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Mbuo M, Okello I, Penn-Kekana L, Willcox M, Portela A, Palestra F, Mathai M. Community engagement in maternal and perinatal death surveillance and response (MPDSR): Realist review protocol. Wellcome Open Res 2023; 8:117. [PMID: 37654740 PMCID: PMC10465996 DOI: 10.12688/wellcomeopenres.18844.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 09/02/2023] Open
Abstract
Background: While there has been a decline in maternal and perinatal mortality, deaths remain high in sub-Saharan Africa and Asia. With the sustainable development goals (SDGs) targets to reduce maternal and perinatal mortality, more needs to be done to accelerate progress and improve survival. Maternal and perinatal death surveillance and response (MPDSR) is a strategy to identify the clinical and social circumstances that contribute to maternal and perinatal deaths. Through MPDSR, an active surveillance and response cycle is established by bringing together different stakeholders to review and address these social and clinical factors. Community engagement in MPDSR provides a strong basis for collective action to address social factors and quality of care issues that contribute to maternal and perinatal deaths. Studies have shown that community members can support identification and reporting of maternal and/or perinatal deaths. Skilled care at birth has been increasing globally, but there are still gaps in quality of care. Through MPDSR, community members can collaborate with health workers to improve quality of care. But we do not know how community engagement in MPDSR works in practice; for whom it works and what aspects work (or do not work) and why. This realist review answers the question: which strategies of community engagement in MPDSR produce which outcomes in which contexts? Methods : For this realist review, we will identify published and grey literature by searching relevant databases for articles. We will include papers published from 2004 in all languages and from all countries. We have set up an advisory group drawn from academia, international organizations, and practitioners of both MPDSR and community engagement to guide the process. Conclusion: This protocol and the subsequent realist review will use theoretical approaches from the community engagement literature to generate theory on community engagement in MPDSR. Prospero registration number: CRD42022345216.
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Affiliation(s)
- Mary Mbuo
- Public health, Environments and Society, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Immaculate Okello
- Primary Care Research Centre , Aldermoor Health Centre, University of Southampton, Southhampton, UK
| | - Loveday Penn-Kekana
- Public health, Environments and Society, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Merlin Willcox
- Primary Care Research Centre , Aldermoor Health Centre, University of Southampton, Southhampton, UK
| | - Anayda Portela
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Francesca Palestra
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Matthews Mathai
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
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Maritim P, Chewe M, Munakaampe MN, Silumbwe A, Sichone G, Zulu JM. Applying community health systems lenses to identify determinants of access to surgery among mobile & migrant populations with hydrocele in Zambia: A mixed methods assessment. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002145. [PMID: 37463160 DOI: 10.1371/journal.pgph.0002145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 06/15/2023] [Indexed: 07/20/2023]
Abstract
Hydrocele which is caused by long term lymphatic filariasis infection can be treated through the provision of surgery. Access to surgeries remains low particularly for hard to reach populations. This study applied community health system lenses to identify determinants to the adoption, implementation and integration of hydrocele surgeries among migrants &mobile populations in Luangwa District, Zambia. A concurrent mixed methods design consisting of cross-sectional survey with hydrocele patients (n = 438) and in-depth interviews with different community actors (n = 38) was conducted in October 2021. Data analysis was based on the relational and programmatic lenses of Community Health Systems. Under the Programmatic lens, insufficient resources resulted in most health facilities being incapable of providing the minimum package of care for lymphatic filariasis. The absence of cross border collaborative structures limits the continuity of care for patients moving across the three countries. Other programmatic barriers include language barriers, inappropriate appointment systems, direct and indirect costs. In the relational lens, despite the key role that community leaders play their engagement in service delivery was low. Community actors including patients were rarely included in planning, implementation or evaluation of hydrocele services. Some patients utilized their power within to act as champions for the surgery but local groups such as fishing associations remained underutilized. Community health systems provide a potential avenue through which access amongst mobile and migrant populations can be enhanced through strategies such engagement of patient groups, knowledge sharing across borders and use of community monitoring initiatives.
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Affiliation(s)
- Patricia Maritim
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Mwimba Chewe
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Margarate Nzala Munakaampe
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Adam Silumbwe
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
| | - George Sichone
- Participatory Research and Innovations Management, Lusaka, Zambia
| | - Joseph Mumba Zulu
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
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3
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Gilmore B, Dsane-Aidoo PH, Rosato M, Yaqub NO, Doe R, Baral S. Institutionalising community engagement for quality of care: moving beyond the rhetoric. BMJ 2023; 381:e072638. [PMID: 37188363 PMCID: PMC10183996 DOI: 10.1136/bmj-2022-072638] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- Brynne Gilmore
- School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland
| | | | | | - Nuhu Omeiza Yaqub
- Department of Maternal, Newborn, Child, Adolescent Health, and Ageing, World Health Organization, Geneva, Switzerland
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4
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Zhang X, Liu X, Wang L. Evaluating Community Capability to Prevent and Control COVID-19 Pandemic in Shenyang, China: An Empirical Study Based on a Modified Framework of Community Readiness Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3996. [PMID: 36901006 PMCID: PMC10002099 DOI: 10.3390/ijerph20053996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
Community plays a crucial role in the successful prevention and control of the COVID-19 pandemic in China. However, evaluation of community capability to fight against COVID-19 is rarely reported. The present study provides a first attempt to assess community capability to combat COVID-19 in Shenyang, the capital city of Liaoning province in Northeast China, based on a modified framework of a community readiness model. We conducted semi-structured interviews with ninety key informants from fifteen randomly selected urban communities to collect the data. The empirical results indicate that the overall level of community capability for epidemic prevention and control in Shenyang was at the stage of preparation. The specific levels of the fifteen communities ranged from the stages of preplanning to preparation to initiation. Concerning the level of each dimension, community knowledge about the issue, leadership, and community attachment exhibited significant disparities between communities, while there were slight differences among communities on community efforts, community knowledge of efforts, and community resources. In addition, leadership demonstrated the highest overall level among all the six dimensions, followed by community attachment and community knowledge of efforts. Community resources displayed the lowest level, followed by community efforts. This study not only extends the application of the modified community readiness model to evaluate community capability of epidemic prevention in the Chinese community context, but also offers practical implications for enhancing Chinese communities' capabilities to deal with various future public health emergencies.
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Affiliation(s)
- Xiaojie Zhang
- Department of Public Administration, School of Humanities & Law, Northeastern University, Shenyang 110169, China
| | - Xiaoyu Liu
- Department of Public Administration, School of Humanities & Law, Northeastern University, Shenyang 110169, China
| | - Lili Wang
- Party School of Weihai Municipal Committee of Communist Party of China, Weihai 264213, China
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5
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Naing C, Htet NH, Aung HH, Whittaker MA. Community engagement in health services research on elimination of lymphatic filariasis: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001226. [PMID: 36963022 PMCID: PMC10021320 DOI: 10.1371/journal.pgph.0001226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/12/2022] [Indexed: 01/19/2023]
Abstract
This study aimed to contextualize the extent, nature, and quality of community engagement in health services research on eliminating lymphatic filariasis in low-and middle-income countries of Southeast Asia and Pacific Region. We performed a systematic review, and the results were reported according to the PRISMA-S checklist. Relevant studies were searched in health-related electronic databases, and selected according to the inclusion criteria. Sixteen studies with various study designs were identified. The majority (68%) were conducted in India. Lay people, community leaders, and volunteers were the most common groups of community members (12/16,75%). Overall, the majority (13/16, 81%) were at the 'moderate level' of engagement in research context mainly by 'collaboration' in 'developing methodology' 'collaboration' in data collection and 'collaboration' for 'dissemination of findings. The common barriers to the community engagement were lack of involvement of participating bodies and technology-related issues. In conclusion, the insufficient description of the community engagement process in the studies limits a deeper understanding and analysis of the issue. Future well-designed prospective studies with attention to the description of mechanisms of engagement, facilitating the whole process and reporting the community level outcome are recommended.
