 11, WHO released the interim guidance to use antigen rapid diagnostic test as a diagnostic tool. The Zimbabwe laboratory pillar quickly adopted it and made plans for its implementation. The National Microbiology Reference Laboratory verified the two emergency-listed kits, the Panbio Abbott and the Standard Q, Biosensor, and they met the WHO minimum performance of ≥97% specificity and ≥80% sensitivity. Decentralizing diagnostic testing leveraging existing human resources became a game-changer in improving COVID-19 containment measures. Task shifting through training on Antigen rapid diagnostic tests (Ag-RDT) commenced, and testing was decentralized to all the ten provinces, from 1 central testing laboratory to more than 1,000 testing centers. WhatsApp platforms made it easier for data to be reported from remote areas. Result turnaround times were improved to the same day, and accessibility to testing was enhanced.
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Affiliation(s)
| | | | - Lucia Sisya
- National Microbiology Reference Laboratory, Harare, Zimbabwe
| | | | | | | | - Raiva Simbi
- Ministry of Health and Child Care, Harare, Zimbabwe
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"Not shifting, but sharing": stakeholders' perspectives on mental health task-shifting in Indonesia. BMC Nurs 2022; 21:165. [PMID: 35751061 PMCID: PMC9229425 DOI: 10.1186/s12912-022-00945-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/15/2022] [Indexed: 12/12/2022] Open
Abstract
Background Task-shifting, the distribution of tasks among health workers to address health workforce shortage, has been widely used to tackle mental health treatment gaps. However, its implementation in Indonesia has still been rarely explored. This study aimed to explore stakeholders’ perspectives on the implementation of mental health task-shifting to nurses in Indonesia's primary health care. Methods An exploratory descriptive approach using in-depth interviews and focused group discussions (FGDs) was used. The study involved 19 stakeholders from the government's ministry directorates, professional organisations, and mental health practitioners. Thematic analysis was used to analyse the data. Results Three themes emerged namely, task-shifting feasibility and acceptability, shared task implementation, and nurse role enhancement issues, with 14 sub-themes. Conclusions Task-shifting on mental health issues in the eye of Indonesian stakeholders is viewed as a matter of sharing and collaboration. Implementation of task-shifting in Indonesia may require policies in place and political will across stakeholders. Further scrutiny on task-shifting implementation is needed by considering the local context and national environment.
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Jensen N, Lund C, Abrahams Z. Exploring effort-reward imbalance and professional quality of life among health workers in Cape Town, South Africa: a mixed-methods study. Glob Health Res Policy 2022; 7:7. [PMID: 35227327 PMCID: PMC8885139 DOI: 10.1186/s41256-022-00242-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the context of a growing appreciation for the wellbeing of the health workforce as the foundation of high-quality, sustainable health systems, this paper presents findings from two complementary studies to explore occupational stress and professional quality of life among health workers that were conducted in preparation for a task-shifting intervention to improve antenatal mental health services in Cape Town. METHODS This mixed-methods, cross-sectional study was conducted in public sector Midwife Obstetric Units and associated Non-Profit Organisations in Cape Town. Semi-structured interviews and a quantitative survey were conducted among facility-and community-based professional and lay health workers. The survey included demographic as well as effort-reward imbalance (ERI) and professional quality of life (PROQOL) questionnaires to examine overall levels of work-related psychosocial stress and professional quality of life, as well as differences between lay and professional health workers. Qualitative data was analysed using a thematic content analysis approach. Quantitative data was analysed using STATA 12. RESULTS Findings from 37 qualitative interviews highlighted the difficult working conditions and often limited reward and support structures experienced by health workers. Corroborating these findings, our quantitative survey of 165 professional and lay health workers revealed that most health workers experienced a mismatch between efforts spent and rewards gained at work (61.1% of professional and 70.2% of lay health workers; p = 0.302). There were few statistically significant differences in ERI and PROQOL scores between professional and lay health workers. Although Compassion Satisfaction was high for all health worker groups, lay health workers also showed elevated levels of burnout and compassion fatigue, with community-based health workers particularly affected. CONCLUSIONS Findings of this study add to the existing evidence base on adverse working conditions faced by South African public-sector health workers that should be taken into consideration as national and local governments seek to 're-engineer' South Africa's Primary Health Care system. Furthermore, they also highlight the importance of taking into consideration the wellbeing of health workers themselves to develop interventions that can sustainably foster resilient and high-quality health systems.
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Affiliation(s)
- N Jensen
- Department of Global Health and Social Medicine, King's College London, London, UK.
| | - C Lund
- Health Service and Population Research Department, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's Global Health Institute, King's College London, London, UK
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Z Abrahams
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
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Jensen N, Kelly AH, Avendano M. Health equity and health system strengthening - Time for a WHO re-think. Glob Public Health 2022; 17:377-390. [PMID: 33427084 PMCID: PMC8820375 DOI: 10.1080/17441692.2020.1867881] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/11/2020] [Indexed: 11/16/2022]
Abstract
The pursuit of health equity is foundational to the global health enterprise. But while moral concerns over health inequities can galvanise political commitment, how such concerns can or should translate into practice remains less clear. This paper reviews evolving ways that equity goals have featured in key World Health Organization (WHO)-related policy documents, before discussing the heuristic value and empirical traction that the concept of equity can bring to the health system strengthening (HSS) agenda. We argue that while health equity is often presented as the overarching goal of HSS, in practice this is typically circumscribed to the provision of healthcare services. Although healthcare equity is important, we suggest that this narrow focus risks losing sight of the structural political, social and economic drivers of health and health inequities, as well as the broader contexts of care and complex socio-political mechanisms through which health systems are strengthened. Drawing on new lines of empirical inquiry, we propose that broadening the equity lens for HSS -offers exciting opportunities to put health systems at the heart of a more ambitious equity agenda in global health.
