1
|
Bosongo S, Belrhiti Z, Ekofo J, Kabanga C, Chenge F, Criel B, Marchal B. How capacity building of district health managers has been designed, delivered and evaluated in sub-Saharan Africa: a scoping review and best fit framework analysis. BMJ Open 2023; 13:e071344. [PMID: 37532484 PMCID: PMC10401232 DOI: 10.1136/bmjopen-2022-071344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVES We aimed to understand how capacity building programmes (CBPs) of district health managers (DHMs) have been designed, delivered and evaluated in sub-Saharan Africa. We focused on identifying the underlying assumptions behind leadership and management CBPs at the district level. DESIGN Scoping review. DATA SOURCES We searched five electronic databases (MEDLINE, Health Systems Evidence, Wiley Online Library, Cochrane Library and Google Scholar) on 6 April 2021 and 13 October 2022. We also searched for grey literature and used citation tracking. ELIGIBILITY CRITERIA We included all primary studies (1) reporting leadership or management capacity building of DHMs, (2) in sub-Saharan Africa, (3) written in English or French and (4) published between 1 January 1987 and 13 October 2022. DATA EXTRACTION AND SYNTHESIS Three independent reviewers extracted data from included articles. We used the best fit framework synthesis approach to identify an a priori framework that guided data coding, analysis and synthesis. We also conducted an inductive analysis of data that could not be coded against the a priori framework. RESULTS We identified 2523 papers and ultimately included 44 papers after screening and assessment for eligibility. Key findings included (1) a scarcity of explicit theories underlying CBPs, (2) a diversity of learning approaches with increasing use of the action learning approach, (3) a diversity of content with a focus on management rather than leadership functions and (4) a diversity of evaluation methods with limited use of theory-driven designs to evaluate leadership and management capacity building interventions. CONCLUSION This review highlights the need for explicit and well-articulated programme theories for leadership and management development interventions and the need for strengthening their evaluation using theory-driven designs that fit the complexity of health systems.
Collapse
Affiliation(s)
- Samuel Bosongo
- Faculté de Médecine et Pharmacie, Département de Santé Publique, Université de Kisangani, Kisangani, Congo (the Democratic Republic of the)
- Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa, Congo (the Democratic Republic of the)
| | - Zakaria Belrhiti
- Département santé publique and management, Ecole Internationale de Santé Publique, Université Mohammed VI des Sciences de la Santé, Casablanca, Morocco
- Centre Mohammed VI de la recherche et Innovation (CM6), Rabat, Morocco
| | - Joël Ekofo
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa, Congo (the Democratic Republic of the)
| | - Chrispin Kabanga
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa, Congo (the Democratic Republic of the)
| | - Faustin Chenge
- Faculté de Médecine et Pharmacie, Département de Santé Publique, Université de Kisangani, Kisangani, Congo (the Democratic Republic of the)
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa, Congo (the Democratic Republic of the)
- Ecole de Santé Publique, Université de Lubumbashi, Lubumbashi, Congo (the Democratic Republic of the)
| | - Bart Criel
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
2
|
Pieterse P. Conducting rapid research to aid the design of a health systems governance intervention in the Somali Region of Ethiopia. FRONTIERS IN SOCIOLOGY 2022; 7:947970. [PMID: 36159163 PMCID: PMC9492999 DOI: 10.3389/fsoc.2022.947970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/04/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The rapid research described in this chapter was conducted as an assignment for a UN agency in Ethiopia's Somali Region. The agency's aim was support the implementation of an interim citizen engagement intervention, with a view of supporting of the Ethiopian Government's Citizen Score Card at primary healthcare facilities and hospitals in future. Many health facilities in Somali Region struggle with budget shortages related to ineffective budget planning and budget execution at woreda health office levels. In this context, an intervention to first improve budget accountability, through the implementation of citizen audits, was proposed. METHODOLOGY The rapid study focused on five woredas (districts) within Somali Region, where interviews were conducted with the heads of woreda health offices. In the same five woredas, directors of healthcare facilities were interviewed and offices and healthcare facilities were observed. The framework of assessment and analysis was based on health systems literature on fragile and conflict affected states guided the questions for the health authorities and health facility management. FINDINGS The research yielded five distinct mini case studies covering woreda health office planning and budgeting capacity and support (or lack thereof), and related impressions of challenges regarding healthcare delivery at health facilities in the same five woredas. RESULTS The findings demonstrated that the capacity for healthcare planning and budgeting Somali Region at woreda level varied significantly and that little guidance was available from regional level health authorities. Frontline health services clearly suffered from budget shortages as a result. CONCLUSION The research provided an evidence base for the delay of the roll-out of the Community Scorecard implementation across Somali Region. In a context whereby health facilities remain under-resourced due to budgeting constraints, a citizen-service provider-focused accountability intervention would have been of limited utility. The rapid case study research, conducted by condensing the usual case study research process, allowed for the production of evidence that was "robust enough" to demonstrate heterogeneity and challenges regarding budgeting quality across the five research sites. This evidence clearly transcended the hitherto anecdotal evidence that woreda-level health budget planning remains an area that faces significant shortcomings.
Collapse
|
3
|
Muhoza P, Saleem H, Faye A, Tine R, Diaw A, Kante AM, Ruff A, Marx MA. Behavioral Determinants of Routine Health Information System Data Use in Senegal: A Qualitative Inquiry Based on the Integrated Behavioral Model. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00686. [PMCID: PMC9242607 DOI: 10.9745/ghsp-d-21-00686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/22/2022] [Indexed: 11/15/2022]
Abstract
Although behavioral factors are thought to be important barriers to routine data use, they remain understudied particularly in low-income country settings. We show that the integrated behavior model can be a valuable theoretical framework for targeted communication strategies and capacity-building interventions aimed at promoting a culture of data use. Routine health information system (RHIS) data are essential in driving decision making and planning in health systems as well as health programs. However, despite their importance, these data are underutilized, and the underlying individual-level facilitators and barriers to use remain understudied. In this research, we applied the Integrated Behavior Model (IBM) to examine how attitudes toward RHIS data, perceived norms concerning RHIS data use, and the ability to use RHIS data influence the demand and use of RHIS data among stakeholders in Senegal. Using data from interviews with respondents working at national levels of malaria, HIV, and TB control programs in Senegal, we used a framework analysis approach to apply the IBM behavioral constructs and identify their linkages to RHIS data use. We found that attitudes about the quality, availability, and relevance of RHIS data for decision making were important in driving data use among respondents. Institutional expectations, organizational protocols, policies, and practices around RHIS data ultimately shape social norms around the use of the data. Although we found that perceived ability and self-efficacy to use RHIS data were not barriers to RHIS data use among stakeholders at the strategic levels of their respective organizations, these were reported to be barriers at lower levels of the health system. Low perceived control of the RHIS data production process ultimately reduced RHIS data use for decision making among the strategic-level respondents. We recommend context-specific reexamination of existing RHIS interventions with a renewed emphasis on behavioral aspects of data use. The IBM can help guide practitioners, policy makers, and academics to address multiple socioecological factors that influence data use behavior when recommending RHIS and data use solutions.
