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Gakwerere M, Ndayisenga JP, Ngabonzima A, Uhawenimana TC, Yamuragiye A, Harindimana F, Rwabufigiri BN. Access to continuous professional development for capacity building among nurses and midwives providing emergency obstetric and neonatal care in Rwanda. BMC Health Serv Res 2024; 24:394. [PMID: 38553745 PMCID: PMC10979581 DOI: 10.1186/s12913-023-10440-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 12/05/2023] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Nurses and midwives are at the forefront of the provision of Emergency Obstetric and Neonatal Care (EmONC) and Continuous Professional Development (CPD) is crucial to provide them with competencies they need to provide quality services. This research aimed to assess uptake and accessibility of midwives and nurses to CPD and determine their knowledge and skills gaps in key competencies of EmONC to inform the CPD programming. METHODS The study applied a quantitative, cross-sectional, and descriptive research methodology. Using a random selection, forty (40) health facilities (HFs) were selected out of 445 HFs that performed at least 20 deliveries per month from July 1st, 2020 to June 30th, 2021 in Rwanda. Questionnaires were used to collect data on updates of CPD, knowledge on EmONC and delivery methods to accessCPD. Data was analyzed using IBM SPSS statistics 27 software. RESULTS Nurses and midwives are required by the Rwandan midwifery regulatory body to complete at least 60 CPD credits before license renewal. However, the study findings revealed that most health care providers (HCPs) have not been trained on EmONC after graduation from their formal education. Results indicated that HCPs who had acquired less than 60 CPD credits related to EmONC training were 79.9% overall, 56.3% in hospitals, 82.2% at health centres and 100% at the health post levels. This resulted in skills and knowledge gaps in management of Pre/Eclampsia, Postpartum Hemorrhage and essential newborn care. The most common method to access CPD credits included workshops (43.6%) and online training (34.5%). Majority of HCPs noted that it was difficult to achieve the required CPD credits (57.0%). CONCLUSION The findings from this study revealed a low uptake of critical EmONC training by nurses and midwives in the form of CPD. The study suggests a need to integrate EmONC into the health workforce capacity building plan at all levels and to make such training systematic and available in multiple and easily accessible formats. IMPLICATION ON NURSING AND MIDWIFERY POLICY Findings will inform the revision of policies and strategies to improve CPD towards accelerating capacity for the reduction of preventable maternal and perinatal deaths as well as reducing maternal disabilities in Rwanda.
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Affiliation(s)
- Mathias Gakwerere
- Regional Office for East and Southern Africa, United Nations Population Fund, 09 Simba Road, Sunninghill, Johannesburg, South Africa.
| | - Jean Pierre Ndayisenga
- School of Nursing and Midwifery, College of Medicine and Health Science, University of Rwanda, Kigali, Rwanda
- Arthur Labatt Family School of Nursing, Western University, London, Canada
| | - Anaclet Ngabonzima
- JSI Research & Training Institute, Inc, International Division, Washington, DC, USA
| | - Thiery Claudien Uhawenimana
- School of Nursing and Midwifery, College of Medicine and Health Science, University of Rwanda, Kigali, Rwanda
| | | | | | - Bernard Ngabo Rwabufigiri
- College of Medicine and Health Sciences, School of Public Health, University of Rwanda, Kigali, Rwanda
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Iroz CB, Ramaswamy R, Bhutta ZA, Barach P. Quality improvement in public-private partnerships in low- and middle-income countries: a systematic review. BMC Health Serv Res 2024; 24:332. [PMID: 38481226 PMCID: PMC10935959 DOI: 10.1186/s12913-024-10802-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Public-private partnerships (PPP) are often how health improvement programs are implemented in low-and-middle-income countries (LMICs). We therefore aimed to systematically review the literature about the aim and impacts of quality improvement (QI) approaches in PPP in LMICs. METHODS We searched SCOPUS and grey literature for studies published before March 2022. One reviewer screened abstracts and full-text studies for inclusion. The study characteristics, setting, design, outcomes, and lessons learned were abstracted using a standard tool and reviewed in detail by a second author. RESULTS We identified 9,457 citations, of which 144 met the inclusion criteria and underwent full-text abstraction. We identified five key themes for successful QI projects in LMICs: 1) leadership support and alignment with overarching priorities, 2) local ownership and engagement of frontline teams, 3) shared authentic learning across teams, 4) resilience in managing external challenges, and 5) robust data and data visualization to track progress. We found great heterogeneity in QI tools, study designs, participants, and outcome measures. Most studies had diffuse aims and poor descriptions of the intervention components and their follow-up. Few papers formally reported on actual deployment of private-sector capital, and either provided insufficient information or did not follow the formal PPP model, which involves capital investment for a explicit return on investment. Few studies discussed the response to their findings and the organizational willingness to change. CONCLUSIONS Many of the same factors that impact the success of QI in healthcare in high-income countries are relevant for PPP in LMICs. Vague descriptions of the structure and financial arrangements of the PPPs, and the roles of public and private entities made it difficult to draw meaningful conclusions about the impacts of the organizational governance on the outcomes of QI programs in LMICs. While we found many articles in the published literature on PPP-funded QI partnerships in LMICs, there is a dire need for research that more clearly describes the intervention details, implementation challenges, contextual factors, leadership and organizational structures. These details are needed to better align incentives to support the kinds of collaboration needed for guiding accountability in advancing global health. More ownership and power needs to be shifted to local leaders and researchers to improve research equity and sustainability.
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Affiliation(s)
- Cassandra B Iroz
- Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
| | - Rohit Ramaswamy
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
- Institute for Global Health & Development, The Aga Khan University, South Central Asia, East Africa, UK
| | - Paul Barach
- Thomas Jefferson University, Philadelphia, PA, USA
- Imperial College, London, UK
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Yan J, Martins N, Amaral S, Francis JR, Kameniar B, Delany C. "Nothing without connection"-Participant perspectives and experiences of mentorship in capacity building in Timor-Leste. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002112. [PMID: 38457415 PMCID: PMC10923460 DOI: 10.1371/journal.pgph.0002112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 02/15/2024] [Indexed: 03/10/2024]
Abstract
The literature on mentorship approaches to capacity building in global health is limited. Likewise, there are few qualitative studies that describe mentorship in capacity building in global health from the perspective of the mentors and mentees. This qualitative study examined the perspectives and experiences of participants involved in a program of health capacity building in Timor-Leste that was based on a side-by-side, in-country mentorship approach. Semi-structured interviews were conducted with 23 participants (including Timorese and expatriate mentors, and local Timorese colleagues) from across a range of professional health disciplines, followed by a series of member checking workshops. Findings were reviewed using inductive thematic analysis. Participants were included in review and refinement of themes. Four major themes were identified: the importance of trust and connection within the mentoring relationship; the side-by-side nature of the relationship (akompaña); mentoring in the context of external environmental challenges; and the need for the mentoring relationship to be dynamic and evolving, and aligned to a shared vision and goals. The importance of accompaniment (akompaña) as a key element of the mentoring relationship requires further exploration and study. Many activities in global health capacity building remain focused on provision of training, supervision, and supportive supervision of competent task performance. Viewed through a decolonising lens, there is an imperative for global health actors to align with local priorities and goals, and work alongside individuals supporting them in their vision to become independent leaders of their professions. We propose that placing mentoring relationships at the centre of human resource capacity building programs encourages deep learning, and is more likely to lead to long term, meaningful and sustainable change.
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Affiliation(s)
- Jennifer Yan
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Nelson Martins
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Salvador Amaral
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Joshua R. Francis
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Barbara Kameniar
- The University of Melbourne, Melbourne, Australia
- The University of Tasmania, Hobart, Australia
| | - Clare Delany
- The University of Melbourne, Melbourne, Australia
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Odhus CO, Kapanga RR, Oele E. Barriers to and enablers of quality improvement in primary health care in low- and middle-income countries: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002756. [PMID: 38236832 PMCID: PMC10796071 DOI: 10.1371/journal.pgph.0002756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/06/2023] [Indexed: 01/22/2024]
Abstract
The quality of health care remains generally poor across primary health care settings, especially in low- and middle-income countries where tertiary care tends to take up much of the limited resources despite primary health care being the first (and often the only) point of contact with the health system for nearly 80 per cent of people in these countries. Evidence is needed on barriers and enablers of quality improvement initiatives. This systematic review sought to answer the question: What are the enablers of and barriers to quality improvement in primary health care in low- and middle-income countries? It adopted an integrative review approach with narrative evidence synthesis, which combined qualitative and mixed methods research studies systematically. Using a customized geographic search filter for LMICs developed by the Cochrane Collaboration, Scopus, Academic Search Ultimate, MEDLINE, CINAHL, PSYCHINFO, EMBASE, ProQuest Dissertations and Overton.io (a new database for LMIC literature) were searched in January and February 2023, as were selected websites and journals. 7,077 reports were retrieved. After removing duplicates, reviewers independently screened titles, abstracts and full texts, performed quality appraisal and data extraction, followed by analysis and synthesis. 50 reports from 47 studies were included, covering 52 LMIC settings. Six themes related to barriers and enablers of quality improvement were identified and organized using the model for understanding success in quality (MUSIQ) and the consolidated framework for implementation research (CFIR). These were: microsystem of quality improvement, intervention attributes, implementing organization and team, health systems support and capacity, external environment and structural factors, and execution. Decision makers, practitioners, funders, implementers, and other stakeholders can use the evidence from this systematic review to minimize barriers and amplify enablers to better the chances that quality improvement initiatives will be successful in resource-limited settings. PROSPERO registration: CRD42023395166.
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Affiliation(s)
- Camlus Otieno Odhus
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | | | - Elizabeth Oele
- County Department of Health, County Government of Kisumu, Kisumu, Kenya
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Okoroafor SC, Dela Christmals C. Health Professions Education Strategies for Enhancing Capacity for Task-Shifting and Task-Sharing Implementation in Africa: A Scoping Review. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023:00005141-990000000-00082. [PMID: 37341562 DOI: 10.1097/ceh.0000000000000517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
INTRODUCTION To compensate for the shortage of health workers and effectively use the available health workforce to provide access to health services at various levels of the health system, several countries are implementing task-shifting and task-sharing (TSTS). This scoping review was conducted to synthesize evidence on health professions education (HPE) strategies applied to enhance capacities for TSTS implementation in Africa. METHODS This scoping review was conducted using the enhanced Arksey and O'Malley's framework for scoping reviews. The sources of evidence included CINAHL, PubMed, and Scopus. RESULTS Thirty-eight studies conducted in 23 countries provided insights on the strategies implemented in various health services contexts including general health, cancer screenings, reproductive, maternal, newborn, child and adolescent health, HIV/AIDS, emergency care, hypertension, tuberculosis, eye care, diabetes, mental health, and medicines. The HPE strategies applied were in-service training, onsite clinical supervision and mentoring, periodic supportive supervision, provision of job aides, and preservice education. DISCUSSION Scaling up HPE based on the evidence from this study will contribute immensely to enhancing the capacity of health workers in contexts where TSTS are being implemented or planned to provide quality health services based on the population's health needs.
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Affiliation(s)
- Sunny C Okoroafor
- Dr. Okoroafor: Technical Officer, Health Systems Strengthening, Universal Health Coverage-Life Course Cluster, World Health Organization Country Office for Uganda, Kampala, Uganda. Dr. Dela Christmals: Associate Professor, Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom Campus, Potchefstroom, South Africa
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Alidina S, Sydlowski MM, Ahearn O, Andualem BG, Barash D, Bari S, Barringer E, Bekele A, Beyene AD, Burssa DG, Derbew M, Drown L, Gulilat D, Gultie TK, Hayirli TC, Meara JG, Staffa SJ, Workineh SE, Zanial N, Zeleke ZB, Mengistu AE, Ashengo TA. Implementing surgical mentorship in a resource-constrained context: a mixed methods assessment of the experiences of mentees, mentors, and leaders, and lessons learned. BMC MEDICAL EDUCATION 2022; 22:653. [PMID: 36045356 PMCID: PMC9434847 DOI: 10.1186/s12909-022-03691-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND A well-qualified workforce is critical to effective functioning of health systems and populations; however, skill gaps present a challenge in low-resource settings. While an emerging body of evidence suggests that mentorship can improve quality, access, and systems in African health settings by building the capacity of health providers, less is known about its implementation in surgery. We studied a novel surgical mentorship intervention as part of a safe surgery intervention (Safe Surgery 2020) in five rural Ethiopian facilities to understand factors affecting implementation of surgical mentorship in resource-constrained settings. METHODS We designed a convergent mixed-methods study to understand the experiences of mentees, mentors, hospital leaders, and external stakeholders with the mentorship intervention. Quantitative data was collected through a survey (n = 25) and qualitative data through in-depth interviews (n = 26) in 2018 to gather information on (1) intervention characteristics including areas of mentorship, mentee-mentor relationships, and mentor characteristics, (2) organizational context including facilitators and barriers to implementation, (3) perceived impact, and (4) respondent characteristics. We analyzed the quantitative and qualitative data using frequency analysis and the constant comparison method, respectively; we integrated findings to identify themes. RESULTS All mentees (100%) experienced the intervention as positive. Participants perceived impact as: safer and more frequent surgical procedures, collegial bonds between mentees and mentors, empowerment among mentees, and a culture of continuous learning. Over 70% of all mentees reported their confidence and job satisfaction increased. Supportive intervention characteristics included a systems focus, psychologically safe mentee-mentor relationships, and mentor characteristics including generosity with time and knowledge, understanding of local context, and interpersonal skills. Supportive organizational context included a receptive implementation climate. Intervention challenges included insufficient clinical training, inadequate mentor support, and inadequate dose. Organizational context challenges included resource constraints and a lack of common understanding of the intervention. CONCLUSION We offer lessons for intervention designers, policy makers, and practitioners about optimizing surgical mentorship interventions in resource-constrained settings. We attribute the intervention's success to its holistic approach, a receptive climate, and effective mentee-mentor relationships. These qualities, along with policy support and adapting the intervention through user feedback are important for successful implementation.
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Affiliation(s)
- Shehnaz Alidina
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA.
| | - Meaghan M Sydlowski
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
| | - Olivia Ahearn
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
| | - Bizuayehu G Andualem
- Amhara Regional Health Bureau, Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Sehrish Bari
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
| | | | - Abebe Bekele
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Andualem D Beyene
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Miliard Derbew
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Laura Drown
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
| | - Dereje Gulilat
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Tuna C Hayirli
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Steven J Staffa
- Department of Anesthesiology and Surgery, Boston Children's Hospital, Boston, MA, USA
| | | | - Noor Zanial
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
| | - Zebenay B Zeleke
- Amhara Regional Health Bureau, Federal Ministry of Health, Addis Ababa, Ethiopia
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Deussom R, Mwarey D, Bayu M, Abdullah SS, Marcus R. Systematic review of performance-enhancing health worker supervision approaches in low- and middle-income countries. HUMAN RESOURCES FOR HEALTH 2022; 20:2. [PMID: 34991604 PMCID: PMC8733429 DOI: 10.1186/s12960-021-00692-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/12/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The strength of a health system-and ultimately the health of a population-depends to a large degree on health worker performance. However, insufficient support to build, manage and optimize human resources for health (HRH) in low- and middle-income countries (LMICs) results in inadequate health workforce performance, perpetuating health inequities and low-quality health services. METHODS The USAID-funded Human Resources for Health in 2030 Program (HRH2030) conducted a systematic review of studies documenting supervision enhancements and approaches that improved health worker performance to highlight components associated with these interventions' effectiveness. Structured by a conceptual framework to classify the inputs, processes, and results, the review assessed 57 supervision studies since 2010 in approximately 29 LMICs. RESULTS Of the successful supervision approaches described in the 57 studies reviewed, 44 were externally funded pilots, which is a limitation. Thirty focused on community health worker (CHW) programs. Health worker supervision was informed by health system data for 38 approaches (67%) and 22 approaches used continuous quality improvement (QI) (39%). Many successful approaches integrated digital supervision technologies (e.g., SmartPhones, mHealth applications) to support existing data systems and complement other health system activities. Few studies were adapted, scaled, or sustained, limiting reports of cost-effectiveness or impact. CONCLUSION Building on results from the review, to increase health worker supervision effectiveness we recommend to: integrate evidence-based, QI tools and processes; integrate digital supervision data into supervision processes; increase use of health system information and performance data when planning supervision visits to prioritize lowest-performing areas; scale and replicate successful models across service delivery areas and geographies; expand and institutionalize supervision to reach, prepare, protect, and support frontline health workers, especially during health emergencies; transition and sustain supervision efforts with domestic human and financial resources, including communities, for holistic workforce support. In conclusion, effective health worker supervision is informed by health system data, uses continuous quality improvement (QI), and employs digital technologies integrated into other health system activities and existing data systems to enable a whole system approach. Effective supervision enhancements and innovations should be better integrated, scaled, and sustained within existing systems to improve access to quality health care.