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Affiliation(s)
- N. Jensen
- Department of Global Health and Social Medicine, King’s College London, North East Wing, 40 Aldwych, London, WC2B 4BG, UK
| | - A. H. Kelly
- Department of Global Health and Social Medicine, King’s College London, North East Wing, 40 Aldwych, London, WC2B 4BG, UK
| | - M. Avendano
- Department of Global Health and Social Medicine, King’s College London, North East Wing, 40 Aldwych, London, WC2B 4BG, UK
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, USA
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Zhao Y, Hagel C, Tweheyo R, Sirili N, Gathara D, English M. Task-sharing to support paediatric and child health service delivery in low- and middle-income countries: current practice and a scoping review of emerging opportunities. HUMAN RESOURCES FOR HEALTH 2021; 19:95. [PMID: 34348709 PMCID: PMC8336272 DOI: 10.1186/s12960-021-00637-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/23/2021] [Indexed: 05/13/2023]
Abstract
BACKGROUND Demographic and epidemiological changes have prompted thinking on the need to broaden the child health agenda to include care for complex and chronic conditions in the 0-19 years (paediatric) age range. Providing such services will be undermined by general and skilled paediatric workforce shortages especially in low- and middle-income countries (LMICs). In this paper, we aim to understand existing, sanctioned forms of task-sharing to support the delivery of care for more complex and chronic paediatric and child health conditions in LMICs and emerging opportunities for task-sharing. We specifically focus on conditions other than acute infectious diseases and malnutrition that are historically shifted. METHODS We (1) reviewed the Global Burden of Diseases study to understand which conditions may need to be prioritized; (2) investigated training opportunities and national policies related to task-sharing (current practice) in five purposefully selected African countries (Kenya, Uganda, Tanzania, Malawi and South Africa); and (3) summarized reported experience of task-sharing and paediatric and child health service delivery through a scoping review of research literature in LMICs published between 1990 and 2019 using MEDLINE, Embase, Global Health, PsycINFO, CINAHL and the Cochrane Library. RESULTS We found that while some training opportunities nominally support emerging roles for non-physician clinicians and nurses, formal scopes of practices often remain rather restricted and neither training nor policy seems well aligned with probable needs from high-burden complex and chronic conditions. From 83 studies in 24 LMICs, and aside from the historically shifted conditions, we found some evidence examining task-sharing for a small set of specific conditions (circumcision, some complex surgery, rheumatic heart diseases, epilepsy, mental health). CONCLUSION As child health strategies are further redesigned to address the previously unmet needs careful strategic thinking on the development of an appropriate paediatric workforce is needed. To achieve coverage at scale countries may need to transform their paediatric workforce including possible new roles for non-physician cadres to support safe, accessible and high-quality care.
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Affiliation(s)
- Yingxi Zhao
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK.
| | - Christiane Hagel
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK
| | - Raymond Tweheyo
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- Department of Public Health, Lira University, Lira, Uganda
| | - Nathanael Sirili
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - David Gathara
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Mike English
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
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Segbefia CI, Goka B, Welbeck J, Amegan-Aho K, Dwuma-Badu D, Rao S, Salifu N, Oppong SA, Odei E, Ohene-Frempong K, Odame I. Implementing newborn screening for sickle cell disease in Korle Bu Teaching Hospital, Accra: Results and lessons learned. Pediatr Blood Cancer 2021; 68:e29068. [PMID: 33890391 DOI: 10.1002/pbc.29068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/27/2021] [Accepted: 03/24/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Early diagnosis of sickle cell disease (SCD) through newborn screening (NBS) is a cost-effective intervention, which reduces morbidity and mortality. In sub-Saharan Africa (SSA) where disease burden is greatest, there are no universal NBS programs and few institutions have the capacity to conduct NBS. We determined the feasibility and challenges of implementing NBS for SCD in Ghana's largest public hospital. PROCEDURE The SCD NBS program at Korle Bu Teaching Hospital (KBTH) is a multiyear partnership between the hospital and the SickKids Center for Global Child Health, Toronto, being implemented in phases. The 13-month demonstration phase (June 2017-July 2018) and phase one (November 2018-December 2019) focused on staff training and the feasibility of universal screening of babies born in KBTH. RESULTS During the demonstration phase, 115 public health nurses and midwives acquired competency in heel stick for dried blood spot sampling. Out of 9990 newborns, 4427 babies (44.3%) were screened, of which 79 (1.8%) were identified with presumptive SCD (P-SCD). Major challenges identified included inadequate nursing staff to perform screening, shortage of screening supplies, and delays in receiving screening results. Strategies to overcome some of the challenges were incorporated into phase one, resulting in increased screening coverage to 83.7%. CONCLUSIONS Implementing NBS for SCD in KBTH presented challenges with implications on achieving and sustaining universal NBS in KBTH and other settings in SSA. Specific steps addressing these challenges comprehensively will help build on the modest initial gains, moving closer toward a sustainable national NBS program.
