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Manguele ALJ, Sidat M, Ferrinho P, Cabral AJR, Craveiro I. Strikes of physicians and other health care workers in sub-Saharan African countries: a systematic review. Front Public Health 2024; 12:1209201. [PMID: 38873309 PMCID: PMC11169935 DOI: 10.3389/fpubh.2024.1209201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 04/25/2024] [Indexed: 06/15/2024] Open
Abstract
Introduction Strikes in the health sector have been of growing concern, given their disruptive nature, negatively impacting the provision of health care and jeopardizing the well-being of patients. This study aims to identify the main actors, the reasons behind industrial actions protests, strikes and lockouts (IAPSL) in sub-Saharan African countries and their impact on health care workers (specifically doctors) and health services, as well as to identify the main strategies adopted to reduce their impact on healthcare services. Methods Studies published between January 2000 and December 2021 and archived in MEDLINE, Google Scholar, Scopus, ProQuest, and Science Direct were included. Quantitative, observational (i.e., cohort, case-control, cross-sectional, and ecological) and experimental studies, as well as mixed methods, quasi-experimental, and qualitative studies were eligible. Results A total of 5521 studies were identified and after eliminating duplicates, applying the inclusion criteria, and assessing the risk of bias, a total of 11 studies were included in the review. Nurses and doctors are the actors most commonly involved in strikes. The main causes of strikes were salary claims and poor working conditions. The main strategies adopted to mitigate the strike consequences were to restrict services and prioritize emergency and chronic care, greater cooperation with the private sector and rearrange tasks of the available staff. The strikes led to a reduction in hospitalizations and in the number of women giving birth in health units, an increase in maternal and child morbidities and delays in the immunization process. Increased mortality was only reported in faith-based hospitals. Discussion This evidence can assist decision-makers in developing strategies and interventions to address IAPSL by health care workers, contributing to strengthen the health system. Strikes in the health sector disrupt healthcare services provision and compromise the well-being of patients, especially the most disadvantaged, with consequences that may be difficult to overcome ever. The potential health impacts of strikes highlights the importance of their prevention or timely resolution through regulation and negotiations to balance the rights of health care workers and the rights of patients. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=334173, identifier CRD42022334173.
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Affiliation(s)
- Alexandre Lourenço Jaime Manguele
- Instituto Superior de Ciências de Saúde, Maputo, Mozambique
- Global Health and Tropical Medicine, GHTM, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Mohsin Sidat
- Global Health and Tropical Medicine, GHTM, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, Lisboa, Portugal
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Paulo Ferrinho
- Global Health and Tropical Medicine, GHTM, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - António Jorge Rodrigues Cabral
- Global Health and Tropical Medicine, GHTM, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Isabel Craveiro
- Global Health and Tropical Medicine, GHTM, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, Lisboa, Portugal
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Buabeng-Baidoo B, Olivier J. Public-Private engagement and health systems resilience in times of health worker strikes: a Ghanaian case study. Health Policy Plan 2024; 39:469-485. [PMID: 38498334 PMCID: PMC11095267 DOI: 10.1093/heapol/czae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/02/2024] [Accepted: 03/13/2024] [Indexed: 03/20/2024] Open
Abstract
In low and middle-income countries like Ghana, private providers, particularly the grouping of faith-based non-profit health providers networked by the Christian Health Association of Ghana (CHAG), play a crucial role in maintaining service continuity during health worker strikes. Poor engagement with the private sector during such strikes could compromise care quality and impose financial hardships on populations, especially the impoverished. This study delves into the engagement between CHAG and the Government of Ghana (GoG) during health worker strikes from 2010 to 2016, employing a qualitative descriptive and exploratory case study approach. By analysing evidence from peer-reviewed literature, media archives, grey literature and interview transcripts from a related study using a qualitative thematic analysis approach, this study identifies health worker strikes as a persistent chronic stressor in Ghana. Findings highlight some system-level interactions between CHAG and GoG, fostering adaptive and absorptive resilience strategies, influenced by CHAG's non-striking ethos, unique secondment policy between the two actors and the presence of a National Health Insurance System. However, limited support from the government to CHAG member facilities during strikes and systemic challenges with the National Health Insurance System pose threats to CHAG's ability to provide quality, affordable care. This study underscores private providers' pivotal role in enhancing health system resilience during strikes in Ghana, advocating for proactive governmental partnerships with private providers and joint efforts to address human-resource-related challenges ahead of strikes. It also recommends further research to devise and evaluate effective strategies for nations to respond to strikes, ensuring preparedness and sustained quality healthcare delivery during such crises.