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Affiliation(s)
- Rachel Deussom
- HRH2030 Program, Chemonics International, 1717 H Street NW, Washington, DC 20006 United States of America
| | - Doris Mwarey
- Human Resources for Health Consultant, Formerly With Chemonics International, PO Box 26432–00100, Nairobi, Kenya
| | - Mekdelawit Bayu
- HRH2030 Program, Chemonics International, 1717 H Street NW, Washington, DC 20006 United States of America
| | - Sarah S. Abdullah
- HRH2030 Program, Chemonics International, 1717 H Street NW, Washington, DC 20006 United States of America
| | - Rachel Marcus
- Office of Health Systems, Bureau for Global Health, United States Agency for International Development, 1300 Pennsylvania Avenue NW, Washington, DC 20004 United States of America
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Akuze J, Annerstedt KS, Benova L, Chipeta E, Dossou JP, Gross MM, Kidanto H, Marchal B, Alvesson HM, Pembe AB, van Damme W, Waiswa P, Hanson C. Action leveraging evidence to reduce perinatal mortality and morbidity (ALERT): study protocol for a stepped-wedge cluster-randomised trial in Benin, Malawi, Tanzania and Uganda. BMC Health Serv Res 2021; 21:1324. [PMID: 34895216 PMCID: PMC8665312 DOI: 10.1186/s12913-021-07155-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/11/2021] [Indexed: 01/01/2023] Open
Abstract
Background Insufficient reductions in maternal and neonatal deaths and stillbirths in the past decade are a deterrence to achieving the Sustainable Development Goal 3. The majority of deaths occur during the intrapartum and immediate postnatal period. Overcoming the knowledge-do-gap to ensure implementation of known evidence-based interventions during this period has the potential to avert at least 2.5 million deaths in mothers and their offspring annually. This paper describes a study protocol for implementing and evaluating a multi-faceted health care system intervention to strengthen the implementation of evidence-based interventions and responsive care during this crucial period. Methods This is a cluster randomised stepped-wedge trial with a nested realist process evaluation across 16 hospitals in Benin, Malawi, Tanzania and Uganda. The ALERT intervention will include four main components: i) end-user participation through narratives of women, families and midwifery providers to ensure co-design of the intervention; ii) competency-based training; iii) quality improvement supported by data from a clinical perinatal e-registry and iv) empowerment and leadership mentoring of maternity unit leaders complemented by district based bi-annual coordination and accountability meetings. The trial’s primary outcome is in-facility perinatal (stillbirths and early neonatal) mortality, in which we expect a 25% reduction. A perinatal e-registry will be implemented to monitor the trial. Our nested realist process evaluation will help to understand what works, for whom, and under which conditions. We will apply a gender lens to explore constraints to the provision of evidence-based care by health workers providing maternity services. An economic evaluation will assess the scalability and cost-effectiveness of ALERT intervention. Discussion There is evidence that each of the ALERT intervention components improves health providers’ practices and has modest to moderate effects. We aim to test if the innovative packaging, including addressing specific health systems constraints in these settings, will have a synergistic effect and produce more considerable perinatal mortality reductions. Trial registration Pan African Clinical Trial Registry (www.pactr.org): PACTR202006793783148. Registered on 17th June 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07155-z.
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Affiliation(s)
- Joseph Akuze
- Centre of Excellence for Maternal Newborn and Child Health, Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda.,Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Effie Chipeta
- College of Medicine, The Centre for Reproductive Health, University of Malawi, Blantyre, Malawi
| | - Jean-Paul Dossou
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Hussein Kidanto
- Aga Khan University, Medical College, Dar es Salaam, Tanzania
| | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Andrea B Pembe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Wim van Damme
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Peter Waiswa
- Centre of Excellence for Maternal Newborn and Child Health, Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden.,Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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Fiori KP, Lauria ME, Singer AW, Jones HE, Belli HM, Aylward PT, Agoro S, Gbeleou S, Sowu E, Grunitzky-Bekele M, Singham Goodwin A, Morrison M, Ekouevi DK, Hirschhorn LR. An Integrated Primary Care Initiative for Child Health in Northern Togo. Pediatrics 2021; 148:peds.2020-035493. [PMID: 34452981 DOI: 10.1542/peds.2020-035493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine if the Integrated Community-Based Health Systems-Strengthening (ICBHSS) initiative was effective in expanding health coverage, improving care quality, and reducing child mortality in Togo. METHODS Population-representative cross-sectional household surveys adapted from the Demographic Household Survey and Multiple Indicator Cluster Surveys were conducted at baseline (2015) and then annually (2016-2020) in 4 ICBHSS catchment sites in Kara, Togo. The primary outcome was under-5 mortality, with health service coverage and health-seeking behavior as secondary outcomes. Costing analyses were calculated by using "top-down" methodology with audited financial statements and programmatic data. RESULTS There were 10 022 household surveys completed from 2015 to 2020. At baseline (2015), under-5 mortality was 51.1 per 1000 live births (95% confidence interval [CI]: 35.5-66.8), and at the study end period (2020), under-5 mortality was 35.8 (95% CI: 23.4-48.2). From 2015 to 2020, home-based treatment by a community health worker increased from 24.1% (95% CI: 21.9%-26.4%) to 45.7% (95% CI: 43.3%-48.2%), and respondents reporting prenatal care in the first trimester likewise increased (37.5% to 50.1%). Among respondents who sought care for a child with fever, presenting for care within 1 day increased from 51.9% (95% CI: 47.1%-56.6%) in 2015 to 80.3% (95% CI: 74.6%-85.0%) in 2020. The estimated annual additional intervention cost was $8.84 per person. CONCLUSIONS Our findings suggest that the ICBHSS initiative, a bundle of evidence-based interventions implemented with a community-based strategy, improves care access and quality and was associated with reduction in child mortality.
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Affiliation(s)
- Kevin P Fiori
- Departments of Pediatrics .,Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York.,Community Health Systems Laboratory, Integrate Health/Santé Intégrée, New York, New York/Kara, Togo
| | - Molly E Lauria
- Community Health Systems Laboratory, Integrate Health/Santé Intégrée, New York, New York/Kara, Togo
| | - Amanda W Singer
- Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York.,Community Health Systems Laboratory, Integrate Health/Santé Intégrée, New York, New York/Kara, Togo
| | - Heidi E Jones
- City University of New York, Graduate School of Public Health & Health Policy, New York, New York
| | - Hayley M Belli
- Department of Population Health, School of Medicine, New York University, New York, New York
| | - Patrick T Aylward
- Community Health Systems Laboratory, Integrate Health/Santé Intégrée, New York, New York/Kara, Togo
| | - Sibabe Agoro
- Kara Regional Health Department, Ministry of Health and Public Hygiene, Kara, Togo
| | - Sesso Gbeleou
- Community Health Systems Laboratory, Integrate Health/Santé Intégrée, New York, New York/Kara, Togo
| | - Etonam Sowu
- Community Health Systems Laboratory, Integrate Health/Santé Intégrée, New York, New York/Kara, Togo
| | | | - Alicia Singham Goodwin
- Community Health Systems Laboratory, Integrate Health/Santé Intégrée, New York, New York/Kara, Togo.,Columbia Mailman School of Public Health, Columbia University, New York, New York
| | - Melissa Morrison
- School of Global Public Health, New York University, New York, New York
| | - Didier K Ekouevi
- Department of Public Health, Health Sciences Faculty, University of Lomé, Lomé, Togo.,African Research Center in Epidemiology and Public Health, Lomé, Togo
| | - Lisa R Hirschhorn
- Community Health Systems Laboratory, Integrate Health/Santé Intégrée, New York, New York/Kara, Togo.,Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Ngabonzima A, Kenyon C, Kpienbaareh D, Luginaah I, Mukunde G, Hategeka C, Cechetto DF. Developing and implementing a model of equitable distribution of mentorship in districts with spatial inequities and maldistribution of human resources for maternal and newborn care in Rwanda. BMC Health Serv Res 2021; 21:744. [PMID: 34315417 PMCID: PMC8314501 DOI: 10.1186/s12913-021-06764-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 07/12/2021] [Indexed: 12/02/2022] Open
Abstract
Background The shortage of health care providers (HCPs) and inequity in their distribution along with the lack of sufficient and equal professional development opportunities in low-income countries contribute to the high mortality and morbidity of women and newborns. Strengthening skills and building the capacity of all HCPs involved in Maternal and Newborn Health (MNH) is essential to ensuring that mothers and newborns receive the required care in the period around birth. The Training, Support, and Access Model (TSAM) project identified onsite mentorship at primary care Health Centers (HCs) as an approach that could help reduce mortality and morbidity through capacity building of HCPs in Rwanda. This paper presents the results and lessons learnt through the design and implementation of a mentorship model and highlights some implications for future research. Methods The design phase started with an assessment of the status of training in HCs to inform the selection of Hospital-Based Mentors (HBMs). These HBMs took different courses to become mentors. A clear process was established for engaging all stakeholders and to ensure ownership of the model. Then the HBMs conducted monthly visits to all 68 TSAM assigned HCs for 18 months and were extended later in 43 HCs of South. Upon completion of 6 visits, mentees were requested to assist their peers who are not participating in the mentoring programme through a process of peer mentoring to ensure sustainability after the project ends. Results The onsite mentorship in HCs by the HBMs led to equal training of HCPs across all HCs regardless of the location of the HC. Research on this mentorship showed that the training improved the knowledge and self-efficacy of HCPs in managing postpartum haemorrhage (PPH) and newborn resuscitation. The lessons learned include that well trained midwives can conduct successful mentorships at lower levels in the healthcare system. The key challenge was the inconsistency of mentees due to a shortage of HCPs at the HC level. Conclusions The initiation of onsite mentorship in HCs by HBMs with the support of the district health leaders resulted in consistent and equal mentoring at all HCs including those located in remote areas.
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Affiliation(s)
- Anaclet Ngabonzima
- Economic Community for Central African States (ECCAS), Libreville, Gabon.
| | - Cynthia Kenyon
- Neonatal - Perinatal Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Daniel Kpienbaareh
- Department of Geography and Environment, University of Western Ontario, Ontario, N6A 5C1, London, Canada
| | - Isaac Luginaah
- Department of Geography and Environment, University of Western Ontario, Ontario, N6A 5C1, London, Canada
| | - Gisele Mukunde
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, N6A 5C1, London, Ontario, Canada
| | - Celestin Hategeka
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, BC, Vancouver, Canada
| | - David F Cechetto
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, N6A 5C1, London, Ontario, Canada
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11
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Hossain I, Mugoya I, Muchai L, Krudwig K, Davis N, Shimp L, Richart V. Blended Learning Using Peer Mentoring and WhatsApp for Building Capacity of Health Workers for Strengthening Immunization Services in Kenya. GLOBAL HEALTH: SCIENCE AND PRACTICE 2021; 9:201-215. [PMID: 33795370 PMCID: PMC8087436 DOI: 10.9745/ghsp-d-20-00421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/12/2021] [Indexed: 11/18/2022]
Abstract
Innovative learning strategies are needed to improve frontline health workers' skills for achieving immunization coverage goals—now even more important with COVID-19. Peer mentoring and WhatsApp networking are low-cost and useful blended learning methods for need-based and individualized capacity building of health workers for improving immunization services that don't disrupt the health care workers' regular work. Evidence from available studies suggests that peer mentoring is a useful tool to build health workers' knowledge, skills, and practices. However, there is a dearth of research on use of this method of learning in immunization programs. Although WhatsApp has been used as a networking platform among health care professionals, there is limited research on its potential contribution to improving the immunization competencies of health workers. This study showed that peer mentoring and WhatsApp networking are useful blended learning methods for need-based and individualized capacity building of health workers providing immunization services. Future research to assess the comparative cost-benefit between classroom-based training and peer mentoring (along with WhatsApp networking) will be useful.
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Affiliation(s)
- Iqbal Hossain
- Immunization Center, JSI Research and Training Institute, Inc., Arlington, VA, USA.
| | - Isaac Mugoya
- JSI Research and Training Institute, Inc., Nairobi, Kenya
| | - Lilian Muchai
- JSI Research and Training Institute, Inc., Nairobi, Kenya
| | - Kirstin Krudwig
- Immunization Center, JSI Research and Training Institute, Inc., Arlington, VA, USA
| | - Nicole Davis
- Center for Health Information, Monitoring and Evaluation, JSI Research and Training Institute, Inc., Arlington, VA, USA
| | - Lora Shimp
- Immunization Center, JSI Research and Training Institute, Inc., Arlington, VA, USA
| | - Vanessa Richart
- Immunization Center, JSI Research and Training Institute, Inc., Arlington, VA, USA
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12
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Uwisanze S, Ngabonzima A, Bazirete O, Hategeka C, Kenyon C, Asingizwe D, Kanazayire C, Cechetto D. Mentors' perspectives on strengths and weaknesses of a novel clinical mentorship programme in Rwanda: a qualitative study. BMJ Open 2021; 11:e042523. [PMID: 33741662 PMCID: PMC7986684 DOI: 10.1136/bmjopen-2020-042523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To identify mentors' perspectives on strengths and weaknesses of the Training, Support and Access Model for Maternal, Newborn and Child Health (TSAM-MNCH) clinical mentorship programme in Rwandan district hospitals. Understanding the perspectives of mentors involved in this programme can aid in the improvement of its implementation. DESIGN The study used a qualitative approach with in-depth interviews. SETTING Mentors of TSAM-MNCH clinical mentorship programme mentoring health professionals at district hospitals of Rwanda. PARTICIPANTS 14 TSAM mentors who had at least completed six mentorship visits on a regular basis in three selected district hospitals. RESULTS Mentors' accounts demonstrated an appreciation of the two mentoring structures which are interprofessional collaboration and training. These structures are highlighted as the strengths of the mentoring programme and they play a significant role in the successful implementation of the mentorship model. Inconsistency of mentoring activities and lack of resources emerged as major weaknesses of the clinical mentorship programme which could hinder the effectiveness of the mentoring scheme. CONCLUSION The findings of this study highlight the strengths and weaknesses perceived by mentors of the TSAM-MNCH clinical mentorship programme, providing insights that can be used to improve its implementation. The study represents unique TSAM-MNCH structural settings, but its findings shed light on Rwandan health system issues that need to be further addressed to ensure better quality of care for mothers, newborns and children.