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Affiliation(s)
- Cho Naing
- Division of Tropical Health and Medicine, James Cook University, Queensland, Australia
| | - Norah Htet Htet
- School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Htar Htar Aung
- School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Maxine A Whittaker
- Division of Tropical Health and Medicine, James Cook University, Queensland, Australia
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Kraft JM, Paina L, Boydell V, Elnakib S, Sihotang A, Bailey A, Tolmie C. Social Accountability Reporting for Research (SAR4Research): checklist to strengthen reporting on studies on social accountability in the literature. Int J Equity Health 2022; 21:121. [PMID: 36042426 PMCID: PMC9425941 DOI: 10.1186/s12939-022-01716-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND An increasing number of evaluations of social accountability (SA) interventions have been published in the past decade, however, reporting gaps make it difficult to summarize findings. We developed the Social Accountability Reporting for Research (SAR4Research) checklist to support researchers to improve the documentation of SA processes, context, study designs, and outcomes in the peer reviewed literature and to enhance application of findings. METHODS We used a multi-step process, starting with an umbrella review of reviews on SA to identify reporting gaps. Next, we reviewed existing guidelines for reporting on behavioral interventions to determine whether one could be used in its current or adapted form. We received feedback from practitioners and researchers and tested the checklist through three worked examples using outcome papers from three SA projects. RESULTS Our umbrella review of SA studies identified reporting gaps in all areas, including gaps in reporting on the context, intervention components, and study methods. Because no existing guidelines called for details on context and the complex processes in SA interventions, we used CONSORT-SPI as the basis for the SAR4Research checklist, and adapted it using other existing checklists to fill gaps. Feedback from practitioners, researchers and the worked examples suggested the need to eliminate redundancies, add explanations for items, and clarify reporting for quantitative and qualitative study components. CONCLUSIONS Results of SA evaluations in the peer-reviewed literature will be more useful, facilitating learning and application of findings, when study designs, interventions and their context are described fully in one or a set of papers. This checklist will help authors report better in peer-reviewed journal articles. With sufficient information, readers will better understand whether the results can inform accountability strategies in their own contexts. As a field, we will be better able to identify emerging findings and gaps in our understanding of SA.
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Affiliation(s)
- Joan Marie Kraft
- Office of Population and Reproductive Health, United States Agency for International Development, 500 D St SW, UA-5th Floor, Washington DC, 20547 USA
| | - Ligia Paina
- Department of International Health, Health Systems Program, Johns Hopkins University School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205 USA
| | - Victoria Boydell
- School of Health and Social Care, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ UK
| | - Shatha Elnakib
- Department of International Health, Health Systems Program, Johns Hopkins University School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205 USA
| | - Andreas Sihotang
- Harry S Truman School of Public Affairs, University of Missouri, 101 Middlebush Hall, Columbia, Missouri 65211 USA
| | - Angela Bailey
- Accountability Research Center, American University, 4400 Massachusetts Ave NW, Washington DC, 20016 USA
| | - Courtney Tolmie
- Wonderlight Consulting, 8342 Charlise Rd, Richmond, VA 23235 USA
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Abayneh S, Lempp H, Kohrt BA, Alem A, Hanlon C. Using participatory action research to pilot a model of service user and caregiver involvement in mental health system strengthening in Ethiopian primary healthcare: a case study. Int J Ment Health Syst 2022; 16:33. [PMID: 35818056 PMCID: PMC9275138 DOI: 10.1186/s13033-022-00545-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/22/2022] [Indexed: 11/14/2022] Open
Abstract
Background Little is known about actual involvement or how to achieve service user and caregiver in mental health systems strengthening in low-and middle-income countries. This study describes the processes and explores involvement experiences of participants in a pilot study of a new model of service user involvement in mental health system strengthening in a rural district in southern Ethiopia. Methods We applied a case study design using participatory action research (PAR). The PAR process comprised of three stages, each with iterative activities of plan, act, observe and reflect. Two stakeholder groups, a Research Advisory Group (RAG) and Research Participant Group (RPG), were established and collaborated in the PAR process. Data collection involved process documentation of meetings and activities: attendances, workshop minutes, discussion outputs, reflective notes, participatory observation of sessions, and in-depth interviews with 12 RPG members. We analyzed the process data descriptively. Thematic analysis was used for qualitative data. Triangulation and synthesis of findings was carried out to develop the case study. Results The stakeholder groups identified their top research priorities, developed an intervention and action plan and made a public presentation of preliminary findings. Key mechanisms used for inclusive participation included capacity building and bringing together diverse stakeholders, anchoring the study in established strong community involvement structures, and making use of participatory strategies and activities during the PAR process. Four themes were developed about experiences of involvement in PAR: (i) expectations and motivation, (ii) experiences of the dynamics of the PAR process, (iii) perceived impacts of involvement in the PAR process, and (iv) implementation challenges and future directions. Conclusions This case study demonstrated the feasibility and acceptability of implementing a complex model of service-user involvement in mental health system strengthening in a resource constrained setting. More needs to be done to embed service-user involvement into routines of the primary healthcare system, alongside sustained support and strengthening multi-stakeholder collaboration at multiple levels. Supplementary Information The online version contains supplementary material available at 10.1186/s13033-022-00545-8.
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Affiliation(s)
- Sisay Abayneh
- College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, WHO Collaborating Centre in Mental Health Research and Capacity Building, Addis Ababa, Ethiopia. .,Madda Walabu University College of Education and Behavoural Studies, Bale Robe, Ethiopia.
| | - Heidi Lempp
- Centre for Rheumatic Diseases, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, Weston Education Centre, King's College London, 10, Cutcombe Rd, London, SE5 9RJ, UK
| | - Brandon A Kohrt
- Department of Psychiatry, George Washington University, Washington, DC, USA
| | - Atalay Alem
- College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, WHO Collaborating Centre in Mental Health Research and Capacity Building, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, WHO Collaborating Centre in Mental Health Research and Capacity Building, Addis Ababa, Ethiopia.,Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.,Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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8
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Dehingia N, Dixit A, Heskett K, Raj A. Collective efficacy measures for women and girls in low- and middle-income countries: a systematic review. BMC Womens Health 2022; 22:129. [PMID: 35468776 PMCID: PMC9036723 DOI: 10.1186/s12905-022-01688-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background Prior research has shown collective efficacy to be a key determinant of women’s well-being. However, much of the work around measuring this construct has been done in high-income geographies, with very little representation from low- and middle-income countries (LMIC). To fill this gap, and guide future research in low resource settings, we aim to summarize best evidence measures of collective efficacy for women and girls from LMICs. Methods Following PRISMA guidelines, we systematically searched five databases for English language peer-reviewed literature on measures of collective efficacy, published between 1 January 2009 and 25 August 2020. In addition, we sought expert input for relevant papers in this area. Research staff screened titles, abstracts, and full-text articles in a double-blind review. Inclusion criteria were: (i) original quantitative analysis, and (ii) sample limited to women/girls only (≥ 100), residing in LMICs. Results We identified 786 unique articles, 14 of which met inclusion criteria. Eligible studies captured a diversity of population groups, including pregnant women, recent mothers, adolescent girls, and female sex workers, from across national settings. Two broad constructs of collective efficacy were captured by the measures: (i) group dynamics, and (ii) collective action. All 14 studies included items on group dynamics in their measures, whereas seven studies included items on collective action. Four studies validated new measures of collective efficacy, and seven provided evidence supporting the relationship between collective efficacy and outcomes related to women’s well-being. Overall, measures demonstrated good reliability and validity when tested, and those testing for associations or effects found a positive relationship of collective efficacy with women’s health behaviors. Conclusion The past decade has resulted in a number of new collective efficacy measures demonstrating good validity in terms of their associations with key health outcomes among women and girls from across LMIC settings, but there remains no standard measure in the field. Those that exist focus on group dynamics, but less often on collective action. A standard measure of collective efficacy inclusive of group dynamics and collective action can support better understanding of the value of women’s collectives across national settings and populations. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01688-z.
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Affiliation(s)
- Nabamallika Dehingia
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA. .,Joint Doctoral Program in Global Health, San Diego State University and University of California San Diego, San Diego, CA, USA.
| | - Anvita Dixit
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA.,Joint Doctoral Program in Global Health, San Diego State University and University of California San Diego, San Diego, CA, USA
| | - Karen Heskett
- Biomedical Library, University of California San Diego, San Diego, CA, USA
| | - Anita Raj
- Center On Gender Equity and Health, School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA
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9
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Abstract
BACKGROUND There is now rapidly growing global awareness of the potential of large-scale community health worker (CHW) programmes not only for improving population health but, even more importantly, for accelerating the achievement of universal health coverage and eliminating readily preventable child and maternal deaths. However, these programmes face many challenges that must be overcome in order for them to reach their full potential. FINDINGS This editorial introduces a series of 11 articles that provide an overview highlighting a broad range of issues facing large-scale CHW programmes. The series addresses many of them: planning, coordination and partnerships; governance, financing, roles and tasks, training, supervision, incentives and remuneration; relationships with the health system and communities; and programme performance and its assessment. Above all, CHW programmes need stronger political and financial support, and this can occur only if the potential of these programmes is more broadly recognized. The authors of the papers in this series believe that these challenges can and will be overcome-but not overnight. For this reason, the series bears the title "Community Health Workers at the Dawn of a New Era". The scientific evidence regarding the ability of CHWs to improve population health is incontrovertible, and the favourable experience with these programmes at scale when they are properly designed, implemented, and supported is compelling. CHW programmes were once seen as a second-class solution to a temporary problem, meaning that once the burden of disease from maternal and child conditions and from communicable diseases in low-income countries had been appropriately reduced, there would be no further need for CHWs. That perspective no longer holds. CHW programmes are now seen as an essential component of a high-performing healthcare system even in developed countries. Their use is growing rapidly in the United States, for instance. And CHWs are also now recognized as having a critically important role in the control of noncommunicable diseases as well as in the response to pandemics of today and tomorrow in all low-, middle-, and high-income countries throughout the world. CONCLUSION The promise of CHW programmes is too great not to provide them with the support they need to achieve their full potential. This series helps to point the way for how this support can be provided.
