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Zulu JM, Mwamba T, Rosen A, Matenga TFL, Mulanda J, Kaimba M, Chilembo M, Silondwa M, Kamboyi RL, Simwanza SC, Sichone G, Chavula MP. Community engagement for the Voluntary Medical Male Circumcision (VMMC) program: an analysis of key stakeholder roles to promote a sustainable program in Zambia. Gates Open Res 2023; 6:50. [PMID: 37069966 PMCID: PMC10105033 DOI: 10.12688/gatesopenres.13587.2] [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] [Accepted: 05/18/2023] [Indexed: 05/31/2023] Open
Abstract
Background: Within the Voluntary Medical Male Circumcision (VMMC) programme, community engagement has been central in facilitating the acceptance of VMMC, especially in non-circumcising communities. We used the case of the development of community engagement plans for sustainability of VMMC in Zambia to illustrate diversity of stakeholders, their power, roles, and strategies in community engagement. Methods: Data were collected using document review, in-depth interviews (n=35) and focus group discussions (n=35) with community stakeholders, health workers, health centre committees, counsellors, teachers, community volunteers and parents/caregivers. Data were analysed using thematic analysis. The analysis was guided by the power and interest model. Results: Differences were noted between the rural and urban sites in terms of power/influence and interest rating of community stakeholders who could be involved in the sustainability phase of the VMMC response in Zambia. For example, in the urban setting, neighbourhood health committees (NHCs), health workers, leaders of clubs, community health workers (CHWs), radio, television and social media platforms were ranked highest. From this list, social media and television platforms were not highly ranked in rural areas. Some stakeholders had more sources of power than others. Forms or sources of power included technical expertise, local authority, financial resources, collective action (action through schools, churches, media platforms, other community spaces), and relational power. Key roles and strategies included strengthening and broadening local coordination systems, enhancing community involvement, promoting community-led monitoring and evaluation, through the use of locally recognised communication spaces and channels, facilitating ownership of VMMC, and improving local accountability processes in VMMC activities. Conclusions: By consulting with the most relevant stakeholders, and considering community needs in programme development, the VMMC programme may be able to leverage the community structures and systems to reduce long term demand generation costs for VMMC and increase the acceptability and frequency of male circumcision.
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Affiliation(s)
- Joseph M. Zulu
- Department of Health Promotion and Education, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia, University of Zambia, Lusaka, 10101, Zambia
| | - Trevor Mwamba
- Clinton Health Access Initiative, Clinton Health Access Initiative, Lusaka, 10101, Zambia
| | - Alyssa Rosen
- Clinton Health Access Initiative, Clinton Health Access Initiative, Lusaka, 10101, Zambia
| | - Tulani Francis L. Matenga
- Department of Health Promotion and Education, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia, University of Zambia, Lusaka, 10101, Zambia
| | - Joseph Mulanda
- Department of Health Promotion and Education, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia, University of Zambia, Lusaka, 10101, Zambia
| | - Mutale Kaimba
- Department of Health Promotion and Education, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia, University of Zambia, Lusaka, 10101, Zambia
| | - Masitano Chilembo
- Clinton Health Access Initiative, Clinton Health Access Initiative, Lusaka, 10101, Zambia
| | - Madaliso Silondwa
- Clinton Health Access Initiative, Clinton Health Access Initiative, Lusaka, 10101, Zambia
| | - Royd L. Kamboyi
- Ministry of Health, Ministry of Health, Lusaka, Lusaka, 10101, Zambia
| | | | - George Sichone
- Department of Health Promotion and Education, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia, University of Zambia, Lusaka, 10101, Zambia
| | - Malizgani Paul Chavula
- Department of Health Promotion and Education, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia, University of Zambia, Lusaka, 10101, Zambia
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Chavula MP, Zulu JM, Hurtig AK. Factors influencing the integration of comprehensive sexuality education into educational systems in low- and middle-income countries: a systematic review. Reprod Health 2022; 19:196. [PMID: 36175901 PMCID: PMC9524136 DOI: 10.1186/s12978-022-01504-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 09/12/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Comprehensive sexuality education (CSE) plays a critical role in promoting youth and adolescent's sexual and reproductive health and wellbeing. However, little is known about the enablers and barriers affecting the integration of CSE into educational programmes. The aim of this review is to explore positive and negative factors influencing the integration of CSE into national curricula and educational systems