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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.
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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
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Artificial intelligence education for radiographers, an evaluation of a UK postgraduate educational intervention using participatory action research: a pilot study. Insights Imaging 2023; 14:25. [PMID: 36735172 PMCID: PMC9897152 DOI: 10.1186/s13244-023-01372-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 01/15/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Artificial intelligence (AI)-enabled applications are increasingly being used in providing healthcare services, such as medical imaging support. Sufficient and appropriate education for medical imaging professionals is required for successful AI adoption. Although, currently, there are AI training programmes for radiologists, formal AI education for radiographers is lacking. Therefore, this study aimed to evaluate and discuss a postgraduate-level module on AI developed in the UK for radiographers. METHODOLOGY A participatory action research methodology was applied, with participants recruited from the first cohort of students enrolled in this module and faculty members. Data were collected using online, semi-structured, individual interviews and focus group discussions. Textual data were processed using data-driven thematic analysis. RESULTS Seven students and six faculty members participated in this evaluation. Results can be summarised in the following four themes: a. participants' professional and educational backgrounds influenced their experiences, b. participants found the learning experience meaningful concerning module design, organisation, and pedagogical approaches, c. some module design and delivery aspects were identified as barriers to learning, and d. participants suggested how the ideal AI course could look like based on their experiences. CONCLUSIONS The findings of our work show that an AI module can assist educators/academics in developing similar AI education provisions for radiographers and other medical imaging and radiation sciences professionals. A blended learning delivery format, combined with customisable and contextualised content, using an interprofessional faculty approach is recommended for future similar courses.
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Chavula MP, Zulu JM, Hurtig AK. Factors influencing the integration of comprehensive sexuality education into educational systems in low- and middle-income countries: a systematic review. Reprod Health 2022; 19:196. [PMID: 36175901 PMCID: PMC9524136 DOI: 10.1186/s12978-022-01504-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 09/12/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Comprehensive sexuality education (CSE) plays a critical role in promoting youth and adolescent's sexual and reproductive health and wellbeing. However, little is known about the enablers and barriers affecting the integration of CSE into educational programmes. The aim of this review is to explore positive and negative factors influencing the integration of CSE into national curricula and educational systems in low- and middle-income countries. METHODS We conducted a systematic literature review (January 2010 to August 2022). The results accord with the Preferred Reporting Items for Systematic Reviews and Meta-analysis standards for systematic reviews. Data were retrieved from the PubMed, Cochrane, Google Scholar, and Web of Hinari databases. The search yielded 442 publications, of which 34 met the inclusion criteria for full-text screening. The review is guided by an established conceptual framework that incorporates the integration of health innovations into health systems. Data were analysed using a thematic synthesis approach. RESULTS The magnitude of the problem is evidenced by sexual and reproductive health challenges such as high teenage pregnancies, early marriages, and sexually transmitted infections. Awareness of these challenges can facilitate the development of interventions and the implementation and integration of CSE. Reported aspects of the interventions include core CSE content, delivery methods, training materials and resources, and various teacher-training factors. Reasons for adoption include perceived benefits of CSE, experiences and characteristics of both teachers and learners, and religious, social and cultural factors. Broad system characteristics include strengthening links between schools and health facilities, school and community-based collaboration, coordination of CSE implementation, and the monitoring and evaluation of CSE. Ultimately, the availability of resources, national policies and laws, international agendas, and political commitment will impact upon the extent and level of integration. CONCLUSION Social, economic, cultural, political, legal, and financial contextual factors influence the implementation and integration of CSE into national curricula and educational systems. Stakeholder collaboration and involvement in the design and appropriateness of interventions is critical.
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Affiliation(s)
- Malizgani Paul Chavula
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden. .,School of Public Health, Department of Health Promotion and Policy Management, University of Zambia, Ridgeway Campus, P. O. Box 50110, Lusaka, Zambia.
| | - Joseph Mumba Zulu
- grid.12984.360000 0000 8914 5257School of Public Health, Department of Health Promotion and Policy Management, University of Zambia, Ridgeway Campus, P. O. Box 50110, Lusaka, Zambia
| | - Anna-Karin Hurtig
- grid.12650.300000 0001 1034 3451Department of Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
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4
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Forchuk C, Russell G, Richardson J, Perreault C, Hassan H, Lucyk B, Gyamfi S. Family matters in Canada: understanding and addressing family homelessness in Ontario. BMC Public Health 2022; 22:614. [PMID: 35351039 PMCID: PMC8966253 DOI: 10.1186/s12889-022-13028-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background Homelessness is becoming an international public health issue in most developed countries, including Canada. Homelessness is regarded as both political and socioeconomic problems warranting broad and consistent result-oriented approaches. Methods This paper represents the qualitative findings of a project that explored risk factors associated with family homelessness and strategies that could mitigate and prevent homelessness among families using a focused ethnographic study guided by the principles of participatory action research (PAR). The sample includes 36 family members residing at a family shelter who participated in focus groups over two years (between April 2016 and December 2017). Most of the participants were single-parent women. Results The analysis yielded five major themes including, life challenges, lack of understanding of the system, existing power differentials, escaping from hardship, and a theme of proposed solutions for reducing family homelessness in the community. Conclusion The findings illustrated the complex nature of family homelessness in Ontario; that the interaction of multiple systems can put families at risk of homelessness. Findings from this study underscore the need for urgent housing protocols aimed at educating homeless families on how to navigate and understand the system, enhance their conflict resolution skills, and develop strategies beyond relocation to help them to cope with difficulties with housing.