Collapse
Affiliation(s)
- Pierre Muhoza
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Correspondence to Pierre Muhoza ()
| | - Haneefa Saleem
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Adama Faye
- Institut de Santé et Développement, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Roger Tine
- Université Cheikh Anta Diop, Faculté de Médecine de Pharmacie et d'Odontologie, Dakar, Senegal
| | - Abdoulaye Diaw
- Direction de la Planification, de la Recherche et des Statistiques/Division du Système d'Information Sanitaire et Social, Ministère de la Santé et de l'Action Sociale, Dakar, Senegal
| | | | - Andrea Ruff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Melissa A. Marx
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
4
|
Boyd MA, Fwoloshi S, Minchella PA, Simpungwe J, Siansalama T, Barradas DT, Shah M, Mulenga L, Agolory S. A national HIV clinical mentorship program: Enabling Zambia to accelerate control of the HIV epidemic. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000074. [PMID: 36962250 PMCID: PMC10021441 DOI: 10.1371/journal.pgph.0000074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/28/2021] [Indexed: 11/19/2022]
Abstract
Although Zambia has increased the proportion of people living with HIV (PLHIV) who are on antiretroviral therapy (ART) in recent years, progress toward HIV epidemic control remains inconsistent. Some districts are still failing to meet the UNAIDS 90/90/90 targets where 90% of PLHIV should know their status, 90% of those diagnosed should be on ART, and 90% of those on ART should achieve viral load suppression (VLS) by 2020. Providing consistently excellent HIV services at all ART health facilities is critical for achieving the UNAIDS 90/90/90 targets and controlling the HIV epidemic in Zambia. Zambia Ministry of Health, in collaboration with the U.S. Centers for Disease Control and Prevention (CDC), aimed to achieve these targets through establishing a national HIV clinical mentorship program in which government-employed mentors were assigned to specific facilities with a mandate to identify and ameliorate programmatic challenges. Mentors were hired, trained and deployed to individual facilities in four provinces to mentor staff on quality HIV clinical and program management. The pre-mentorship period was July 2018-September 2018 and the post-mentorship period was July 2019-September 2019. Review of key programmatic indicators from the pre and post-deployment periods revealed the proportion of people who had a positive HIV test result out of those tested increased from 4.2% to 6.8% (P <0.001) as fewer HIV tests were needed despite the number of PLHIV being identified and placed on ART increasing from 492,613 to 521,775, and VLS increased from 84.8% to 90.1% (p <0.001). Key considerations in the establishment of an HIV clinical mentorship program include having a government-led process of regular site level data review and continuous clinical mentorship underpinned by quality improvement methodology.
Collapse
Affiliation(s)
- Mary Adetinuke Boyd
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sombo Fwoloshi
- Ministry of Health, Lusaka, Government of the Republic of Zambia
| | - Peter A Minchella
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - James Simpungwe
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Terence Siansalama
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Danielle T Barradas
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Minesh Shah
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lloyd Mulenga
- Ministry of Health, Lusaka, Government of the Republic of Zambia
| | - Simon Agolory
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| |
Collapse
|
5
|
Prakash R, Dehury B, Yadav C, Tripathi AB, Sodhi C, Bilal H, Vasanthakumar N, Isac S, Ramesh BM, Blanchard J, Boerma T. Establishing evidence-based decision-making mechanism in a health eco-system and its linkages with health service coverage in 25 high-priority districts of Uttar Pradesh, India. BMC Health Serv Res 2021; 21:196. [PMID: 34511088 PMCID: PMC8436494 DOI: 10.1186/s12913-021-06172-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Achievement of successful health outcomes depends on evidence-based programming and implementation of effective health interventions. Routine Health Management Information System is one of the most valuable data sets to support evidence-based programming, however, evidence on systemic use of routine monitoring data for problem-solving and improving health outcomes remain negligible. We attempt to understand the effects of systematic evidence-based review mechanism on improving health outcomes in Uttar Pradesh, India. Methods Data comes from decision-tracking system and routine health management information system for period Nov-2017 to Mar-2019 covering 6963 health facilities across 25 high-priority districts of the state. Decision-tracking data captured pattern of decisions taken, actions planned and completed, while the latter one provided information on service coverage outcomes over time. Three service coverage indicators, namely, pregnant women receiving 4 or more times ANC and haemoglobin testing during pregnancy, delivered at the health facility, and receive post-partum care within 48 h of delivery were used as outcomes. Univariate and bivariate analyses were conducted. Results Total 412 decisions were taken during the study reference period and a majority were related to ante-natal care services (31%) followed by delivery (16%) and post-natal services (16%). About 21% decisions-taken were focused on improving data quality. By 1 year, 67% of actions planned based on these decisions were completed, 26% were in progress, and the remaining 7% were not completed. We found that, over a year, districts witnessing > 20 percentage-point increase in outcomes were also the districts with significantly higher action completion rates (> 80%) compared to the districts with < 10 percentage-point increase in outcomes having completion of action plans around 50–70%. Conclusions Findings revealed a significantly higher improvement in coverage outcomes among the districts which used routine health management data to conduct monthly review meetings and had high actions completion rates. A data-based review-mechanisms could specifically identify programmatic gaps in service delivery leading to strategic decision making by district authorities to bridge the programmatic gaps. Going forward, establishing systematic evidence-based review platforms can be an important strategy to improve health outcomes and promote the use of routine health monitoring system data in any setting. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06172-2.
Collapse
Affiliation(s)
- Ravi Prakash
- Department of Community Health Sciences, Institute of Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Manitoba, R3E 0T6, Winnipeg, Canada. .,India Health Action Trust (IHAT), Lucknow, India.
| | | | - Charu Yadav
- India Health Action Trust (IHAT), Lucknow, India
| | | | - Chhavi Sodhi
- India Health Action Trust (IHAT), Lucknow, India
| | | | - N Vasanthakumar
- Department of Community Health Sciences, Institute of Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Manitoba, R3E 0T6, Winnipeg, Canada
| | - Shajy Isac
- Department of Community Health Sciences, Institute of Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Manitoba, R3E 0T6, Winnipeg, Canada.,India Health Action Trust (IHAT), Lucknow, India
| | - B M Ramesh
- Department of Community Health Sciences, Institute of Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Manitoba, R3E 0T6, Winnipeg, Canada
| | - James Blanchard
- Department of Community Health Sciences, Institute of Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Manitoba, R3E 0T6, Winnipeg, Canada
| | - Ties Boerma
- Department of Community Health Sciences, Institute of Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Manitoba, R3E 0T6, Winnipeg, Canada
| |
Collapse
|
6
|
Munyangaju I, Langa MAS, Clemens SAC, Marchetti E. Evaluation of the partnership between international non-governmental organizations and the State in the health sector in Mozambique. Pan Afr Med J 2021; 39:91. [PMID: 34466193 PMCID: PMC8379398 DOI: 10.11604/pamj.2021.39.91.25970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 05/18/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Mozambique is one of the poorest nations in the world and its health budget is heavily dependent on external funding. Increasingly, donors prefer to direct their funds through international non-governmental organizations instead of direct donations to the State budget. In the current climate of increased emphasis on health system strengthening, a strong and stable partnership between government and international non-governmental organizations is pivotal for health system strengthening in Mozambique. Methods the study evaluates the current partnership through a standardized survey to healthcare workers employed by international non-governmental organizations in health (INGO, private) and the ministry of health (MOH, public). Results of the survey have been analyzed only descriptively and no statistical evaluations have been performed. Results out of the valid 109 responses obtained 55.1% were from MOH cadres and 45.0% from INGO cadres. Most have been in the health sector for more than 5 years. Most of the respondents recognize that INGOs assist the government in strengthening the health system (71.6%), see the internal brain drain to INGOs and salary scale difference as major problems (70.6% and 78.0%); 87.2% reported that the coordination between INGOs and government needs to be improved. MOH cadres perceived the migration of cadres to INGOs and the need for improving coordination as major issues more acutely than their INGO counterparts (80.0% vs. 59.2% and 88.3% vs. 85.7% respectively). INGOs were perceived to offer better quality health services by 51.4% of respondents (of these 69.4% were INGO respondents). The quality of health services was alike between INGOs and MOH for 33% of the respondents. Conclusion through the various efforts outlined the MOH and INGOs are moving towards an environment of mutual accountability, joint planning and coordination as well as harmonization of activities; but there are still challenges to be addressed. Prioritization and increased funding of the planning unit and planning and cooperation directorate as well as strategies for workforce retention are urgently needed.