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Affiliation(s)
- Sandrine Uwisanze
- School of Social and Political Science, The University of Edinburgh, Edinburgh, UK
| | | | - Oliva Bazirete
- Midwifery Department, College of Medicine and Health Sciences- University of Rwanda, Kigali, Rwanda
| | - Celestin Hategeka
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Cynthia Kenyon
- Perinatal Medicine, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Domina Asingizwe
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | | | - David Cechetto
- Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
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13
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Ngabonzima A, Kenyon C, Hategeka C, Utuza AJ, Banguti PR, Luginaah I, F Cechetto D. Developing and implementing a novel mentorship model (4 + 1) for maternal, newborn and child health in Rwanda. BMC Health Serv Res 2020; 20:924. [PMID: 33028300 PMCID: PMC7542882 DOI: 10.1186/s12913-020-05789-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are a number of factors that may contribute to high mortality and morbidity of women and newborns in low-income countries. These include a shortage of competent health care providers (HCP) and a lack of sufficient continuous professional development (CPD) opportunities. Strengthening the skills and building the capacity of HCP involved in the provision of maternal, newborn and child health (MNCH) is essential to ensure quality care for mothers, newborns and children. To address this challenge in Rwanda, mentorship of HCPs was identified as an approach that could help build capacity, improve the provision of care and accelerate the reduction in maternal and neonatal mortality and morbidity. In this paper, we describe the development and implementation of a novel mentorship model named Four plus One (4+ 1) for MNCH in Rwanda. METHODS The mentorship model built on the basis of inter-professional collaboration (IPC) was developed in early 2017 through consultations with different key actors. The design phase included refresher courses in specific skills and training course on mentoring. Field visits were conducted in 10 hospitals from June 2017 to February 2020. Hospital management teams (MT) were involved in the development and implementation of this mentorship model to ensure ownership of the program. RESULTS Upon completion of planned visits to each hospital, a total of 218 HCPs were involved in the process. Reports prepared by mentors upon each mentorship visit and compiled by Training Support and Access Model (TSAM) for MNCH'CPD team, highlighted the mothers and newborns who were saved by both mentors and mentees. Also, different logbooks of mentees showed how the capacity of staff was strengthened, thereby suggesting effectiveness of the model. Through different mentorship coordination meetings, the model was much appreciated by the MTs of hospitals, especially the IPC component of the model and confirmed the program 'effectiveness. CONCLUSION The initiation of a mentorship model built on IPC together with the involvement of the leadership of the hospital may be the cause effect of reduction of specific mortality and improve MNCH in low resource settings even when there are a limited number of specialists in the health facilities.
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Affiliation(s)
- Anaclet Ngabonzima
- Economic Community of Central African States (ECCAS), Libreville, Gabon. .,Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, N6A 5C1, Canada.
| | - Cynthia Kenyon
- Neonatal - Perinatal Medicine, University of Western Ontario, 800 Commissioners Rd E, D4-200, London, Ontario, N6A 5W9, Canada
| | - Celestin Hategeka
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | | | - Paulin Ruhato Banguti
- College of Medicine and Health Sciences (CMHS), University of Rwanda, Kigali, Rwanda
| | - Isaac Luginaah
- Department of Geography, University of Western Ontario, London, Ontario, N6A 5C1, Canada
| | - David F Cechetto
- Department of Geography, University of Western Ontario, London, Ontario, N6A 5C1, Canada
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Umunyana J, Sayinzoga F, Ricca J, Favero R, Manariyo M, Kayinamura A, Tayebwa E, Khadka N, Molla Y, Kim YM. A practice improvement package at scale to improve management of birth asphyxia in Rwanda: a before-after mixed methods evaluation. BMC Pregnancy Childbirth 2020; 20:583. [PMID: 33023484 PMCID: PMC7539497 DOI: 10.1186/s12884-020-03181-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 08/14/2020] [Indexed: 11/12/2022] Open
Abstract
Background Helping Babies Breathe (HBB) is a competency-based educational method for an evidence-based protocol to manage birth asphyxia in low resource settings. HBB has been shown to improve health worker skills and neonatal outcomes, but studies have documented problems with skills retention and little evidence of effectiveness at large scale in routine practice. This study examined the effect of complementing provider training with clinical mentorship and quality improvement as outlined in the second edition HBB materials. This “system-oriented” approach was implemented in all public health facilities (n = 172) in ten districts in Rwanda from 2015 to 2018. Methods A before-after mixed methods study assessed changes in provider skills and neonatal outcomes related to birth asphyxia. Mentee knowledge and skills were assessed with HBB objective structured clinical exam (OSCE) B pre and post training and during mentorship visits up to 1 year afterward. The study team extracted health outcome data across the entirety of intervention districts and conducted interviews to gather perspectives of providers and managers on the approach. Results Nearly 40 % (n = 772) of health workers in maternity units directly received mentorship. Of the mentees who received two or more visits (n = 456), 60 % demonstrated competence (received > 80% score on OSCE B) on the first mentorship visit, and 100% by the sixth. In a subset of 220 health workers followed for an average of 5 months after demonstrating competence, 98% maintained or improved their score. Three of the tracked neonatal health outcomes improved across the ten districts and the fourth just missed statistical significance: neonatal admissions due to asphyxia (37% reduction); fresh stillbirths (27% reduction); neonatal deaths due to asphyxia (13% reduction); and death within 30 min of birth (19% reduction, p = 0.06). Health workers expressed satisfaction with the clinical mentorship approach, noting improvements in confidence, patient flow within the maternity, and data use for decision-making. Conclusions Framing management of birth asphyxia within a larger quality improvement approach appears to contribute to success at scale. Clinical mentorship emerged as a critical element. The specific effect of individual components of the approach on provider skills and health outcomes requires further investigation.
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Affiliation(s)
- Jacqueline Umunyana
- Maternal and Child Survival Program, KN 8 Avenue, Rwanda National Police (RNP) Road, Kigali, Rwanda
| | | | - Jim Ricca
- Maternal and Child Survival Program, 1776 Massachusetts Ave, NW, Suite 300, Washington, DC, 20036, USA.
| | - Rachel Favero
- Maternal and Child Survival Program, 1776 Massachusetts Ave, NW, Suite 300, Washington, DC, 20036, USA.
| | - Marcel Manariyo
- Maternal and Child Survival Program, KN 8 Avenue, Rwanda National Police (RNP) Road, Kigali, Rwanda
| | - Assumpta Kayinamura
- Maternal and Child Survival Program, KN 8 Avenue, Rwanda National Police (RNP) Road, Kigali, Rwanda
| | - Edwin Tayebwa
- Maternal and Child Survival Program, KN 8 Avenue, Rwanda National Police (RNP) Road, Kigali, Rwanda
| | - Neena Khadka
- Maternal and Child Survival Program, 1776 Massachusetts Ave, NW, Suite 300, Washington, DC, 20036, USA
| | - Yordanos Molla
- Maternal and Child Survival Program, 1776 Massachusetts Ave, NW, Suite 300, Washington, DC, 20036, USA
| | - Young-Mi Kim
- Jhpiego Corporation, 1615 Thames St., Baltimore, MD, USA
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15
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Hoover J, Koon AD, Rosser EN, Rao KD. Mentoring the working nurse: a scoping review. HUMAN RESOURCES FOR HEALTH 2020; 18:52. [PMID: 32727573 PMCID: PMC7388510 DOI: 10.1186/s12960-020-00491-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/09/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Mentoring programs for nurses already in the health workforce are growing in importance. Yet, the settings, goals, scale, and key features of these programs are not widely known. OBJECTIVE To identify and synthesize research on in-service nurse mentoring programs. METHODS We reviewed nurse mentoring research from six databases. Studies either referred explicitly to in-service nurse mentoring programs, were reviews of such programs, or concerned nurse training/education in which mentoring was an essential component. RESULTS We included 69 articles from 11 countries, published from 1995 to 2019. Most articles were from high-income countries (n = 46) and in rural areas (n = 22). Programs were developed to strengthen clinical care (particularly maternal and neonatal care), promote evidence-based practice, promote retention, support new graduate nurses, and develop nurse leaders. Of the articles with sufficient data, they typically described small programs implemented in one facility (n = 23), with up to ten mentors (n = 13), with less than 50 mentees (n = 25), meeting at least once a month (n = 27), and lasting at least a year (n = 24). While over half of the studies (n = 36) described programs focused almost exclusively on clinical skills acquisition, many (n = 33) specified non-clinical professional development activities. Reflective practice featured to a varying extent in many articles (n = 29). Very few (n = 6) explicitly identified the theoretical basis of their programs. CONCLUSIONS Although the literature about in-service nurse mentoring comes mostly from small programs in high-income countries, the largest nurse mentoring programs in the world are in low- and middle-income countries. Much can be learned from studying these programs in greater detail. Future research should analyze key features of programs to make models of mentoring more transparent and translatable. If carefully designed and flexibly implemented, in-service nurse mentoring represents an exciting avenue for enhancing the role of nurses and midwives in people-centered health system strengthening. The contents in this article are those of the authors and do not necessarily reflect the view of the U.S. President's Emergency Plan for AIDS Relief, the U.S. Agency for International Development or the U.S. Government.
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Affiliation(s)
- Jerilyn Hoover
- Credence Management Solutions, LLC, the Global Health Technical Professionals, USAID, 8609 Westwood Center Drive, Suite 300, Vienna, VA 22192 USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| | - Adam D. Koon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| | - Erica N. Rosser
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| | - Krishna D. Rao
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
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16
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Edward A, Jung Y, Chhorvann C, Ghee AE, Chege J. Can social accountability mechanisms using community scorecards improve quality of pediatric care in rural Cambodia? Int J Qual Health Care 2020; 32:364-372. [DOI: 10.1093/intqhc/mzaa052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 02/25/2020] [Accepted: 05/07/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
To determine the effect of social accountability strategies on pediatric quality of care.
Design and Setting
A non-randomized quasi experimental study was conducted in four districts in Cambodia and all operational public health facilities were included.
Participants
Five patients under 5 years and their caretakers were randomly selected in each facility.
Interventions
To determine the effect of maternal and child health interventions integrating citizen voice and action using community scorecards on quality of pediatric care.
Outcome Measures
Patient observations were conducted to determine quality of screening and counseling, followed by exit interviews with caretakers.
Results
Results indicated significant differences between intervention and comparison facilities; screening by Integrated Management of Childhood Illness (IMCI) trained providers (100% vs 67%, P < 0.019), screening for danger signs; ability to drink/breastfeed (100% vs 86.7%, P < 0.041), lethargy (86.7% vs 40%, P < 0.004) and convulsions (83.3 vs 46.7%, P < 0.023). Screening was significantly higher for patients in the intervention facilities for edema (56.7% vs 6.7%, P < 0.000), immunization card (90% vs 40%, P < 0.002), child weight (100 vs 86.7, P < 0.041) and checking growth chart (96.7% vs 66.7%, P < 0.035). The IMCI index, constructed from key performance indicators, was significantly higher for patients in the intervention facilities than comparison facilities (screening index 8.8 vs 7.0, P < 0.018, counseling index 2.7 vs 1.5, P < 0.001). Predictors of screening quality were child age, screening by IMCI trained provider, wealthier quintiles and intervention facilities.
Conclusion
The institution of social accountability mechanisms to engage communities and facility providers showed some improvements in quality of care for common pediatric conditions, but socioeconomic disparities were evident.
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Affiliation(s)
- Anbrasi Edward
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
| | - Younghee Jung
- Neglected Tropical Disease, WHO Timor-Leste Office United Nations House Caicoli street, Dili, Timor-Leste
| | - Chea Chhorvann
- National Institute of Public Health, N° 2, Sena Pramuk Kim Il Sung (St. 289), Phnom Penh, Cambodia
| | - Annette E Ghee
- Department of Global Health, University of Washington Harris Hydraulics Laboratory 1510 San Juan Rd NE, Seattle, WA 98195-7965 USA
| | - Jane Chege
- Monitoring & Evaluation, Ministry Strategy and Evidence, World Vision International, 34834 Weyerhaeuser Way S, Federal Way, Washington, DC 98001, USA
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Asibon A, Lufesi N, Choudhury A, Olvera S, Molyneux E, Oden M, Richards‐Kortum R, Kawaza K. Using a peer mentorship approach improved the use of neonatal continuous positive airway pressure and related outcomes in Malawi. Acta Paediatr 2020; 109:705-710. [PMID: 31535392 DOI: 10.1111/apa.15025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/09/2019] [Accepted: 09/16/2019] [Indexed: 11/27/2022]
Abstract
AIM This study evaluated whether peer mentorship was an effective and sustainable way of improving and maintaining knowledge and skills on neonatal continuous positive airway pressure (CPAP) in a low-resource setting with a high turnover of healthcare providers. METHODS The Malawi Ministry of Health recruited five nurses with considerable CPAP experience and provided them with mentorship training from July to August 2014. The mentors then provided 1-week on-site mentorship for 113 colleagues at 10 secondary and one tertiary hospital where gaps in neonatal CPAP use had been identified. CPAP competencies and outcomes were compared 3 months before and after each mentorship. RESULTS In the 3 months before and after mentorship, the average CPAP competency score increased from 32 ± 4% to 97 ± 2%, while CPAP usage increased from 7% to 23% among eligible neonates. Survival following CPAP mentorship increased from 23% to 35%, but this was not significant due to the small sample size. Both mentees and mentors reported useful transfers of knowledge and skills when using CPAP. CONCLUSION Mentorship effectively bridged the knowledge and skills gaps among health workers and increased CPAP use, competency scores and survival rates.
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Affiliation(s)
- Aba Asibon
- Rice 360 Institute for Global Health Houston Texas
| | | | | | | | - Elizabeth Molyneux
- Department of Pediatrics College of Medicine Queen Elizabeth Central Hospital Blantyre Malawi
| | - Maria Oden
- Rice 360 Institute for Global Health Houston Texas
- Department of Bioengineering Rice University Houston Texas
| | - Rebecca Richards‐Kortum
- Rice 360 Institute for Global Health Houston Texas
- Department of Bioengineering Rice University Houston Texas
| | - Kondwani Kawaza
- Department of Pediatrics College of Medicine Queen Elizabeth Central Hospital Blantyre Malawi
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18
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Schwarz D, Dhungana S, Kumar A, Acharya B, Agrawal P, Aryal A, Baum A, Choudhury N, Citrin D, Dangal B, Dhimal M, Gauchan B, Gupta T, Halliday S, Karmacharya B, Kishore S, Koirala B, Kshatriya U, Levine E, Maru S, Rimal P, Sapkota S, Schwarz R, Shrestha A, Thapa A, Maru D. An integrated intervention for chronic care management in rural Nepal: protocol of a type 2 hybrid effectiveness-implementation study. Trials 2020; 21:119. [PMID: 31996250 PMCID: PMC6990567 DOI: 10.1186/s13063-020-4063-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 01/09/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In Nepal, the burden of noncommunicable, chronic diseases is rapidly rising, and disproportionately affecting low and middle-income countries. Integrated interventions are essential in strengthening primary care systems and addressing the burden of multiple comorbidities. A growing body of literature supports the involvement of frontline providers, namely mid-level practitioners and community health workers, in chronic care management. Important operational questions remain, however, around the digital, training, and supervisory structures to support the implementation of effective, affordable, and equitable chronic care management programs. METHODS A 12-month, population-level, type 2 hybrid effectiveness-implementation study will be conducted in rural Nepal to evaluate an integrated noncommunicable disease care management intervention within Nepal's new municipal governance structure. The intervention will leverage the government's planned roll-out of the World Health Organization's Package of Essential Noncommunicable Disease Interventions (WHO-PEN) program in four municipalities in Nepal, with a study population of 80,000. The intervention will leverage both the WHO-PEN and its cardiovascular disease-specific technical guidelines (HEARTS), and will include three evidence-based components: noncommunicable disease care provision using mid-level practitioners and community health workers; digital clinical decision support tools to ensure delivery of evidence-based care; and training and digitally supported supervision of mid-level practitioners to provide motivational interviewing for modifiable risk factor optimization, with a focus on medication adherence, and tobacco and alcohol use. The study will evaluate effectiveness using a pre-post design with stepped implementation. The primary outcomes will be disease-specific, "at-goal" metrics of chronic care management; secondary outcomes will include alcohol and tobacco consumption levels. DISCUSSION This is the first population-level, hybrid effectiveness-implementation study of an integrated chronic care management intervention in Nepal. As low and middle-income countries plan for the Sustainable Development Goals and universal health coverage, the results of this pragmatic study will offer insights into policy and programmatic design for noncommunicable disease care management in the future. TRIAL REGISTRATION ClinicalTrials.gov, NCT04087369. Registered on 12 September 2019.