in low- and middle-income countries. METHODS We conducted a systematic literature review (January 2010 to August 2022). The results accord with the Preferred Reporting Items for Systematic Reviews and Meta-analysis standards for systematic reviews. Data were retrieved from the PubMed, Cochrane, Google Scholar, and Web of Hinari databases. The search yielded 442 publications, of which 34 met the inclusion criteria for full-text screening. The review is guided by an established conceptual framework that incorporates the integration of health innovations into health systems. Data were analysed using a thematic synthesis approach. RESULTS The magnitude of the problem is evidenced by sexual and reproductive health challenges such as high teenage pregnancies, early marriages, and sexually transmitted infections. Awareness of these challenges can facilitate the development of interventions and the implementation and integration of CSE. Reported aspects of the interventions include core CSE content, delivery methods, training materials and resources, and various teacher-training factors. Reasons for adoption include perceived benefits of CSE, experiences and characteristics of both teachers and learners, and religious, social and cultural factors. Broad system characteristics include strengthening links between schools and health facilities, school and community-based collaboration, coordination of CSE implementation, and the monitoring and evaluation of CSE. Ultimately, the availability of resources, national policies and laws, international agendas, and political commitment will impact upon the extent and level of integration. CONCLUSION Social, economic, cultural, political, legal, and financial contextual factors influence the implementation and integration of CSE into national curricula and educational systems. Stakeholder collaboration and involvement in the design and appropriateness of interventions is critical.
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Affiliation(s)
- Malizgani Paul Chavula
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden. .,School of Public Health, Department of Health Promotion and Policy Management, University of Zambia, Ridgeway Campus, P. O. Box 50110, Lusaka, Zambia.
| | - Joseph Mumba Zulu
- grid.12984.360000 0000 8914 5257School of Public Health, Department of Health Promotion and Policy Management, University of Zambia, Ridgeway Campus, P. O. Box 50110, Lusaka, Zambia
| | - Anna-Karin Hurtig
- grid.12650.300000 0001 1034 3451Department of Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
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Zulu JM, Mwamba T, Rosen A, Matenga TFL, Mulanda J, Kaimba M, Chilembo M, Silondwa M, Kamboyi RL, Simwanza SC, Sichone G, Chavula MP. Community engagement for the Voluntary Medical Male Circumcision (VMMC) program: an analysis of key stakeholder roles to promote a sustainable program in Zambia. Gates Open Res 2022; 6:50. [PMID: 37069966 PMCID: PMC10105033 DOI: 10.12688/gatesopenres.13587.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Within the Voluntary Medical Male Circumcision (VMMC) programme, community engagement has been central in facilitating the acceptance of VMMC, especially in non-circumcising communities. We used the case of the development of community engagement plans for sustainability of VMMC in Zambia to illustrate diversity of stakeholders, their power, roles, and strategies in community engagement. Methods: Data were collected using document review, in-depth interviews (n=35) and focus group discussions (n=35) with community stakeholders, health workers, health centre committees, counsellors, teachers, community volunteers and parents/caregivers. Data were analysed using thematic analysis. The analysis was guided by the power and interest model. Results: Differences were noted between the rural and urban sites in terms of power/influence and interest rating of community stakeholders who could be involved in the sustainability phase of the VMMC response in Zambia. For example, in the urban setting, neighbourhood health committees (NHCs), health workers, leaders of clubs, community health workers (CHWs), radio, television and social media platforms were ranked highest. From this list, social media and television platforms were not highly ranked in rural areas. Some stakeholders had more sources of power than others. Forms or sources of power included technical expertise, local authority, financial resources, collective action (action through schools, churches, media platforms, other community spaces), and relational power. Key roles and strategies included strengthening and broadening local coordination systems, enhancing community involvement, promoting community-led monitoring and evaluation, through the use of locally recognised communication spaces and channels, facilitating ownership of VMMC, and improving local accountability processes in VMMC activities. Conclusions: By consulting with the most relevant stakeholders, and considering community needs in programme development, the VMMC programme may be able to leverage the community structures and systems to reduce long term demand generation costs for VMMC and increase the acceptability and frequency of male circumcision.