Collapse
Affiliation(s)
- Isabelle Munyangaju
- Tinpswalo Association, Vicentian Association to Fight AIDS and Tuberculosis, Gaza, Mozambique
| | | | | | - Elisa Marchetti
- GlaxoSmithKline (GSK) Vaccines Institute for Global Health, Siena, Italy
| |
Collapse
|
7
|
Argaw MD, Desta BF, Muktar SA, Abera WS, Beshir IA, Otoro IA, Samuel A, Rogers D, Eifler K. Comparison of maternal and child health service performances following a leadership, management, and governance intervention in Ethiopia: a propensity score matched analysis. BMC Health Serv Res 2021; 21:862. [PMID: 34425808 PMCID: PMC8383359 DOI: 10.1186/s12913-021-06873-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/13/2021] [Indexed: 11/30/2022] Open
Abstract
Background Leadership, management, and governance (LMG) interventions play a significant role in improving management systems, enhancing the work climate, and creating responsive health systems. Hence, the Ethiopian Ministry of Health with the support of the USAID Transform: Primary Health Care project has been implementing LMG interventions to improve performances of primary healthcare entities. The purpose of this evaluation was to compare maternal and child health service performances and overall health system strengthening measurement results of primary health care entities by LMG intervention exposed groups. Methods The study used a cross-sectional study design with a propensity matched score analysis, and was conducted from August 28, 2017, to September 30, 2018, in Amhara, Oromia, Tigray, and Southern Nations, Nationalities, and Peoples’ (SNNP) regions. Data collection took place through interviewer and self-administered questionnaires among 227 LMG intervention exposed and 227 non-exposed health workers. Propensity score matched analysis was used to balance comparison groups with respect to measured covariates. Results The mean overall maternal and child health key performance indicator score with standard deviation (± SD) for the LMG intervention exposed group was 63.86 ± 13.16 and 57.02 ± 13.71 for the non-exposed group. The overall health system strengthening score for the LMG intervention exposed group (mean rank = 269.31) and non-exposed group (mean rank = 158.69) had statistically significant differences (U = 10.145, z = − 11.175, p = 0.001). In comparison with its counterpart, the LMG exposed group had higher average performances in 3.54, 3.51, 2.64, 3.00, 1.07, and 3.34 percentage-points for contraceptive acceptance rate, antenatal care, skilled birth attendance, postnatal care, full immunization, and growth monitoring services, respectively. Conclusion There were evidences on the positive effects of the LMG intervention on increased maternal and child health services performances at primary healthcare entities. Moreover, health facilities with LMG intervention exposed health workers had higher and statistically significant differences in management systems, work climates, and readiness to face new challenges. Therefore, this study generated evidence for integrating LMG interventions to improve the performance of primary healthcare entities and maternal and child service uptake of community members, which contributes to the reduction of maternal and child deaths. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06873-8.
Collapse
Affiliation(s)
- Mesele Damte Argaw
- USAID Transform: Primary Health Care, JSI Research & Training Institute, Inc, Addis Ababa, Ethiopia.
| | - Binyam Fekadu Desta
- USAID Transform: Primary Health Care, JSI Research & Training Institute, Inc, Addis Ababa, Ethiopia
| | - Sualiha Abdlkader Muktar
- USAID Transform: Primary Health Care, JSI Research & Training Institute, Inc, Addis Ababa, Ethiopia
| | - Wondwosen Shiferaw Abera
- USAID Transform: Primary Health Care, JSI Research & Training Institute, Inc, Addis Ababa, Ethiopia
| | - Ismael Ali Beshir
- USAID Transform: Primary Health Care, JSI Research & Training Institute, Inc, Addis Ababa, Ethiopia
| | - Israel Ataro Otoro
- Federal Ministry of Health, Health Extension and Primary Health Services Directorate, Addis Ababa, Ethiopia
| | - Asegid Samuel
- Federal Ministry of Health, Human Resource Development Directorate, Addis Ababa, Ethiopia
| | | | | |
Collapse
|
8
|
Muhoza P, Saleem H, Faye A, Gaye I, Tine R, Diaw A, Gueye A, Kante AM, Ruff A, Marx MA. Key informant perspectives on the challenges and opportunities for using routine health data for decision-making in Senegal. BMC Health Serv Res 2021; 21:594. [PMID: 34154578 PMCID: PMC8218491 DOI: 10.1186/s12913-021-06610-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background Increasing the performance of routine health information systems (RHIS) is an important policy priority both globally and in Senegal. As RHIS data become increasingly important in driving decision-making in Senegal, it is imperative to understand the factors that determine their use. Methods Semi-structured interviews were conducted with 18 high- and mid-level key informants active in the malaria, tuberculosis and HIV programmatic areas in Senegal. Key informants were employed in the relevant divisions of the Senegal Ministry of Health or nongovernmental / civil society organizations. We asked respondents questions related to the flow, quality and use of RHIS data in their organizations. A framework approach was used to analyze the qualitative data. Results Although the respondents worked at the strategic levels of their respective organizations, they consistently indicated that data quality and data use issues began at the operational level of the health system before the data made its way to the central level. We classify the main identified barriers and facilitators to the use of routine data into six categories and attempt to describe their interrelated nature. We find that data quality is a central and direct determinant of RHIS data use. We report that a number of upstream factors in the Senegal context interact to influence the quality of routine data produced. We identify the sociopolitical, financial and system design determinants of RHIS data collection, dissemination and use. We also discuss the organizational and infrastructural factors that influence the use of RHIS data. Conclusions We recommend specific prescriptive actions with potential to improve RHIS performance in Senegal, the quality of the data produced and their use. These actions include addressing sociopolitical factors that often interrupt RHIS functioning in Senegal, supporting and motivating staff that maintain RHIS data systems as well as ensuring RHIS data completeness and representativeness. We argue for improved coordination between the various stakeholders in order to streamline RHIS data processes and improve transparency. Finally, we recommend the promotion of a sustained culture of data quality assessment and use.
Collapse
Affiliation(s)
- Pierre Muhoza
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Haneefa Saleem
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Adama Faye
- Institut de Santé et Développement, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Ibrahima Gaye
- Institut de Santé et Développement, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Roger Tine
- Faculté de Médecine, de Pharmacie et d'Odontologie, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Abdoulaye Diaw
- Direction de la Planification, de la Recherche et des Statistiques/ Division du Système d'Information Sanitaire et Social, Ministère de la Santé et de l'Action Sociale (MSAS), Dakar, Senegal
| | - Alioune Gueye
- Programme National de Lutte Contre le Paludisme, Ministère de la Santé et de l'Action Sociale (MSAS), Dakar, Senegal
| | - Almamy Malick Kante
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea Ruff
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Melissa A Marx
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
9
|
Fonn S, Ray S, Couper I, Ezeh A, Omigbodun A, Morhason-Bello I, Ng'wena G, Oyungu E, Muchiri L, Tumwine J, Ibingira C, Conco D, Blaauw D. Acceptability and feasibility of inter-related activities to improve agency among African district health managers: A four-country study. Glob Public Health 2021; 17:1267-1281. [PMID: 34097583 DOI: 10.1080/17441692.2021.1924220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
District health managers (DHMs) lead and manage Ministry of Health programmes and system performance. We report on the acceptability and feasibility of inter-related activities to increase the agency of DHMs in Kenya, Nigeria, South Africa and Uganda using a cross-sectional rapid appraisal with 372 DHMs employing structured questionnaires. We found differences and similarities between the countries, in particular, who becomes a DHM. The opportunity to provide leadership and effect change and being part of a team were reported as rewarding aspects of DHMs' work. Demotivating factors included limited resources, bureaucracy, staff shortages, lack of support from leadership and inadequate delegation of authority. District managers ranked the acceptability of the inter-related activities similarly despite differences between contexts. Activities highly ranked by DHMs were to employ someone to support primary care staff to compile and analyse district-level data; to undertake study tours to well-functioning districts; and joining an African Regional DHM Association. DHMs rated these activities as feasible to implement. This study confirms that DHMs are in support of a process to promote bottom-up, data-driven, context-specific actions that can promote self-actualisation, recognises the roles DHMs play, provides opportunities for peer learning and can potentially improve quality of care.