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Affiliation(s)
- Catherine I Segbefia
- University of Ghana Medical School, College of Health Sciences, Accra, Ghana.,Korle Bu Teaching Hospital, Accra, Ghana
| | - Bamenla Goka
- University of Ghana Medical School, College of Health Sciences, Accra, Ghana.,Korle Bu Teaching Hospital, Accra, Ghana
| | - Jennifer Welbeck
- University of Ghana Medical School, College of Health Sciences, Accra, Ghana.,Korle Bu Teaching Hospital, Accra, Ghana
| | | | | | - Sudha Rao
- Korle Bu Teaching Hospital, Accra, Ghana
| | | | - Samuel A Oppong
- University of Ghana Medical School, College of Health Sciences, Accra, Ghana.,Korle Bu Teaching Hospital, Accra, Ghana
| | - Eric Odei
- Korle Bu Teaching Hospital, Accra, Ghana
| | | | - Isaac Odame
- Center for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Haematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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15
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Trang K, Ly AT, Lam LX, Brown CA, To MQ, Sullivan PS, Worthman CM, Giang LM, Jovanovic T. Mental health in HIV prevention and care: A qualitative study of challenges and facilitators to integration in Vietnam. Soc Sci Med 2021; 279:113978. [PMID: 34000583 PMCID: PMC8684791 DOI: 10.1016/j.socscimed.2021.113978] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Globally, men who have sex with men (MSM) experience a disproportionate burden of mental health issues. While HIV service providers may possess the skills and relationships to provision mental health and psychosocial support (MHPSS) to this population, task-sharing models that integrate MHPSS into HIV contexts remain limited. The aim of this study was to explore the sociodemographic, psychological, and structural factors operant at the client and HIV service provider levels that shape MHPSS access and burden among MSM and opportunities for integration in Vietnam. METHODS Between June and August 2018, semi-structured interviews were conducted with 20 MSM and 13 service providers at out-patient clinics (OPCs) and community-based organizations (CBOs) in Hanoi, Vietnam. Interviews explored participants' understandings of and experiences with the signs, causes, and appropriate treatments for mental health concerns; and perceived barriers to MHPSS integration in HIV contexts. Data were coded thematically and analyzed in MAXQDA. RESULTS Most MSM did not view their mental distress as constituting illness or as warranting clinical attention. Specifically, terms like "mental illness" were often associated with being "crazy" or immoral, while symptoms of distress were interpreted as having to do with everyday difficulties associated with being MSM and/or HIV-positive. Due to mental health stigma, MSM were reluctant to access services while service providers were similarly reluctant to query about needs. Few service providers knew where to refer patients for MHPSS, and none had done so previously. Most service providers reported lacking the human capital, expertise, and funding to address MHPSS needs. CONCLUSIONS Our findings suggest that aside from mental health stigma, future integration strategies must address competing demands and incentivization structures, limitations in existing mental health infrastructure and funding, misperceptions around MHPSS needs and symptoms, and opportunities to streamline MHPSS with existing CBO activities to strengthen community wellbeing.
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Affiliation(s)
- Kathy Trang
- Institute of Human Development and Social Change, New York University, New York, NY, United States.
| | - An Thanh Ly
- Australian Research Center in Sex, Health and Society, LaTrobe University, Melbourne, Australia; Department of Global Health, School of Preventive Medicine and Public Health, Hanoi Medical University, Viet Nam
| | - Le Xuan Lam
- Center for Training and Research on Substance Abuse-HIV, Hanoi Medical University, Ha Noi, Viet Nam
| | - Carolyn A Brown
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Margaret Q To
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, GA, United States
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Carol M Worthman
- Department of Anthropology, Emory University, Atlanta, GA, United States
| | - Le Minh Giang
- Center for Training and Research on Substance Abuse-HIV, Hanoi Medical University, Ha Noi, Viet Nam
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neuroscience, School of Medicine, Wayne State, University, Detroit, MI, United States
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Sabet Sarvestani A, Coulentianos M, Sienko KH. Defining and characterizing task-shifting medical devices. Global Health 2021; 17:60. [PMID: 34022920 PMCID: PMC8140413 DOI: 10.1186/s12992-021-00684-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/04/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Task shifting could help address limited human resources available for the delivery of quality health care services in low-resource settings. However, the role of medical devices in supporting task shifting is not fully understood. This study aimed to 1) define "task-shifting medical devices" and 2) identify product characteristics to guide the design and development of task-shifting medical devices. A three-part survey questionnaire comprising open-ended, rank-ordering, and multiple-choice questions was disseminated to healthcare professionals worldwide. The survey included questions to capture stakeholders' general understanding of and preferences for task shifting in medicine and public health, and questions to define task-shifting medical devices and identify desirable product characteristics of task-shifting medical devices. RESULTS Task-shifting medical devices were defined by respondents as "devices that can be used by a less specialized health worker". Aside from safe and effective, both essential characteristics for medical devices, easy to use was the most cited product characteristic for a task-shifting medical device. Responses also emphasized the importance of task-shifting medical devices to enable local agency, such as peer-to-peer training and local maintenance. Several additional frequently mentioned attributes included low cost, contextually appropriate, maintainable, capable of using an alternative power source, easy to understand, easy to learn, reusable, and easy to manage throughout its use cycle. CONCLUSION This study defines and characterizes task-shifting medical devices based on healthcare professionals' responses. Ease of use was identified as the most important characteristic that defines a task-shifting medical device, alongside safe and effective, and was strongly associated with enabling peer-to-peer training and maintainability. The findings from this study can be used to inform technology product profiles for medical devices used by lower-level cadres of healthcare workers in low-resource settings.