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Affiliation(s)
- Joseph M. Zulu
- Department of Health Promotion and Education, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia, University of Zambia, Lusaka, 10101, Zambia
| | - Trevor Mwamba
- Clinton Health Access Initiative, Clinton Health Access Initiative, Lusaka, 10101, Zambia
| | - Alyssa Rosen
- Clinton Health Access Initiative, Clinton Health Access Initiative, Lusaka, 10101, Zambia
| | - Tulani Francis L. Matenga
- Department of Health Promotion and Education, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia, University of Zambia, Lusaka, 10101, Zambia
| | - Joseph Mulanda
- Department of Health Promotion and Education, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia, University of Zambia, Lusaka, 10101, Zambia
| | - Mutale Kaimba
- Department of Health Promotion and Education, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia, University of Zambia, Lusaka, 10101, Zambia
| | - Masitano Chilembo
- Clinton Health Access Initiative, Clinton Health Access Initiative, Lusaka, 10101, Zambia
| | - Madaliso Silondwa
- Clinton Health Access Initiative, Clinton Health Access Initiative, Lusaka, 10101, Zambia
| | - Royd L. Kamboyi
- Ministry of Health, Ministry of Health, Lusaka, Lusaka, 10101, Zambia
| | | | - George Sichone
- Department of Health Promotion and Education, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia, University of Zambia, Lusaka, 10101, Zambia
| | - Malizgani Paul Chavula
- Department of Health Promotion and Education, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia, University of Zambia, Lusaka, 10101, Zambia
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Lamba G, Shroff ZC, Babar ZUD, Ghaffar A. Drug shops for stronger health systems: learning from initiatives in six LMICs. J Pharm Policy Pract 2021; 14:94. [PMID: 34784982 PMCID: PMC8594096 DOI: 10.1186/s40545-021-00374-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Private sector retail pharmacies, or drug shops, play an important role in access to essential medicines and services in low-and-middle-income countries. Recognising that they have the potential to contribute to health system strengthening efforts, many recent initiatives to engage with drug shops have been launched. These include initiatives that focus on changes in policy, regulation and training. However, the specific factors that influence their success remain poorly understood. Seven country case studies supported under the Alliance's programme of work 'Strengthening health systems: the role of drug shops' help to explore this issue. METHODS Country case studies from the above programme of research from Bangladesh, Indonesia, Myanmar, Nigeria, Tanzania and Zambia were used as the main sources of data for this paper. A modified version of Bigdeli et al.'s Access to Medicines framework was applied within a partially grounded approach to analyze each country case study and compare themes between countries. RESULTS Many factors may help initiatives targeting drug shops successfully achieve their intended outcomes. At the micro level, these include community demand for drug shops and a positive relationship between drug shops and their clients. At the meso level, facilitators of initiative success include training and positive attitudes from drug shops towards the initiative. Barriers include client pressure, procurement challenges and financial and administrative costs associated with initiatives. At the macro level, collaboration between stakeholders, high-level buy in and supervision, monitoring and regulation may influence initiative success. These factors are inter-dependent and interact with each other in a dynamic way. CONCLUSIONS Using a framework approach, these country case studies demonstrate common factors that influence how drug shops can strengthen health systems. These learnings can help inform the design and implementation of successful strategies to engage drug shops towards sustainable systems change.
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Affiliation(s)
- Geetanjali Lamba
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland.
| | - Zubin Cyrus Shroff
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Zaheer-Ud-Din Babar
- Centre for Pharmaceutical Policy and Practice Research, Department of Pharmacy, University of Huddersfield, Queensgate, Huddersfield, UK
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
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