Collapse
Affiliation(s)
- Sharon Fonn
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Sunanda Ray
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Department of Medical Education, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Ian Couper
- Ukwanda Centre for Rural Health, Stellenbosch University, Stellenbosch, South Africa
| | - Alex Ezeh
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | | | | | - Gideon Ng'wena
- Department of Medical Physiology School of Medicine, Maseno University, Kisumu, Kenya
| | - Eren Oyungu
- School of Medicine, Moi University, Eldoret, Kenya
| | - Lucy Muchiri
- Department of Human Pathology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - James Tumwine
- College of Health Sciences, Makerere University, Kampala, Uganda.,School of Medicine, Kabale University, Kabale, Uganda
| | - Charles Ibingira
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Daphney Conco
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Duane Blaauw
- Centre for Health Policy, University of the Witwatersrand, Johannesburg South Africa
| |
Collapse
|
10
|
Desta BF, Abitew A, Beshir IA, Argaw MD, Abdlkader S. Leadership, governance and management for improving district capacity and performance: the case of USAID transform: primary health care. BMC FAMILY PRACTICE 2020; 21:252. [PMID: 33276728 PMCID: PMC7718658 DOI: 10.1186/s12875-020-01337-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 11/29/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Primary health care (PHC) in Ethiopia serves as the main entry point for preventive, promotive and curative health services. The district health office is responsible for the planning, implementation and evaluation of all district health activities. In addition, district health offices manage service delivery facilities working on provision of PHC - primary hospitals, health centers and health posts. As the leader of the health care system tier, district health management must ensure direction, alignment and commitment within teams and organizations and make sure that achievements are consistent with the vision, values and strategy of the organization. USAID Transform: Primary Health Care provides diverse support to improve district health manager competencies including in-service trainings followed by planning and implementation of performance improvement projects and on-the-job mentoring and support. METHODS This study was conducted to compare district level capacity and performances between leadership, management and governance (LMG) and non-LMG districts. Project outcome monitoring data that shows the performance of districts was collected from 284 districts from January to December 2019. The study was carried out using a comparative-cross sectional study design, which assessed and compared district health office level indicators. Districts were classified into two categories: LMG and non-LMG districts. The study compared data from 94 LMG and 190 non-LMG districts. Propensity score matching was used to control the effect of differences between LMG and non-LMG districts. RESULTS Results of the independent samples t-test revealed that LMG districts scored better average performances of 61.8 ± 121.45 standard deviation (SD) compared to non-LMG districts 56.89 ± 110.39 SD, with t (282243) = - 3.407317 and p < 0.001, two-tailed. The difference of 4.9 percentage unit in the average performance indicated a statistically significant difference between the LMG and non-LMG districts. CONCLUSION District level leadership development program contributes to improving district capacity, structure and management practices, and quality of care.
Collapse
Affiliation(s)
- Binyam Fekadu Desta
- USAID Transform: Primary Health Care, JSI Training & Research Institute Inc. in Ethiopia, P.O. Box 1392, 1110, Addis Ababa, Ethiopia.
| | - Azeb Abitew
- USAID Transform: Primary Health Care, JSI Training & Research Institute Inc. in Ethiopia, P.O. Box 1392, 1110, Addis Ababa, Ethiopia
| | - Ismael Ali Beshir
- USAID Transform: Primary Health Care, JSI Training & Research Institute Inc. in Ethiopia, P.O. Box 1392, 1110, Addis Ababa, Ethiopia
| | - Mesele Damte Argaw
- USAID Transform: Primary Health Care, JSI Training & Research Institute Inc. in Ethiopia, P.O. Box 1392, 1110, Addis Ababa, Ethiopia
| | - Sualiha Abdlkader
- USAID Transform: Primary Health Care, JSI Training & Research Institute Inc. in Ethiopia, P.O. Box 1392, 1110, Addis Ababa, Ethiopia
| |
Collapse
|
11
|
Ravaghi H, Beyranvand T, Mannion R, Alijanzadeh M, Aryankhesal A, Belorgeot VD. Effectiveness of training and educational programs for hospital managers: A systematic review. Health Serv Manage Res 2020; 34:113-126. [PMID: 33143488 DOI: 10.1177/0951484820971460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Developing and strengthening the competencies and skills of health care managers is a key objective in many health systems. Selecting adequate training methods, content, and using appropriate criteria for assessing their impact is fundamental for improving their usefulness and effectiveness. Filling an important gap in knowledge, this review assesses the evidence on the effectiveness of different types of training and educational programmes delivered to hospital managers. METHODS In this narrative systematic review, the following electronic databases were searched for literature published between January 1st, 1990 and January 31st, 2019. The Joanna Briggs Institute (JBI) checklist was used to evaluate the quality of the included studies. RESULTS In total, 9 articles were included. Results showed that the main topics covered by training programs for hospital managers were: planning, organization and coordination, control and supervision of hospital staff, teamwork, communication, motivation and leadership, monitoring and evaluation, and quality improvement skills. Training in these skills was found to improve managers' strategic and operational planning abilities, change management and behavioural management methods, and leadership. CONCLUSIONS The examined training programs had a relatively positive effect on the managerial skills, knowledge and competencies of hospital managers. In general, these capacity-building programs focused on developing three types of skills: technical, interpersonal and conceptual. Training programs focused on developing technical skills among managers were more effective than those focused on developing other types of skills. Increased investment and large-scale planning are needed to develop better the knowledge and competencies of hospital managers.
Collapse
Affiliation(s)
- Hamid Ravaghi
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Tina Beyranvand
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Mehran Alijanzadeh
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Aidin Aryankhesal
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Victoria D Belorgeot
- World Health Organisation Regional Office for the Eastern Mediterranean, Cairo, Egypt
| |
Collapse
|
12
|
Steege R, Taegtmeyer M, Ndima S, Give C, Sidat M, Ferrão C, Theobald S. Redressing the gender imbalance: a qualitative analysis of recruitment and retention in Mozambique's community health workforce. HUMAN RESOURCES FOR HEALTH 2020; 18:37. [PMID: 32448359 PMCID: PMC7245854 DOI: 10.1186/s12960-020-00476-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 05/05/2020] [Indexed: 05/23/2023]
Abstract
BACKGROUND Mozambique's community health programme has a disproportionate number of male community health workers (known as Agentes Polivalentes Elementares (APEs)). The Government of Mozambique is aiming to increase the proportion of females to constitute 60% to improve maternal and child health outcomes. To understand the imbalance, this study explored the current recruitment processes for APEs and how these are shaped by gender norms, roles and relations, as well as how they influence the experience and retention of APEs in Maputo Province, Mozambique. METHODS We employed qualitative methods with APEs, APE supervisors, community leaders and a government official in two districts within Maputo Province. Interviews were recorded, transcribed and translated. A coding framework was developed in accordance with thematic analysis to synthesise the findings. FINDINGS In-depth interviews (n = 30), key informant interviews (n = 1) and focus group discussions (n = 3) captured experiences and perceptions of employment processes. Intra-household decision-making structures mean women may experience additional barriers to join the APE programme, often requiring their husband's consent. Training programmes outside of the community were viewed positively as an opportunity to build a cohort. However, women reported difficulty leaving family responsibilities behind, and men reported challenges in providing for their families during training as other income-generating opportunities were not available to them. These dynamics were particularly acute in the case of single mothers, serving both a provider and primary carer role. Differences in attrition by gender were reported: women are likely to leave the programme when they marry, whereas men tend to leave when offered another job with a higher salary. Age and geographic location were also important intersecting factors: younger male and female APEs seek employment opportunities in neighbouring South Africa, whereas older APEs are more content to remain. CONCLUSION Gender norms, roles and power dynamics intersect with other axes of inequity such as marital status, age and geographic location to impact recruitment and retention of APEs in Maputo Province, Mozambique. Responsive policies to support gender equity within APE recruitment processes are required to support and retain a gender-equitable APE cadre.
Collapse
Affiliation(s)
- Rosalind Steege
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom.