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Affiliation(s)
| | - Jill Olivier
- School of Public Health, University of Cape Town, Rondebosch 7701, South Africa
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Lateef MA, Kuupiel D, Mchunu GG, Pillay JD. Utilization of Antenatal Care and Skilled Birth Delivery Services in Sub-Saharan Africa: A Systematic Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:440. [PMID: 38673351 PMCID: PMC11050659 DOI: 10.3390/ijerph21040440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/15/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024]
Abstract
Daily, the number of women who die around the world reaches an average of 800; these deaths are a result of obstetric complications in pregnancy and childbirth, and 99% of these deaths occur in low- and middle-income countries. This review probes the use of antenatal care (ANC) and skilled birth delivery (SBD) services in sub-Saharan Africa (SSA) and highlights research gaps using Arksey and O'Malley's methodological approach. The screening of abstracts and full text was carried out by two independent authors who ensured the eligibility of data extraction from the included articles. An exploration of the data was undertaken with descriptive analyses. In total, 350 potentially eligible articles were screened, and 137 studies were included for data extraction and analysis. From the 137 included studies, the majority were from Ethiopia (n = 40, 29.2%), followed by Nigeria (n = 30, 21.9%). Most of the studies were published between 2019 and 2023 (n = 84, 61%). Significant trends and challenges with ANC and SBD services emerged from the studies. It is revealed that there are wide gaps in the utilization of ANC and SBD services. Policy attention, intervention strategies to improve access, resources, rural-urban disparity, and women's literacy are recommended to improve the utilization of ANC and SBD services in SSA countries.
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Affiliation(s)
- Monsurat A. Lateef
- Faculty of Health Sciences, Durban University of Technology, Durban 4001, South Africa; (D.K.); (G.G.M.); (J.D.P.)
| | - Desmond Kuupiel
- Faculty of Health Sciences, Durban University of Technology, Durban 4001, South Africa; (D.K.); (G.G.M.); (J.D.P.)
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Gugu G. Mchunu
- Faculty of Health Sciences, Durban University of Technology, Durban 4001, South Africa; (D.K.); (G.G.M.); (J.D.P.)
| | - Julian D. Pillay
- Faculty of Health Sciences, Durban University of Technology, Durban 4001, South Africa; (D.K.); (G.G.M.); (J.D.P.)
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Miller L, Wanduru P, Wangia J, Calkins K, Spindler H, Butrick E, Santos N, Kirumbi L, Walker D. Simulation and team training to improve preterm birth knowledge, evidence-based practices, and communication skills in midwives in Kenya and Uganda: Findings from a pre- and post-intervention analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001695. [PMID: 37289721 DOI: 10.1371/journal.pgph.0001695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 05/10/2023] [Indexed: 06/10/2023]
Abstract
Simulation training in basic and emergency obstetric and neonatal care has previously shown success in reducing maternal and neonatal mortality in low-resource settings. Though preterm birth is the leading cause of neonatal deaths, application of this training methodology geared specifically towards reducing preterm birth mortality and morbidity has not yet been implemented and evaluated. The East Africa Preterm Birth Initiative (PTBi-EA) was a multi-country cluster randomized controlled (CRCT) trial that successfully improved outcomes of preterm neonates in Migori County, Kenya and the Busoga region of Uganda through an intrapartum package of interventions. PRONTO simulation and team training (STT) was one component of this package and was introduced to maternity unit providers in 13 facilities. This analysis was nested within the larger CRCT and specifically looked at the impact of the STT portion of the intervention package. The PRONTO STT curriculum was modified to emphasize prematurity-related intrapartum and immediate postnatal care practices, such as assessment of gestational age, identification of preterm labour, and administration of antenatal corticosteroids. Knowledge and communication techniques were assessed at the beginning and end of the intervention through a multiple-choice knowledge test. Clinical skills and communication techniques used in context were assessed through the use of evidence-based practiced (EBPs) as documented in video-recorded simulations through StudioCodeTM video analysis. Pre-and-post scores were compared in both categories using Chi-squared tests. Knowledge assessment scores improved from 51% to 73% with maternal-related questions improving from 61% to 74%, neonatal questions from 55% to 73%, and communication technique questions from 31% to 71%. The portion of indicated preterm birth EBPs performed in simulation increased from 55% to 80% with maternal-related EBPs improving from 48% to 73%, neonatal-related EBPs from 63% to 93%, and communication techniques from 52% to 69%. STT substantially increased preterm birth-specific knowledge and EBPs performed in simulation.