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Affiliation(s)
- Joseph M. Zulu
- Health Promotion and Education Department, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Henry B. Perry
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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10
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Ozano K, Dean L, Adekeye O, Bettee AK, Dixon R, Gideon NU, Gwani N, Isiyaku S, Kollie K, Lar L, Oluwole A, Piotrowski H, Siakeh A, Thomson R, Yashiyi J, Zawolo G, Theobald S. Guiding principles for quality, ethical standards and ongoing learning in implementation research: multicountry learnings from participatory action research to strengthen health systems. Health Policy Plan 2021; 35:ii137-ii149. [PMID: 33156936 PMCID: PMC7646736 DOI: 10.1093/heapol/czaa123] [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] [Accepted: 09/03/2020] [Indexed: 12/17/2022] Open
Abstract
Global health gains can be achieved through strengthening health systems to identify and address implementation challenges in low- and middle-income countries. Participatory research, that promotes joint problem and solution finding between communities and different health systems actors, supports policy implementation analysis at all levels. Within the neglected tropical disease programmes in Liberia and Nigeria, we applied participatory action research (PAR) to address programmatic and health system bottlenecks with health systems strengthening embedded. This paper shares learning from 20 interviews with co-researchers, from national and sub-national levels and academic researchers who worked collaboratively to understand challenges, co-create solutions and advocate for policy change. Through analysis and reflections of existing PAR principles, we inductively identified five additional guiding principles for quality, ethical standards and ongoing learning within PAR projects that aim to strengthen health systems. (1) Recognize communities as units of identity and define stakeholder participation to ensure equitable engagement of all actors; (2) enable flexible action planning that builds on existing structures whilst providing opportunities for embedding change; (3) address health systems and research power differentials that can impede co-production of knowledge and solution development; (4) embed relational practices that lead to new political forms of participation and inquiry within health systems and (5) develop structures for ongoing learning at multiple levels of the health system. PAR can strengthen health systems by connecting and co-creating potentially sustainable solutions to implementation challenges. Additional research to explore how these five additional principles can support the attainment of quality and ethical standards within implementation research using a PAR framework for health systems strengthening is needed.
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Affiliation(s)
- Kim Ozano
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L35QA, UK
| | - Laura Dean
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L35QA, UK
| | - Oluwatosin Adekeye
- Sightsavers, Nigeria Country Office, Golf Course Road, City Centre, Kaduna, Nigeria
| | - Anthony K Bettee
- Ministry of Health, Government of Liberia, SKD Boulevard, Monrovia, Liberia
| | - Ruth Dixon
- Sightsavers, 35 Perrymount Rd, Haywards Heath RH16 3BZ, UK
| | - Ntuen Uduak Gideon
- Ministry of Health, Government of Nigeria, Federal Secretariat, Complex Garki PMB, 83 Abuja, Nigeria
| | - Noela Gwani
- Sightsavers, Nigeria Country Office, Golf Course Road, City Centre, Kaduna, Nigeria
| | - Sunday Isiyaku
- Sightsavers, Nigeria Country Office, Golf Course Road, City Centre, Kaduna, Nigeria
| | - Karsor Kollie
- Ministry of Health, Government of Liberia, SKD Boulevard, Monrovia, Liberia
| | - Luret Lar
- Sightsavers, Nigeria Country Office, Golf Course Road, City Centre, Kaduna, Nigeria
| | - Akinola Oluwole
- Sightsavers, Nigeria Country Office, Golf Course Road, City Centre, Kaduna, Nigeria
| | - Helen Piotrowski
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L35QA, UK
| | - Alice Siakeh
- Pacific Institute for Research and Evaluation UL-PIRE Africa Center, University of Liberia, Capitol Hill Liberia
| | - Rachael Thomson
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L35QA, UK
| | - James Yashiyi
- Sightsavers, Nigeria Country Office, Golf Course Road, City Centre, Kaduna, Nigeria
| | - Georgina Zawolo
- Pacific Institute for Research and Evaluation UL-PIRE Africa Center, University of Liberia, Capitol Hill Liberia
| | - Sally Theobald
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L35QA, UK
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11
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Mayhew SH, Kyamusugulwa PM, Kihangi Bindu K, Richards P, Kiyungu C, Balabanova D. Responding to the 2018-2020 Ebola Virus Outbreak in the Democratic Republic of the Congo: Rethinking Humanitarian Approaches. Risk Manag Healthc Policy 2021; 14:1731-1747. [PMID: 33953623 PMCID: PMC8092619 DOI: 10.2147/rmhp.s219295] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/20/2021] [Indexed: 11/23/2022] Open
Abstract
The Democratic Republic of Congo (DRC) presents a challenging context in which to respond to public health crises. Its 2018-2020 Ebola outbreak was the second largest in history. Lessons were known from the previous West African outbreak. Chief among these was the recognition that local action and involvement are key to establishing effective epidemic-response. It remains unclear whether and how this was achieved in DRC's Ebola response. Additionally, there is a lack of scholarship on how to build resilience (the ability to adapt or transform under pressure) in crisis-response. In this article, we critically review literature to examine evidence on whether and how communities were involved, trust built, and resilience strengthened through adaptation or transformation of DRC's 2018-2020 Ebola response measures. Overall, we found limited evidence that the response adapted to engage and involve local actors and institutions or respond to locally expressed concerns. When adaptations occurred, they were shaped by national and international actors rather than enabling local actors to develop locally trusted initiatives. Communities were "engaged" to understand their perceptions but were not involved in decision-making or shaping responses. Few studies documented how trust was built or analyzed power dynamics between different groups in DRC. Yet, both these elements appear to be critical in building effective, resilient responses. These failures occurred because there was no willingness by the national government or international agencies to concede decision-making power to local people. Emergency humanitarian response is entrenched in highly medicalized, military style command and control approaches which have no space for decentralizing decision-making to "non-experts". To transform humanitarian responses, international responders can no longer be regarded as "experts" who own the knowledge and control the response. To successfully tackle future humanitarian crises requires a transformation of international humanitarian and emergency response systems such that they are led, or shaped, through inclusive, equitable collaboration with local actors.
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Affiliation(s)
- Susannah H Mayhew
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Patrick Milabyo Kyamusugulwa
- Bukavu Medical University College/Institut Supérieur des Techniques Médicales de Bukavu (ISTM-Bukavu), Bukavu, Eastern Democratic Republic of Congo
| | - Kennedy Kihangi Bindu
- Centre de Recherche sur la Démocratie et le Développement en Afrique (CREDDA), Université Libre des Pays des Grands Lacs, Goma, Democratic Republic of Congo
| | - Paul Richards
- School of Environmental Sciences, Njala University, Freetown, Sierra Leone
| | - Cyrille Kiyungu
- Hygiene, State Administration, Kikwit, Democratic Republic of Congo
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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12
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Naccarella L, Saxton D, Lugg E, Marley J. It takes a community to save a life in cardiac arrest: Heart safe community pilots, Australia. Health Promot J Austr 2021; 33:99-105. [PMID: 33743556 DOI: 10.1002/hpja.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/17/2021] [Accepted: 03/12/2021] [Indexed: 11/08/2022] Open
Abstract
ISSUE ADDRESSED In Australia only 1 in 12 people will survive an out of hospital cardiac arrest (OHCA). Heart Safe Community (HSC) is a public health initiative being implemented by the Heart Foundation, Victoria in partnership with Ambulance Victoria. It aims to improve survival from OHCA by improving public access to 24 hours Automated External Defibrillators (AEDs) and by building local community skills and confidence in basic resuscitation. Over the period 2017-20, the University of Melbourne was commissioned to evaluate the implementation, effectiveness, and sustainability of three HSC pilots in Victoria, Australia. METHODS Mixed methods were used including eight focus group discussions with 64 local HSC community stakeholders and local HSC pilot site evaluation data. RESULTS The local HSC pilot community presentation surveys revealed that the HSC pilots delivered hundreds of presentations on bystander resuscitation, with 2772 local community members being exposed to the call to action: 'Call, Push Shock' and 'anyone can save a life'. Focus group discussions revealed that the HSC pilots built local community capacity to respond to OHCA as demonstrated by increased knowledge, confidence and skills to call Emergency Medical Services, attempt chest compression, acquire and use an AED. Community leadership to advocate for improved access to AEDs and to propagate HSC initiatives amongst community settings and cohorts has occurred. HSC implementation enablers and challenges exist. Community capacity-building frameworks can explain what makes the HSC pilot work. CONCLUSION HSC can build local community capacity to respond to OHCA. Eight principles are suggested to support the building, implementation and sustainability of future HSC efforts. SO WHAT?: The HSC experience reveals that community members across the lifespan and multiple settings embrace opportunities to improve the safety and response in their community to a cardiac arrest when the action is simplified and community ownership cultivated.