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Affiliation(s)
- Cheryl Forchuk
- Western University, Nursing, London, ON, Canada. .,Lawson Health Research Institute, London, ON, Canada. .,Parkwood Research Institute, London, ON, Canada. .,STN B, Beryl and Richard Ivey Research Chair in Aging, Mental Health, Rehabilitation and Recovery, Mental Health Nursing Research Alliance, Lawson Health Research Institute, Parkwood Institute Mental Health Care Building, 550 Wellington Road, Suite B3-110, P.O. Box 5777, London, N6A 4V2, Canada.
| | | | | | | | - Heba Hassan
- Lawson Health Research Institute, London, ON, Canada.,Parkwood Research Institute, London, ON, Canada
| | - Bryanna Lucyk
- Lawson Health Research Institute, London, ON, Canada.,Parkwood Research Institute, London, ON, Canada
| | - Sebastian Gyamfi
- Lawson Health Research Institute, London, ON, Canada.,Parkwood Research Institute, London, ON, Canada
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5
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Ssensamba JT, Nakafeero M, Musana H, Amollo M, Ssennyonjo A, Kiwanuka SN. Primary care provider notions on instituting community-based geriatric support in Uganda. BMC Geriatr 2022; 22:258. [PMID: 35351013 PMCID: PMC8962536 DOI: 10.1186/s12877-022-02897-9] [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: 07/09/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Understanding of the most economical and sustainable models of providing geriatric care to Africa’s rising ageing population is critical. In Uganda, the number of old adults (60 years and above) continues to rise against absence of policies and guidelines, and models for providing care to this critical population. Our study explored public primary health care provider views on how best community-based geriatric support (CBGS) could be instituted as an adaptable model for delivering geriatric care in Uganda’s resource-limited primary public health care settings. Methods We interviewed 20 key informants from four districts of Bukomansimbi, Kalungu, Rakai, and Lwengo in Southern Central Uganda. Respondents were leads (in-charges) of public primary health units that had spent at least 6 months at the fore said facilities. All interviews were audio-recorded, transcribed verbatim, and analysed based on Hsieh and Shannon’s approach to conventional manifest content analysis. Results During analysis, four themes emerged: 1) Structures to leverage for CBGS, 2) How to promote CBGS, 3) Who should be involved in CBGS, and 4) What activities need to be leveraged to advance CBGS? The majority of the respondents viewed using the existing village health team and local leadership structures as key to the successful institutionalization of CBGS; leveraging community education and sensitization using radio, television, and engaging health workers, family relatives, and neighbors. Health outreach activities were mentioned as one of the avenues that could be leveraged to provide CBGS. Conclusion Provider notions pointed to CBGS as a viable model for instituting geriatric care in Uganda’s public primary healthcare system. However, this requires policymakers to leverage existing village health team and local governance structures, conduct community education and sensitization about CBGS, and bring onboard health workers, family relatives, and neighbors. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02897-9.