| | - Miriam Taegtmeyer
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom
| | - Sozinho Ndima
- Universidade Eduardo Mondlane, 3453 Avenida Julius Nyerere, Maputo, Mozambique
| | - Celso Give
- Universidade Eduardo Mondlane, 3453 Avenida Julius Nyerere, Maputo, Mozambique
| | - Mohsin Sidat
- Universidade Eduardo Mondlane, 3453 Avenida Julius Nyerere, Maputo, Mozambique
| | - Clara Ferrão
- Universidade Eduardo Mondlane, 3453 Avenida Julius Nyerere, Maputo, Mozambique
| | - Sally Theobald
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom
| |
Collapse
|
13
|
Bravo MP, Peratikos MB, Muicha AS, Mahagaja E, Alvim MFS, Green AF, Wester CW, Vermund SH. Monitoring Pharmacy and Test Kit Stocks in Rural Mozambique: U.S. President's Emergency Plan for AIDS Relief Surveillance to Help Prevent Ministry of Health Shortages. AIDS Res Hum Retroviruses 2020; 36:415-426. [PMID: 31914787 DOI: 10.1089/aid.2019.0057] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Support of human immunodeficiency virus (HIV) and tuberculosis (TB) testing and treatment supported by President's Emergency Plan for AIDS Relief (PEPFAR) in Africa requires immense quantities of tests and medications. We sought to use central pharmacy supply data of Mozambique's rural Zambézia Province (2017 population ≈5.11 million persons; ≈12.6% adult HIV prevalence in 2016) to examine shortages, stockouts, and trends in availability. Using stock surveillance for 60 weeks in 2014-2015, we assessed availability of 36 medications [4 classes: adult antiretroviral (ARV) medications, pediatric ARVs, anti-TB medications, and antibiotics] and diagnostic test kits (2 rapid tests for HIV; 1 each for malaria and syphilis). We contrasted these to 2018-2019 data. We modeled pharmacy data using ordinal logistic regression, characterizing weekly product availability in four categories: good, adequate, shortage, or complete stockout. We found 166 (7.7%) stockouts and 150 (6.9%) shortages among 2,160 weekly records. Earlier calendar time was associated with reduced medication supplies (p < .001). Certain medication/test kit classes were associated with reduced supply (p < .001). We found an interaction between time and medication class on the odds of reduced supply (p < .001). Pediatric ARVs had a 17.4 (95% confidence interval: 8.8-34.4) times higher odds of reduced medication supply compared with adult ARVs at study midpoint. Trends comparing the first and last weeks showed adult ARVs having 67% and pediatric having 71% lower odds of reduced supplies. Only adult ARV shortages improved amid growing demand. Data from 2018 to 2019 suggest continuing inventory management challenges. Monitoring of drug (especially pediatric) and test kit shortages is vital to ensure quality improvement to guarantee adequate supplies to enable patients and care providers to achieve sustained viral suppression. A central Mozambican drug repository in the nation's second largest Province continues to experience drug and rapid test kit stockouts.
Collapse
Affiliation(s)
- Magdalena P. Bravo
- Vanderbilt Institute for Global Health (VIGH), Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Meridith Blevins Peratikos
- Vanderbilt Institute for Global Health (VIGH), Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Epifanio Mahagaja
- Direcção Provincial de Saúde-Província da Zambézia, Ministério de Saúde, Maputo, Mozambique
| | | | - Ann F. Green
- Vanderbilt Institute for Global Health (VIGH), Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - C. William Wester
- Vanderbilt Institute for Global Health (VIGH), Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Friends in Global Health (FGH), Maputo, Mozambique
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Sten H. Vermund
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Epidemiology of Microbial Diseases and Office of the Dean, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| |
Collapse
|
14
|
Heerdegen ACS, Aikins M, Amon S, Agyemang SA, Wyss K. Managerial capacity among district health managers and its association with district performance: A comparative descriptive study of six districts in the Eastern Region of Ghana. PLoS One 2020; 15:e0227974. [PMID: 31968010 PMCID: PMC6975551 DOI: 10.1371/journal.pone.0227974] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 01/03/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION District health managers play a pivotal role in the delivery of basic health services in many countries, including Ghana, as they are responsible for converting inputs and resources such as, staff, supplies and equipment into effective services that are responsive to population needs. Weak management capacity among local health managers has been suggested as a major obstacle for responsive health service delivery. However, evidence on district health managers' competencies and its association with health system performance is scarce. AIM To examine managerial capacity among district health managers and its association with health system performance in six districts in the Eastern Region of Ghana. METHODS Fifty-nine district health managers' in six different performing districts in the Eastern Region of Ghana completed a self-administered questionnaire measuring their management competencies and skills. In addition, the participants provided information on their socio-demographic background; previous management experience and training; the extent of available management support systems, and the dynamics within their district health management teams. A non-parametric one-way analysis was applied to test the association between management capacity and district performance, which was measured by 17 health indicators. RESULTS Shortcomings within different aspects of district management were identified, however there were no significant differences observed in the availability of support systems, characteristics and qualifications of district health managers across the different performing districts. Overall management capacity among district health managers were significantly higher in high performing districts compared with lower performing districts (p = 0.02). Furthermore, district health managers in better performing districts reported a higher extent of teamwork (p = 0.02), communication within their teams (p<0.01) and organizational commitment (p<0.01) compared with lower performing districts. CONCLUSION The findings demonstrate individual and institutional capacity needs, and highlights the importance of developing management competencies and skills as well as positive team dynamics among health managers at district level.
Collapse
Affiliation(s)
- Anne Christine Stender Heerdegen
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Moses Aikins
- School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Samuel Amon
- School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Samuel Agyei Agyemang
- School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Kaspar Wyss
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| |
Collapse
|
15
|
Feyissa GT, Balabanova D, Woldie M. How Effective are Mentoring Programs for Improving Health Worker Competence and Institutional Performance in Africa? A Systematic Review of Quantitative Evidence. J Multidiscip Healthc 2019; 12:989-1005. [PMID: 31824166 PMCID: PMC6901118 DOI: 10.2147/jmdh.s228951] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/27/2019] [Indexed: 02/02/2023] Open
Abstract
Introduction Mentoring programs are frequently recommended as innovative and low-cost solutions, and these have been implemented in many healthcare institutions to tackle multiple human resource-related challenges. This review sought to locate, appraise and describe the literature reporting on mentorship programs that were designed to improve healthcare worker competence and institutional performance in Africa. Methods This review searched and synthesized reports from studies that assessed the effectiveness of mentorship programs among healthcare workers in Africa. We searched for studies reported in the English language in EMBASE, CINAHL, COCHRANE and MEDLINE. Additional search was conducted in Google Scholar. Results We included 30 papers reporting on 24 studies. Diverse approaches of mentorship were reported: a) placing a mentor in health facility for a period of time (embedded mentor), b) visits by a mobile mentor, c) a mentoring approach involving a team of mobile multidisciplinary mentors, d) facility twinning, and e) within-facility mentorship by a focal person or a manager. Implication for practice Mentoring interventions were effective in improving the clinical management of infectious diseases, maternal, neonatal and childhood illnesses. Mentoring interventions were also found to improve managerial performance (accounting, human resources, monitoring and evaluation, and transportation management) of health institutions. Additionally, mentoring had improved laboratory accreditation scores. Mentoring interventions may be used to increase adherence of health professionals to guidelines, standards, and protocols. While different types of interventions (embedded mentoring, visits by mobile mentors, facility twinning and within-facility mentorship by a focal person) were reported to be effective, there is no evidence to recommend one model of mentoring over other types of mentoring. Implications for research Further research—experimental methods measuring the impact of different mentoring formats and longitudinal studies establishing their long-term effectiveness—is required to compare the effectiveness and cost-effectiveness of different models of mentoring. Further studies are needed to explore why and how different mentoring programs succeed and the meaningfulness of mentoring programs for the different stakeholders are also required.
Collapse
Affiliation(s)
- Garumma Tolu Feyissa
- Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia.,Ethiopian Evidence Based Healthcare: JBI Center of Excellence, Jimma University, Jimma, Ethiopia
| | - Dina Balabanova
- Department of Health Policy and Management, London School of Hygiene and Tropical Medicine, London, UK
| | - Mirkuzie Woldie
- Ethiopian Evidence Based Healthcare: JBI Center of Excellence, Jimma University, Jimma, Ethiopia.,Department of Global Health and Population, T.H. Chan Harvard School of Public Health, Addis Ababa, Ethiopia
| |
Collapse
|
16
|
Hossain MS, Kiumarsi S, Yahya S, Hashemi S. The effect of healthcare management and physicians’ loyalty. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2019. [DOI: 10.1080/20479700.2019.1620479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Md Shamim Hossain
- Graduate School of Business, Universiti Sains Malaysia, USM Penang, Malaysia
- Management Studies Department, Faculty of Business Studies, University of Rajshahi, Rajshahi, Bangladesh
| | - Shaian Kiumarsi
- Graduate School of Business, Universiti Sains Malaysia, USM Penang, Malaysia
| | - Sofri Yahya
- Graduate School of Business, Universiti Sains Malaysia, USM Penang, Malaysia
| | - Shiva Hashemi
- School of Housing, Building and Planning (HBP), (USM), Penang, Malaysia
| |
Collapse
|
17
|
Baker H, Rochat R, Hepburn K, Hennink M, Thiam M, Guede C, Koalaga A, Amegan E, Fombo K, Ogunbiyi B, Sibley L. ' It is a question of determination': a case study of monitoring and evaluation of integrated family planning services in urban areas of Togo. Gates Open Res 2019; 3:1451. [PMID: 31633084 PMCID: PMC6784308 DOI: 10.12688/gatesopenres.12944.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Integrating family planning into postabortion and postpartum services can increase contraceptive use and decrease maternal and child death; however, little information exists on the monitoring and evaluation of such programs. This article draws on research completed by the EngenderHealth’s
AgirPF project in three urban areas of Togo on the extent to which monitoring and evaluation systems of health services, which operated within the
AgirPF project area in Togo, captured integrated family planning services. Methods: This mixed methods case study used 25 health facility assessments with health service record review in hospitals, large community clinics, a dispensary, and private clinics and 41 key informant interviews with health faculty, individuals working at reproductive health organizations, individuals involved in reproductive health policy and politics, health care workers, and health facility directors. Results: The study found the reporting system for health care was labor intensive and involved multiple steps for health care workers. The system lacked a standardized method to record family planning services as part of other health care at the patient level, yet the Ministry of Health required integrated family planning services to be reported on district and partner organization reporting forms. Key informants suggested improving the system by using computer-based monitoring, streamlining the reporting process to include all necessary information at the patient level, and standardizing what information is needed for the Ministry of Health and partner organizations. Conclusion: Future research should focus on assessing the best methods for recording integrated health services and task shifting of reporting. Recommendations for future policy and programming include consolidating data for reproductive health indicators, ensuring type of information needed is captured at all levels, and reducing provider workload for reporting.