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Affiliation(s)
- Lucio Naccarella
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia
| | - Danielle Saxton
- Ambulance Victoria Regional Capability and Development, Wangaratta, Vic, Australia
| | - Eugene Lugg
- Chain of Survival Project, Heart Foundation (Victoria), Docklands, Vic, Australia
| | - Joel Marley
- Division Ambulance Victoria, Strategic Communication and Engagement, Melbourne, Vic, Australia
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Fontanet CP, Fong RM, Kaiser JL, Bwalya M, Ngoma T, Vian T, Biemba G, Scott NA. A Qualitative Exploration of Community Ownership of a Maternity Waiting Home Model in Rural Zambia. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:344-357. [PMID: 33008852 PMCID: PMC7541113 DOI: 10.9745/ghsp-d-20-00136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022]
Abstract
Community-based maternal child health programs should foster a sense of community ownership to promote sustainability. In rural Zambia, health interventions should be accessible to target communities and clear roles should be established among stakeholders for effective governance. Context: Ownership is an important construct of sustainability for community-based health programming, though it is often not clearly defined or measured. We implemented and evaluated a community-driven maternity waiting home (MWH) model in rural Zambia. We engaged stakeholders at all levels and provided intensive mentorship to an MWH governance committee comprised of community-selected members. We then examined how different stakeholders perceive community ownership of the MWH. Methods: We conducted 42 focus group discussions with community stakeholders (pregnant women, fathers, elders, and community health volunteers) and 161 in-depth interviews with MWH stakeholders (health facility staff, district health officials, and MWH governance committee and management unit members) at multiple time-points over 24 months. We conducted a content analysis and triangulated findings to understand community ownership of the MWH and observe changes in perceptions of ownership over time. Results: Community members’ perceptions of ownership were related to their ability to use the MWH and a responsibility toward its success. Community and MWH stakeholders described increasingly more specific responsibilities over time. Governance committee and management unit members perceived their ability to represent the community as a crucial component of their role. Multiple respondent types saw collaboration between the governance committee and the health facility staff as key to allowing the MWH to meet its goal of serving the community. Conclusion: The perceptions of community ownership evolved as the intervention became more established. Use of the MWH, and clear understanding of roles and responsibilities in management of the MWH, seemed to foster feelings of community ownership. To improve the sustainability of community-based maternal and child health programs, interventions should be accessible to target communities and clear roles should be established among stakeholders.
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Affiliation(s)
- Constance P Fontanet
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
| | - Rachel M Fong
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Jeanette L Kaiser
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Misheck Bwalya
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Thandiwe Ngoma
- Department of Research, Right to Care Zambia, Lusaka, Zambia
| | - Taryn Vian
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Godfrey Biemba
- National Health Research Authority, Pediatric Centre of Excellence, Lusaka, Zambia
| | - Nancy A Scott
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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Abayneh S, Lempp H, Alem A, Kohrt BA, Fekadu A, Hanlon C. Developing a Theory of Change model of service user and caregiver involvement in mental health system strengthening in primary health care in rural Ethiopia. Int J Ment Health Syst 2020; 14:51. [PMID: 32760440 PMCID: PMC7379363 DOI: 10.1186/s13033-020-00383-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 07/18/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The involvement of service users and caregivers is recommended as a strategy to strengthen health systems and scale up quality mental healthcare equitably, particularly in low-and-middle-income countries. Service user and caregiver involvement is complex, and its meaningful implementation seems to be a worldwide challenge. Theory of Change (ToC) has been recommended to guide the development, implementation and evaluation of such complex interventions. This paper aims to describe a ToC model for service user and caregiver involvement in a primary mental health care in rural Ethiopia. METHODS The ToC was developed in two workshops conducted in (i) Addis Ababa with purposively selected psychiatrists (n = 4) and multidisciplinary researchers (n = 3), and (ii) a rural district in south-central Ethiopia (Sodo), with community stakeholders (n = 24). Information from the workshops (provisional ToC maps, minutes, audio recordings), and inputs from a previous qualitative study were triangulated to develop the detailed ToC map. This ToC map was further refined with written feedback and further consultative meetings with the research team (n = 6) and community stakeholders (n = 35). RESULTS The experiential knowledge and professional expertise of ToC participants combined to produce a ToC map that incorporated key components (community, health organisation, service user and caregiver), necessary interventions, preconditions, assumptions and indicators towards the long-term outcomes. The participatory nature of ToC by itself raised awareness of the possibilities for servicer user and caregiver involvement, promoted co-working and stimulated immediate commitments to mobilise support for a grass roots service user organization. CONCLUSIONS The ToC workshops provided an opportunity to co-produce a ToC for service user and caregiver involvement in mental health system strengthening linked to the planned model for scale-up of mental health care in Ethiopia. The next steps will be to pilot a multi-faceted intervention based on the ToC and link locally generated evidence to published evidence and theories to refine the ToC for broader transferability to other mental health settings.
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Affiliation(s)
- Sisay Abayneh
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, WHO Collaborating Centre in Mental Health Research and Capacity Building, Addis Ababa, Ethiopia
| | - Heidi Lempp
- Faculty of Life Sciences and Medicine, Centre for Rheumatic Diseases, School of Immunology and Microbial Sciences, King’s College London, Weston Education Centre 10, Cutcombe Rd, London, SE5 9RJ UK
| | - Atalay Alem
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, WHO Collaborating Centre in Mental Health Research and Capacity Building, Addis Ababa, Ethiopia
| | - Brandon A. Kohrt
- Department of Psychiatry, George Washington University, Washington, DC USA
| | - Abebaw Fekadu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, WHO Collaborating Centre in Mental Health Research and Capacity Building, Addis Ababa, Ethiopia
- College of Health Sciences, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
- Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, WHO Collaborating Centre in Mental Health Research and Capacity Building, Addis Ababa, Ethiopia
- College of Health Sciences, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF UK
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Haque M, Islam T, Rahman NAA, McKimm J, Abdullah A, Dhingra S. Strengthening Primary Health-Care Services to Help Prevent and Control Long-Term (Chronic) Non-Communicable Diseases in Low- and Middle-Income Countries. Risk Manag Healthc Policy 2020; 13:409-426. [PMID: 32547272 PMCID: PMC7244358 DOI: 10.2147/rmhp.s239074] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/24/2020] [Indexed: 12/31/2022] Open
Abstract
The prevalence of long-term (chronic) non-communicable diseases (NCDs) is increasing globally due to an ageing global population, urbanization, changes in lifestyles, and inequitable access to healthcare. Although previously more common in high- and upper-middle-income countries, lower-middle-income countries (LMICs) are more affected, with NCDs in LMICs currently accounting for 85–90% of premature deaths among 30–69 years old. NCDs have both high morbidity and mortality and high treatment costs, not only for the diseases themselves but also for their complications. Primary health care (PHC) services are a vital component in the prevention and control of long-term NCDs, particularly in LMICs, where the health infrastructure and hospital services may be under strain. Drawing from published studies, this review analyses how PHC services can be utilized and strengthened to help prevent and control long-term NCDs in LMICs. The review finds that a PHC service approach, which deals with health in a comprehensive way, including the promotion, prevention, and control of diseases, can be useful in both high and low resource settings. Further, a PHC based approach also provides opportunities for communities to better access appropriate healthcare, which ensures more significant equity, efficiency, effectiveness, safety, and timeliness, empowers service users, and helps healthcare providers to achieve better health outcomes at lower costs. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/33l6gK1RNFo
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Affiliation(s)
- Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kuala Lumpur 57000, Malaysia
| | - Tariqul Islam
- UChicago Research Bangladesh, Dhaka 1230, Bangladesh
| | - Nor Azlina A Rahman
- Department of Physical Rehabilitation Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan, 25200, Malaysia
| | - Judy McKimm
- Swansea University School of Medicine, Swansea University, Swansea, Wales SA2 8PP, UK
| | - Adnan Abdullah
- Unit of Occupational Medicine, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kuala Lumpur 57000, Malaysia
| | - Sameer Dhingra
- School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Mount Hope, Trinidad & Tobago
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Moodley K, Beyer C. Tygerberg Research Ubuntu-Inspired Community Engagement Model: Integrating Community Engagement into Genomic Biobanking. Biopreserv Biobank 2019; 17:613-624. [PMID: 31603696 PMCID: PMC6921246 DOI: 10.1089/bio.2018.0136] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Introduction: Community engagement (CE) is an ethical imperative in research, but the knowledge base for what constitutes effective and ethically sound CE is limited. Ubuntu, as a component of responsive communitarianism where communal welfare is valued together with individual autonomy, is useful in furthering our understanding of effective CE and how it could best be achieved. Similarly, a relative solidarity model serves as a compromise between extreme individualism and extreme communalism and is more appropriate in a heterogenous African context. Approaching CE from an Ubuntu philosophical perspective in southern Africa is particularly important in genomic biobanking, given the implications for individuals, families, and communities. Discussion: CE is often implemented in a tokenistic manner as an ancillary component of research. Understanding consent information is challenging where genomic biobanking is concerned due to scientific complexity. We started a process of CE around genomic biobanking and conducted empirical research in an attempt to develop a model to promote effective and ethically sound CE, using relative solidarity to create a nuanced application of Ubuntu. The TRUCE model is an eight-step model that uses social mapping to identify potential communities, establishes the scope of CE, and requires that communities are approached early. Co-creation strategies for CE are encouraged and co-ownership of knowledge production is emphasized. Recruiting and engaging communities at each stage of research is necessary. Evaluation and adaptation of CE strategies are included. Discussion and dissemination of results after the research is completed are encouraged. Conclusions: There is a significant gap between the theory of CE and its authentic application to research in Africa. This Ubuntu-inspired model facilitates bridging that gap and is particularly suited to genomic biobanking. The CE model enhances and complements the consent process and should be integrated into research as a funding and regulatory requirement where applicable.