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Affiliation(s)
- Jude Thaddeus Ssensamba
- Division of Infectious Diseases and Geriatric Health, Center for Innovations in Health Africa, Kampala, Uganda. .,Health Care Programmes, VIVES University of Applied Sciences, Kortrijk, Belgium. .,School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Mary Nakafeero
- Division of Infectious Diseases and Geriatric Health, Center for Innovations in Health Africa, Kampala, Uganda.,School of Public Health, Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Hellen Musana
- Division of Infectious Diseases and Geriatric Health, Center for Innovations in Health Africa, Kampala, Uganda.,School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mathew Amollo
- School of Public Health, Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Aloysius Ssennyonjo
- School of Public Health, Department of Health Policy and Planning, Makerere University College of Health Sciences, Kampala, Uganda
| | - Suzanne N Kiwanuka
- School of Public Health, Department of Health Policy and Planning, Makerere University College of Health Sciences, Kampala, Uganda
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Khan AM, Dunlop DMD, Lennon DM, Dubiel DM. Towards Designing Mobile Apps for Independent Travel. ACM TRANSACTIONS ON ACCESSIBLE COMPUTING 2021. [DOI: 10.1145/3460943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Performing daily independent activities can be a challenge for people with Down's Syndrome (DS). This article investigates how to better support these activities with smart devices based on three cycles of a collaborative participatory action research (PAR) process. The first cycle involved semi-structured interviews (
n = 4
) with parents and an online survey (
n = 39
) with people with DS and their parents to explore barriers and opportunities for independent activities. This cycle highlighted that travelling independently was a common challenge among discussed barriers to independent activities for young adults with DS, an issue that smart devices have the potential to overcome. The second cycle involved seven focus group discussions (
n = 20
) with parents (
n = 13
) and young adults with DS (
n = 7
) for gaining deeper insights into barriers to independent travel. We explored key barriers to independent travel and gathered design requirements for smartphone apps to overcome these barriers. In the third cycle, we designed a digital prototype based on participant recommendations and conducted seven focus group meetings (
n = 19
) with caregivers (
n = 12
) and individuals with DS (
n = 7
). This final cycle reviewed the proposed digital prototype and validated the key barriers found in the second cycle. Overall, our studies confirmed that mobile technology can support people with DS in performing daily life activities that increase social inclusion. The studies resulted in identified barriers and requirements along with co-designed solutions for independent travel apps.
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Affiliation(s)
- Al Majed Khan
- Computer & Information Sciences, University of Strathclyde, Glasgow, Scotland
| | - Dr Mark D. Dunlop
- Computer & Information Sciences, University of Strathclyde, Glasgow, Scotland
| | - Dr Marilyn Lennon
- Computer & Information Sciences, University of Strathclyde, Glasgow, Scotland
| | - Dr Mateusz Dubiel
- Computer & Information Sciences, University of Strathclyde, Glasgow, Scotland
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Ozano K, Dean L, Adekeye O, Bettee AK, Dixon R, Gideon NU, Gwani N, Isiyaku S, Kollie K, Lar L, Oluwole A, Piotrowski H, Siakeh A, Thomson R, Yashiyi J, Zawolo G, Theobald S. Guiding principles for quality, ethical standards and ongoing learning in implementation research: multicountry learnings from participatory action research to strengthen health systems. Health Policy Plan 2021; 35:ii137-ii149. [PMID: 33156936 PMCID: PMC7646736 DOI: 10.1093/heapol/czaa123] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 12/17/2022] Open
Abstract
Global health gains can be achieved through strengthening health systems to identify and address implementation challenges in low- and middle-income countries. Participatory research, that promotes joint problem and solution finding between communities and different health systems actors, supports policy implementation analysis at all levels. Within the neglected tropical disease programmes in Liberia and Nigeria, we applied participatory action research (PAR) to address programmatic and health system bottlenecks with health systems strengthening embedded. This paper shares learning from 20 interviews with co-researchers, from national and sub-national levels and academic researchers who worked collaboratively to understand challenges, co-create solutions and advocate for policy change. Through analysis and reflections of existing PAR principles, we inductively identified five additional guiding principles for quality, ethical standards and ongoing learning within PAR projects that aim to strengthen health systems. (1) Recognize communities as units of identity and define stakeholder participation to ensure equitable engagement of all actors; (2) enable flexible action planning that builds on existing structures whilst providing opportunities for embedding change; (3) address health systems and research power differentials that can impede co-production of knowledge and solution development; (4) embed relational practices that lead to new political forms of participation and inquiry within health systems and (5) develop structures for ongoing learning at multiple levels of the health system. PAR can strengthen health systems by connecting and co-creating potentially sustainable solutions to implementation challenges. Additional research to explore how these five additional principles can support the attainment of quality and ethical standards within implementation research using a PAR framework for health systems strengthening is needed.
