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Makwero MK, Majo T, Devarsetty P, Sharma M, Mash B, Dullie L, Munar W. Characterising the performance measurement and management system in the primary health care systems of Malawi. Afr J Prim Health Care Fam Med 2024; 16:e1-e11. [PMID: 38299545 PMCID: PMC10839197 DOI: 10.4102/phcfm.v16i1.4007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Performance Measurement and Management (PMM) systems are levers that support key management functions in health care systems. Just like many low- and middle-income countries (LMICs), Malawi strives to improve performance via evidence-based decision making and a suitable performance culture. AIM This study sought to describe PMM practices at all levels of primary health care (PHC) in Malawi. SETTING This study targeted three levels of PHC, namely the district health centres (DHCs), the zones, and the ministry headquarters. METHODS This was a qualitative exploratory research study where decision-makers at each level of PHC were engaged using key-informant interviews (KII) and focus group discussions (FGDs). RESULTS We found that there is a weak link among levels of PHC in supporting PMM practices leading to poor dissemination of priorities and goals. There is also failure to appropriately institute good PMM practices, and the use of performance information was found to be limited among decision-makers. CONCLUSION Though PMM is acknowledged to be key in supporting health service delivery systems, Malawi's PHC system has not fully embarked on making this a priority. Some challenges include unsupportive culture and inadequate capacity for PMM.Contribution: This study contributes to the understanding of the PMM processes in Malawi and further highlights the salient challenges in the use of information for performance management. While the presence of policies on PMM is acknowledged, implementation studies that deal with challenges are urgent and imperative.
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Affiliation(s)
- Martha K Makwero
- Department of Family Medicine, Faculty of Medicine, Kamuzu University of Health Sciences, Blantyre.
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Thout SR, Yu J, Tian M, Huffman MD, Arnott C, Li Q, Devarsetty P, Johnson C, Pettigrew S, Neal B, Wu JHY. Rationale, design, and baseline characteristics of the Salt Substitute in India Study (SSiIS): The protocol for a double-blinded, randomized-controlled trial. J Clin Hypertens (Greenwich) 2020; 22:1504-1512. [PMID: 32710677 DOI: 10.1111/jch.13947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 02/04/2023]
Abstract
Reduced-sodium, added-potassium salt substitutes have favorable effects on blood pressure, but have not been tested in India. The Salt Substitute in India Study (SSiIS) is a double-blinded, randomized-controlled trial designed to investigate the effects of reduced-sodium, added-potassium salt substitution to replace usual cooking salt use and blood pressure (BP) among hypertensive patients in rural India. The primary objective is to assess effects on systolic blood pressure at 3 months. The secondary objectives are to determine effects on diastolic blood pressure, urinary sodium, and potassium levels, and to determine acceptability of the intervention. Eligible individuals received usual salt (100% sodium chloride) or salt substitute (70% sodium chloride and 30% potassium chloride) to replace all salt required for cooking and seasoning in the household. A total of 502 participants aged ≥18 years with a history of hypertension were successfully recruited and randomized in a 1:1 ratio to intervention or control, between November 2019 and January 2020. Mean blood pressure at baseline was 133.5/83.6 mm Hg and 96% were using one or more blood pressure-lowering medications. The overall mean average 24-hour urinary sodium excretion was 2825 (SD, 1166) mg/L, which corresponds to a urinary salt excretion of 10.4 g/d. Baseline findings suggest sodium intake in this population significantly exceeds World Health Organization recommendations. The SSiIS trial has successfully recruited participants and is well placed to determine whether salt substitution is an effective means of lowering blood pressure for rural Indian patients with hypertension.
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Affiliation(s)
- Sudhir Raj Thout
- The George Institute for Global Health India, Punjagutta, Hyderabad, India
| | - Jie Yu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Maoyi Tian
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,The George Institute for Global Health at Peking University Health Science Centre, Beijing, China
| | - Mark D Huffman
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Clare Arnott
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Qiang Li
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Praveen Devarsetty
- The George Institute for Global Health India, Punjagutta, Hyderabad, India
| | - Claire Johnson
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Imperial College London, London, UK
| | - Jason H Y Wu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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