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Affiliation(s)
- Lara Miller
- University of California, San Francisco Institute for Global Health Sciences, San Francisco, CA, United States of America
| | - Phillip Wanduru
- Makerere University School of Public Health, Kampala, Uganda
| | | | | | - Hilary Spindler
- University of California, San Francisco Institute for Global Health Sciences, San Francisco, CA, United States of America
| | - Elizabeth Butrick
- University of California, San Francisco Institute for Global Health Sciences, San Francisco, CA, United States of America
| | - Nicole Santos
- University of California, San Francisco Institute for Global Health Sciences, San Francisco, CA, United States of America
| | - Leah Kirumbi
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Dilys Walker
- University of California, San Francisco Institute for Global Health Sciences, San Francisco, CA, United States of America
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Getahun M, Oboke EN, Ogolla BA, Kinyua J, Ongeri L, Sterling M, Oluoch I, Lyndon A, Afulani PA. Sources of stress and coping mechanisms: Experiences of maternal health care providers in Western Kenya. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001341. [PMID: 36962929 PMCID: PMC10022275 DOI: 10.1371/journal.pgph.0001341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/11/2023] [Indexed: 02/12/2023]
Abstract
The dynamic and complex nature of care provision predisposes healthcare workers to stress, including physical, emotional, or psychological fatigue due to individual, interpersonal, or organizational factors. We conducted a convergent mixed-methods study with maternity providers to understand their sources of stress and coping mechanisms they adopt. Data were collected in Migori County in western Kenya utilizing quantitative surveys with n = 101 maternity providers and in-depth interviews with a subset of n = 31 providers. We conducted descriptive analyses for the quantitative data. For qualitative data, we conducted thematic analysis, where codes were deductively developed from interview guides, iteratively refined based on emergent data, and applied by a team of five researchers using Dedoose software. Code queries were then analysed to identify themes and organized using the socioecological (SE) framework to present findings at the individual, interpersonal, and organizational levels. Providers reported stress due to high workloads (61%); lack of supplies (37%), poor salary (32%), attitudes of colleagues and superiors (25%), attitudes of patients (21%), and adverse outcomes (16%). Themes from the qualitative analysis mirrored the quantitative analysis with more detailed information on the factors contributing to each and how these sources of stress affect providers and patient outcomes. Coping mechanisms adopted by providers are captured under three themes: addressing stress by oneself, reaching out to others, and seeking help from a higher power. Findings underscore the need to address organizational, interpersonal, and individual level stressors. Strategies are needed to support staff retention, provide adequate resources and incentives for providers, and ultimately improve patient outcomes. Interventions should support and leverage the positive coping mechanisms identified.
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Affiliation(s)
- Monica Getahun
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | | | | | | | | | - Mona Sterling
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | | | - Audrey Lyndon
- NYU Rory Meyers College of Nursing, New York, NY, United States of America
| | - Patience A. Afulani
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
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Macharia PM, Joseph NK, Nalwadda GK, Mwilike B, Banke-Thomas A, Benova L, Johnson O. Spatial variation and inequities in antenatal care coverage in Kenya, Uganda and mainland Tanzania using model-based geostatistics: a socioeconomic and geographical accessibility lens. BMC Pregnancy Childbirth 2022; 22:908. [PMID: 36474193 PMCID: PMC9724345 DOI: 10.1186/s12884-022-05238-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pregnant women in sub-Saharan Africa (SSA) experience the highest levels of maternal mortality and stillbirths due to predominantly avoidable causes. Antenatal care (ANC) can prevent, detect, alleviate, or manage these causes. While eight ANC contacts are now recommended, coverage of the previous minimum of four visits (ANC4+) remains low and inequitable in SSA. METHODS We modelled ANC4+ coverage and likelihood of attaining district-level target coverage of 70% across three equity stratifiers (household wealth, maternal education, and travel time to the nearest health facility) based on data from malaria indicator surveys in Kenya (2020), Uganda (2018/19) and Tanzania (2017). Geostatistical models were fitted to predict ANC4+ coverage and compute exceedance probability for target coverage. The number of pregnant women without ANC4+ were computed. Prediction was at 3 km spatial resolution and aggregated at national and district -level for sub-national planning. RESULTS About six in ten women reported ANC4+ visits, meaning that approximately 3 million women in the three countries had <ANC4+ visits. The majority of the 366 districts in the three countries had ANC4+ coverage of 50-70%. In Kenya, 13% of districts had < 70% coverage, compared to 10% and 27% of the districts in Uganda and mainland Tanzania, respectively. Only one district in Kenya and ten districts in mainland Tanzania were likely met the target coverage. Six percent, 38%, and 50% of the districts had at most 5000 women with <ANC4+ visits in Kenya, Uganda, and mainland Tanzania, respectively, while districts with > 20,000 women having <ANC4+ visits were 38%, 1% and 1%, respectively. In many districts, ANC4+ coverage and likelihood of attaining the target coverage was lower among the poor, uneducated and those geographically marginalized from healthcare. CONCLUSIONS These findings will be invaluable to policymakers for annual appropriations of resources as part of efforts to reduce maternal deaths and stillbirths.