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Affiliation(s)
- Dan Schwarz
- Nyaya Health Nepal, Kathmandu, Nepal
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA USA
- Department of Medicine, Harvard Medical School, Boston, MA USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA USA
- Ariadne Labs, Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital, Boston, MA USA
| | - Santosh Dhungana
- Department of Internal Medicine, Hurley Medical Center, Flint, MI USA
| | - Anirudh Kumar
- Department of Medicine, NYU Langone Health, New York, NY USA
| | - Bibhav Acharya
- Nyaya Health Nepal, Kathmandu, Nepal
- Department of Psychiatry, University of California San Francisco, San Francisco, CA USA
| | | | - Anu Aryal
- Nyaya Health Nepal, Kathmandu, Nepal
- School of Medical Sciences, Kathmandu University, Dhulikhel, Nepal
| | - Aaron Baum
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Nandini Choudhury
- Nyaya Health Nepal, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - David Citrin
- Nyaya Health Nepal, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Global Health, University of Washington, Seattle, WA USA
- Department of Anthropology, University of Washington, Seattle, WA USA
- Henry M. Jackson School of International Studies, University of Washington, Seattle, WA USA
| | | | - Meghnath Dhimal
- Nepal Health Research Council, Ministry of Health and Population, Kathmandu, Nepal
| | | | - Tula Gupta
- Nyaya Health Nepal, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
| | - Scott Halliday
- Nyaya Health Nepal, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Global Health, University of Washington, Seattle, WA USA
| | - Biraj Karmacharya
- School of Medical Sciences, Kathmandu University, Dhulikhel, Nepal
- Nepal Technology Innovation Center, Kathmandu University, Dhulikhel, Nepal
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Sandeep Kishore
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Young Professionals Chronic Disease Network, New York, NY USA
| | - Bhagawan Koirala
- Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | | | - Erica Levine
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Sheela Maru
- Nyaya Health Nepal, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA USA
| | | | - Sabitri Sapkota
- Nyaya Health Nepal, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Ryan Schwarz
- Nyaya Health Nepal, Kathmandu, Nepal
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA USA
- Department of Medicine, Harvard Medical School, Boston, MA USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Archana Shrestha
- School of Medical Sciences, Kathmandu University, Dhulikhel, Nepal
- Yale School of Public Health, Center for Methods in Implementation and Prevention Science, New Haven, CT USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT USA
| | | | - Duncan Maru
- Nyaya Health Nepal, Kathmandu, Nepal
- Department of Psychiatry, University of California San Francisco, San Francisco, CA USA
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY USA
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19
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Assessment of Factors Affecting the Implementation of Integrated Management of Neonatal and Childhood Illness for Treatment of under Five Children by Health Professional in Health Care Facilities in Yifat Cluster in North Shewa Zone, Amhara Region, Ethiopia. Int J Pediatr 2020; 2019:9474612. [PMID: 31949443 PMCID: PMC6948312 DOI: 10.1155/2019/9474612] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/10/2019] [Accepted: 09/09/2019] [Indexed: 01/17/2023] Open
Abstract
Background Every year some 12 million children in developing countries die before they reach their fifth birthday. Seven in ten of these deaths are due to acute respiratory infections (mostly pneumonia), diarrhea, measles, malaria or malnutrition. The WHO Department of Child and Adolescent Health and Development (CAH), in collaboration with eleven other WHO programmes and UNICEF, has responded to this challenge by developing the Integrated Management of Childhood Illness (IMCI) strategy. Research that examines assessment of factors influencing the implementing the integrated management of neonatal and childhood illnesses (IMCI) strategy in Ethiopia is limited. Objective To assess factors influencing the implementation of the IMNCI strategy by health professionals in public health institutions of Yifat cluster in North Shewa zone, Ethiopia, 2018. Method An institutional based cross-sectional study will be conducted from March to May. A total of 201 health professionals will be selected using proportionally allocated to population size and interviewed using structured and pretested questionnaires. Data will be coded, entered and cleaned using SPSS version 20 for analysis. Univariate (frequency), Bivariate, Multiple logistic regression analysis will be employed. P-value and 95% confidence interval (CI) for OR will be used in judging the significance of the associations. P-value less than 0.05 will be taken as significant association. Results Data were obtained from 201 health care professionals, yielding a response rate of 100%. The overall IMNCI implementation was 58% as high level implementation and 42% as low level implementation. In multivariate analysis the implementation of IMNCI was higher among IMNCI trained health care professionals ([AOR = 2.7, 95% CI: (1.1.278, 4.562)]) and among those whose always referring chart booklet [AOR = 2.76, 95% CI: (1.753, 5.975)]. Conclusion IMNCI strategy can be better implemented through provision of training for the health workers. However, a variety of factor found to be a barrier to IMNCI implementation in a consistent way. Recommendations have been made related to provision of the training to the nurses and Health Care system strengthening among others.
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20
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Shikuku DN, Mukosa R, Peru T, Yaite A, Ambuchi J, Sisimwo K. Reducing intrapartum fetal deaths through low-dose high frequency clinical mentorship in a rural hospital in Western Kenya: a quasi-experimental study. BMC Pregnancy Childbirth 2019; 19:518. [PMID: 31870325 PMCID: PMC6929310 DOI: 10.1186/s12884-019-2673-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 12/12/2019] [Indexed: 01/10/2023] Open
Abstract
Background Intrapartum fetal mortality can be prevented by quality emergency obstetrics and newborn care (EmONC) during pregnancy and childbirth. This study evaluated the effectiveness of a low-dose high-frequency onsite clinical mentorship in EmONC on the overall reduction in intrapartum fetal deaths in a busy hospital providing midwife-led maternity services in rural Kenya. Methods A quasi-experimental (nonequivalent control group pretest – posttest) design in a midwife-led maternity care hospitals. Clinical mentorship and structured supportive supervision on EmONC signal functions was conducted during intervention. Maternity data at two similar time points: Oct 2015 to July 2016 (pre) and August 2016 to May 2017 (post) reviewed. Indicators of interest at Kirkpatrick’s levels 3 and 4 focusing on change in practice and health outcomes between the two time periods were evaluated and compared through a two-sample test of proportions. Proportions and p-values were reported to test the strength of the evidence after the intervention. Results Spontaneous vaginal delivery was the commonest route of delivery between the two periods in both hospitals. At the intervention hospital, assisted vaginal deliveries (vacuum extractions) increased 13 times (0.2 to 2.5%, P < 0.0001), proportion of babies born with low APGAR scores requiring newborn resuscitation doubled (1.7 to 3.7%, P = 0.0021), proportion of fresh stillbirths decreased 5 times (0.5 to 0.1%, P = 0.0491) and referred cases for comprehensive emergency obstetric care doubled (3.0 to 6.5%, P < 0.0001) with no changes observed in the control hospital. The proportion of live births reduced (98 to 97%, P = 0.0547) at the control hospital. Proportion of macerated stillbirths tripled at the control hospital (0.4 to 1.4%, P = 0.0039) with no change at the intervention hospital. Conclusion Targeted mentorship improves the competencies of nurse/midwives to identify, manage and/or refer pregnancy and childbirth cases and/or complications contributing to a reduction in intrapartum fetal deaths. Scale up of this training approach will improve maternal and newborn health outcomes.
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21
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Ngoga G, Park PH, Borg R, Bukhman G, Ali E, Munyaneza F, Tapela N, Rusingiza E, Edwards JK, Hedt-Gauthier B. Outcomes of decentralizing hypertension care from district hospitals to health centers in Rwanda, 2013-2014. Public Health Action 2019; 9:142-147. [PMID: 32042605 DOI: 10.5588/pha.19.0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 07/26/2019] [Indexed: 02/08/2023] Open
Abstract
Setting Three district hospitals (DHs) and seven health centers (HCs) in rural Rwanda. Objective To describe follow-up and treatment outcomes in stage 1 and 2 hypertension patients receiving care at HCs closer to home in comparison to patients receiving care at DHs further from home. Design A retrospective descriptive cohort study using routinely collected data involving adult patients aged ⩾18 years in care at chronic non-communicable disease clinics and receiving treatment for hypertension at DH and HC between 1 January 2013 and 30 June 2014. Results Of 162 patients included in the analysis, 36.4% were from HCs. Patients at DHs travelled significantly further to receive care (10.4 km vs. 2.9 km for HCs, P < 0.01). Odds of being retained were significantly lower among DH patients when not adjusting for distance (OR 0.11, P = 0.01). The retention effect was consistent but no longer significant when adjusting for distance (OR 0.18, P = 0.10). For those retained, there was no significant difference in achieving blood pressure targets between the DHs and HCs. Conclusion By removing the distance barrier, decentralizing hypertension management to HCs may improve long-term patient retention and could provide similar hypertension outcomes as DHs.
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Affiliation(s)
- G Ngoga
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - P H Park
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - R Borg
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - G Bukhman
- Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Partners In Health, Boston, MA, USA
| | - E Ali
- Médecins Sans Frontières, Operational Centre Brussels, Operational Research Unit (LuxOR), Luxembourg, Luxembourg
| | - F Munyaneza
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - N Tapela
- Department of Medicine, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.,Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - E Rusingiza
- Ministry of Health, Kigali, Rwanda.,School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - J K Edwards
- Médecins Sans Frontières, Operational Centre Brussels, Operational Research Unit (LuxOR), Luxembourg, Luxembourg.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - B Hedt-Gauthier
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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22
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Feyissa GT, Balabanova D, Woldie M. How Effective are Mentoring Programs for Improving Health Worker Competence and Institutional Performance in Africa? A Systematic Review of Quantitative Evidence. J Multidiscip Healthc 2019; 12:989-1005. [PMID: 31824166 PMCID: PMC6901118 DOI: 10.2147/jmdh.s228951] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/27/2019] [Indexed: 02/02/2023] Open
Abstract
Introduction Mentoring programs are frequently recommended as innovative and low-cost solutions, and these have been implemented in many healthcare institutions to tackle multiple human resource-related challenges. This review sought to locate, appraise and describe the literature reporting on mentorship programs that were designed to improve healthcare worker competence and institutional performance in Africa. Methods This review searched and synthesized reports from studies that assessed the effectiveness of mentorship programs among healthcare workers in Africa. We searched for studies reported in the English language in EMBASE, CINAHL, COCHRANE and MEDLINE. Additional search was conducted in Google Scholar. Results We included 30 papers reporting on 24 studies. Diverse approaches of mentorship were reported: a) placing a mentor in health facility for a period of time (embedded mentor), b) visits by a mobile mentor, c) a mentoring approach involving a team of mobile multidisciplinary mentors, d) facility twinning, and e) within-facility mentorship by a focal person or a manager. Implication for practice Mentoring interventions were effective in improving the clinical management of infectious diseases, maternal, neonatal and childhood illnesses. Mentoring interventions were also found to improve managerial performance (accounting, human resources, monitoring and evaluation, and transportation management) of health institutions. Additionally, mentoring had improved laboratory accreditation scores. Mentoring interventions may be used to increase adherence of health professionals to guidelines, standards, and protocols. While different types of interventions (embedded mentoring, visits by mobile mentors, facility twinning and within-facility mentorship by a focal person) were reported to be effective, there is no evidence to recommend one model of mentoring over other types of mentoring. Implications for research Further research—experimental methods measuring the impact of different mentoring formats and longitudinal studies establishing their long-term effectiveness—is required to compare the effectiveness and cost-effectiveness of different models of mentoring. Further studies are needed to explore why and how different mentoring programs succeed and the meaningfulness of mentoring programs for the different stakeholders are also required.
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Affiliation(s)
- Garumma Tolu Feyissa
- Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia.,Ethiopian Evidence Based Healthcare: JBI Center of Excellence, Jimma University, Jimma, Ethiopia
| | - Dina Balabanova
- Department of Health Policy and Management, London School of Hygiene and Tropical Medicine, London, UK
| | - Mirkuzie Woldie
- Ethiopian Evidence Based Healthcare: JBI Center of Excellence, Jimma University, Jimma, Ethiopia.,Department of Global Health and Population, T.H. Chan Harvard School of Public Health, Addis Ababa, Ethiopia
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23
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Towards improved health service quality in Tanzania: contribution of a supportive supervision approach to increased quality of primary healthcare. BMC Health Serv Res 2019; 19:848. [PMID: 31747932 PMCID: PMC6865029 DOI: 10.1186/s12913-019-4648-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 10/16/2019] [Indexed: 11/26/2022] Open
Abstract
Background Universal Health Coverage only leads to the desired health outcomes if quality of health services is ensured. In Tanzania, quality has been a major concern for many years, including the problem of ineffective and inadequate routine supportive supervision of healthcare providers by council health management teams. To address this, we developed and assessed an approach to improve quality of primary healthcare through enhanced routine supportive supervision. Methods Mixed methods were used, combining trends of quantitative quality of care measurements with qualitative data mainly collected through in-depth interviews. The former allowed for identification of drivers of quality improvements and the latter investigated the perceived contribution of the new supportive supervision approach to these improvements. Results The results showed that the new approach managed to address quality issues that could be solved either solely by the healthcare provider, or in collaboration with the council. The new approach was able to improve and maintain crucial primary healthcare quality standards across different health facility level and owner categories in various contexts. Conclusion Together with other findings reported in companion papers, we could show that the new supportive supervision approach not only served to assess quality of primary healthcare, but also to improve and maintain crucial primary healthcare quality standards. The new approach therefore presents a powerful tool to support, guide and drive quality improvement measures within council. It can thus be considered a suitable option to make routine supportive supervision more effective and adequate.
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24
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Nass SS, Isah MB, Sani A. Effect of Integrated Supportive Supervision on the Quality of Health-Care Service Delivery in Katsina State, Northwest Nigeria. Health Serv Res Manag Epidemiol 2019; 6:2333392819878619. [PMID: 31633000 PMCID: PMC6767721 DOI: 10.1177/2333392819878619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/05/2019] [Accepted: 09/05/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Katsina State Government in Northern Nigeria introduced integrated supportive
supervision (ISS) in primary health centers. The study was guided by the Primary Health
Care Performance Initiative Conceptual Framework. The goal of the study was to measure
the impact of ISS on the quality of primary health-care delivery. The outcome variables
measured include infrastructure, basic equipment, human resources for health, essential
drugs, the number of pregnant women screened for HIV, and the number of children
receiving immunization. Methods: The study was a cross-sectional survey of 34 health facilities. Kruskal-Wallis
nonparametric test followed by Dunn post hoc test and analysis of variance followed by
Tukey post hoc test were both employed to compare the mean values of various indicators
obtained over 6 visits of the ISS program from July 2018 to December 2018. Findings: The study shows the positive effect of the ISS on infrastructure, human resources for
health, essential drugs, and the number of pregnant women screened for HIV
(P < .05). Human resources for health and the number of children
receiving immunization were both not affected by ISS (P > .05). Conclusion: Integrated supportive supervision need to be embedded into the 3 levels (primary,
secondary, and tertiary) of health-care service delivery. Implications: Integrated supportive supervision will strengthen the Katsina State health system,
ensure efficient use of the health facility assets and resources utilization, and
improve patient/client satisfaction.