Collapse
Affiliation(s)
- Helen Baker
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, 30322, USA
| | - Roger Rochat
- Rollins School of Public Health, Emory University, Atlanta, Georgia, 30322, USA
| | - Kenneth Hepburn
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, 30322, USA
| | - Monique Hennink
- Rollins School of Public Health, Emory University, Atlanta, Georgia, 30322, USA
| | | | | | | | | | | | | | - Lynn Sibley
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, 30322, USA
| |
Collapse
|
18
|
Filimão DBC, Moon TD, Senise JF, Diaz RS, Sidat M, Castelo A. Individual factors associated with time to non-adherence to ART pick-up within HIV care and treatment services in three health facilities of Zambézia Province, Mozambique. PLoS One 2019; 14:e0213804. [PMID: 30908522 PMCID: PMC6433271 DOI: 10.1371/journal.pone.0213804] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/28/2019] [Indexed: 02/04/2023] Open
Abstract
Introduction Mozambique has made significant gains in addressing its HIV epidemic, yet adherence to visit schedules remains a challenge. HIV programmatic gains to date could be impaired if adherence and retention to ART remains low. We investigate individual factors associated with non-adherence to ART pick-up in Mozambique. Methods This was a retrospective cohort of patients initiating ART between January 2013 and June 2014. Non-adherence to ART pick-up was defined as a delay in pick-up ≥ 15 days. Descriptive statistics were used to calculate socio-demographic and clinical characteristics. Adherence to ART pick-up was assessed using Kaplan Meier estimates. Cox proportional hazards model was used to determine factors associated with non-adherence. Results 1,413 participants were included (77% female). Median age was 30.4 years. 19% of patients remained adherent to ART pick-up during the evaluation period, while 81% of patients were non-adherent to ART pick-up. Probability of being non-adherent to ART pick-up by 166 days following initiation was 50%. In univariate analysis, being widowed was associated with higher adherence to ART pick-up than other marital status groups (p = 0.01). After adjusting, being ≥35 years (aHR: 0.843, 95% CI: 0.738–0.964, p = 0.012); receiving efavirenz (aHR: 0.932, 95% CI: 0.875–0.992, p = 0.026); and being urban (aHR: 0.754, 95% CI: 0.661–0.861, p<0.0001) were associated with improved adherence. Non-participation in a Community ART Support Group (CASG) was associated with a 43% increased hazard of non-adherence to ART pick-up (aHR 1.431, 1.192–1.717, p<0.0001) Conclusions Interventions should focus on the first 6 months following ARV initiation for improvements. Younger persons and widows are two target groups for better understanding facilitators and barriers to visit schedule adherence. Future strategies should explore the benefits of joining CASGs earlier in one´s treatment course. Finally, greater efforts should be made to accelerate the scale-up of viral load capacity and HIV resistance monitoring.
Collapse
Affiliation(s)
- Dércio B. C. Filimão
- Provincial Directorate of Health, Zambézia Province, Quelimane, Mozambique
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
- Retrovirology Laboratory, Federal University of São Paulo, São Paulo, Brazil
- * E-mail:
| | - Troy D. Moon
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Jorge F. Senise
- Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Ricardo S. Diaz
- Retrovirology Laboratory, Federal University of São Paulo, São Paulo, Brazil
| | - Mohsin Sidat
- Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Adauto Castelo
- Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| |
Collapse
|
19
|
Jobson G, Mabitsi M, Railton J, Grobbelaar CJ, McIntyre JA, Struthers HE, Peters RPH. Targeted mentoring for human immunodeficiency virus programme support in South Africa. South Afr J HIV Med 2019; 20:873. [PMID: 30863623 PMCID: PMC6407314 DOI: 10.4102/sajhivmed.v20i1.873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/16/2018] [Indexed: 11/19/2022] Open
Abstract
Background Mentoring is a required component of health systems strengthening technical assistance interventions in low- and middle-income countries (LMICs). Mentoring is useful because it does not necessarily compromise service delivery and promotes the sharing of newly acquired knowledge and skills. However, there is a lack of research on the implementation of mentoring in the context of the HIV epidemic in southern Africa. Objectives This qualitative evaluation focussed on understanding the implementation process of targeted mentoring for clinical practice, data management and pharmacy management, at public health care facilities in South Africa; and on identifying critical factors influencing the effectiveness of mentoring as a technical assistance intervention in this context. Methods Purposive sampling was used to select participants from public health facilities in three South African Provinces. Participants were invited to take part in structured interviews. Datawere analysed using thematic analysis, and two core themes were identified: mentoring as knowledge and skills transfer; and mentoring as psychosocial support. Results In terms of knowledge and skills transfer, the sequential implementation of proactive and reactive mentoring was critical. Initial proactive mentoring involved mentors initiating training and developing professional relationships with mentees. Thereafter, a reactive mentoring phase allowed mentees to request support when required. This enabled mentors to leverage real-world problems faced by health workers to support their implementation of new knowledge and skills. The availability and accessibility of mentors alongside the relationships between mentors and mentees provided psychosocial support for health care workers which facilitated their self-efficacy in implementing new knowledge and skills. Conclusion These findings suggest that the success of mentoring programmes in LMICs may require specific attention to both knowledge transfer and the management of interpersonal relationships.
Collapse
Affiliation(s)
| | | | | | | | - James A McIntyre
- Anova Health Institute, South Africa.,School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Helen E Struthers
- Anova Health Institute, South Africa.,Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, South Africa
| | | |
Collapse
|
20
|
Fetene N, Canavan ME, Megentta A, Linnander E, Tan AX, Nadew K, Bradley EH. District-level health management and health system performance. PLoS One 2019; 14:e0210624. [PMID: 30707704 PMCID: PMC6358064 DOI: 10.1371/journal.pone.0210624] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 12/28/2018] [Indexed: 11/21/2022] Open
Abstract
Strengthening district-level management may be an important lever for improving key public health outcomes in low-income settings; however, previous studies have not established the statistical associations between better management and primary healthcare system performance in such settings. To explore this gap, we conducted a cross-sectional study of 36 rural districts and 226 health centers in Ethiopia, a country which has made ambitious investment in expanding access to primary care over the last decade. We employed quantitative measure of management capacity at both the district health office and health center levels and used multiple regression models, accounting for clustering of health centers within districts, to estimate the statistical association between management capacity and a key performance indicator (KPI) summary score based on antenatal care coverage, contraception use, skilled birth attendance, infant immunization, and availability of essential medications. In districts with above median district management capacity, health center management capacity was strongly associated (p < 0.05) with KPI performance. In districts with below median management capacity, health center management capacity was not associated with KPI performance. Having more staff at the district health office was also associated with better KPI performance (p < 0.05) but only in districts with above median management capacity. The results suggest that district-level management may provide an opportunity for improving health system performance in low-income country settings.