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Affiliation(s)
- Peter M. Macharia
- grid.33058.3d0000 0001 0155 5938Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya ,grid.9835.70000 0000 8190 6402Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Noel K. Joseph
- grid.33058.3d0000 0001 0155 5938Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya ,grid.9835.70000 0000 8190 6402Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK
| | | | - Beatrice Mwilike
- grid.25867.3e0000 0001 1481 7466Community Health Nursing Department, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Aduragbemi Banke-Thomas
- grid.36316.310000 0001 0806 5472School of Human Sciences, University of Greenwich, London, UK
| | - Lenka Benova
- grid.11505.300000 0001 2153 5088Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Olatunji Johnson
- grid.5379.80000000121662407Department of Mathematics, The University of Manchester, Manchester, UK
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Scanlon ML, Maldonado LY, Ikemeri JE, Jumah A, Anusu G, Chelagat S, Keter JC, Songok J, Ruhl LJ, Christoffersen-Deb A. 'It was hell in the community': a qualitative study of maternal and child health care during health care worker strikes in Kenya. Int J Equity Health 2021; 20:210. [PMID: 34556148 PMCID: PMC8461886 DOI: 10.1186/s12939-021-01549-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health care workers in Kenya have launched major strikes in the public health sector in the past decade but the impact of strikes on health systems is under-explored. We conducted a qualitative study to investigate maternal and child health care and services during nationwide strikes by health care workers in 2017 from the perspective of pregnant women, community health volunteers (CHVs), and health facility managers. METHODS We conducted in-depth interviews and focus group discussions (FGDs) with three populations: women who were pregnant in 2017, CHVs, and health facility managers. Women who were pregnant in 2017 were part of a previous study. All participants were recruited using convenience sampling from a single County in western Kenya. Interviews and FGDs were conducted in English or Kiswahili using semi-structured guides that probed women's pregnancy experiences and maternal and child health services in 2017. Interviews and FGDs were audio-recorded, translated, and transcribed. Content analysis followed a thematic framework approach using deductive and inductive approaches. RESULTS Forty-three women and 22 CHVs participated in 4 FGDs and 3 FGDs, respectively, and 8 health facility managers participated in interviews. CHVs and health facility managers were majority female (80%). Participants reported that strikes by health care workers significantly impacted the availability and quality of maternal and child health services in 2017 and had indirect economic effects due to households paying for services in the private sector. Participants felt it was the poor, particularly poor women, who were most affected since they were more likely to rely on public services, while CHVs highlighted their own poor working conditions in response to strikes by physicians and nurses. Strikes strained relationships and trust between communities and the health system that were identified as essential to maternal and child health care. CONCLUSION We found that the impacts of strikes by health care workers in 2017 extended beyond negative health and economic effects and exacerbated fundamental inequities in the health system. While this study was conducted in one County, our findings suggest several potential avenues for strengthening maternal and child health care in Kenya that were highlighted by nationwide strikes in 2017.
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Affiliation(s)
- Michael L Scanlon
- Indiana University Center for Global Health, 702 Rotary Circle, Suite RO 101, Indianapolis, IN, USA. .,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
| | - Lauren Y Maldonado
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Medicine and Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Justus E Ikemeri
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Anjellah Jumah
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Getrude Anusu
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Sheilah Chelagat
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Julia Songok
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Child Health and Paediatrics, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Laura J Ruhl
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Astrid Christoffersen-Deb
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada.,Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada
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