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Affiliation(s)
- Kim Ozano
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L35QA, UK
| | - Laura Dean
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L35QA, UK
| | - Oluwatosin Adekeye
- Sightsavers, Nigeria Country Office, Golf Course Road, City Centre, Kaduna, Nigeria
| | - Anthony K Bettee
- Ministry of Health, Government of Liberia, SKD Boulevard, Monrovia, Liberia
| | - Ruth Dixon
- Sightsavers, 35 Perrymount Rd, Haywards Heath RH16 3BZ, UK
| | - Ntuen Uduak Gideon
- Ministry of Health, Government of Nigeria, Federal Secretariat, Complex Garki PMB, 83 Abuja, Nigeria
| | - Noela Gwani
- Sightsavers, Nigeria Country Office, Golf Course Road, City Centre, Kaduna, Nigeria
| | - Sunday Isiyaku
- Sightsavers, Nigeria Country Office, Golf Course Road, City Centre, Kaduna, Nigeria
| | - Karsor Kollie
- Ministry of Health, Government of Liberia, SKD Boulevard, Monrovia, Liberia
| | - Luret Lar
- Sightsavers, Nigeria Country Office, Golf Course Road, City Centre, Kaduna, Nigeria
| | - Akinola Oluwole
- Sightsavers, Nigeria Country Office, Golf Course Road, City Centre, Kaduna, Nigeria
| | - Helen Piotrowski
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L35QA, UK
| | - Alice Siakeh
- Pacific Institute for Research and Evaluation UL-PIRE Africa Center, University of Liberia, Capitol Hill Liberia
| | - Rachael Thomson
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L35QA, UK
| | - James Yashiyi
- Sightsavers, Nigeria Country Office, Golf Course Road, City Centre, Kaduna, Nigeria
| | - Georgina Zawolo
- Pacific Institute for Research and Evaluation UL-PIRE Africa Center, University of Liberia, Capitol Hill Liberia
| | - Sally Theobald
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L35QA, UK
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8
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Ahmad RA, Ferdiana A, Surendra H, Sy TR, Herbianto D, Rahayujati TB, Rejeki DSS, Murhandarwati EEH. A participatory approach to address within-country cross-border malaria: the case of Menoreh Hills in Java, Indonesia. Malar J 2021; 20:137. [PMID: 33676491 PMCID: PMC7937247 DOI: 10.1186/s12936-021-03673-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria remains a significant public health issue in Indonesia. Most of the endemic areas are in the eastern parts of Indonesia, but there are a few remaining foci of persistent endemic malaria in Java, particularly in Menoreh Hills, a region bordering three districts of two provinces on this island. Despite a commitment to build a partnership to eliminate cross-border malaria, there is a lack of understanding of how this partnership might be translated into an implementable strategic plan. The study aims to provide evidence of how a participatory approach was used to strengthen the cross-border collaboration and stakeholders' capacity to develop a joint strategic, operational, and costing plan for cross-border malaria elimination. METHODS A participatory action research was conducted from January to August 2017, involving participants from the village, district, provincial, and national levels. This study was conducted in seven phases, including document review, focus group discussions (FGDs), planning and costing workshops, and a dissemination meeting. A total of 44 participants from primary health centres (PHC) and 27 representatives of affected villages in three districts, 16 participants from the district and provincial malaria programmes and planning bureaus, and 11 participants from the national level were involved in the processes. Data on priority issues, costing, programme coverage, and administration were collected. Thematic coding and feedback were used for analysis. RESULTS Problems identified by stakeholders included low community awareness and participation in malaria prevention, high mobility across three districts, lack of financial and human resources, lack of inter-district coordination, and poor implementation of migration surveillance. Cross-border strategies identified to address malaria were improving cross-border migration surveillance, strengthening the network, governance, and advocacy of malaria control implementation across borders, and developing the malaria information system. A working group composed of the three districts' representatives authorized to decide on cross-border issues will be created. CONCLUSIONS The participatory approach was applicable in cross-border malaria planning for within-country settings and useful in enhancing stakeholders' capacities as implementers. While done in a participatory way, the joint plan crafted was a non-binding agreement; stakeholders should advocate to ensure adequate funds are poured into mobilizing the programme.
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Affiliation(s)
- Riris Andono Ahmad
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia. .,Department of Biostatistics, Epidemiology and Population Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Astri Ferdiana
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Department of Public Health, Faculty of Medicine, University of Mataram, Mataram, Indonesia
| | - Henry Surendra
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | - Tyrone Reden Sy
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Deni Herbianto
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Theodola Baning Rahayujati
- Disease Prevention and Control, District Health Office of Kulon Progo, Kulon Progo, Yogyakarta, Indonesia
| | - Dwi Sarwani Sri Rejeki
- Department of Public Health, Faculty of Health Sciences, Universitas Jenderal Soedirman, Purwokerto, Central Java, Indonesia
| | - E Elsa Herdiana Murhandarwati
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Department of Parasitology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Paina L, Namazzi G, Tetui M, Mayora C, Kananura RM, Kiwanuka SN, Waiswa P, Mutebi A, Ekirapa-Kiracho E. Applying the model of diffusion of innovations to understand facilitators for the implementation of maternal and neonatal health programmes in rural Uganda. Global Health 2019; 15:38. [PMID: 31196193 PMCID: PMC6567581 DOI: 10.1186/s12992-019-0483-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 05/28/2019] [Indexed: 11/10/2022] Open
Abstract
In Uganda, more than 336 out of every 100,000 women die annually during childbirth. Pregnant women, particularly in rural areas, often lack the financial resources and means to access health facilities in a timely manner for quality antenatal, delivery, and post-natal services. For nearly the past decade, the Makerere University School of Public Health researchers, through various projects, have been spearheading innovative interventions, embedded in implementation research, to reduce barriers to access to care. In this paper, we describe two of projects that were initially conceived to tackle the financial barriers to access to care – through a voucher program in the community - on the demand side - and a series of health systems strengthening activities at the district and facility level - on the supply side. Over time, the projects diverged in the content of the intervention and the modality in which they were implemented, providing an opportunity for reflection on innovation and scaling up. In this short report, we used an adaptation of Greenhalgh’s Model of Diffusion to reflect on these projects’ approaches to implementing innovative interventions, with the ultimate goal of reducing maternal and neonatal mortality in rural Uganda. We found that the adapted model of diffusion of innovations facilitated the emergence of insights on barriers and facilitators to the implementation of health systems interventions. Health systems research projects would benefit from analyses beyond the implementation period, in order to better understand how adoption and diffusion happen, or not, over time, after the external catalyst departs.