Collapse
Affiliation(s)
- Netsanet Fetene
- Yale Global Health Leadership Initiative, New Haven, Connecticut, United States of America
| | - Maureen E. Canavan
- Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Abraham Megentta
- Yale Global Health Leadership Initiative, New Haven, Connecticut, United States of America
| | - Erika Linnander
- Yale Global Health Leadership Initiative, New Haven, Connecticut, United States of America
- Yale School of Public Health, New Haven, Connecticut, United States of America
- * E-mail:
| | - Annabel X. Tan
- Yale Global Health Leadership Initiative, New Haven, Connecticut, United States of America
- Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Kidest Nadew
- Yale Global Health Leadership Initiative, New Haven, Connecticut, United States of America
- Yale School of Public Health, New Haven, Connecticut, United States of America
| | | |
Collapse
|
21
|
Martineau T, Raven J, Aikins M, Alonso-Garbayo A, Baine S, Huss R, Maluka S, Wyss K. Strengthening health district management competencies in Ghana, Tanzania and Uganda: lessons from using action research to improve health workforce performance. BMJ Glob Health 2018; 3:e000619. [PMID: 29662692 PMCID: PMC5898347 DOI: 10.1136/bmjgh-2017-000619] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 02/07/2018] [Accepted: 02/24/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND To achieve Universal Health Coverage (UHC), more health workers are needed; also critical is supporting optimal performance of existing staff. Integrated human resource management (HRM) strategies, complemented by other health systems strategies, are needed to improve health workforce performance, which is possible at district level in decentralised contexts. To strengthen the capacity of district management teams to develop and implement workplans containing integrated strategies for workforce performance improvement, we introduced an action-research-based management strengthening intervention (MSI). This consisted of two workshops, follow-up by facilitators and meetings between participating districts. Although often used in the health sector, there is little evaluation of this approach in middle-income and low-income country contexts. The MSI was tested in three districts in Ghana, Tanzania and Uganda. This paper reports on the appropriateness of the MSI to the contexts and its effects. METHODS Documentary evidence (workshop reports, workplans, diaries, follow-up visit reports) was collected throughout the implementation of the MSI in each district and interviews (50) and focus-group discussions (6) were conducted with managers at the end of the MSI. The findings were analysed using Kirkpatrick's evaluation framework to identify effects at different levels. FINDINGS The MSI was appropriate to the needs and work patterns of District Health Management Teams (DHMTs) in all contexts. DHMT members improved management competencies for problem analysis, prioritisation and integrated HRM and health systems strategy development. They learnt how to refine plans as more information became available and the importance of monitoring implementation. The MSI produced changes in team behaviours and confidence. There were positive results regarding workforce performance or service delivery; these would increase with repetition of the MSI. CONCLUSIONS The MSI is appropriate to the contexts where tested and can improve staff performance. However, for significant impact on service delivery and UHC, a method of scaling up and sustaining the MSI is required.
Collapse
Affiliation(s)
- Tim Martineau
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Joanna Raven
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Moses Aikins
- School of Public Health, University of Ghana, Legon, Ghana
| | | | - Sebastian Baine
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Reinhard Huss
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Stephen Maluka
- Institute of Development Studies, University of Dar-es-Salaam, Dar-es-Salaam, Tanzania
| | - Kaspar Wyss
- Schweizerisches Tropen- und Public Health-Institut, Basel, Switzerland
- University of Basel, Basel, Switzerland
| |
Collapse
|
22
|
Sebuliba I, Lindan C, Baryamutuma R, Kyomugisha C, Muhumuza S, Bazeyo W, Akello E. Improving the ability of districts in Uganda to monitor their HIV programs. EAST AFRICAN JOURNAL OF APPLIED HEALTH MONITORING AND EVALUATION 2018; 2018:http://eajahme.com/wp-content/uploads/2018/03/Sebuliba_FINAL.pdf. [PMID: 30918924 PMCID: PMC6433397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Although district health teams (DHT) in Uganda are supposed to monitor and support facilities to ensure quality HIV data collection, reporting and use, they are often ill-equipped to do so. We implemented a program designed to build the capacity of districts to manage and use their own HIV-related program data and to assist facilities to collect and evaluate their own data. METHODS We conducted a baseline assessment of the monitoring and evaluation (M&E) capacity of 38 districts. In the 10 worst-performing districts, we identified and trained district-level staff to become M&E mentors who in turn trained and supervised facility-level staff. We collected information on action plans developed by facilities to address major issues of concern. Following the intervention, we reassessed M&E capacity of the 10 targeted districts. RESULTS Among the 38 districts assessed, one-half did not have a biostatistician, less than one-quarter had staff trained in the basics of M&E or data analysis, and less than one-quarter had an M&E plan. The main concerns of facilities included lack of updated data collection tools, lack of supervision, inaccurate data recording, and limited ability to analyze and use data. In the 10 targeted districts, comparison before and after the intervention showed that the number of districts with trained M&E staff increased (4 to 9), the number of M&E plans increased (3 to 6), and the number using data for programming increased (4 to 8). Implementation of action plans by facilities successfully addressed many issues and led to improved programming. CONCLUSION Challenges of district M&E in Uganda mainly result from a lack of skilled human resources. On-the-job training and direct involvement of district staff to provide support to facilities can lead to improvements in data quality and use.
Collapse
Affiliation(s)
- Isaac Sebuliba
- Makerere University School of Public Health, Kampala, Uganda
| | - Christina Lindan
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | | | | | - Simon Muhumuza
- Makerere University School of Public Health, Kampala, Uganda
| | - William Bazeyo
- Makerere University School of Public Health, Kampala, Uganda
| | - Evelyn Akello
- Makerere University School of Public Health, Kampala, Uganda
| |
Collapse
|
23
|
Dansereau E, Miangotar Y, Squires E, Mimche H, El Bcheraoui C. Challenges to implementing Gavi's health system strengthening support in Chad and Cameroon: results from a mixed-methods evaluation. Global Health 2017; 13:83. [PMID: 29145871 PMCID: PMC5691914 DOI: 10.1186/s12992-017-0310-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 11/06/2017] [Indexed: 02/01/2023] Open
Abstract
Background Since 2005, Gavi has provided health system strengthening (HSS) grants to address bottlenecks affecting immunization services. This study is the first to evaluate the Gavi HSS implementation process in either Cameroon or Chad, two countries with significant health system challenges and poor achievement on the child and maternal health Millennium Development Goals. Methods We triangulated quantitative and qualitative data including financial records, document review, field visit questionnaires, and key informant interviews (KII) with representatives from the Ministries of Health, Gavi, and other partners. We conducted a Root Cause Analysis of key implementation challenges, guided by the Consolidated Framework for Implementation Research. Results We conducted 124 field visits and 43 KIIs in Cameroon, and 57 field visits and 39 KIIs in Chad. Cameroon’s and Chad’s HSS programs were characterized by delayed disbursements, significant deviations from approved expenditures, and reprogramming of funds. Nearly a year after the programs were intended to be complete, many district and facility-level activities were only partially implemented and significant funds remained unabsorbed. Root causes of these challenges included unpredictable Gavi processes and disbursements, poor communication between the countries and Gavi, insufficient country planning without adequate technical assistance, lack of country staff and leadership, and weak country systems to manage finances and promote institutional memory. Conclusions Though Chad and Cameroon both critically needed support to strengthen their weak health systems, serious challenges drastically limited implementation of their Gavi HSS programs. Implementation of future HSS programs in these and similar settings can be improved by transparent and reliable procedures and communication from Gavi, proposals that account for countries’ programmatic capacity and the potential for delayed disbursements, implementation practices that foster learning and adaptation, and an early emphasis on developing managerial and other human resources. Electronic supplementary material The online version of this article (10.1186/s12992-017-0310-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Emily Dansereau
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA, 98121, USA
| | - Yodé Miangotar
- University of N'Djamena, Avenue Mobutu, BP, 1117, N'Djamena, Chad
| | - Ellen Squires
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA, 98121, USA
| | - Honoré Mimche
- Institut de Formation et de Recherche Démographiques, University of Yaoundé II, 1556, Yaoundé, Cameroon
| | | | | | - Charbel El Bcheraoui
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA, 98121, USA.
| |
Collapse
|
24
|
Linnander EL, Mantopoulos JM, Allen N, Nembhard IM, Bradley EH. Professionalizing Healthcare Management: A Descriptive Case Study. Int J Health Policy Manag 2017; 6:555-560. [PMID: 28949471 PMCID: PMC5627783 DOI: 10.15171/ijhpm.2017.40] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/18/2017] [Indexed: 11/29/2022] Open
Abstract
Despite international recognition of the importance of healthcare management in the development of high-performing systems, the path by which countries may develop and sustain a professional healthcare management workforce has not been articulated. Accordingly, we sought to identify a set of common themes in the establishment of a professional workforce of healthcare managers in low- and middle-income country (LMIC) settings using a descriptive case study approach. We draw on a historical analysis of the development of this profession in the United States and Ethiopia to identify five common themes in the professionalization of healthcare management: (1) a country context in which healthcare management is demanded; (2) a national framework that elevates a professional management role; (3) standards for healthcare management, and a monitoring function to promote adherence to standards; (4) a graduatelevel educational path to ensure a pipeline of well-prepared healthcare managers; and (5) professional associations to sustain and advance the field. These five components can to inform the creation of a long-term national strategy for the development of a professional cadre of heathcare managers in LMIC settings.