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Affiliation(s)
| | | | - Kathleen H. Sienko
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, USA
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Anh NTK, Yen LM, Nguyen NT, Nhat PTH, Thuy TTD, Phong NT, Tuyen PT, Yen NH, Chambers M, Hao NV, Rollinson T, Denehy L, Thwaites CL. Feasibility of establishing a rehabilitation programme in a Vietnamese intensive care unit. PLoS One 2021; 16:e0247406. [PMID: 33657158 PMCID: PMC7928504 DOI: 10.1371/journal.pone.0247406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/08/2021] [Indexed: 11/18/2022] Open
Abstract
Increasing numbers of people are surviving critical illness throughout the world, but survivorship is associated with long-term disability. In high-income settings physical rehabilitation is commonly employed to counter this and improve outcomes. These utilize highly-trained multidisciplinary teams and are unavailable and unaffordable in most low and middle income countries (LMICs). We aimed to design a sustainable intensive care unit (ICU) rehabilitation program and to evaluate its feasibility in a LMIC setting. In this project patients, care-givers and experts co-designed an innovative rehabilitation programme that can be delivered by non-expert ICU staff and family care-givers in a LMIC. We implemented this programme in adult patient with patients with tetanus at the Hospital for Tropical Diseases, Ho Chi Minh City over a 5-month period, evaluating the programme's acceptability, enablers and barriers. A 6-phase programme was designed, supported by written and video material. The programme was piloted in total of 30 patients. Rehabilitation was commenced a median 14 (inter quartile range (IQR) 10-18) days after admission. Each patient received a median of 25.5 (IQR 22.8-34.8) rehabilitation sessions out of a median 27 (22.8-35) intended (prescribed) sessions. There were no associated adverse events. Patients and staff found rehabilitation to be beneficial, enhanced relationships between carers, patients and staff and was deemed to be a positive step towards recovery and return to work. The main barrier was staff time. The programme was feasible for patients with tetanus and viewed positively by staff and participants. Staff time was identified as the major barrier to ongoing implementation.
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Affiliation(s)
| | - Lam Minh Yen
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | | | | | - Pham Thi Tuyen
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Hoang Yen
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Mary Chambers
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Nguyen Van Hao
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | | | | | - C. Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- * E-mail:
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Igaga EN, Sendagire C, Ayebale ET. Task Sharing in Global Anesthesia and Surgery: Workforce Concerns. CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-020-00433-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Surey J, Francis M, Gibbons J, Leonard M, Abubakar I, Story A, MacLellan J. Practising critical resilience as an advanced peer support worker in London: A qualitative evaluation of a peer-led hepatitis C intervention amongst people experiencing homelessness who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 91:103089. [PMID: 33460981 DOI: 10.1016/j.drugpo.2020.103089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Peer support has been used as a mechanism to facilitate active engagement with healthcare amongst underserved populations. The HepCare project upskilled experienced peer support workers (PSWs) to become equal members of a service provider team, taking on advanced clinical roles normally carried out by medical or nursing specialists. METHOD A participatory case study approach was taken to the study following the methodological guidance of Merriam (1998). The subject of the case in our study is the advanced peer support workers (APSWs) functioning in the HepCare project as service providers. The object of the case is an exploration of their transition to service provider in the HCV screening and treatment support service. Five peer led in-depth interviews with APSWs were supplemented by a survey of health professionals, interviews with service users, documentary evidence in the form of job descriptions, observational notes and a blog from the field. Thematic analysis of the data was conducted, refined and finalised in a workshop with the research team and APSW participants. RESULTS Three themes were generated from the data that explore the peer support worker's transition to APSW in the programme: Transition to Integration, Retaining 'Peerness', and Practising Critical Resilience. The advocacy and support enacted by the APSWs through the HepCare project, offer purpose and meaning alongside integration into a new social group. This is buffered by the supportive context of the programme and facilitates a motivating sense of worth. CONCLUSION The programme offers policy guidance for the structured career development of APSWs and a platform for enactment of critical resilience as they transition to their advanced role, in the healthcare provider team.
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Affiliation(s)
- Julian Surey
- Institute of Global Health, University College London, UK; Find and Treat, UCLH NHS Trust, London, UK
| | - Marie Francis
- Institute of Global Health, University College London, UK; Find and Treat, UCLH NHS Trust, London, UK
| | - John Gibbons
- Find and Treat, UCLH NHS Trust, London, UK; Groundswell, London, UK
| | - Mark Leonard
- Institute of Global Health, University College London, UK; Find and Treat, UCLH NHS Trust, London, UK
| | | | - Alistair Story
- Find and Treat, UCLH NHS Trust, London, UK; Collaborative Centre for Inclusion Health, University College London, UK
| | - Jennifer MacLellan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
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Jansen R, Reid M. Interest in Communication Technology by Rural Caregivers of Adolescents with Mental Health Issues in South Africa: The Mmogo-Method ®. Issues Ment Health Nurs 2021; 42:24-37. [PMID: 32633169 DOI: 10.1080/01612840.2020.1774017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Caregivers determine the level of care adolescents with mental issues receive; however, caregivers' own needs are often unmet. Communication technology can be tailored to address these challenges, especially in a rural environment. This study aimed to explore caregivers' interest in using communication technology to provide support to address challenges. This study involved a visual-based narrative inquiry that gathered data through the Mmogo-method®. Three (n = 3) groups were held with rural caregivers (n = 17) of adolescents with mental health issues in a rural area in the Free State province of South Africa during 2017. Three themes captured challenges confronting caregivers, namely, psychosocial, social resources, and informational challenges. Interest in communication technology was captured in a fourth theme. The findings indicate that communication technology can address caregivers' challenges by providing support and information to caregivers in rural areas. Communication technology, including mobile phones, electronic devices, and the Internet, has transformed healthcare services and proved to be valuable in resource constraint environments.