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Affiliation(s)
- Keymanthri Moodley
- Department of Medicine, Faculty of Medicine and Health Sciences, Centre for Medical Ethics & Law, Stellenbosch University, Cape Town, South Africa
- Address correspondence to: Keymanthri Moodley, MBChB, MFamMed, MPhil, FCFP (SA), Executive MBA, DPhil, Department of Medicine, Faculty of Medicine and Health Sciences, Centre for Medical Ethics & Law, Stellenbosch University, P.O. Box 241, Cape Town 7505, South Africa
| | - Chad Beyer
- Department of Medicine, Faculty of Medicine and Health Sciences, Centre for Medical Ethics & Law, Stellenbosch University, Cape Town, South Africa
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George A, Olivier J, Glandon D, Kapilashrami A, Gilson L. Health systems for all in the SDG era: key reflections based on the Liverpool statement for the fifth global symposium on health systems research. Health Policy Plan 2019; 34:ii135-ii138. [PMID: 31723972 DOI: 10.1093/heapol/czz115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2019] [Indexed: 12/16/2022] Open
Affiliation(s)
- Asha George
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, Cape Town, South Africa
| | - Jill Olivier
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa
| | - Douglas Glandon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, USA
| | | | - Lucy Gilson
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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Zulu JM, Kinsman J, Hurtig AK, Michelo C, George A, Schneider H. Integrating community health assistant-driven sexual and reproductive health services in the community health system in Nyimba district in Zambia: mapping key actors, points of integration, and conditions shaping the process. Reprod Health 2019; 16:122. [PMID: 31409362 PMCID: PMC6693243 DOI: 10.1186/s12978-019-0788-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/05/2019] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Although large scale public sector community health worker programs have been key in providing sexual and reproductive health (SRH) services in low- and middle-income countries, their integration process into community health systems is not well understood. This study aimed to identify the conditions and strategies through which Community Health Assistants (CHAs) gained entry and acceptability into community health systems to provide SRH services to youth in Zambia. The country's CHA program was launched in 2010. METHODOLOGY A phenomenological design was conducted in Nyimba district. All nine CHAs deployed in Nyimba district were interviewed in-depth on their experiences of navigating the introduction of SRH services for youth in community settings, and the data obtained analyzed thematically. RESULTS In delivering SRH services targeting youth, CHAs worked with a range of community actors, including other health workers, safe motherhood action groups, community health workers, neighborhood health committees, teachers, as well as political, traditional and religious leaders. CHAs delivered SRH education and services in health facilities, schools, police stations, home settings, and community spaces. They used their health facility service delivery role to gain trust and entry into the community, and they also worked to build relationships with other community level actors by holding regular joint meetings, and acting as brokers between the volunteer health workers and the Ministry of Health. CHAs used their existing social networks to deliver SRH services to adolescents. By embedding the provision of information about SRH into general life skills at community level, the topic's sensitivity was reduced and its acceptability was enhanced. Further, support from community leaders towards CHA-driven services promoted the legitimacy of providing SRH for youth. Factors limiting the acceptability of CHA services included the taboo of discussing sexuality issues, a gender discriminatory environment, competition with other providers, and challenges in conducting household visits. CONCLUSION Strengthening CHAs' ability to negotiate and navigate and gain acceptability in the community health system as they deliver SRH, requires support from both the formal health system and community networks. Limitations to the acceptability of CHA-driven SRH services are a product of challenges both in the community and in the formal health system.
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Affiliation(s)
- Joseph M. Zulu
- Department of Public Health, School of Medicine, University of Zambia, School of Public Health, P.O. Box 50110, Lusaka, Zambia
| | - John Kinsman
- Department of Global Health and Epidemiology, Umeå University, 90185 Umeå, SE Sweden
| | - Anna-Karin Hurtig
- Department of Global Health and Epidemiology, Umeå University, 90185 Umeå, SE Sweden
| | - Charles Michelo
- Department of Public Health, School of Medicine, University of Zambia, School of Public Health, P.O. Box 50110, Lusaka, Zambia
| | - Asha George
- School of Public Health and SAMRC Health Services to Systems Unit, University of the Western Cape, Robert Sobukwe Road, Bellville, Cape Town, 7535 South Africa
| | - Helen Schneider
- School of Public Health and SAMRC Health Services to Systems Unit, University of the Western Cape, Robert Sobukwe Road, Bellville, Cape Town, 7535 South Africa
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Kaunda-Khangamwa BN, van den Berg H, McCann RS, Kabaghe A, Takken W, Phiri K, van Vugt M, Manda-Taylor L. The role of health animators in malaria control: a qualitative study of the health animator (HA) approach within the Majete malaria project (MMP) in Chikwawa District, Malawi. BMC Health Serv Res 2019; 19:478. [PMID: 31299974 PMCID: PMC6624973 DOI: 10.1186/s12913-019-4320-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 07/02/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Malaria continues to place a high burden on communities due to challenges reaching intervention target levels in Chikwawa District, Malawi. The Hunger Project Malawi is using a health animator approach (HA) to address gaps in malaria control coverage. We explored the influence of community-based volunteers known as health animators (HAs) in malaria control. We assessed the impact of HAs on knowledge, attitudes, and practices towards malaria interventions. METHODS This paper draws on the qualitative data collected to explore the roles of communities, HAs and formal health workers attending and not attending malaria workshops for malaria control. Purposive sampling was used to select 78 respondents. We conducted 10 separate focus group discussions (FGDs)-(n = 6) with community members and (n = 4) key informants. Nine in-depth interviews (IDIs) were held with HAs and Health Surveillance Assistants (HSAs) in three focal areas near Majete Wildlife Reserve. Nvivo 11 was used for coding and analysis. We employed the framework analysis and social capital theory to determine how the intervention influenced health and social outcomes. RESULTS Using education, feedback sessions and advocacy in malaria workshop had mixed outcomes. There was a high awareness of community participation and comprehensive knowledge of the HA approach as key to malaria control. HAs were identified as playing a complementary role in malaria intervention. Community members' attitudes towards advocacy for better health services were poor. Attendance in malaria workshops was sporadic towards the final year of the intervention. Respondents mentioned positive attitudes and practices on net usage for prevention and prompt health-seeking behaviours. CONCLUSION The HA approach is a useful strategy for complementing malaria prevention strategies in rural communities and improving practices for health-seeking behaviour. Various factors influence HAs' motivation, retention, community engagement, and programme sustainability. However, little is known about how these factors interact to influence volunteers' motivation, community participation and sustainability over time. More research is needed to explore the acceptability of an HA approach and the impact on malaria control in other rural communities in Malawi.