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Affiliation(s)
| | | | - Aminu Sani
- World Health Organization, North-West Zonal Office, Nigeria
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25
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Lauria ME, Fiori KP, Jones HE, Gbeleou S, Kenkou K, Agoro S, Agbèrè AD, Lue KD, Hirschhorn LR. Assessing the Integrated Community-Based Health Systems Strengthening initiative in northern Togo: a pragmatic effectiveness-implementation study protocol. Implement Sci 2019; 14:92. [PMID: 31619250 PMCID: PMC6796416 DOI: 10.1186/s13012-019-0921-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/01/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Over the past decade, prevalence of maternal and child morbidity and mortality in Togo, particularly in the northern regions, has remained high despite global progress. The causes of under-five child mortality in Togo are diseases with effective and low-cost prevention and/or treatment strategies, including malaria, acute lower respiratory infections, and diarrheal diseases. While Togo has a national strategy for implementing the integrated management of childhood illness (IMCI) guidelines, including a policy on integrated community case management (iCCM), challenges in implementation and low public sector health service utilization persist. There are critical gaps to access and quality of community health systems throughout the country. An integrated facility- and community-based initiative, the Integrated Community-Based Health Systems Strengthening (ICBHSS) initiative, seeks to address these gaps while strengthening the public sector health system in northern Togo. This study aims to evaluate the effect and implementation strategy of the ICBHSS initiative over 48 months in the catchment areas of 21 public sector health facilities. METHODS The ICBHSS model comprises a bundle of evidence-based interventions targeting children under five, women of reproductive age, and people living with HIV through (1) community engagement and feedback; (2) elimination of point-of-care costs; (3) proactive community-based IMCI using community health workers (CHWs) with additional services including family planning, HIV testing, and referrals; (4) clinical mentoring and enhanced supervision; and (5) improved supply chain management and facility structures. Using a pragmatic type II hybrid effectiveness-implementation study, we will evaluate the ICBHSS initiative with two primary aims: (1) determine effectiveness through changes in under-five mortality rates and (2) assess the implementation strategy through measures of reach, adoption, implementation, and maintenance. We will conduct a mixed-methods assessment using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. This assessment consists of four components: (1) a stepped-wedge cluster randomized control trial using a community-based household survey, (2) annual health facility assessments, (3) key informant interviews, and (4) costing and return-on-investment assessments for each randomized cluster. DISCUSSION Our research is expected to contribute to continuous quality improvement initiatives, optimize implementation factors, provide knowledge regarding health service delivery, and accelerate health systems improvements in Togo and more broadly. TRIAL REGISTRATION ClinicalTrials.gov , NCT03694366 , registered 3 October 2018.
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Affiliation(s)
- Molly E Lauria
- Community Health Systems Lab, Integrate Health/Santé Intégrée, Kara, Togo.
| | - Kevin P Fiori
- Community Health Systems Lab, Integrate Health/Santé Intégrée, Kara, Togo
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Heidi E Jones
- CUNY Graduate School of Public Health & Health Policy, New York, USA
| | | | | | - Sibabe Agoro
- Kara Regional Health Department, Ministry of Health and Public Hygiene, Kara, Togo
| | - Abdourahmane Diparidé Agbèrè
- Department of Pediatrics, Health Sciences Faculty, University of Lomé, Lomé, Togo
- Department of Pediatrics, Regional Hospital, Lomé-Commune, Lomé, Togo
| | - Kelly D Lue
- Community Health Systems Lab, Integrate Health/Santé Intégrée, Kara, Togo
| | - Lisa R Hirschhorn
- Community Health Systems Lab, Integrate Health/Santé Intégrée, Kara, Togo
- Northwestern University Feinberg School of Medicine, Chicago, USA
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Xiong X, Carter R, Lusamba-Dikassa PS, Kuburhanwa EC, Kimanuka F, Salumu F, Clarysse G, Tutu BK, Yuma S, Iyeti AM, Hernandez JH, Shaffer JG, Villeneuve S, Prual A, Pyne-Mercier L, Nigussie A, Buekens P. Improving the quality of maternal and newborn health outcomes through a clinical mentorship program in the Democratic Republic of the Congo: study protocol. Reprod Health 2019; 16:147. [PMID: 31601228 PMCID: PMC6785870 DOI: 10.1186/s12978-019-0796-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 08/26/2019] [Indexed: 11/10/2022] Open
Abstract
Background The Democratic Republic of the Congo (DRC) boasts one of the highest rates of institutional deliveries in sub-Saharan Africa (80%), with eight out of every ten births also assisted by a skilled provider. However, the maternal and neonatal mortality are still among the highest in the world, which demonstrates the poor in-facility quality of maternal and newborn care. The objective of this ongoing project is to design, implement, and evaluate a clinical mentorship program in 72 health facilities in two rural provinces of Kwango and Kwilu, DRC. Methods This is an ongoing quasi-experimental study. In the 72 facilities, 48 facilities were assigned to the group where the clinical mentorship program is being implemented (intervention group), and 24 facilities were assigned to the group where the clinical mentorship program is not being implemented (control group). The groups were selected and assigned based on administrative criteria, taking into account the number of deliveries in each facility, the coverage of health zones, accessibility, and ease of implementation of a clinical mentorship program. The main activities are organizing and training a national team of mentors (including senior midwives, obstetricians, and pediatricians) in clinical mentoring, deploying them to mentor all health providers (mentees) performing maternal and newborn health (MNH) services, and providing in-service training in routine and Emergency Obstetrical and Newborn Care (EmONC) to the mentees in health facilities over an 18-month period. Baseline and endline assessments are carried out to evaluate the effectiveness of the clinical mentorship program on the quality of MNH care and the effective coverage of key interventions to reduce maternal and neonatal mortality. Findings will be disseminated nationwide and internationally, as scientific evidence is scarce. A national strategy, guidelines, and tools for clinical mentorship in MNH will be developed for replication in other provinces, thus benefitting the entire country. Discussion This is the largest project on clinical mentorship aimed to improving the quality of MNH care in Africa. This program is expected to generate one of the first pieces of scientific evidence on the effectiveness of a clinical mentorship program in MNH on a scientifically designed and sustainable model.
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Affiliation(s)
- Xu Xiong
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Ste. 2000, New Orleans, LA, 70112, USA.
| | - Rebecca Carter
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Ste. 2000, New Orleans, LA, 70112, USA
| | - Paul-Samson Lusamba-Dikassa
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Ste. 2000, New Orleans, LA, 70112, USA.,Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Elvis C Kuburhanwa
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Ste. 2000, New Orleans, LA, 70112, USA.,Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Francine Kimanuka
- UNICEF, 372, avenue Colonel Mondjiba, Kinshasa-Ngaliema, Democratic Republic of the Congo
| | - Freddy Salumu
- UNICEF, 372, avenue Colonel Mondjiba, Kinshasa-Ngaliema, Democratic Republic of the Congo
| | - Guy Clarysse
- UNICEF, 372, avenue Colonel Mondjiba, Kinshasa-Ngaliema, Democratic Republic of the Congo
| | - Baudouin Kalume Tutu
- Ministère de la Santé, Secrétariat général, 36 Avenue de la Justice, Kinshasa - Gombe, Democratic Republic of the Congo
| | - Sylvain Yuma
- Ministère de la Santé, Secrétariat général, 36 Avenue de la Justice, Kinshasa - Gombe, Democratic Republic of the Congo
| | - Alain Mboko Iyeti
- Ministère de la Santé, Secrétariat général, 36 Avenue de la Justice, Kinshasa - Gombe, Democratic Republic of the Congo
| | - Julie H Hernandez
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Ste. 2000, New Orleans, LA, 70112, USA
| | - Jeffrey G Shaffer
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Ste. 2000, New Orleans, LA, 70112, USA
| | - Susie Villeneuve
- UNICEF Western & Central Africa Regional Office, PO Box 29720, Dakar-Yoff, Senegal
| | - Alain Prual
- UNICEF Western & Central Africa Regional Office, PO Box 29720, Dakar-Yoff, Senegal
| | | | - Assaye Nigussie
- Bill & Melinda Gates Foundation, PO Box 23350, Seattle, WA, USA
| | - Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Ste. 2000, New Orleans, LA, 70112, USA
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27
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Roder-DeWan S, Gupta N, Kagabo DM, Habumugisha L, Nahimana E, Mugeni C, Bucyana T, Hirschhorn LR. Four delays of child mortality in Rwanda: a mixed methods analysis of verbal social autopsies. BMJ Open 2019; 9:e027435. [PMID: 31133592 PMCID: PMC6549629 DOI: 10.1136/bmjopen-2018-027435] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We sought to understand healthcare-seeking patterns and delays in obtaining effective treatment for rural Rwandan children aged 1-5 years by analysing verbal and social autopsies (VSA). Factors in the home, related to transport and to quality of care in the formal health sector (FHS) were thought to contribute to delays. DESIGN We collected quantitative and qualitative cross-sectional data using the validated 2012 WHO VSA tool. Descriptive statistics were performed. We inductively and deductively coded narratives using the three delays model, conducted thematic content analysis and used convergent mixed methods to synthesise findings. SETTING The study took place in the catchment areas of two rural district hospitals in Rwanda-Kirehe and Southern Kayonza. Participants were caregivers of children aged 1-5 years who died in our study area between March 2013 and February 2014. RESULTS We analysed 77 VSAs. Although 74% of children (n=57) had contact with the FHS before dying, most (59%, n=45) died at home. Many caregivers (44%, n=34) considered using traditional medicine and 23 (33%) actually did. Qualitative themes reflected difficulty recognising the need for care, the importance of traditional medicine, especially for 'poisoning' and poor perceived quality of care. We identified an additional delay-phase IV-which occurred after leaving formal healthcare facilities. These delays were associated with caregiver dissatisfaction or inability to adhere to care plans. CONCLUSION Delays in deciding to seek care (phase I) and receiving quality care in FHS (phase III) dominated these narratives; delays in reaching a facility (phase II) were rarely discussed. An unwillingness or inability toadhere to treatment plans after leaving facilities (phase IV) were an important additional delay. Improving quality of care, especially provider capacity to communicate danger signs/treatment plans and promote adherence in the presence of alternative explanatory models informed by traditional medicine, could help prevent childhood deaths.
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Affiliation(s)
- Sanam Roder-DeWan
- Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Ifakara Health Institute, Dar es Salaam, Dar es Salaam, United Republic of Tanzania
| | - Neil Gupta
- Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | | | | | | | - Catherine Mugeni
- Maternal Child and Community Health Rwanda Biomédical Center, Rwanda Ministry of Health, Kigali, Rwanda
| | - Tatien Bucyana
- Maternal Child and Community Health Rwanda Biomédical Center, Rwanda Ministry of Health, Kigali, Rwanda
| | - Lisa R Hirschhorn
- Ariadne Labs, Boston, Massachusetts, USA
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Nyishime M, Borg R, Ingabire W, Hedt-Gauthier B, Nahimana E, Gupta N, Hansen A, Labrecque M, Nkikabahizi F, Mutaganzwa C, Biziyaremye F, Mukayiranga C, Mwamini F, Magge H. A retrospective study of neonatal case management and outcomes in rural Rwanda post implementation of a national neonatal care package for sick and small infants. BMC Pediatr 2018; 18:353. [PMID: 30419867 PMCID: PMC6233583 DOI: 10.1186/s12887-018-1334-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 10/31/2018] [Indexed: 11/23/2022] Open
Abstract
Background Despite worldwide efforts to reduce neonatal mortality, 44% of under-five deaths occur in the first 28 days of life. The primary causes of neonatal death are preventable or treatable. This study describes the presentation, management and outcomes of hospitalized newborns admitted to the neonatal units of two rural district hospitals in Rwanda after the 2012 launch of a national neonatal protocol and standards. Methods We retrospectively reviewed routinely collected data for all neonates (0 to 28 days) admitted to the neonatal units at Rwinkwavu and Kirehe District Hospitals from January 1, 2013 to December 31, 2014. Data on demographic and clinical characteristics, clinical management, and outcomes were analyzed using median and interquartile ranges for continuous data and frequencies and proportions for categorical data. Clinical management and outcome variables were stratified by birth weight and differences between low birth weight (LBW) and normal birth weight (NBW) neonates were assessed using Fisher’s exact or Wilcoxon rank-sum tests at the α = 0.05 significance level. Results A total of 1723 neonates were hospitalized over the two-year study period; 88.7% were admitted within the first 48 h of life, 58.4% were male, 53.8% had normal birth weight and 36.4% were born premature. Prematurity (27.8%), neonatal infection (23.6%) and asphyxia (20.2%) were the top three primary diagnoses. Per national protocol, vital signs were assessed every 3 h within the first 48 h for 82.6% of neonates (n = 965/1168) and 93.4% (n = 312/334) of neonates with infection received antibiotics. The overall mortality rate was 13.3% (n = 185/1386) and preterm/LBW infants had similar mortality rate to NBW infants (14.7 and 12.2% respectively, p = 0.131). The average length of stay in the neonatal unit was 5 days. Conclusions Our results suggest that it is possible to provide specialized neonatal care for both LBW and NBW high-risk neonates in resource-limited settings. Despite implementation challenges, with the introduction of the neonatal care package and defined clinical standards these most vulnerable patients showed survival rates comparable to or higher than neighboring countries.
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Affiliation(s)
- Merab Nyishime
- Partners In Health/Inshuti Mu Buzima (PIH/IMB), P.O. Box 3432, Kigali, Rwanda.
| | - Ryan Borg
- Partners In Health/Inshuti Mu Buzima (PIH/IMB), P.O. Box 3432, Kigali, Rwanda
| | - Willy Ingabire
- Partners In Health/Inshuti Mu Buzima (PIH/IMB), P.O. Box 3432, Kigali, Rwanda
| | - Bethany Hedt-Gauthier
- Partners In Health/Inshuti Mu Buzima (PIH/IMB), P.O. Box 3432, Kigali, Rwanda.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | - Evrard Nahimana
- Partners In Health/Inshuti Mu Buzima (PIH/IMB), P.O. Box 3432, Kigali, Rwanda
| | - Neil Gupta
- Partners In Health/Inshuti Mu Buzima (PIH/IMB), P.O. Box 3432, Kigali, Rwanda.,Brigham and Women's Hospital, Boston, USA
| | | | | | | | | | | | | | | | - Hema Magge
- Partners In Health/Inshuti Mu Buzima (PIH/IMB), P.O. Box 3432, Kigali, Rwanda.,Brigham and Women's Hospital, Boston, USA.,Boston Children's Hospital, Boston, USA.,Institute for Healthcare Improvement, Addis Ababa, Ethiopia
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Beck K, Mukantaganda A, Bayitondere S, Ndikuriyo R, Dushimirimana A, Bihibindi V, Nyiranganji S, Habiyaremye M, Werdenberg J. Experience: developing an inpatient malnutrition checklist for children 6 to 59 months to improve WHO protocol adherence and facilitate quality improvement in a low-resource setting. Glob Health Action 2018; 11:1503785. [PMID: 30092747 PMCID: PMC6097458 DOI: 10.1080/16549716.2018.1503785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In low-resource settings, inpatient case fatality for severe acute malnutrition (SAM) remains high despite evidenced-based protocols and resources to treat SAM. Key reasons include a combination of insufficiently trained staff, poor teamwork and inadequate compliance to WHO treatment guidelines which are proven to reduce mortality. Checklists have been used in surgery and obstetrics to ameliorate similarly complicated yet repetitive work processes and may be a key strategy to improving inpatient SAM protocol adherence and reducing unnecessary death. Here, we share our experience developing and piloting an inpatient malnutrition checklist (MLNC) for children 6 to 59 months and associated scoring system to coordinate care delivery, improve team documentation, strengthen WHO malnutrition protocol adherence and facilitate quality improvement in a district hospital in rural Rwanda. MLNC was developed after careful review of the 2009 Rwandan National Nutrition Protocol and 2013 WHO malnutrition guidelines. Critical steps were harmonized, extracted and designed into an initial MLNC with input from pediatric ward nurses, doctors, a locally based pediatrician and a registered dietitian. A scoring system was developed to facilitate quality improvement. Using the standard Plan-Do-Study-Act cycle, MLNC was modified and progress assessed on a monthly to bimonthly basis. Significant modifications occurred in the first 6 months of piloting including incorporation of treatment reminders and formatting improvements, as well as initiation of the MLNC from the emergency department. The MLNC is the first checklist to be developed that unifies WHO 10 steps of treatment of inpatient SAM with local standards. Anecdotally, MLNC was observed to identify gaps in key malnutrition care, promote protocol adherence and facilitate quality improvement. Data gathering on the MLNC local facility impact is underway. Collaborative international efforts are needed to create an inpatient malnutrition checklist for wider use to improve quality and reduce unnecessary, facility-based child mortality.