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Affiliation(s)
- Ligia Paina
- Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gertrude Namazzi
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Complex, Kampala, Uganda
| | - Moses Tetui
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Complex, Kampala, Uganda. .,Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden.
| | - Chrispus Mayora
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Complex, Kampala, Uganda
| | - Rornald Muhumuza Kananura
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Complex, Kampala, Uganda
| | - Suzanne N Kiwanuka
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Complex, Kampala, Uganda
| | - Peter Waiswa
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Complex, Kampala, Uganda
| | - Aloysius Mutebi
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Complex, Kampala, Uganda
| | - Elizabeth Ekirapa-Kiracho
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Complex, Kampala, Uganda
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10
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Gray C, Crawford G, Lobo R, Maycock B. Co-Designing an Intervention to Increase HIV Testing Uptake with Women from Indonesia At-Risk of HIV: Protocol for a Participatory Action Research Study. Methods Protoc 2019; 2:E41. [PMID: 31164620 PMCID: PMC6632167 DOI: 10.3390/mps2020041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/20/2019] [Accepted: 05/20/2019] [Indexed: 01/05/2023] Open
Abstract
Early diagnosis is a critical component of the global response to the human immunodeficiency virus (HIV). In Australia, more than two-thirds of women from Southeast Asia are diagnosed late with HIV. There is limited evidence regarding the barriers to HIV testing and which interventions work to increase an uptake among migrants living in high-income countries. This participatory action research (PAR) project will work with women from Indonesia to co-design an intervention to increase HIV testing uptake in Western Australia. The project will involve trained community researchers, representatives from relevant organizations, and community women born in Indonesia. We will conduct three PAR cycles. Phase one will use focus groups to understand enablers for HIV testing among community members. In phase two, data will be presented back to members of the participating communities who will be invited to co-design an intervention to increase HIV testing. The final cycle will focus on implementing and evaluating the resulting intervention. This project will add to the small body of literature on pathways and enablers to HIV testing, and to new insights regarding interventions that work for women from migrant communities and why.
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Affiliation(s)
- Corie Gray
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, 6102 Bentley, Australia.
| | - Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, 6102 Bentley, Australia.
| | - Roanna Lobo
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, 6102 Bentley, Australia.
| | - Bruce Maycock
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, 6102 Bentley, Australia.
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11
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Ekirapa-Kiracho E, Tetui M, Bua J, Muhumuza Kananura R, Waiswa P, Makumbi F, Atuyambe L, Ajeani J, George A, Mutebi A, Kakaire A, Namazzi G, Paina L, Namusoke Kiwanuka S. Maternal and neonatal implementation for equitable systems. A study design paper. Glob Health Action 2018; 10:1346925. [PMID: 28849723 PMCID: PMC5645657 DOI: 10.1080/16549716.2017.1346925] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Evidence on effective ways of improving maternal and neonatal health outcomes is widely available. The challenge that most low-income countries grapple with is implementation at scale and sustainability. Objectives: The study aimed at improving access to quality maternal and neonatal health services in a sustainable manner by using a participatory action research approach. Methods: The study consisted of a quasi-experimental design, with a participatory action research approach to implementation in three rural districts (Pallisa, Kibuku and Kamuli) in Eastern Uganda. The intervention had two main components; namely, community empowerment for comprehensive birth preparedness, and health provider and management capacity-building. We collected data using both quantitative and qualitative methods using household and facility-level structured surveys, record reviews, key informant interviews and focus group discussions. We purposively selected the participants for the qualitative data collection, while for the surveys we interviewed all eligible participants in the sampled households and health facilities. Descriptive statistics were used to describe the data, while the difference in difference analysis was used to measure the effect of the intervention. Qualitative data were analysed using thematic analysis. Conclusions: This study was implemented to generate evidence on how to increase access to quality maternal and newborn health services in a sustainable manner using a multisectoral participatory approach.