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Affiliation(s)
- Blessings N. Kaunda-Khangamwa
- The School of Public Health and Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi
- The Malaria Alert Centre, University of Malawi, College of Medicine, Blantyre, Malawi
- The University of Witwatersrand, School of Public Health, Johannesburg, South Africa
| | - Henk van den Berg
- Amsterdam UMC, location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Robert S. McCann
- Wageningen University and Research Centre, Wageningen, The Netherlands
- Training and Research Unit of Excellence, University of Malawi, College of Medicine, Blantyre, Malawi
| | - Alinune Kabaghe
- The School of Public Health and Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi
- Training and Research Unit of Excellence, University of Malawi, College of Medicine, Blantyre, Malawi
| | - Willem Takken
- Wageningen University and Research Centre, Wageningen, The Netherlands
| | - Kamija Phiri
- The School of Public Health and Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi
- Training and Research Unit of Excellence, University of Malawi, College of Medicine, Blantyre, Malawi
| | - Michele van Vugt
- Amsterdam UMC, location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Lucinda Manda-Taylor
- The School of Public Health and Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi
- Training and Research Unit of Excellence, University of Malawi, College of Medicine, Blantyre, Malawi
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O'Connor EC, Hutain J, Christensen M, Kamara MS, Conteh A, Sarriot E, Samba TT, Perry HB. Piloting a participatory, community-based health information system for strengthening community-based health services: findings of a cluster-randomized controlled trial in the slums of Freetown, Sierra Leone. J Glob Health 2019; 9:010418. [PMID: 30842881 PMCID: PMC6394878 DOI: 10.7189/jogh.09.010418] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although community engagement has been promoted as a strategy for health systems strengthening, there is need for more evidence for effectiveness of this approach. We describe an operations research (OR) Study and assessment of one form of community engagement, the development and implementation of a participatory community-based health information system (PCBHIS), in slum communities in Freetown, Sierra Leone. METHODS A child survival project was implemented in 10 slum communities, which were then randomly allocated to intervention (PCBHIS) and comparison areas. In the 5 PCBHIS communities, the findings from monthly reports submitted by community health workers (CHWs) and verbal autopsy findings for deaths of children who died before reaching 5 years of age, were processed and shared at bimonthly meetings in each community. These meetings, called Community Health Data Review (CHDR) meetings, were attended by community leaders, including members of the Ward Development Committee (WDC) and Health Management Committee (HMC), by the CHW Peer Supervisors, and by representatives of the Peripheral Health Unit. Following a review of the information, attendees proposed actions to strengthen community-based health services in their community. These meetings were held over a period of 20 months from July 2015 to March 2017. At baseline and endline, knowledge, practice and coverage (KPC) surveys measured household health-related behaviors and care-seeking behaviors. The capacity of HMCs and WDCs to engage with the local health system was also measured at baseline and endline. Reports of CHW household contact and assessments of CHW quality were obtained in the endline KPC household survey, and household contacts measured in monthly submitted reports were also tabulated. RESULTS The self-assessment scores of WDCs' capacity to fulfil their roles improved more in the intervention than in the comparison area for all six components, but for only 1 of the 6 was the improvement statistically significant (monthly and quarterly meetings in which Peer Supervisor and/or CHW supervision was an agenda item). The scores for the HMCs improved less in the intervention area than in the comparison area for all six components, but none of these differences were statistically significant. Topics of discussion in CHDRs focused primarily on CHW functionality. All three indicators of CHW functioning (as measured by reports submitted from CHWs) improved more in the intervention area relative to the comparison area, with 2 out of 3 measures of improvement reaching statistical significance. Five of 7 household behaviors judged to be amenable to promotion by CHWs improved more in the intervention area than in the comparison area, and 2 out of the 5 were statistically significant (feeding colostrum and appropriate infant and young child feeding). Four of the 6 care-seeking behaviors judged to be amenable to promotion by CHWs improved more in the intervention area than in the comparison area, and 1 was statistically significant (treatment of diarrhea with ORS and zinc). None of the findings that favored the comparison area were statistically significant. CONCLUSIONS This study was implemented in challenging circumstances. The OR Study intervention was delayed because of interruptions in finalizing the national CHW policy, two separate cholera epidemics, and the Ebola epidemic lasting more than 2 years. Weaknesses in the CHW intervention severely limited the extent to which the PCBHIS could be used to observe trends in mortality and morbidity. Nonetheless, the positive results achieved in the area of functionality of the CHW intervention and community structure capacity are encouraging. Results suggest there is value in further methodologically rigorous investigations into improving community-based health system functioning through a similar approach to community engagement.
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Affiliation(s)
| | | | | | | | - Abu Conteh
- Formerly Concern Worldwide/Sierra Leone, Freetown, Sierra Leone
| | | | - Thomas T Samba
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Henry B Perry
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Zwama G, Stuttaford MC, Haricharan HJ, London L. Rights-Based Training Enhancing Engagement of Health Providers With Communities, Cape Metropole, South Africa. FRONTIERS IN SOCIOLOGY 2019; 4:35. [PMID: 33869358 PMCID: PMC8022734 DOI: 10.3389/fsoc.2019.00035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 04/04/2019] [Indexed: 06/12/2023]
Abstract
Community participation, the central principle of the primary health care approach, is widely accepted in the governance of health systems. Health Committees (HCs) are community-based structures that can enable communities to participate in the governance of primary health care. Previous research done in the Cape Town Metropole, South Africa, reports that HCs' potential can, however, be limited by a lack of local health providers' (HPs) understanding of HC roles and functions as well as lack of engagement with HCs. This study was the first to evaluate HPs' responsiveness towards HCs following participation in an interactive rights-based training. Thirty-four HPs, from all Cape Metropole health sub-districts, participated in this qualitative training evaluation. Two training groups were observed and participants completed pre- and post-training questionnaires. Semi-structured interviews were held with 10 participants 3-4 months after training. Following training, HPs understood HCs to play an important role in the communication between the local community and HPs. HPs also perceived HCs as able to assist with and improve the quality and accessibility of PHC, as well as the answerability of services to local community needs. HPs expressed intentions to actively engage with the facility's HC and stressed the importance of setting clear roles and responsibilities for all HC members. This training evaluation reveals HPs' willingness to engage with HCs and their desire for skills to achieve this. Moreover, it confirms that HPs are crucial players for the effective functioning of HCs. This evaluation indicates that HPs' increased responsiveness to HCs following training can contribute to tackling the disconnect between service delivery and community needs. Therefore, the training of HPs on HCs potentially promotes the development of needs-responsive PHC and a people-centred health system. The training requires ongoing evaluation as it is extended to other contexts.
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Affiliation(s)
- Gimenne Zwama
- Health and Human Rights Programme, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Institute for Global Health and Development, School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Maria Clasina Stuttaford
- Health and Human Rights Programme, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Health, Social Care and Education, Kingston and St George's University of London, London, United Kingdom
| | - Hanne Jensen Haricharan
- Health and Human Rights Programme, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Leslie London
- Health and Human Rights Programme, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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George AS, LeFevre AE, Schleiff M, Mancuso A, Sacks E, Sarriot E. Hubris, humility and humanity: expanding evidence approaches for improving and sustaining community health programmes. BMJ Glob Health 2018; 3:e000811. [PMID: 29946489 PMCID: PMC6014224 DOI: 10.1136/bmjgh-2018-000811] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/03/2018] [Accepted: 05/03/2018] [Indexed: 11/16/2022] Open
Abstract
Community-based approaches are a critical foundation for many health outcomes, including reproductive, maternal, newborn and child health (RMNCH). Evidence is a vital part of strengthening that foundation, but largely focuses on the technical content of what must be done, rather than on how disparate community actors continuously interpret, implement and adapt interventions in dynamic and varied community health systems. We argue that efforts to strengthen evidence for community programmes must guard against the hubris of relying on a single approach or hierarchy of evidence for the range of research questions that arise when sustaining community programmes at scale. Moving forward we need a broader evidence agenda that better addresses the implementation realities influencing the scale and sustainability of community programmes and the partnerships underpinning them if future gains in community RMNCH are to be realised. This will require humility in understanding communities as social systems, the complexity of the interventions they engage with and the heterogeneity of evidence needs that address the implementation challenges faced. It also entails building common ground across epistemological word views to strengthen the robustness of implementation research by improving the use of conceptual frameworks, addressing uncertainty and fostering collaboration. Given the complexity of scaling up and sustaining community RMNCH, ensuring that evidence translates into action will require the ongoing brokering of relationships to support the human creativity, scepticism and scaffolding that together build layers of evidence, critical thinking and collaborative learning to effect change.