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Affiliation(s)
- Ronelle Jansen
- School of Nursing, University of the Free State, Bloemfontein, South Africa
| | - Marianne Reid
- School of Nursing, University of the Free State, Bloemfontein, South Africa
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21
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Fitzgerald L, Gathara D, McKnight J, Nzinga J, English M. Are health care assistants part of the long-term solution to the nursing workforce deficit in Kenya? HUMAN RESOURCES FOR HEALTH 2020; 18:79. [PMID: 33081790 PMCID: PMC7576771 DOI: 10.1186/s12960-020-00523-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 10/09/2020] [Indexed: 05/24/2023]
Abstract
This commentary article addresses a critical issue facing Kenya and other Low- and Middle-Income Countries (LMIC): how to remedy deficits in hospitals' nursing workforce. Would employing health care assistants (HCAs) provide a partial solution? This article first gives a brief introduction to the Kenyan context and then explores the development of workforce roles to support nurses in Europe to highlight the diversity of these roles. Our introduction pinpoints that pressures to maintain or restrict costs have led to a wide variety of formal and informal task shifting from nurses to some form of HCA in the EU with differences noted in issues of appropriate skill mix, training, accountability, and regulation of HCA. Next, we draw from a suite of recent studies in hospitals in Kenya which illustrate nursing practices in a highly pressurized context. The studies took place in neo-natal wards in Kenyan hospitals between 2015 and 2018 and in a system with no legal or regulatory basis for task shifting to HCAs. We proffer data on why and how nurses informally delegate tasks to others in the public sector and the decision-making processes of nurses and frame this evidence in the specific contextual conditions. In the conclusion, the paper aims to deepen the debates on developing human resources for health. We argue that despite the urgent pressures to address glaring workforce deficits in Kenya and other LMIC, caution needs to be exercised in implementing changes to nursing practices through the introduction of HCAs. The evidence from EU suggests that the rapid growth in the employment of HCA has created crucial issues which need addressing. These include clearly defining the scope of practice and developing the appropriate skill mix between nurses and HCAs to match the specific health system context. Moreover, we suggest efforts to develop and implement such roles should be carefully designed and rigorously evaluated to inform continuing policy development.
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Affiliation(s)
| | - David Gathara
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Jacob McKnight
- Nuffield Dept. of Medicine, University of Oxford, Oxford, UK
| | | | - Mike English
- NDM, University of Oxford, Oxford, UK
- Health Services and Research Group, KEMRI-Wellcome Trust, Kenya Medical Research Institute/Wellcome Trust Research Programme, PO Box 43640, Nairobi, 00100 Kenya
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22
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Feringa MM, de Swardt HC, Havenga Y. Registered nurses' knowledge, attitude and practice regarding their scope of practice in Botswana. Health SA 2020; 25:1415. [PMID: 33240532 PMCID: PMC7669984 DOI: 10.4102/hsag.v25i0.1415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 07/14/2020] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The articulation of the scope of practice in nursing is important to provide boundaries for registered nurses in which to practice. Registered nurses in Botswana have frequently experienced challenges and raised concerns with their scope of practice. Research related to registered nurses' knowledge, attitudes and practice regarding their scope of practice appears to be limited in the African context, particularly in Botswana. AIM The aim of this study was to develop guidelines for professional nurses to explore and describe registered nurses' knowledge, attitude and practice regarding their scope of practice in Botswana. METHODS A convergent parallel mixed-methods design was employed using a three-tier sampling approach to ensure a representative sample of various settings, health facilities and nurses. For the purpose of this article, the data from the qualitative component are reported. Thirty registered nurses, working in the public health sector in Botswana, participated in semi-structured interviews. Data were analysed using thematic content analysis. FINDINGS Data analysis revealed that registered nurses' scope of their knowledge was lacking. Registered nurses' attitudes were reflected in the adaptation process to expanded practice, as demonstrated through emotive aspects, adjustments to practice beyond scope and the learning of new skills considered beyond scope. Participants reported implementing many skills deemed beyond their scope, whilst their motive to do so included their experience of a lack of control over practice, lack of resources or they were doing so out of consideration for the patient. Guidance in terms of their scope was found to be inadequate. CONCLUSION As in other resource-limited countries in Africa, registered nurses in Botswana experience challenges with their scope of practice. Inadequate boundaries may result in compromised nursing care and may have detrimental consequences for both the patient and the nurse.
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Affiliation(s)
- Maria M. Feringa
- Adelaide Tambo School of Nursing Science, Faculty of Science, Tshwane University of Technology, Pretoria, South Africa
| | - Hester C. de Swardt
- Adelaide Tambo School of Nursing Science, Faculty of Science, Tshwane University of Technology, Pretoria, South Africa
| | - Yolanda Havenga
- Adelaide Tambo School of Nursing Science, Faculty of Science, Tshwane University of Technology, Pretoria, South Africa
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English M, Gathara D, Nzinga J, Kumar P, Were F, Warfa O, Tallam-Kimaiyo E, Nandili M, Obengo A, Abuya N, Jackson D, Brownie S, Molyneux S, Jones COH, Murphy GAV, McKnight J. Lessons from a Health Policy and Systems Research programme exploring the quality and coverage of newborn care in Kenya. BMJ Glob Health 2020; 5:e001937. [PMID: 32133169 PMCID: PMC7042598 DOI: 10.1136/bmjgh-2019-001937] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/13/2019] [Accepted: 12/22/2019] [Indexed: 11/02/2022] Open
Abstract
There are global calls for research to support health system strengthening in low-income and middle-income countries (LMICs). To examine the nature and magnitude of gaps in access and quality of inpatient neonatal care provided to a largely poor urban population, we combined multiple epidemiological and health services methodologies. Conducting this work and generating findings was made possible through extensive formal and informal stakeholder engagement linked to flexibility in the research approach while keeping overall goals in mind. We learnt that 45% of sick newborns requiring hospital care in Nairobi probably do not access a suitable facility and that public hospitals provide 70% of care accessed with private sector care either poor quality or very expensive. Direct observations of care and ethnographic work show that critical nursing workforce shortages prevent delivery of high-quality care in high volume, low-cost facilities and likely threaten patient safety and nurses' well-being. In these challenging settings, routines and norms have evolved as collective coping strategies so health professionals maintain some sense of achievement in the face of impossible demands. Thus, the health system sustains a functional veneer that belies the stresses undermining quality, compassionate care. No one intervention will dramatically reduce neonatal mortality in this urban setting. In the short term, a substantial increase in the number of health workers, especially nurses, is required. This must be combined with longer term investment to address coverage gaps through redesign of services around functional tiers with improved information systems that support effective governance of public, private and not-for-profit sectors.