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Affiliation(s)
- Kathryn Beck
- a Maternal and Child Health Department , Partners In Health/Inshuti Mu Buzima , Rwinkwavu , Rwanda
| | - Angelique Mukantaganda
- b Department of Pediatrics , Rwinkwavu District Hospital, Ministry of Health Rwanda , Rwinkwavu , Rwanda
| | - Scheilla Bayitondere
- b Department of Pediatrics , Rwinkwavu District Hospital, Ministry of Health Rwanda , Rwinkwavu , Rwanda
| | - Richard Ndikuriyo
- b Department of Pediatrics , Rwinkwavu District Hospital, Ministry of Health Rwanda , Rwinkwavu , Rwanda
| | - Almaque Dushimirimana
- b Department of Pediatrics , Rwinkwavu District Hospital, Ministry of Health Rwanda , Rwinkwavu , Rwanda
| | - Vianney Bihibindi
- a Maternal and Child Health Department , Partners In Health/Inshuti Mu Buzima , Rwinkwavu , Rwanda
| | - Souzane Nyiranganji
- b Department of Pediatrics , Rwinkwavu District Hospital, Ministry of Health Rwanda , Rwinkwavu , Rwanda
| | - Michel Habiyaremye
- b Department of Pediatrics , Rwinkwavu District Hospital, Ministry of Health Rwanda , Rwinkwavu , Rwanda
| | - Jennifer Werdenberg
- a Maternal and Child Health Department , Partners In Health/Inshuti Mu Buzima , Rwinkwavu , Rwanda.,c Boston Children's Hospital , Global Pediatrics Program , Massachusetts , USA
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Ridge LJ, Klar RT, Stimpfel AW, Squires A. The meaning of "capacity building" for the nurse workforce in sub-Saharan Africa: An integrative review. Int J Nurs Stud 2018; 86:151-161. [PMID: 30029056 DOI: 10.1016/j.ijnurstu.2018.04.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 04/27/2018] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND "Capacity building" is an international development strategy which receives billions of dollars of investment annually and is utilized by major development agencies globally. However, there is a lack of consensus around what "capacity building", or even "capacity" itself, means. Nurses are the frequent target of capacity building programming in sub-Saharan Africa as they provide the majority of healthcare in that region. OBJECTIVES This study explored how "capacity" was conceptualized and operationalized by capacity building practitioners working in sub-Saharan Africa to develop its nursing workforce, and to assess Grindle and Hilderbrand's (1995) "Dimensions of Capacity" model was for fit with "capacity's" definition in the field. DESIGN An integrative review of the literature using systematic search criteria. DATA SOURCES SEARCHED INCLUDED PubMed, the Cumulative Index for Nursing and Allied Health Literature Plus, the Excerpt Medica Database, and Web of Science. REVIEW METHODS This review utilized conventional content analysis to assess how capacity building practitioners working in sub-Saharan Africa utilize the term "capacity" in the nursing context. Content analysis was conducted separately for how capacity building practitioners described "capacity" versus how their programs operationalized it. Identified themes were then assessed for fit with Grindle and Hilderbrand's (1995) "Dimensions of Capacity" model. RESULTS Analysis showed primary themes for conceptualization of capacity building of nurses by practitioners included: human resources for health, particularly pre- and post- nursing licensure training, and human (nursing) resource retention. Other themes included: management, health expenditure, and physical resources. There are several commonly used metrics for human resources for health, and a few for health expenditures, but none for management or physical resources. Overlapping themes of operationalization include: number of healthcare workers, post-licensure training, and physical resources. The Grindle and Hilderbrand (1995) model was a strong fit with how capacity is defined by practitioners working on nursing workforce issues in sub-Saharan Africa. CONCLUSIONS This review indicates there is significant informal consensus on the definition of "capacity" and that the Grindle and Hilderbrand (1995) framework is a good representation of that consensus. This framework could be utilized by capacity building practitioners and researchers as those groups plan, execute, and evaluate nursing capacity building programming.
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Affiliation(s)
- Laura Jean Ridge
- New York University, 433 First Avenue, New York, NY 10010, United States.
| | - Robin Toft Klar
- New York University, 433 First Avenue, New York, NY 10010, United States
| | | | - Allison Squires
- New York University, 433 First Avenue, New York, NY 10010, United States
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Hirschhorn LR, Krasne M, Maisonneuve J, Kara N, Kalita T, Henrich N, Rana D, Maji P, Delaney MM, Firestone R, Sharma N, Kumar V, Gawande AA, Semrau KE. Integration of the Opportunity-Ability-Motivation behavior change framework into a coaching-based WHO Safe Childbirth Checklist program in India. Int J Gynaecol Obstet 2018; 142:321-328. [PMID: 29862506 PMCID: PMC6099329 DOI: 10.1002/ijgo.12542] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/05/2018] [Accepted: 06/01/2018] [Indexed: 11/07/2022]
Abstract
Objective To evaluate whether integration of the Opportunity‐Ability‐Motivation plus Supplies (OAMS) framework into coaching improved the delivery of essential birth practices in a low‐resource setting. Methods This prospective mixed‐methods study used routine coaching visit data obtained from the first eight intervention facilities of the BetterBirth trial in Uttar Pradesh, India, between December 19, 2014, and October 21, 2015. The 8‐month intervention was peer coaching that integrated the OAMS framework to support uptake of the WHO Safe Childbirth Checklist. Descriptive statistics were used to measure nonadherence to essential birth practices. The frequency and accuracy of coaches’ coding of barriers and the appropriateness of chosen resolution strategies to measure feasibility, acceptability, and fidelity of using OAMS, were assessed. Results Coaches observed 666 deliveries, including 12 602 practices. Overall, essential practice nonadherence decreased from 15.6% (262/1675 practices observed) to 4.5% (4/88 practices) (P<0.001). Of the 1048 barriers identified, opportunity (556 [53.1%]) and motivation (287 [27.4%]) were the most frequently reported categories; the frequency of both decreased over time (P=0.003 and P<0.001, respectively). The coaches appropriately categorized 930 (99.8%) of 932 barriers and provided an appropriate strategy for 800 (85.8%). The commonest reason for unaddressed barriers was lack of coaching opportunities. Conclusion Successful integration of OAMS framework into delivery attendant coaching enabled coaches to rapidly diagnose barriers to practice adherence and develop responsive strategies. ClinicalTrials.gov NCT2148952 (WHO Universal Trial Number: U11111‐1315‐647). Using a modified behavior change framework, peer‐coaches were able to identify barriers to the provision of essential delivery practices and design problem‐solving interventions.
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Affiliation(s)
| | | | - Jenny Maisonneuve
- Ariadne LabsBrigham and Women's HospitalHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Nabihah Kara
- Ariadne LabsBrigham and Women's HospitalHarvard T.H. Chan School of Public HealthBostonMAUSA
| | | | - Natalie Henrich
- Ariadne LabsBrigham and Women's HospitalHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Darpan Rana
- Population Services InternationalLucknowIndia
| | - Pinki Maji
- Population Services InternationalLucknowIndia
| | - Megan M. Delaney
- Ariadne LabsBrigham and Women's HospitalHarvard T.H. Chan School of Public HealthBostonMAUSA
| | | | | | | | - Atul A. Gawande
- Ariadne LabsBrigham and Women's HospitalHarvard T.H. Chan School of Public HealthBostonMAUSA
- Department of SurgeryBrigham and Women's HospitalBostonMAUSA
- Department of Health Policy and ManagementHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Katherine E.A. Semrau
- Ariadne LabsBrigham and Women's HospitalHarvard T.H. Chan School of Public HealthBostonMAUSA
- Division of Global Health EquityBrigham and Women's HospitalBostonMAUSA
- Department of MedicineHarvard Medical SchoolBostonMAUSA
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Iyer HS, Chukwuma A, Mugunga JC, Manzi A, Ndayizigiye M, Anand S. A Comparison of Health Achievements in Rwanda and Burundi. Health Hum Rights 2018; 20:199-211. [PMID: 30008563 PMCID: PMC6039746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Strong primary health care systems are essential for implementing universal health coverage and fulfilling health rights entitlements, but disagreement exists over how best to create them. Comparing countries with similar histories, lifestyle practices, and geography but divergent health outcomes can yield insights into possible mechanisms for improvement. Rwanda and Burundi are two such countries. Both faced protracted periods of violence in the 1990s, leading to significant societal upheaval. In subsequent years, Rwanda's improvement in health has been far greater than Burundi's. To understand how this divergence occurred, we studied trends in life expectancy following the periods of instability in both countries, as well as the health policies implemented after these conflicts. We used the World Bank's World Development Indicators to assess trends in life expectancy in the two countries and then evaluated health policy reforms using Walt and Gilson's framework. Following both countries' implementation of health sector policies in 2005, we found a statistically significant increase in life expectancy in Rwanda after adjusting for GDP per capita (14.7 years, 95% CI: 11.4-18.0), relative to Burundi (4.6 years, 95% CI: 1.8-7.5). Strong public sector leadership, investments in health information systems, equity-driven policies, and the use of foreign aid to invest in local capacity helped Rwanda achieve greater health gains compared to Burundi.
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Affiliation(s)
- Hari S. Iyer
- Doctoral candidate in the Department of Epidemiology at the Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Adanna Chukwuma
- Young professional at the World Bank Group, Washington, DC, USA
| | - Jean Claude Mugunga
- Associate director of monitoring, evaluation, and quality at Partners In Health, Boston, MA, USA
| | - Anatole Manzi
- Director of clinical practice and quality improvement at Partners In Health, Boston, MA, USA
| | | | - Sudhir Anand
- Centennial professor at the London School of Economics, a professor of economics at the University of Oxford, UK, and an adjunct professor of Global Health at the Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Manzi A, Mugunga JC, Iyer HS, Magge H, Nkikabahizi F, Hirschhorn LR. Economic evaluation of a mentorship and enhanced supervision program to improve quality of integrated management of childhood illness care in rural Rwanda. PLoS One 2018; 13:e0194187. [PMID: 29547624 PMCID: PMC5856263 DOI: 10.1371/journal.pone.0194187] [Citation(s) in RCA: 4] [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: 08/20/2016] [Accepted: 02/19/2018] [Indexed: 11/21/2022] Open
Abstract
Background Integrated management of childhood illness (IMCI) can reduce under-5 morbidity and mortality in low-income settings. A program to strengthen IMCI practices through Mentorship and Enhanced Supervision at Health centers (MESH) was implemented in two rural districts in eastern Rwanda in 2010. Methods We estimated cost per improvement in quality of care as measured by the difference in correct diagnosis and correct treatment at baseline and 12 months of MESH. Costs of developing and implementing MESH were estimated in 2011 United States Dollars (USD) from the provider perspective using both top-down and bottom-up approaches, from programmatic financial records and site-level data. Improvement in quality of care attributed to MESH was measured through case management observations (n = 292 cases at baseline, 413 cases at 12 months), with outcomes from the intervention already published. Sensitivity analyses were conducted to assess uncertainty under different assumptions of quality of care and patient volume. Results The total annual cost of MESH was US$ 27,955.74 and the average cost added by MESH per IMCI patient was US$1.06. Salary and benefits accounted for the majority of total annual costs (US$22,400 /year). Improvements in quality of care after 12 months of MESH implementation cost US$2.95 per additional child correctly diagnosed and $5.30 per additional child correctly treated. Conclusions The incremental costs per additional child correctly diagnosed and child correctly treated suggest that MESH could be an affordable method for improving IMCI quality of care elsewhere in Rwanda and similar settings. Integrating MESH into existing supervision systems would further reduce costs, increasing potential for spread.
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Affiliation(s)
- Anatole Manzi
- University of Rwanda, College of Medicine and Health Sciences; Kigali, Rwanda
- Partners In Health; Kigali; Rwanda and Boston, United States of America
- * E-mail:
| | | | - Hari S. Iyer
- Partners In Health; Kigali; Rwanda and Boston, United States of America
- Division of Global Health Equity, Brigham and Women’s Hospital; Boston, United States of America
- Department of Epidemiology, Harvard T. H. Chan School of Public Health; Boston, United States of America
| | - Hema Magge
- Division of Global Health Equity, Brigham and Women’s Hospital; Boston, United States of America
- Division of General Pediatrics, Boston Children’s Hospital; Boston, United States of America
| | | | - Lisa R. Hirschhorn
- Partners In Health; Kigali; Rwanda and Boston, United States of America
- Division of Global Health Equity, Brigham and Women’s Hospital; Boston, United States of America
- Department of Global Health and Social Medicine, Harvard Medical School; Boston, United States of America
- Ariadne Labs, Boston, United States of America
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Manzi A, Nyirazinyoye L, Ntaganira J, Magge H, Bigirimana E, Mukanzabikeshimana L, Hirschhorn LR, Hedt-Gauthier B. Beyond coverage: improving the quality of antenatal care delivery through integrated mentorship and quality improvement at health centers in rural Rwanda. BMC Health Serv Res 2018; 18:136. [PMID: 29471830 PMCID: PMC5824606 DOI: 10.1186/s12913-018-2939-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 02/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inadequate antenatal care (ANC) can lead to missed diagnosis of danger signs or delayed referral to emergency obstetrical care, contributing to maternal mortality. In developing countries, ANC quality is often limited by skill and knowledge gaps of the health workforce. In 2011, the Mentorship, Enhanced Supervision for Healthcare and Quality Improvement (MESH-QI) program was implemented to strengthen providers' ANC performance at 21 rural health centers in Rwanda. We evaluated the effect of MESH-QI on the completeness of danger sign assessments. METHODS Completeness of danger sign assessments was measured by expert nurse mentors using standardized observation checklists. Checklists completed from October 2010 to May 2011 (n = 330) were used as baseline measurement and checklists completed between February and November 2012 (12-15 months after the start of MESH-QI implementation) were used for follow-up. We used a mixed-effects linear regression model to assess the effect of the MESH-QI intervention on the danger sign assessment score, controlling for potential confounders and the clustering of effect at the health center level. RESULTS Complete assessment of all danger signs improved from 2.1% at baseline to 84.2% after MESH-QI (p < 0.001). Similar improvements were found for 20 of 23 other essential ANC screening items. After controlling for potential confounders, the improvement in danger sign assessment score was significant. However, the effect of the MESH-QI was different by intervention district and type of observed ANC visit. In Southern Kayonza District, the increase in the danger sign assessment score was 6.28 (95% CI: 5.59, 6.98) for non-first ANC visits and 5.39 (95% CI: 4.62, 6.15) for first ANC visits. In Kirehe District, the increase in danger sign assessment score was 4.20 (95% CI: 3.59, 4.80) for non-first ANC visits and 3.30 (95% CI: 2.80, 3.81) for first ANC visits. CONCLUSION Assessment of critical danger signs improved under MESH-QI, even when controlling for nurse-mentees' education level and previous training in focused ANC. MESH-QI offers an approach to enhance quality of care after traditional training and may be an approach to support newer providers who have not yet attended content-focused courses.