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Affiliation(s)
- Asha S George
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Amnesty E LeFevre
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Emma Sacks
- Johns Hopkins University, Baltimore, Maryland, USA.,Maternal and Child Survival Program, USAID, Washington, District of Columbia, USA
| | - Eric Sarriot
- Maternal and Child Survival Program, USAID, Washington, District of Columbia, USA.,Save the Children, Washington, District of Columbia, USA
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Pfaffmann Zambruni J, Rasanathan K, Hipgrave D, Miller NP, Momanyi M, Pearson L, Rio D, Romedenne M, Singh S, Young M, Peterson S. Community health systems: allowing community health workers to emerge from the shadows. LANCET GLOBAL HEALTH 2018; 5:e866-e867. [PMID: 28807181 DOI: 10.1016/s2214-109x(17)30268-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 06/19/2017] [Accepted: 06/23/2017] [Indexed: 01/23/2023]
Affiliation(s)
| | | | | | | | - Maureen Momanyi
- Eastern and Southern Africa Regional Office, UNICEF, Nairobi, Kenya
| | | | - Dolores Rio
- Nutrition Section, UNICEF, New York, NY, USA
| | | | | | - Mark Young
- Health Section, UNICEF, New York, NY 10017, USA
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Jimenez-Gomez A, Castillo H, Burckart C, Castillo J. Endoscopic Third Ventriculostomy to address hydrocephalus in Africa: A call for education and community-based rehabilitation. J Pediatr Rehabil Med 2017; 10:267-273. [PMID: 29125515 DOI: 10.3233/prm-170454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Endoscopic Third Ventriculostomy (ETV) and Choroid Plexus Cautery (CPC) are low-cost, safe, and promising interventions for spina bifida-associated hydrocephalus (SBHCP). The purpose of this review was to explore and describe these efforts in Africa in order to upscale surgical training and rehabilitation services. METHODS A PubMed search for articles on ETV and CPC as management of SBHCP in Africa was performed. Two authors appraised the results for key themes in content: indications, technique, outcomes, complications, education, and rehabilitation. RESULTS Twenty of 47 articles identified were included for appraisal. Twelve described indications, ten and seven outlined technique and complications, respectively, and four described predictors of operative success. Fourteen studies describe outcomes, including operative and neurodevelopmental outcomes. Only two outlined educational efforts. Half of the literature stems from a single site in Uganda; in total, only six countries were represented. No articles described significant post-operative rehabilitation services or related training. CONCLUSION The experience of ETV and CPC in Africa is promising, however, efforts to train and empower local staff in surgical technique and methods to upscale post-operative community-based rehabilitation services remain as a key to long-term success.
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Affiliation(s)
- Andres Jimenez-Gomez
- Department of Child Neurology and Developmental Neuroscience, Texas Children's Hospital - Baylor College of Medicine, Houston, TX, USA
| | - Heidi Castillo
- Developmental and Behavioral Pediatrics, Department of Pediatrics, Texas Children's Hospital - Baylor College of Medicine, Houston, TX, USA
| | | | - Jonathan Castillo
- Developmental and Behavioral Pediatrics, Department of Pediatrics, Texas Children's Hospital - Baylor College of Medicine, Houston, TX, USA
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George AS, Branchini C. Principles and processes behind promoting awareness of rights for quality maternal care services: a synthesis of stakeholder experiences and implementation factors. BMC Pregnancy Childbirth 2017; 17:264. [PMID: 28854888 PMCID: PMC5577669 DOI: 10.1186/s12884-017-1446-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 08/04/2017] [Indexed: 11/21/2022] Open
Abstract
Background Promoting awareness of rights is a value-based process that entails a different way of thinking and acting, which is at times misunderstood or deemed as aspirational. Methods Guided by the SURE framework, we undertook a secondary analysis of 26 documents identified by an earlier systematic review on promoting awareness of rights to increase use of maternity care services. We thematically analysed stakeholder experiences and implementation factors across the diverse initiatives to derive common elements to guide future efforts. Results Interventions that promote awareness of rights for maternal health varied in nature, methodological orientation, depth and quality. Materials included booklets, posters, pamphlets/ briefs and service standards/charters. Target populations included women, family members, communities, community structures, community-based and non governmental organizations, health providers and administrators, as well as elected representatives. While one initiative only focused on raising awareness, most were embedded within larger efforts to improve the accountability and responsiveness of service delivery through community monitoring and advocacy, with a few aiming to change policies and contest elections. Underlying these action oriented forms of promoting awareness of rights, was a critical consciousness and attitudinal change gained through iterative capacity-building for all stakeholders; materials and processes that supported group discussion and interaction; the formation or strengthening of community groups; situational analysis to ensure adaptation to local context; facilitation to ensure common ground and language across stakeholders; and strategic networking and alliance building across health system levels. While many positive experiences are discussed, few challenges or barriers to implementation are documented. The limited documentation and poor quality of information found indicate that while various examples of promoting awareness of rights for maternal health exists, research partnerships to systematically evaluate their processes, learning and effects are lacking. Conclusion Rather than being aspirational, several examples of promoting awareness of women’s rights for quality maternity care services exist. More than mainly disseminate information, they aim to change stakeholder mindsets and relationships across health system levels. Due to their transformatory intent they require sustained investment, with strategic planning, concrete operationalization and political adeptness to manage dynamic stakeholder expectations and reactions overtime. More investment is also required in research partnerships that support such initiatives and better elucidate their context specific variations.
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Affiliation(s)
- Asha S George
- South African Research Chair in Health Systems, Complexity and Social Change, School of Public Health, University of the Western Cape, Private Bag X17, Bellville, 7535, South Africa. .,Health Systems Program, Department of International Health, Johns Hopkins School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Casey Branchini
- Health Systems Program, Department of International Health, Johns Hopkins School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA
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Martin S, Leitão J, Muhangi D, Nuwa A, Magul D, Counihan H. Community dialogues for child health: results from a qualitative process evaluation in three countries. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2017; 36:29. [PMID: 28583170 PMCID: PMC5460475 DOI: 10.1186/s41043-017-0106-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 05/29/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Across the developing world, countries are increasingly adopting the integrated community case management of childhood illnesses (iCCM) strategy in efforts to reduce child mortality. This intervention's effectiveness is dependent on community adoption and changes in care-seeking practices. We assessed the implementation process of a theory-driven community dialogue (CD) intervention specifically designed to strengthen the support and uptake of the newly introduced iCCM services and related behaviours in three African countries. METHODS A qualitative process evaluation methodology was chosen and used secondary project data and primary data collected in two districts of each of the three countries, in purposefully sampled communities. The final data set included 67 focus group discussions and 57 key informant interviews, totalling 642 respondents, including caregivers, CD facilitators community leaders, and trainers. Thematic analysis of the data followed the 'Framework Approach' utilising both a deduction and induction process. RESULTS Results show that CDs contribute to triggering community uptake of and support for iCCM services through filling health information gaps and building cooperation within communities. We found it to be an effective approach for addressing social norms around child care practices. This approach was embraced by communities for its flexibility and value in planning individual and collective change. CONCLUSIONS Regular CDs can contribute to the formation of new habits, particularly in relation to seeking timely care in case of child sickness. This study also confirms the value of process evaluation to unwrap the mechanisms of community mobilisation approaches in context and provides key insights for improving the CD approach.