Collapse
Affiliation(s)
- Erika L Linnander
- Yale School of Public Health, Yale University, New Haven, CT, USA.,Yale Global Health Leadership Institute, Yale University, New Haven, CT, USA
| | - Jeannie M Mantopoulos
- Yale School of Public Health, Yale University, New Haven, CT, USA.,Yale Global Health Leadership Institute, Yale University, New Haven, CT, USA
| | - Nikole Allen
- Yale School of Public Health, Yale University, New Haven, CT, USA.,Yale Global Health Leadership Institute, Yale University, New Haven, CT, USA
| | - Ingrid M Nembhard
- Yale School of Public Health, Yale University, New Haven, CT, USA.,Yale Global Health Leadership Institute, Yale University, New Haven, CT, USA
| | - Elizabeth H Bradley
- Yale School of Public Health, Yale University, New Haven, CT, USA.,Yale Global Health Leadership Institute, Yale University, New Haven, CT, USA
| |
Collapse
|
25
|
Belrhiti Z, Booth A, Marchal B, Verstraeten R. To what extent do site-based training, mentoring, and operational research improve district health system management and leadership in low- and middle-income countries: a systematic review protocol. Syst Rev 2016; 5:70. [PMID: 27116915 PMCID: PMC4847191 DOI: 10.1186/s13643-016-0239-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/06/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND District health managers play a key role in the effectiveness of decentralized health systems in low- and middle-income countries. Inadequate management and leadership skills often hamper their ability to improve quality of care and effectiveness of health service delivery. Nevertheless, significant investments have been made in capacity-building programmes based on site-based training, mentoring, and operational research. This systematic review aims to review the effectiveness of site-based training, mentoring, and operational research (or action research) on the improvement of district health system management and leadership. Our secondary objectives are to assess whether variations in composition or intensity of the intervention influence its effectiveness and to identify enabling and constraining contexts and underlying mechanisms. METHODS We will search the following databases: MEDLINE, PsycInfo, Cochrane Library, CRD database (DARE), Cochrane Effective Practice and Organisation of Care (EPOC) group, ISI Web of Science, Health Evidence.org, PDQ-Evidence, ERIC, EMBASE, and TRIP. Complementary search will be performed (hand-searching journals and citation and reference tracking). Studies that meet the following PICO (Population, Intervention, Comparison, Outcome) criteria will be included: P: professionals working at district health management level; I: site-based training with or without mentoring, or operational research; C: normal institutional arrangements; and O: district health management functions. We will include cluster randomized controlled trials, controlled before-and-after studies, interrupted time series analysis, quasi-experimental designs, and cohort and longitudinal studies. Qualitative research will be included to contextualize findings and identify barriers and facilitators. Primary outcomes that will be reported are district health management and leadership functions. We will assess risk of bias with the Cochrane Collaboration's tools for randomized controlled trials (RCT) and non RCT studies and Critical Appraisal Skills Programme checklists for qualitative studies. We will assess strength of recommendations with the GRADE tool for quantitative studies, and the CERQual approach for qualitative studies. Synthesis of quantitative studies will be performed through meta-analysis when appropriate. Best fit framework synthesis will be used to synthesize qualitative studies. DISCUSSION This protocol paper describes a systematic review assessing the effectiveness of site-based training (with or without mentoring programmes or operational research) on the improvement of district health system management and leadership. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015032351.
Collapse
Affiliation(s)
- Zakaria Belrhiti
- Department of Management and Economy, National School of Public Health, Rabat, Morocco.
| | - Andrew Booth
- School of Health & Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Bruno Marchal
- Health Services Organisation Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | | |
Collapse
|
26
|
Maternal and Neonatal and Child Health Priorities in Africa and Asia. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9107970. [PMID: 27722175 PMCID: PMC5045995 DOI: 10.1155/2016/9107970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 06/08/2016] [Indexed: 11/18/2022]
|
27
|
Moon TD, Edwards LJ, Vermund SH. Health Management Mentoring for Health Systems Strengthening: A Response to Recent Commentaries. Int J Health Policy Manag 2015; 4:793-4. [PMID: 26673346 DOI: 10.15171/ijhpm.2015.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 09/30/2015] [Indexed: 11/09/2022] Open
Affiliation(s)
- Troy D Moon
- Vanderbilt Institute for Global Health, Department of Pediatrics, Vanderbilt University, Nashville, TN, USA
| | - Laura J Edwards
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, USA.,Abt Associates, Atlanta, GA, USA
| | - Sten H Vermund
- Vanderbilt Institute for Global Health, Department of Pediatrics, Vanderbilt University, Nashville, TN, USA
| |
Collapse
|
28
|
Schwarcz SK, Rutherford GW, Horvath H. Training for Better Management: Avante Zambézia, PEPFAR and Improving the Quality of Administrative Services Comment on "Implementation of a Health Management Mentoring Program: Year-1 Evaluation of Its Impact on Health System Strengthening in Zambézia Province, Mozambique". Int J Health Policy Manag 2015; 4:773-5. [PMID: 26673340 DOI: 10.15171/ijhpm.2015.136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/22/2015] [Indexed: 11/09/2022] Open
Abstract
The United States President's Emergency Plan for AIDS Relief (PEPFAR) emphasizes health systems strengthening as a cornerstone of programmatic success. Health systems strengthening, among other things, includes effective capacity building for clinical care, administrative management and public health practice. Avante Zambézia is a district-level in-service training program for administrative staff. It is associated with improved accounting practices and human resources and transportation management but not monitoring and evaluation. We discuss other examples of successful administrative training programs that vary in the proportion of time that is spent learning on the job and the proportion of time spent in classrooms. We suggest that these programs be more rigorously evaluated so that lessons learned can be generalized to other countries and regions.
Collapse
Affiliation(s)
- Sandra K Schwarcz
- Global Health Sciences and Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,The San Francisco Department of Public Health, San Francisco, CA, USA
| | - George W Rutherford
- Global Health Sciences and Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Hacsi Horvath
- Global Health Sciences and Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| |
Collapse
|
29
|
Lapão LV. Seriously Implementing Health Capacity Strengthening Programs in Africa: Comment on "Implementation of a Health Management Mentoring Program: Year-1 Evaluation of Its Impact on Health System Strengthening in Zambézia Province, Mozambique". Int J Health Policy Manag 2015; 4:691-3. [PMID: 26673182 DOI: 10.15171/ijhpm.2015.130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 07/10/2015] [Indexed: 11/09/2022] Open
Abstract
Faced with the challenges of healthcare reform, skills and new capabilities are needed to support the reform and it is of crucial importance in Africa where shortages affects the health system resilience. Edwards et al provides a good example of the challenge of implementing a mentoring program in one province in a sub-Saharan country. From this example, various aspects of strengthening the capacity of managers in healthcare are examined based on our experience in action-training in Africa, as mentoring shares many characteristics with action-training. What practical lessons can be drawn to promote the strengthening so that managers can better intervene in complex contexts? Deeper involvement of health authorities and more rigorous approaches are seriously desirable for the proper development of health capacity strengthening programs in Africa.
Collapse
Affiliation(s)
- Luís Velez Lapão
- International Public Health and Biostatistics, WHO Collaborating Center on Health Workforce Policy and Planning, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| |
Collapse
|