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Affiliation(s)
- Anatole Manzi
- Partners In Health, Kigali, Rwanda. .,Partners In Health, Boston, USA. .,College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
| | | | - Joseph Ntaganira
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Hema Magge
- Division of General Pediatrics, Boston Children's Hospital, Boston, USA.,Institute for Healthcare Improvement, Addis Ababa, Ethiopia.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, USA
| | | | | | | | - Bethany Hedt-Gauthier
- Partners In Health, Kigali, Rwanda.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
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Schriver M, Cubaka VK, Itangishaka S, Nyirazinyoye L, Kallestrup P. Perceptions on evaluative and formative functions of external supervision of Rwandan primary healthcare facilities: A qualitative study. PLoS One 2018; 13:e0189844. [PMID: 29462144 PMCID: PMC5819767 DOI: 10.1371/journal.pone.0189844] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 12/01/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND External supervision of primary healthcare facilities in low- and middle-income countries often has a managerial main purpose in which the role of support for professional development is unclear. AIM To explore how Rwandan primary healthcare supervisors and providers (supervisees) perceive evaluative and formative functions of external supervision. DESIGN Qualitative, exploratory study. DATA Focus group discussions: three with supervisors, three with providers, and one mixed (n = 31). Findings were discussed with individual and groups of supervisors and providers. RESULTS Evaluative activities occupied providers' understanding of supervision, including checking, correcting, marking and performance-based financing. These were presented as sources of motivation, that in self-determination theory indicate introjected regulation. Supervisors preferred to highlight their role in formative supervision, which may mask their own and providers' uncontested accounts that systematic performance evaluations predominated supervisors' work. Providers strongly requested larger focus on formative and supportive functions, voiced as well by most supervisors. Impact of performance evaluation on motivation and professional development is discussed. CONCLUSION While external supervisors intended to support providers' professional development, our findings indicate serious problems with this in a context of frequent evaluations and performance marking. Separating the role of supporter and evaluator does not appear as the simple solution. If external supervision is to improve health care services, it is essential that supervisors and health centre managers are competent to support providers in a way that transparently accounts for various performance pressures. This includes delivery of proper formative supervision with useful feedback, maintaining an effective supervisory relationship, as well as ensuring providers are aware of the purpose and content of evaluative and formative supervision functions.
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Affiliation(s)
- Michael Schriver
- Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
- Aarhus University Hospital, Aarhus, Denmark
| | - Vincent Kalumire Cubaka
- Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Sylvere Itangishaka
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Laetitia Nyirazinyoye
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Per Kallestrup
- Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
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Kassie GM, Belay T, Sharma A, Feleke G. Promoting Local Ownership: Lessons Learned from Process of Transitioning Clinical Mentoring of HIV Care and Treatment in Ethiopia. Front Public Health 2018; 6:14. [PMID: 29459890 PMCID: PMC5807662 DOI: 10.3389/fpubh.2018.00014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 01/16/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction Focus on improving access and quality of HIV care and treatment gained acceptance in Ethiopia through the work of the International Training and Education Center for Health. The initiative deployed mobile field-based teams and capacity building teams to mentor health care providers on clinical services and program delivery in three regions, namely Tigray, Amhara, and Afar. Transitioning of the clinical mentoring program (CMP) began in 2012 through capacity building and transfer of skills and knowledge to local health care providers and management. Objective The initiative explored the process of transitioning a CMP on HIV care and treatment to local ownership and documented key lessons learned. Methods A mixed qualitative design was used employing focus group discussions, individual in-depth interviews, and review of secondary data. The participants included regional focal persons, mentors, mentees, multidisciplinary team members, and International Training and Education Center for Health (I-TECH) staff. Three facilities were selected in each region. Data were collected by trained research assistants using customized guides for interviews and with data extraction format. The interviews were recorded and fully transcribed. Open Code software was used for coding and categorizing the data. Results A total of 16 focus group discussions and 20 individual in-depth interviews were conducted. The critical processes for transitioning a project were: establishment of a mentoring transition task force, development of a roadmap to define steps and directions for implementing the transition, and signing of a memorandum of understanding (MOU) between the respective regional health bureaus and I-TECH Ethiopia to formalize the transition. The elements of implementation included mentorship and capacity building, joint mentoring, supportive supervision, review meetings, and independent mentoring supported by facility-based mechanisms: multidisciplinary team meetings, case-based discussions, and catchment area meetings. Conclusion The process of transitioning the CMP to local ownership involved signing an MOU, training of mentors, and building capacity of mentoring in each region. The experience shed light on how to transition donor-supported work to local country ownership, with key lessons related to strengthening the structures of regional health bureaus, and other facilities addressing critical issues and ensuring continuity of the facility-based activities.
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Affiliation(s)
| | | | - Anjali Sharma
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Manzi A, Hirschhorn LR, Sherr K, Chirwa C, Baynes C, Awoonor-Williams JK. Mentorship and coaching to support strengthening healthcare systems: lessons learned across the five Population Health Implementation and Training partnership projects in sub-Saharan Africa. BMC Health Serv Res 2017; 17:831. [PMID: 29297323 PMCID: PMC5763487 DOI: 10.1186/s12913-017-2656-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Despite global efforts to increase health workforce capacity through training and guidelines, challenges remain in bridging the gap between knowledge and quality clinical practice and addressing health system deficiencies preventing health workers from providing high quality care. In many developing countries, supervision activities focus on data collection, auditing and report completion rather than catalyzing learning and supporting system quality improvement. To address this gap, mentorship and coaching interventions were implemented in projects in five African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) as components of health systems strengthening (HSS) strategies funded through the Doris Duke Charitable Foundation’s African Health Initiative. We report on lessons learned from a cross-country evaluation. Methods The evaluation was designed based on a conceptual model derived from the project-specific interventions. Semi-structured interviews were administered to key informants to capture data in six categories: 1) mentorship and coaching goals, 2) selection and training of mentors and coaches, 3) integration with the existing systems, 4) monitoring and evaluation, 5) reported outcomes, and 6) challenges and successes. A review of project-published articles and technical reports from the individual projects supplemented interview information. Results Although there was heterogeneity in the approaches to mentorship and coaching and targeted areas of the country projects, all led to improvements in core health system areas, including quality of clinical care, data-driven decision making, leadership and accountability, and staff satisfaction. Adaptation of approaches to reflect local context encouraged their adoption and improved their effectiveness and sustainability. Conclusion We found that incorporating mentorship and coaching activities into HSS strategies was associated with improvements in quality of care and health systems, and mentorship and coaching represents an important component of HSS activities designed to improve not just coverage, but even further effective coverage, in achieving Universal Health Care.
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Affiliation(s)
- Anatole Manzi
- Partners In Health, Kigali, Rwanda. .,Partners In Health, 800 Boylston Street, Suite 300, Boston, MA, 02199, USA. .,College of Medicine and Health Sciences, School of Public Health, University of Rwanda, Kigali, Rwanda.
| | - Lisa R Hirschhorn
- Partners In Health, Kigali, Rwanda.,Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA, USA.,Health Alliance International, Beira, Mozambique
| | - Cindy Chirwa
- Primary Care and Health Systems Department, Center for Infectious Disease Research, Lusaka, Zambia
| | - Colin Baynes
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA.,Ifakara Health Institute, Dar es Salaam, Tanzania
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Ndayisaba A, Harerimana E, Borg R, Miller AC, Kirk CM, Hann K, Hirschhorn LR, Manzi A, Ngoga G, Dusabeyezu S, Mutumbira C, Mpunga T, Ngamije P, Nkikabahizi F, Mubiligi J, Niyonsenga SP, Bavuma C, Park PH. A Clinical Mentorship and Quality Improvement Program to Support Health Center Nurses Manage Type 2 Diabetes in Rural Rwanda. J Diabetes Res 2017; 2017:2657820. [PMID: 29362719 PMCID: PMC5738565 DOI: 10.1155/2017/2657820] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/08/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The prevalence of diabetes mellitus is rapidly rising in SSA. Interventions are needed to support the decentralization of services to improve and expand access to care. We describe a clinical mentorship and quality improvement program that connected nurse mentors with nurse mentees to support the decentralization of type 2 diabetes care in rural Rwanda. METHODS This is a descriptive study. Routinely collected data from patients with type 2 diabetes cared for at rural health center NCD clinics between January 1, 2013 and December 31, 2015, were extracted from EMR system. Data collected as part of the clinical mentorship program were extracted from an electronic database. Summary statistics are reported. RESULTS The patient population reflects the rural settings, with low rates of traditional NCD risk factors: 5.6% of patients were current smokers, 11.0% were current consumers of alcohol, and 11.9% were obese. Of 263 observed nurse mentee-patient encounters, mentor and mentee agreed on diagnosis 94.4% of the time. Similarly, agreement levels were high for medication, laboratory exam, and follow-up plans, at 86.3%, 87.1%, and 92.4%, respectively. CONCLUSION Nurses that receive mentorship can adhere to a type 2 diabetes treatment protocol in rural Rwanda primary health care settings.
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Affiliation(s)
| | | | - Ryan Borg
- Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | | | | | | | | | - Gedeon Ngoga
- Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | | | | | | | | | - Joel Mubiligi
- Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | - Charlotte Bavuma
- Ministry of Health, Kigali, Rwanda
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Paul H. Park
- Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda
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Forte ECN, Pires DEPD, Trigo SVVP, Martins MMFPDS. A HERMENÊUTICA E O SOFTWARE ATLAS.TI: UNIÃO PROMISSORA. TEXTO & CONTEXTO ENFERMAGEM 2017. [DOI: 10.1590/0104-07072017000350017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: descrever uma possibilidade de associação da análise hermenêutica, com base em Jürgen Habermas e Paul Ricoeur, com as principais funcionalidades do software Atlas.ti. Método: reflexão teórico-metodológica que tem como objetivo descrever uma possibilidade de associação da análise hermenêutica, com base em Jürgen Habermas e Paul Ricoeur, com as principais funcionalidades do software Atlas.ti. Resultados: o software se constitui numa importante ferramenta que facilita o armazenamento e análise dos dados, contribuindo com o desafio de prover qualidade e credibilidade em estudos qualitativos. O uso do software mostrou-se adequado para utilização em abordagens como a hermenêutica, economizando tempo e facilitando a organização e análise dos dados. Conclusão: o Atlas.ti tem um potencial significativo quando da sua utilização com abordagens compreensivas, como a hermenêutica, e os cuidados a serem considerados são os mesmos referentes a outras abordagens qualitativas.
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Sueiras P, Romano-Betech V, Vergil-Salgado A, de Hoyos A, Quintana-Vargas S, Ruddick W, Castro-Santana A, Islas-Andrade S, Altamirano-Bustamante NF, Altamirano-Bustamante MM. Today´s medical self and the other: Challenges and evolving solutions for enhanced humanization and quality of care. PLoS One 2017; 12:e0181514. [PMID: 28759585 PMCID: PMC5536364 DOI: 10.1371/journal.pone.0181514] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 07/03/2017] [Indexed: 11/18/2022] Open
Abstract
Background Recent scientific developments, along with growing awareness of cultural and social diversity, have led to a continuously growing range of available treatment options; however, such developments occasionally lead to an undesirable imbalance between science, technology and humanism in clinical practice. This study explores the understanding and practice of values and value clusters in real-life clinical settings, as well as their role in the humanization of medicine and its institutions. The research focuses on the values of clinical practice as a means of finding ways to enhance the pairing of Evidence-Based Medicine (EBM) with Values-based Medicine (VBM) in daily practice. Methods and findings The views and representations of clinical practice in 15 pre-CME and 15 post-CME interviews were obtained from a random sampling of active healthcare professionals. These views were then identified and qualitatively analyzed using a three-step hermeneutical approach. A clinical values space was identified in which ethical and epistemic values emerge, grow and develop within the biomedical, ethical, and socio-economic dimensions of everyday health care. Three main values—as well as the dynamic clusters and networks that they tend to form—were recognized: healthcare personnel-patient relationships, empathy, and respect. An examination of the interviews suggested that an adequate conceptualization of values leads to the formation of a wider axiological system. The role of clinician-as-consociate emerged as an ideal for achieving medical excellence. Conclusions By showing the intricate clusters and networks into which values are interwoven, our analysis suggests methods for fine-tuning educational interventions so they can lead to demonstrable changes in attitudes and practices.
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Affiliation(s)
- Perla Sueiras
- Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, Mexico
| | - Victoria Romano-Betech
- Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, Mexico
| | - Alejandro Vergil-Salgado
- Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, Mexico
| | - Adalberto de Hoyos
- CIECAS, Instituto Politécnico Nacional, Lauro Aguirre 120, Agricultura, Miguel Hidalgo, Ciudad de México, México
| | - Silvia Quintana-Vargas
- Instituto de Salud Pública del Estado de Guanajuato, Tamazuca 4, Centro, Guanajuato, México
| | - William Ruddick
- Center for Bioethics, New York University, New York, NY, United States of America
| | - Anaclara Castro-Santana
- National Research Council for Science and Technology (CONACYT), Ciudad de México, México
- Instituto Nacional de Pediatría, Secretaría de Salud, Insurgentes Sur 3700, Insurgentes Cuicuilco, Ciudad de México, México
| | - Sergio Islas-Andrade
- Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, Mexico
- Unidad de Investigación de Enfermedades Metabólicas, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, México
| | - Nelly F. Altamirano-Bustamante
- Instituto Nacional de Pediatría, Secretaría de Salud, Insurgentes Sur 3700, Insurgentes Cuicuilco, Ciudad de México, México
- * E-mail: (NFAB); (MMAB)
| | - Myriam M. Altamirano-Bustamante
- Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, Mexico
- Unidad de Investigación de Enfermedades Metabólicas, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, México
- * E-mail: (NFAB); (MMAB)
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Abstract
Skills strengthening and capacity building for maternal and newborn health (MNH) providers are essential to ensure quality care for mothers and newborns. There is, however, limited research regarding what constitutes an effective model in low-income countries. The Lao People’s Democratic Republic (Laos) has some of the region’s worst outcomes for neonatal and maternal mortality. Moreover, with a 23-year hiatus in midwifery training, which ended approximately 7 years ago, there is a cadre of new and inexperienced midwives in practice without support systems, skills, or continuing professional development opportunities. Traditional didactic teaching methodologies prevail in Laos, but with little evidence of efficacy. As an alternative model, Save the Children International has been implementing a mentorship approach for MNH providers in two provinces in northern Laos since January 2016, with technical guidance and funding from the United States Agency for International Development-supported global Maternal Child Survival Program. This community case study will describe and reflect on the approach by highlighting the need and rationale for mentorship, followed by a description of the program’s core components and the results observed so far. Lessons learned and the application of the approach to different contexts and health-care professionals, considering both constraints and opportunities, will be discussed.