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Affiliation(s)
- Sandrine Martin
- Malaria Consortium Mozambique, Rua Joseph Ki-Zerbo 191, PO Box 3655, Coop, Maputo Mozambique
| | - Jordana Leitão
- Independant consultant, Rua Custódio Bento de Azevedo n° 24, Luanda, Angola
| | - Denis Muhangi
- Department of Social Work and Social Administration, Makerere University, P.O.Box 7062, Kampala, Uganda
| | - Anthony Nuwa
- Malaria Consortium Uganda, Plot 25 Upper Naguru East Road, P.O.Box 8045, Kampala, Uganda
| | - Dieterio Magul
- Malaria Consortium Mozambique, Av. Prof. De Moçambique, 62, Inhambane, Mozambique
| | - Helen Counihan
- Malaria Consortium Headquarters, Development House 56-64 Leonard Street, London, EC2A 4LT UK
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Paina L, Vadrevu L, Hanifi SMMA, Akuze J, Rieder R, Chan KS, Peters DH. What is the role of community capabilities for maternal health? An exploration of community capabilities as determinants to institutional deliveries in Bangladesh, India, and Uganda. BMC Health Serv Res 2016; 16:621. [PMID: 28185588 PMCID: PMC5123293 DOI: 10.1186/s12913-016-1861-0] [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] [Indexed: 11/11/2022] Open
Abstract
Background While community capabilities are recognized as important factors in developing resilient health systems and communities, appropriate metrics for these have not yet been developed. Furthermore, the role of community capabilities on access to maternal health services has been underexplored. In this paper, we summarize the development of a community capability score based on the Future Health System (FHS) project’s experience in Bangladesh, India, and Uganda, and, examine the role of community capabilities as determinants of institutional delivery in these three contexts. Methods We developed a community capability score using a pooled dataset containing cross-sectional household survey data from Bangladesh, India, and Uganda. Our main outcome of interest was whether the woman delivered in an institution. Our predictor variables included the community capability score, as well as a series of previously identified determinants of maternal health. We calculate both population-averaged effects (using GEE logistic regression), as well as sub-national level effects (using a mixed effects model). Results Our final sample for analysis included 2775 women, of which 1238 were from Bangladesh, 1199 from India, and 338 from Uganda. We found that individual-level determinants of institutional deliveries, such as maternal education, parity, and ante-natal care access were significant in our analysis and had a strong impact on a woman’s odds of delivering in an institution. We also found that, in addition to individual-level determinants, greater community capability was significantly associated with higher odds of institutional delivery. For every additional capability, the odds of institutional delivery would increase by up to almost 6 %. Conclusion Individual-level characteristics are strong determinants of whether a woman delivered in an institution. However, we found that community capability also plays an important role, and should be taken into account when designing programs and interventions to support institutional deliveries. Consideration of individual factors and the capabilities of the communities in which people live would contribute to the vision of supporting people-centered approaches to health. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1861-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ligia Paina
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Lalitha Vadrevu
- Indian Institute of Health Management Research, 1 Prabhu Dayal Marg, Sanganer, Jaipur, 302029, India
| | | | - Joseph Akuze
- Department of Health Policy, Planning, and Management, Center of Excellence for Maternal and Newborn Health Research, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Rachel Rieder
- DKT International Tanzania, Meranani St, Dar es Salaam, Tanzania
| | - Kitty S Chan
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, #633, Baltimore, MD, 21205, USA
| | - David H Peters
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Barman D, Vadrevu L. How is perceived community cohesion and membership in community groups associated with children's dietary adequacy in disadvantaged communities? A case of the Indian Sundarbans. BMC Health Serv Res 2016; 16:622. [PMID: 28185598 PMCID: PMC5123337 DOI: 10.1186/s12913-016-1862-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Membership in community groups and a sense of community cohesion may facilitate collective action in mobilizing resources towards better health outcomes. This paper explores the relationship of these factors, along with individual level socio-economic variables, to dietary adequacy among children below 6 years of age, a proximate determinant of child malnutrition. Methods We conducted a cross-sectional survey in Patharpratima block of the Sundarbans in West Bengal, India, using a two-stage, 30 cluster random sampling design. In 1200 sampled households, we used a structured questionnaire to interview mothers of children below 6 years of age on their child’s nutritional intake. We also interviewed household heads to assess perceived community cohesion using a nine item scale, membership in any community self-help organization, and other socio-economic determinants. We used a logistic regression model to assess their association with a minimum acceptable diet among children between 6 months to 6 years. Results Only 9.33 % children between 6 and 71 months of age received a minimum acceptable diet. With each increase in the perceived community cohesion score (scale 0-9), a child is 1.31 times more likely to have minimum acceptable diet (95 % CI 1.14, 1.50). The odds of minimum acceptable diet were also higher among children whose mothers had primary education (2.09, 95 % CI 1.03, 2.94) as compared to illiterate mothers and in households with surplus food resources (2.72, 95 % CI 1.32, 5.58) as compared to those without surplus or deficit. In contrast, registering at an Anganwadi (government early child development) centre (odds ratio 1.34 95 % CI 0.69, 2.60) and community membership (odds ratio 0.93, 95 % CI 0.59, 1.46) were not associated with minimum acceptable diet. Conclusion The results are consistent with what is known about the importance of maternal education and access to food resources in ensuring that children have a minimum acceptable diet. Perceived community cohesion seems to play a positive role in children’s diets. Further research needs to clarify which community characteristics and services are the most relevant, how they can better support children’s diets, and how interventions can strengthen these community characteristics and services.
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Bhuiya A, Hanifi SMA, Hoque S. Unlocking community capability through promotion of self-help for health: experience from Chakaria, Bangladesh. BMC Health Serv Res 2016; 16:624. [PMID: 28185584 PMCID: PMC5123251 DOI: 10.1186/s12913-016-1865-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND People's participation in health, enshrined in the 1978 Alma Ata declaration, seeks to tap into community capability for better health and empowerment. One mechanism to promote participation in health is through participatory action research (PAR) methods. Beginning in 1994, the Bangladeshi research organization ICDDR,B implemented a project "self-help for health," to work with existing rural self-help organizations (SHOs). SHOs are organizations formed by villagers for their well-being through their own initiatives without external material help. This paper describes the project's implementation, impact, and reflective learnings. METHODS Following a self-help conceptual framework and PAR, the project focused on building the capacity of SHOs and their members through training on organizational issues, imparting health literacy, and supporting participatory planning and monitoring. Quarterly activity reports and process documentation were the main sources of qualitative data used for this paper, enabling documentation of changes in organizational issues, as well as the number and nature of initiatives taken by the SHOs in the intervention area. Health and demographic surveillance system (HDSS) data from intervention and comparison areas since 1999 allowed assessment of changes in health indicators over time. RESULTS Villagers and members of the SHOs actively participated in the self-help activities. SHO functionality increased in the intervention area, in terms of improved organizational processes and planned health activities. These included most notably in convening more regular meetings, identifying community needs, developing and implementing action plans, and monitoring progress and impact. Between 1999 and 2015, while decreases in infant mortality and increases in utilization of at least one antenatal care visit occurred similarly in intervention and comparison areas, increases in immunization, skilled birth attendance, facility deliveries and sanitary latrines were substantially more in intervention than comparison areas. CONCLUSION Building community capability by working with pre-existing SHOs, encouraging them to place health on their agendas, strengthening their functioning and implementation of health activities led to sustained improvements in utilization of services for over 20 years. Key elements underpinning success include efforts to build and maintain trust, ensuring social inclusion in project activities, and balancing demands for material resources with flexibility to be responsive to community needs.
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Affiliation(s)
- Abbas Bhuiya
- Partners in Population and Development, Dhaka, Bangladesh. .,Formerly of Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Bangladesh.
| | - Syed Manzoor Ahmed Hanifi
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Bangladesh
| | - Shahidul Hoque
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Bangladesh
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George AS, Scott K, Sarriot E, Kanjilal B, Peters DH. Unlocking community capabilities across health systems in low- and middle-income countries: lessons learned from research and reflective practice. BMC Health Serv Res 2016; 16:631. [PMID: 28185599 PMCID: PMC5123243 DOI: 10.1186/s12913-016-1859-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Asha S George
- School of Public Health, University of the Western Cape, Cape Town, 7535, South Africa. .,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Kerry Scott
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.,Global Health Consultant, Bangalore, Karnataka, 560084, India
| | - Eric Sarriot
- Department of Global Health, Save the Children, Washington DC, 20002, USA
| | - Barun Kanjilal
- Indian Institute of Health Management Research, Jaipur, 302029, India
| | - David H Peters
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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Abstract
BACKGROUND Health systems research is increasingly being conducted in low and middle-income countries (LMICs). Such research should aim to reduce health disparities between and within countries as a matter of global justice. For such research to do so, ethical guidance that is consistent with egalitarian theories of social justice proposes it ought to (amongst other things) focus on worst-off countries and research populations. Yet who constitutes the worst-off is not well-defined. METHODS AND RESULTS By applying existing work on disadvantage from political philosophy, the paper demonstrates that (at least) two options exist for how to define the worst-off upon whom equity-oriented health systems research should focus: those who are worst-off in terms of health or those who are systematically disadvantaged. The paper describes in detail how both concepts can be understood and what metrics can be relied upon to identify worst-off countries and research populations at the sub-national level (groups, communities). To demonstrate how each can be used, the paper considers two real-world cases of health systems research and whether their choice of country (Uganda, India) and research population in 2011 would have been classified as amongst the worst-off according to the proposed concepts. CONCLUSIONS The two proposed concepts can classify different countries and sub-national populations as worst-off. It is recommended that health researchers (or other actors) should use the concept that best reflects their moral commitments-namely, to perform research focused on reducing health inequalities or systematic disadvantage more broadly. If addressing the latter, it is recommended that they rely on the multidimensional poverty approach rather than the income approach to identify worst-off populations.
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Affiliation(s)
- Bridget Pratt
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, 161 Barry Street Carlton, VIC 3053 Australia
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| | - Adnan A. Hyder
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
- Johns Hopkins Berman Institute of Bioethics, 1809 Ashland Avenue, Baltimore, MD 21205 USA
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