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Affiliation(s)
- Mike English
- Health Services Unit, KEMRI – Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine & Global Health, Nuffield Department of Clinical Medicine, Oxford, Oxfordshire, UK
| | - David Gathara
- Health Services Unit, KEMRI – Wellcome Trust Research Programme, Nairobi, Kenya
| | - Jacinta Nzinga
- Health Services Unit, KEMRI – Wellcome Trust Research Programme, Nairobi, Kenya
| | - Pratap Kumar
- Institute of Healthcare Management, Strathmore University Strathmore Business School, Nairobi, Nairobi Area, Kenya
- Health-E-Net Limited, Nairobi, Kenya
| | - Fred Were
- Department of Paediatrics, University of Nairobi, Nairobi, Nairobi, Kenya
| | - Osman Warfa
- Neonatal, Child and Adolescent Health Unit, Kenya Ministry of Health, Nairobi, Kenya
| | | | - Mary Nandili
- Neonatal, Child and Adolescent Health Unit, Kenya Ministry of Health, Nairobi, Kenya
| | - Alfred Obengo
- National Nurses Association of Kenya, Nairobi, Kenya
| | | | - Debra Jackson
- University of Technology Sydney, Sydney, New South Wales, Australia
| | - Sharon Brownie
- Griffith University Menzies Health Institute Queensland, Nathan, Queensland, Australia
| | - Sassy Molyneux
- Health Systems and Research Ethics, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, Oxford, UK
| | - Caroline Olivia Holmes Jones
- Center for Tropical Medicine and Global Health, University of Oxford Centre for Tropical Medicine, Oxford, UK
- Department of Health System and Research Ethics, KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Jacob McKnight
- Center for Tropical Medicine and Global Health, University of Oxford Centre for Tropical Medicine, Oxford, UK
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Okello G, Molyneux S, Zakayo S, Gerrets R, Jones C. Producing routine malaria data: an exploration of the micro-practices and processes shaping routine malaria data quality in frontline health facilities in Kenya. Malar J 2019; 18:420. [PMID: 31842872 PMCID: PMC6915927 DOI: 10.1186/s12936-019-3061-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 12/08/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Routine health information systems can provide near real-time data for malaria programme management, monitoring and evaluation, and surveillance. There are widespread concerns about the quality of the malaria data generated through routine information systems in many low-income countries. However, there has been little careful examination of micro-level practices of data collection which are central to the production of routine malaria data. METHODS Drawing on fieldwork conducted in two malaria endemic sub-counties in Kenya, this study examined the processes and practices that shape routine malaria data generation at frontline health facilities. The study employed ethnographic methods-including observations, records review, and interviews-over 18-months in four frontline health facilities and two sub-county health records offices. Data were analysed using a thematic analysis approach. RESULTS Malaria data generation was influenced by a range of factors including human resource shortages, tool design, and stock-out of data collection tools. Most of the challenges encountered by health workers in routine malaria data generation had their roots in wider system issues and at the national level where the framing of indicators and development of data collection tools takes place. In response to these challenges, health workers adopted various coping mechanisms such as informal task shifting and use of improvised tools. While these initiatives sustained the data collection process, they also had considerable implications for the data recorded and led to discrepancies in data that were recorded in primary registers. These discrepancies were concealed in aggregated monthly reports that were subsequently entered into the District Health Information Software 2. CONCLUSION Challenges to routine malaria data generation at frontline health facilities are not malaria or health information systems specific; they reflect wider health system weaknesses. Any interventions seeking to improve routine malaria data generation must look beyond just malaria or health information system initiatives and include consideration of the broader contextual factors that shape malaria data generation.
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Affiliation(s)
- George Okello
- Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O Box 230, 80108, Kilifi, Kenya.
| | - Sassy Molyneux
- Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O Box 230, 80108, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Scholastica Zakayo
- Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O Box 230, 80108, Kilifi, Kenya
| | - Rene Gerrets
- Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
| | - Caroline Jones
- Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O Box 230, 80108, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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Preston A, Okebe J, Balen J, Ribera JM, Masunaga Y, Bah A, Dabira E, D’Alessandro U. Involving community health workers in disease-specific interventions: perspectives from The Gambia on the impact of this approach. JOURNAL OF GLOBAL HEALTH REPORTS 2019. [DOI: 10.29392/joghr.3.e2019084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Nzinga J, McKnight J, Jepkosgei J, English M. Exploring the space for task shifting to support nursing on neonatal wards in Kenyan public hospitals. HUMAN RESOURCES FOR HEALTH 2019; 17:18. [PMID: 30841900 PMCID: PMC6404312 DOI: 10.1186/s12960-019-0352-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 02/15/2019] [Indexed: 05/14/2023]
Abstract
BACKGROUND Nursing practice is a key driver of quality care and can influence newborn health outcomes where nurses are the primary care givers to this highly dependent group. However, in sub-Saharan Africa, nursing work environments are characterized by heavy workloads, insufficient staffing and regular medical emergencies, which compromise the ability of nurses to provide quality care. Task shifting has been promoted as one strategy for making efficient use of human resources and addressing these issues. AIMS AND OBJECTIVES We aimed to understand the nature and practice of neonatal nursing in public hospitals in Nairobi so as to determine what prospect there might be for relieving pressure by shifting nurses' work to others. METHODS This paper is based on an 18-month qualitative study of three newborn units of three public hospitals-all located in Nairobi county-using an ethnographic approach. We draw upon a mix of 32 interviews, over 250 h' observations, field notes and informal conversations. Data were collected from senior nursing experts in newborn nursing, neonatal nurse in-charges, neonatal nurses, nursing students and support staff. RESULTS To cope with difficult work conditions characterized by resource challenges and competing priorities, nurses have developed a ritualized schedule and a form of 'subconscious triage'. Informal, organic task shifting was already taking place whereby particular nursing tasks were delegated to students, mothers and support staff, often without any structured supervision. Despite this practice, nurses were agnostic about formal institutionalization of task shifting due to concerns around professional boundaries and the practicality of integrating a new cadre into an already stressed health system. CONCLUSION Our findings revealed a routine template of neonatal nursing work which nurses used to control unpredictability. We found that this model of nursing encouraged delegation of less technical tasks to subordinates, parents and other staff through the process of 'subconscious triage'. The rich insights we gained from this organic form of task shifting can inform more formal task-shifting projects as they seek to identify tasks most easily delegated, and how best to support and work with busy nurses.