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Affiliation(s)
| | - Moses Tetui
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda.,b Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - John Bua
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda
| | - Rornald Muhumuza Kananura
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda.,d Maternal and Neonatal Health Center of Excellence, Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda
| | - Peter Waiswa
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda.,c Global Health Division , Karolinska Institutet , Stockholm , Sweden.,d Maternal and Neonatal Health Center of Excellence, Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda
| | - Fred Makumbi
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda
| | - Lynn Atuyambe
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda
| | - Judith Ajeani
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda
| | - Asha George
- e Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,f School of Public Health , University of the Western Cape , Robert Sobukwe Road , Bellville 7535 , Republic of South Africa
| | - Aloysuis Mutebi
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda
| | - Ayub Kakaire
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda
| | - Gertrude Namazzi
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda.,d Maternal and Neonatal Health Center of Excellence, Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda
| | - Ligia Paina
- e Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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12
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Ekirapa-Kiracho E, Paina L, Muhumuza Kananura R, Mutebi A, Jane P, Tumuhairwe J, Tetui M, Kiwanuka SN. 'Nurture the sprouting bud; do not uproot it'. Using saving groups to save for maternal and newborn health: lessons from rural Eastern Uganda. Glob Health Action 2018; 10:1347311. [PMID: 28820046 PMCID: PMC5645701 DOI: 10.1080/16549716.2017.1347311] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Saving groups are increasingly being used to save in many developing countries. However, there is limited literature about how they can be exploited to improve maternal and newborn health. Objectives: This paper describes saving practices, factors that encourage and constrain saving with saving groups, and lessons learnt while supporting communities to save through saving groups. Methods: This qualitative study was done in three districts in Eastern Uganda. Saving groups were identified and provided with support to enhance members’ access to maternal and newborn health. Fifteen focus group discussions (FGDs) and 18 key informant interviews (KIIs) were conducted to elicit members’ views about saving practices. Document review was undertaken to identify key lessons for supporting saving groups. Qualitative data are presented thematically. Results: Awareness of the importance of saving, safe custody of money saved, flexible saving arrangements and easy access to loans for personal needs including transport during obstetric emergencies increased willingness to save with saving groups. Saving groups therefore provided a safety net for the poor during emergencies. Poor management of saving groups and detrimental economic practices like gambling constrained saving. Efficient running of saving groups requires that they have a clear management structure, which is legally registered with relevant authorities and that it is governed by a constitution. Conclusions: Saving groups were considered a useful form of saving that enabled easy acess to cash for birth preparedness and transportation during emergencies. They are like ‘a sprouting bud that needs to be nurtured rather than uprooted’, as they appear to have the potential to act as a safety net for poor communities that have no health insurance. Local governments should therefore strengthen the management capacity of saving groups so as to ensure their efficient running through partnerships with non-governmental organizations that can provide support to such groups.
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Affiliation(s)
- Elizabeth Ekirapa-Kiracho
- a Makerere University School of Public Health , Department of Health Policy Planning and Management , Kampala , Uganda
| | - Ligia Paina
- b Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Rornald Muhumuza Kananura
- a Makerere University School of Public Health , Department of Health Policy Planning and Management , Kampala , Uganda
| | - Aloysius Mutebi
- a Makerere University School of Public Health , Department of Health Policy Planning and Management , Kampala , Uganda
| | - Pacuto Jane
- a Makerere University School of Public Health , Department of Health Policy Planning and Management , Kampala , Uganda
| | | | - Moses Tetui
- a Makerere University School of Public Health , Department of Health Policy Planning and Management , Kampala , Uganda.,d Department of Public Health and Clinical Medicine Sweden , Umeå University, Epidemiology and Global Health Unit , Umeå , Sweden
| | - Suzanne N Kiwanuka
- a Makerere University School of Public Health , Department of Health Policy Planning and Management , Kampala , Uganda
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13
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Ekirapa-Kiracho E, Muhumuza Kananura R, Tetui M, Namazzi G, Mutebi A, George A, Paina L, Waiswa P, Bumba A, Mulekwa G, Nakiganda-Busiku D, Lyagoba M, Naiga H, Putan M, Kulwenza A, Ajeani J, Kakaire-Kirunda A, Makumbi F, Atuyambe L, Okui O, Namusoke Kiwanuka S. Effect of a participatory multisectoral maternal and newborn intervention on maternal health service utilization and newborn care practices: a quasi-experimental study in three rural Ugandan districts. Glob Health Action 2018; 10:1363506. [PMID: 28871853 PMCID: PMC5645678 DOI: 10.1080/16549716.2017.1363506] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: The MANIFEST study in eastern Uganda employed a participatory multisectoral approach to reduce barriers to access to maternal and newborn care services. Objectives: This study analyses the effect of the intervention on the utilization of maternal and newborn services and care practices. Methods: The quasi-experimental pre- and post-comparison design had two main components: community mobilization and empowerment, and health provider capacity building. The primary outcomes were utilization of antenatal care (ANC), delivery and postnatal care, and newborn care practices. Baseline (n = 2237) and endline (n = 1946) data were collected from women of reproductive age. The data was analysed using difference in differences (DiD) analysis and logistic regression. Results: The DiD results revealed an 8% difference in early ANC attendance (p < 0.01) and facility delivery (p < 0.01). Facility delivery increased from 66% to 73% in the intervention area, but remained unchanged in the comparison area (64% vs 63%, p < 0.01). The DiD results also demonstrated a 20% difference in clean cord care (p < 0.001) and an 8% difference in delayed bathing (p < 0.001). The intervention elements that predicted facility delivery were attending ANC four times [adjusted odds ratio (aOR) 1.42, 95% confidence interval (CI) 1.17–1.74] and saving for maternal health (aOR 2.11, 95% CI 1.39–3.21). Facility delivery and village health team (VHT) home visits were key predictors for clean cord care and skin-to-skin care. Conclusions: The multisectoral approach had positive effects on early ANC attendance, facility deliveries and newborn care practices. Community resources such as VHTs and savings are crucial to maternal and newborn outcomes and should be supported. VHT-led health education should incorporate practical measures that enable families to save and access transport services to enhance adequate preparation for birth.