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Affiliation(s)
- Helen Nita Catton
- Primary Health Care Program, Save the Children International, Luang Prabang, Laos
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Maternal predictors of neonatal outcomes after emergency cesarean section: a retrospective study in three rural district hospitals in Rwanda. Matern Health Neonatol Perinatol 2017. [PMID: 28630744 PMCID: PMC5468976 DOI: 10.1186/s40748-017-0050-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background In sub-Saharan Africa, neonatal mortality post-cesarean delivery is higher than the global average. In this region, most emergency cesarean sections are performed at district hospitals. This study assesses maternal predictors for poor neonatal outcomes post-emergency cesarean delivery in three rural district hospitals in Rwanda. Methods This retrospective study includes a random sample of 441 neonates from Butaro, Kirehe and Rwinkwavu District Hospitals, born between 01 January and 31 December 2015. We described the demographic and clinical characteristics of the mothers of these neonates using frequencies and proportions. We assessed the association between maternal characteristics with poor neonatal outcomes, defined as death within 24 h or APGAR < 7 at 5 min after birth, using Fisher’s exact test. Factors significant at α = 0.20 significance level were considered for the multivariate logistic regression model, built using a backwards stepwise process. We stopped when all the factors were significant at the α = 0.05 level. Results For all 441 neonates included in this study, 40 (9.0%) had poor outcomes. In the final model, three factors were significantly associated with poor neonatal outcomes. Neonates born to mothers who had four or more prior pregnancies were more likely to have poor outcomes (OR = 3.01, 95%CI:1.23,7.35, p = 0.015). Neonates whose mothers came from health centers with ambulance travel times of more than 30 min to the district hospital had greater odds of having poor outcomes (for 30–60 min: OR = 3.80, 95%CI:1.07,13.40, p = 0.012; for 60+ minutes: OR = 5.82, 95%CI:1.47,23.05, p = 0.012). Neonates whose mothers presented with very severe indications for cesarean section had twice odds of having a poor outcome (95% CI: 1.11,4.52, p = 0.023). Conclusions Longer travel time to the district hospital was a leading predictor of poor neonatal outcomes post cesarean delivery. Improving referral systems, ambulance availability, number of equipped hospitals per district, and road networks may lessen travel delays for women in labor. Boosting the diagnostic capacity of labor conditions at the health center level through facilities and staff training can improve early identification of very severe indications for cesarean delivery for early referral and intervention.
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Niles P, Ojemeni MT, Kaplogwe NA, Voeten SMJ, Stafford R, Kibwana M, Deng L, Theonestina S, Budin W, Chhun N, Squires A. Mentoring to build midwifery and nursing capacity in the Africa region: An integrative review. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2017. [DOI: 10.1016/j.ijans.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Mboya D, Mshana C, Kessy F, Alba S, Lengeler C, Renggli S, Vander Plaetse B, Mohamed MA, Schulze A. Embedding systematic quality assessments in supportive supervision at primary healthcare level: application of an electronic Tool to Improve Quality of Healthcare in Tanzania. BMC Health Serv Res 2016; 16:578. [PMID: 27737679 PMCID: PMC5064905 DOI: 10.1186/s12913-016-1809-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 09/30/2016] [Indexed: 12/03/2022] Open
Abstract
Background Assessing quality of health services, for example through supportive supervision, is essential for strengthening healthcare delivery. Most systematic health facility assessment mechanisms, however, are not suitable for routine supervision. The objective of this study is to describe a quality assessment methodology using an electronic format that can be embedded in supervision activities and conducted by council health staff. Methods An electronic Tool to Improve Quality of Healthcare (e-TIQH) was developed to assess the quality of primary healthcare provision. The e-TIQH contains six sub-tools, each covering one quality dimension: infrastructure and equipment of the facility, its management and administration, job expectations, clinical skills of the staff, staff motivation and client satisfaction. As part of supportive supervision, council health staff conduct quality assessments in all primary healthcare facilities in a given council, including observation of clinical consultations and exit interviews with clients. Using a hand-held device, assessors enter data and view results in real time through automated data analysis, permitting immediate feedback to health workers. Based on the results, quality gaps and potential measures to address them are jointly discussed and actions plans developed. Results For illustrative purposes, preliminary findings from e-TIQH application are presented from eight councils of Tanzania for the period 2011–2013, with a quality score <75 % classed as ‘unsatisfactory’. Staff motivation (<50 % in all councils) and job expectations (≤50 %) scored lowest of all quality dimensions at baseline. Clinical practice was unsatisfactory in six councils, with more mixed results for availability of infrastructure and equipment, and for administration and management. In contrast, client satisfaction scored surprisingly high. Over time, each council showed a significant overall increase of 3–7 % in mean score, with the most pronounced improvements in staff motivation and job expectations. Conclusions Given its comprehensiveness, convenient handling and automated statistical reports, e-TIQH enables council health staff to conduct systematic quality assessments. Therefore e-TIQH may not only contribute to objectively identifying quality gaps, but also to more evidence-based supervision. E-TIQH also provides important information for resource planning. Institutional and financial challenges for implementing e-TIQH on a broader scale need to be addressed. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1809-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dominick Mboya
- Ifakara Health Institute, Dar es Salaam/Ifakara, United Republic of Tanzania
| | - Christopher Mshana
- Ifakara Health Institute, Dar es Salaam/Ifakara, United Republic of Tanzania
| | - Flora Kessy
- Ifakara Health Institute, Dar es Salaam/Ifakara, United Republic of Tanzania
| | - Sandra Alba
- KIT Biomedical Research, Royal Tropical Institute, Meibergdreef 39, 1105 AZ, Amsterdam, The Netherlands
| | - Christian Lengeler
- Swiss Tropical and Public Health Institute, Socinstr. 57, P.O. Box, 4002, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Sabine Renggli
- Swiss Tropical and Public Health Institute, Socinstr. 57, P.O. Box, 4002, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Bart Vander Plaetse
- Novartis Foundation, Novartis Campus, Forum 1-3.92, 4002, Basel, Switzerland
| | - Mohamed A Mohamed
- Ministry of Health, Community Development, Gender, Elderly and Children, Samora Avenue, Dar es Salaam, United Republic of Tanzania
| | - Alexander Schulze
- Novartis Foundation, Novartis Campus, Forum 1-3.92, 4002, Basel, Switzerland. .,Swiss Agency for Development and Cooperation, Freiburgstr. 130, 3003, Berne, Switzerland.
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Jaribu J, Penfold S, Manzi F, Schellenberg J, Pfeiffer C. Improving institutional childbirth services in rural Southern Tanzania: a qualitative study of healthcare workers' perspective. BMJ Open 2016; 6:e010317. [PMID: 27660313 PMCID: PMC5051329 DOI: 10.1136/bmjopen-2015-010317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe health workers' perceptions of a quality improvement (QI) intervention that focused on improving institutional childbirth services in primary health facilities in Southern Tanzania. DESIGN A qualitative design was applied using in-depth interviews with health workers. SETTING This study involved the Ruangwa District Reproductive and Child Health Department, 11 dispensaries and 2 health centres in rural Southern Tanzania. PARTICIPANTS 4 clinical officers, 5 nurses and 6 medical attendants from different health facilities were interviewed. RESULTS The healthcare providers reported that the QI intervention improved their skills, capacity and confidence in providing counselling and use of a partograph during labour. The face-to-face QI workshops, used as a platform to refresh their knowledge on maternal and newborn health and QI methods, facilitated peer learning, networking and standardisation of care provision. The onsite follow-up visits were favoured by healthcare providers because they gave the opportunity to get immediate help, learn how to perform tasks in practice and be reminded of what they had learnt. Implementation of parallel interventions focusing on similar indicators was mentioned as a challenge that led to duplication of work in terms of data collection and reporting. District supervisors involved in the intervention showed interest in taking over the implementation; however, funding remained a major obstacle. CONCLUSIONS Healthcare workers highlighted the usefulness of applying a QI approach to improve maternal and newborn health in rural settings. QI programmes need careful coordination at district level in order to reduce duplication of work.
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Affiliation(s)
- Jennie Jaribu
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Basel University, Basel, Switzerland
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | | | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | | | - Constanze Pfeiffer
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Basel University, Basel, Switzerland
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Successes and Challenges of HIV Mentoring in Malawi: The Mentee Perspective. PLoS One 2016; 11:e0158258. [PMID: 27352297 PMCID: PMC4924818 DOI: 10.1371/journal.pone.0158258] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 06/13/2016] [Indexed: 11/29/2022] Open
Abstract
HIV clinical mentoring has been utilized for capacity building in Africa, but few formal program evaluations have explored mentee perspectives on these programs. EQUIP is a PEPFAR-USAID funded program in Malawi that has been providing HIV mentoring on clinical and health systems since 2010. We sought to understand the successes and challenges of EQUIP’s mentorship program. From June-September 2014 we performed semi-structured, in-depth interviews with EQUIP mentees who had received mentoring for ≥ 1 year. Interview questions focused on program successes and challenges and were performed in English, audio recorded, coded, and analyzed using inductive content analysis with ATLAS.ti v7. Fifty-two mentees from 32 health centers were interviewed. The majority of mentees were 18–40 years old (79%, N = 41), 69% (N = 36) were male, 50% (N = 26) were nurses, 29% (N = 15) medical assistants, and 21% (N = 11) clinical officers. All mentees felt that EQUIP mentorship was successful (100%, N = 52). The most common benefit reported was an increase in clinical knowledge allowing for initiation of antiretroviral therapy (33%, N = 17). One-third of mentees (N = 17) reported increased clinic efficiency and improved systems for patient care due to EQUIP’s systems mentoring including documentation, supply chain and support for minor construction at clinics. The most common challenge (52%, N = 27) was understaffing at facilities, with mentees having multiple responsibilities during mentorship visits resulting in impaired ability to focus on learning. Mentees also reported that medication stock-outs (42%, N = 22) created challenges for the mentoring process. EQUIP’s systems-based mentorship and infrastructure improvements allowed for an optimized environment for clinical training. Shortages of health workers at sites pose a challenge for mentoring programs because mentees are pulled from learning experiences to perform non-HIV-related clinic duties. Evaluations of existing mentoring models are needed to continue to improve mentoring strategies that result in sustainable benefits for mentees, facilities, and patients.
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Tuti T, Bitok M, Malla L, Paton C, Muinga N, Gathara D, Gachau S, Mbevi G, Nyachiro W, Ogero M, Julius T, Irimu G, English M. Improving documentation of clinical care within a clinical information network: an essential initial step in efforts to understand and improve care in Kenyan hospitals. BMJ Glob Health 2016; 1:e000028. [PMID: 27398232 PMCID: PMC4934599 DOI: 10.1136/bmjgh-2016-000028] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In many low income countries health information systems are poorly equipped to provide detailed information on hospital care and outcomes. Information is thus rarely used to support practice improvement. We describe efforts to tackle this challenge and to foster learning concerning collection and use of information. This could improve hospital services in Kenya. We are developing a Clinical Information Network, a collaboration spanning 14 hospitals, policy makers and researchers with the goal of improving information available on the quality of inpatient paediatric care across common childhood illnesses in Kenya. Standardised data from hospitals' paediatric wards are collected using non-commercial and open source tools. We have implemented procedures for promoting data quality which are performed prior to a process of semi-automated analysis and routine report generation for hospitals in the network. In the first phase of the Clinical Information Network, we collected data on over 65 000 admission episodes. Despite clinicians' initial unfamiliarity with routine performance reporting, we found that, as an initial focus, both engaging with each hospital and providing them information helped improve the quality of data and therefore reports. The process has involved mutual learning and building of trust in the data and should provide the basis for collaborative efforts to improve care, to understand patient outcome, and to evaluate interventions through shared learning. We have found that hospitals are willing to support the development of a clinically focused but geographically dispersed Clinical Information Network in a low-income setting. Such networks show considerable promise as platforms for collaborative efforts to improve care, to provide better information for decision making, and to enable locally relevant research.
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Affiliation(s)
- Timothy Tuti
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Michael Bitok
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Lucas Malla
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Chris Paton
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Naomi Muinga
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - David Gathara
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Susan Gachau
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - George Mbevi
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Wycliffe Nyachiro
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Morris Ogero
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Thomas Julius
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Grace Irimu
- College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Mike English
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya; Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Ingabire W, Reine PM, Hedt-Gauthier BL, Hirschhorn LR, Kirk CM, Nahimana E, Nepomscene Uwiringiyemungu J, Ndayisaba A, Manzi A. Roadmap to an effective quality improvement and patient safety program implementation in a rural hospital setting. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2015; 3:277-82. [PMID: 26699357 DOI: 10.1016/j.hjdsi.2015.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 10/22/2022]
Abstract
Implementation lessons: (1) implementation of an effective quality improvement and patient safety program in a rural hospital setting requires collaboration between hospital leadership, Ministry of Health and other stakeholders. (2) Building Quality Improvement (QI) capacity to develop engaged QI teams supported by mentoring can improve quality and patient safety.
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Affiliation(s)
| | | | - Bethany L Hedt-Gauthier
- Partners In Health/Inshuti Mu Buzima, Rwanda; Department of Global Health and Social Medicine, Harvard Medical School, USA
| | - Lisa R Hirschhorn
- Department of Global Health and Social Medicine, Harvard Medical School, USA; Ariadne Labs, Boston, MA, USA
| | | | | | | | | | - Anatole Manzi
- Partners In Health/Inshuti Mu Buzima, Rwanda; Partners In Health, USA.
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Assessing the Queuing Process Using Data Envelopment Analysis: an Application in Health Centres. J Med Syst 2015; 40:32. [DOI: 10.1007/s10916-015-0393-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
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Bailey C, Blake C, Schriver M, Cubaka VK, Thomas T, Martin Hilber A. A systematic review of supportive supervision as a strategy to improve primary healthcare services in Sub-Saharan Africa. Int J Gynaecol Obstet 2015; 132:117-25. [PMID: 26653397 DOI: 10.1016/j.ijgo.2015.10.004] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND It may be assumed that supportive supervision effectively builds capacity, improves the quality of care provided by frontline health workers, and positively impacts clinical outcomes. Evidence on the role of supervision in Sub-Saharan Africa has been inconclusive, despite the critical need to maximize the workforce in low-resource settings. OBJECTIVES To review the published literature from Sub-Saharan Africa on the effects of supportive supervision on quality of care, and health worker motivation and performance. SEARCH STRATEGY A systematic review of seven databases of both qualitative and quantitative studies published in peer-reviewed journals. SELECTION CRITERIA Selected studies were based in primary healthcare settings in Sub-Saharan Africa and present primary data concerning supportive supervision. DATA COLLECTION AND ANALYSIS Thematic synthesis where data from the identified studies were grouped and interpreted according to prominent themes. MAIN RESULTS Supportive supervision can increase job satisfaction and health worker motivation. Evidence is mixed on whether this translates to increased clinical competence and there is little evidence of the effect on clinical outcomes. CONCLUSIONS Results highlight the lack of sound evidence on the effects of supportive supervision owing to limitations in research design and the complexity of evaluating such interventions. The approaches required a high level of external inputs, which challenge the sustainability of such models.
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Affiliation(s)
- Claire Bailey
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK.
| | - Carolyn Blake
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Michael Schriver
- Center for Global Health, Department of Public Health, Aarhus University, Denmark
| | - Vincent Kalumire Cubaka
- Center for Global Health, Department of Public Health, Aarhus University, Denmark; School of Medicine and Pharmacy, University of Rwanda, Rwanda
| | - Tisa Thomas
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Adriane Martin Hilber
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
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