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Affiliation(s)
- Jacinta Nzinga
- Health services and Research Group, Kenya Medical Research Institute/Wellcome Trust Research Programme, PO Box 43640, Nairobi, 00100 Kenya
| | - Jacob McKnight
- Nuffield Department of Medicine and Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Joyline Jepkosgei
- Health services and Research Group, Kenya Medical Research Institute/Wellcome Trust Research Programme, PO Box 43640, Nairobi, 00100 Kenya
| | - Mike English
- Health services and Research Group, Kenya Medical Research Institute/Wellcome Trust Research Programme, PO Box 43640, Nairobi, 00100 Kenya
- Nuffield Department of Medicine and Department of Paediatrics, University of Oxford, Oxford, United Kingdom
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Kennedy MC, Boyd J, Mayer S, Collins A, Kerr T, McNeil R. Peer worker involvement in low-threshold supervised consumption facilities in the context of an overdose epidemic in Vancouver, Canada. Soc Sci Med 2019; 225:60-68. [PMID: 30798157 DOI: 10.1016/j.socscimed.2019.02.014] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 02/07/2019] [Accepted: 02/09/2019] [Indexed: 01/05/2023]
Abstract
Overdose prevention sites (OPS) are a form of supervised consumption facility that have been implemented in Vancouver, Canada as an innovative response to an ongoing overdose epidemic. OPS are primarily staffed by peers - people who use(d) drugs (PWUD) - trained in overdose response. We sought to characterize peer worker involvement in OPS programming, including how this shapes service dynamics and health outcomes among PWUD. Data were drawn from a rapid ethnographic study examining the implementation, operations and impacts of OPS in Vancouver from December 2016 to April 2017. We conducted approximately 185 h of observational fieldwork at OPS and 72 in-depth qualitative interviews with PWUD. Data were analyzed thematically, with a focus on peer worker involvement at OPS and related outcomes. OPS implementation and operations depended on peer worker involvement and thus allowed for recognition of capacities developed through roles that peers were already undertaking through local programming for PWUD. Peer involvement at OPS enhanced feelings of comfort and facilitated engagement with OPS among PWUD. These dynamics and appreciation of peer worker expertise enabled communication with staff in ways that fostered harm reduction practices and promoted health benefits. However, many peer workers received minimal financial compensation and experienced considerable grief due to the emotional toll of the epidemic and lack of supports, which contributed to staff burnout. Our findings illustrate the specific contributions of task shifting OPS service delivery to peer workers, including how this can enhance service engagement and promote the reduction of harms among PWUD. Amidst an ongoing overdose epidemic, expanding formalized peer worker involvement in supervised consumption programming may help to mitigate overdose-related harms, particularly in settings where peers are actively involved in existing programming. However, efforts are needed to ensure that peer workers receive adequate financial support and workplace benefits to promote the sustainability of this approach.
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Affiliation(s)
- Mary Clare Kennedy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Samara Mayer
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Alexandra Collins
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
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Oluoch D, Murphy G, Gathara D, Abuya N, Nzinga J, English M, Jones C. Neonatal nursing policy and practice in Kenya: Key stakeholders and their views on task-shifting as an intervention to improve care quality. Wellcome Open Res 2018. [DOI: 10.12688/wellcomeopenres.14291.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Improving the quality of facility based neonatal care is central to tackling the burden of neonatal mortality in Low and Middle Income Countries (LMIC). Quality neonatal care is highly dependent on nursing care but a major challenge facing health systems in LMICs is human resource shortage. In Kenya, task-shifting among professional care cadres is being discussed as one potential strategy of addressing the human resource shortage, but little attention is being paid to the potential for task-shifting in the provision of in-patient sick newborn care. This study identified key neonatal policy-making and implementation stakeholders in Kenya and explored their perceptions of task-shifting in newborn units. Methods: The study was exploratory and descriptive, employing qualitative methods including: document review, stakeholder analysis, observation of policy review process meetings and stakeholder feedback. A framework approach was used for analysis. Results: In Kenya, guidelines for the care of sick neonates exist but there are few specialized neonatal nurses and no policy documents outlining the nurse to patient ratio required in neonatal care or other higher dependency areas. The Ministry of Health, Nursing Council of Kenya and international agencies were identified as playing key roles in policy formulation while County governments, the National Nurses Association of Kenya and frontline care providers are central to implementation. Newborns were perceived to be highly vulnerable requiring skilled care but in light of human resources challenges, most expressed some support for shifting ‘unskilled’ tasks. However, a few of the key implementers were concerned about the use of unqualified staff and all stakeholders emphasized the need for training, regulation and supervision. Conclusions: Task-shifting has the potential to help address human recourse challenge in low-income settings. However, any potential task-shifting intervention in neonatal care would require a carefully planned process involving all key stakeholders and clear regulations to steer implementation.