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Affiliation(s)
- Elizabeth Ekirapa-Kiracho
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda
| | - Rornald Muhumuza Kananura
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda
| | - Moses Tetui
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda.,b Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Gertrude Namazzi
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda
| | - Aloysius Mutebi
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda
| | - Asha George
- c Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,d School of Public Health , University of the Western Cape , Bellville , South Africa
| | - Ligia Paina
- c Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Peter Waiswa
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda.,e Makerere University Centre of Excellence for Maternal and Newborn Health Research , Kampala , Uganda.,f Global Health Division , Karolinska Institutet , Stockholm , Sweden
| | - Ahmed Bumba
- g Kibuku District Health Office , Kibuku , Uganda
| | | | | | | | | | - Mary Putan
- h Pallisa District Health Office , Pallisa , Uganda
| | | | - Judith Ajeani
- j Department of Obstetrics and Gynaecology , Makerere University Medical School , Kampala , Uganda
| | - Ayub Kakaire-Kirunda
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda
| | - Fred Makumbi
- k Department of Epidemiology and Biostatistics , Makerere University School of Public Health , Kampala , Uganda
| | - Lynn Atuyambe
- l Department of Community Health and Behavioural Sciences , Makerere University School of Public Health , Kampala , Uganda
| | - Olico Okui
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda
| | - Suzanne Namusoke Kiwanuka
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda
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14
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Tetui M, Zulu JM, Hurtig AK, Ekirapa-Kiracho E, Kiwanuka SN, Coe AB. Elements for harnessing participatory action research to strengthen health managers' capacity: a critical interpretative synthesis. Health Res Policy Syst 2018; 16:33. [PMID: 29673346 PMCID: PMC5907405 DOI: 10.1186/s12961-018-0306-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 04/02/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Health managers play a key role in ensuring that health services are responsive to the needs of the population. Participatory action research (PAR) is one of the approaches that have been used to strengthen managers' capacity. However, collated knowledge on elements for harnessing PAR to strengthen managers' capacity is missing. This paper bridges this gap by reviewing existing literature on the subject matter. METHODS A critical interpretive synthesis method was used to interrogate eight selected articles. These articles reported the use of PAR to strengthen health managers' capacity. The critical interpretive synthesis method's approach to analysis guided the synthesis. Here, the authors interpretively made connections and linkages between different elements identified in the literature. Finally, the Atun et al. (Heal Pol Plann, 25:104-111, 2010) framework on integration was used to model the elements synthesised in the literature into five main domains. RESULTS Five elements with intricate bi-directional interactions were identified in the literature reviewed. These included a shared purpose, skilled facilitation and psychological safety, activity integration into organisational procedures, organisational support, and external supportive monitoring. A shared purpose of the managers' capacity strengthening initiative created commitment and motivation to learn. This purpose was built upon a set of facilitation skills that included promoting participation, self-efficacy and reflection, thereby creating a safe psychological space within which the managers interacted and learnt from each other and their actions. Additionally, an integrated intervention strengthened local capacity and harnessed organisational support for learning. Finally, supportive monitoring from external partners, such as researchers, ensured quality, building of local capacity and professional safety networks essential for continued learning. CONCLUSIONS The five elements identified in this synthesis provide a basis upon which the use of PAR can be harnessed, not only to strengthen health managers' capacity, but also to foster other health systems strengthening initiatives involving implementation research. In addition, the findings demonstrated the intricate and complex relations between the elements, which further affirms the need for a systems thinking approach to tackling health systems challenges.
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Affiliation(s)
- Moses Tetui
- Makerere University College of Health Sciences, School of Public Health (MakCHS-SPH), New Mulago Complex, P.O. B0X 7072, Kampala, Uganda
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden
| | - Joseph Mumba Zulu
- School of Public Health, University of Zambia, P.O. Box 50110, Lusaka, Zambia
| | - Anna-Karin Hurtig
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden
| | - Elizabeth Ekirapa-Kiracho
- Makerere University College of Health Sciences, School of Public Health (MakCHS-SPH), New Mulago Complex, P.O. B0X 7072, Kampala, Uganda
| | - Suzanne N. Kiwanuka
- Makerere University College of Health Sciences, School of Public Health (MakCHS-SPH), New Mulago Complex, P.O. B0X 7072, Kampala, Uganda
| | - Anna-Britt Coe
- Sociology Department, Umeå University, 901 87 Umeå, Sweden
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15
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Tetui M, Coe AB, Hurtig AK, Bennett S, Kiwanuka SN, George A, Kiracho EE. A participatory action research approach to strengthening health managers' capacity at district level in Eastern Uganda. Health Res Policy Syst 2017; 15:110. [PMID: 29297346 PMCID: PMC5751402 DOI: 10.1186/s12961-017-0273-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Many approaches to improving health managers’ capacity in poor countries, particularly those pursued by external agencies, employ non-participatory approaches and often seek to circumvent (rather than strengthen) weak public management structures. This limits opportunities for strengthening local health managers’ capacity, improving resource utilisation and enhancing service delivery. This study explored the contribution of a participatory action research approach to strengthening health managers’ capacity in Eastern Uganda. Methods This was a qualitative study that used open-ended key informant interviews, combined with review of meeting minutes and observations to collect data. Both inductive and deductive thematic analysis was undertaken. The Competing Values Framework of organisational management functions guided the deductive process of analysis and the interpretation of the findings. The framework builds on four earlier models of management and regards them as complementary rather than conflicting, and identifies four managers’ capacities (collaborate, create, compete and control) by categorising them along two axes, one contrasting flexibility versus control and the other internal versus external organisational focus. Results The findings indicate that the participatory action research approach enhanced health managers’ capacity to collaborate with others, be creative, attain goals and review progress. The enablers included expanded interaction spaces, encouragement of flexibility, empowerment of local managers, and the promotion of reflection and accountability. Tension and conflict across different management functions was apparent; for example, while there was a need to collaborate, maintaining control over processes was also needed. These tensions meant that managers needed to learn to simultaneously draw upon and use different capacities as reflected by the Competing Values Framework in order to maximise their effectiveness. Conclusions Improved health manager capacity is essential if sustained improvements in health outcomes in low-income countries are to be attained. The expansion of interaction spaces, encouragement of flexibility, empowerment of local managers, and the promotion of reflection and accountability were the key means by which participatory action research strengthened health managers’ capacity. The participatory approach to implementation therefore created opportunities to strengthen health managers’ capacity. Electronic supplementary material The online version of this article (doi:10.1186/s12961-017-0273-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Moses Tetui
- Makerere University School of Public Health (MakSPH), Makerere University, New Mulago Complex, P.O. B0X 7072, Kampala, Uganda. .,Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden.
| | - Anna-Britt Coe
- Sociology Department, Umeå University, 901 87, Umeå, Sweden
| | - Anna-Karin Hurtig
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Sara Bennett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, 21205, United States of America
| | - Suzanne N Kiwanuka
- Makerere University School of Public Health (MakSPH), Makerere University, New Mulago Complex, P.O. B0X 7072, Kampala, Uganda
| | - Asha George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, 21205, United States of America.,School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535, Republic of South Africa
| | - Elizabeth Ekirapa Kiracho
- Makerere University School of Public Health (MakSPH), Makerere University, New Mulago Complex, P.O. B0X 7072, Kampala, Uganda
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16
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George A, Tetui M, Pariyo GW, Peterson SS. Maternal and newborn health implementation research: programme outcomes, pathways of change and partnerships for equitable health systems in Uganda. Glob Health Action 2017; 10:1359924. [PMID: 28876193 PMCID: PMC5786315 DOI: 10.1080/16549716.2017.1359924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Asha George
- School of Public Health, University of the Western Cape, Bellville, Republic of South Africa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Moses Tetui
- Makerere University School of Public Health (MakSPH), Makerere University, Kampala, Uganda
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - George W Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Stefan S Peterson
- Makerere University School of Public Health (MakSPH), Makerere University, Kampala, Uganda
- Health Section, Programme Division, UNICEF NY, New York, NY, USA
- International Maternal and Child Health, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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