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Kudsk-Iversen S, Shamambo N, Bould MD. Strengthening the Anesthesia Workforce in Low- and Middle-Income Countries. Anesth Analg 2018; 126:1291-1297. [DOI: 10.1213/ane.0000000000002722] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Glenton C, Sorhaindo AM, Ganatra B, Lewin S. Implementation considerations when expanding health worker roles to include safe abortion care: a five-country case study synthesis. BMC Public Health 2017; 17:730. [PMID: 28934942 PMCID: PMC5609023 DOI: 10.1186/s12889-017-4764-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 09/15/2017] [Indexed: 11/30/2022] Open
Abstract
Background Allowing a broader range of trained health workers to deliver services can be an important way of improving access to safe abortion care. However, the expansion of health worker roles may be challenging to implement. This study aimed to explore factors influencing the implementation of role expansion strategies for non-physician providers to include the delivery of abortion care. Methods We conducted a multi-country case study synthesis in Bangladesh, Ethiopia, Nepal, South Africa and Uruguay, where the roles of non-physician providers have been formally expanded to include the provision of abortion care. We searched for documentation from each country related to non-physician providers, abortion care services and role expansion through general internet searches, Google Scholar and PubMed, and gathered feedback from 12 key informants. We carried out a thematic analysis of the data, drawing on categories from the SURE Framework of factors affecting the implementation of policy options. Results Several factors appeared to affect the successful implementation of including non-physician providers to provide abortion care services. These included health workers’ knowledge about abortion legislation and services; and health workers’ willingness to provide abortion care. Health workers’ willingness appeared to be influenced by their personal views about abortion, the method of abortion and stage of pregnancy and their perceptions of their professional roles. While managers’ and co-workers’ attitudes towards the use of non-physician providers varied, the synthesis suggests that female clients focused less on the type of health worker and more on factors such as trust, privacy, cost, and closeness to home. Health systems factors also played a role, including workloads and incentives, training, supervision and support, supplies, referral systems, and monitoring and evaluation. Strategies used, with varying success, to address some of these issues in the study countries included values clarification workshops, health worker rotation, access to emotional support for health workers, the incorporation of abortion care services into pre-service curricula, and in-service training strategies. Conclusions To increase the likelihood of success for role expansion strategies in the area of safe abortion, programme planners must consider how to ensure motivation, support and reasonable working conditions for affected health workers. Electronic supplementary material The online version of this article (10.1186/s12889-017-4764-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Claire Glenton
- Global Health Unit, Norwegian Institute of Public Health, Oslo, Norway.
| | - Annik M Sorhaindo
- Independent Consultant in Reproductive and Sexual Health, Mexico City, Mexico
| | - Bela Ganatra
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Simon Lewin
- Global Health Unit, Norwegian Institute of Public Health / Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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Morley CP, Wang D, Mader EM, Plante KP, Kingston LN, Rabiei A. Analysis of the association between millennium development goals 4 & 5 and the physician workforce across international economic strata. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2017; 17:18. [PMID: 28720089 PMCID: PMC5516300 DOI: 10.1186/s12914-017-0126-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 07/12/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND The Millennium Development Goals (MDGs) are 8 international development goals voluntarily adopted by 189 nations. The goals included health related aims to reduce the under-five child mortality rate by two-thirds (MDG4), and to reduce the maternal mortality ratio by three-quarters (MDG5). To assess the relationship between the healthcare workforce and MDGs 4-5, we examined the physician workforces of countries around the globe, in terms of the Physician Density Level (PDL, or number of physicians per 1000 population), and compared this rate across a number of years to several indicator variables specified as markers of progress towards MDG4 and MDG5. METHODS Data for each variable of interest were obtained from the World Bank's Millennium Development Goals and World Development Indicators databases for 208 countries and territories from 2004 to 2014, representing a ten-year period for which the most information is available. We analyzed the relationships between MDG outcomes and PDL, controlling for national income levels and other covariates, using linear mixed model regression. Dependent variables were logarithmically transformed to meet assumptions necessary for multivariate analysis. RESULTS In unadjusted models, an increase of every one physician per 1000 population (one unit change in PDL) lowered the risk of not being vaccinated for measles-mumps-rubella (MMR) to 29.3% (p < 0.001, 95% CI: 22.2%-38.7%) and for not receiving diphtheria-tetanus-pertussis (DTaP) vaccination rate decreased to 38.5% (p < 0.001, 95% CI: 28.7% - 51.7%). Maternal mortality rate decreased to 76.6% (p < 0.001, 95% CI: 74.3% - 79.0%), neonatal mortality decreased to 58.8% (p < 0.001, 95% CI: 54.8% - 63.2%) and under-5 mortality rate decreased to 52.1% (p < 0.001, 95% CI: 48.0% - 56.4%), with every one-unit change in PDL. Adjusted models tended to reflect unadjusted risk assessments. CONCLUSION The maintenance and improvement of the health workforce is a vital consideration when assessing how to achieve global development goals related to health outcomes.
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Affiliation(s)
- Christopher P. Morley
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, USA
- Department of Family Medicine, SUNY Upstate Medical University, Syracuse, USA
- Department of Psychiatry & Behavioral Sciences, SUNY Upstate Medical University, Syracuse, USA
- Center for Global Health & Translational Studies, SUNY Upstate Medical University, Syracuse, USA
| | - Dongliang Wang
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, USA
| | | | - Kyle P. Plante
- College of Medicine, SUNY Upstate Medical University, Syracuse, USA
| | - Lindsey N. Kingston
- Department of History, Politics, and International Relations, Webster University, Webster Groves, USA
| | - Azadeh Rabiei
- St. Joseph’s Family Medicine Residency, Syracuse, USA
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