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Sarpong E, Acheampong DO, Fordjour GNR, Anyanful A, Aninagyei E, Tuoyire DA, Blackhurst D, Kyei GB, Ekor M, Thomford NE. Zero malaria: a mirage or reality for populations of sub-Saharan Africa in health transition. Malar J 2022; 21:314. [PMID: 36333802 PMCID: PMC9636766 DOI: 10.1186/s12936-022-04340-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
The global burden of malaria continues to be a significant public health concern. Despite advances made in therapeutics for malaria, there continues to be high morbidity and mortality associated with this infectious disease. Sub-Saharan Africa continues to be the most affected by the disease, but unfortunately the region is burdened with indigent health systems. With the recent increase in lifestyle diseases, the region is currently in a health transition, complicating the situation by posing a double challenge to the already ailing health sector. In answer to the continuous challenge of malaria, the African Union has started a "zero malaria starts with me” campaign that seeks to personalize malaria prevention and bring it down to the grass-root level. This review discusses the contribution of sub-Saharan Africa, whose population is in a health transition, to malaria elimination. In addition, the review explores the challenges that health systems in these countries face, that may hinder the attainment of a zero-malaria goal.
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Munywoki J, Kagwanja N, Chuma J, Nzinga J, Barasa E, Tsofa B. Tracking health sector priority setting processes and outcomes for human resources for health, five-years after political devolution: a county-level case study in Kenya. Int J Equity Health 2020; 19:165. [PMID: 32958000 PMCID: PMC7507677 DOI: 10.1186/s12939-020-01284-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 09/15/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Health sector priority setting in Low and Middle-Income Countries (LMICs) entails balancing between a high demand and low supply of scarce resources. Human Resources for Health (HRH) consume the largest allocation of health sector resources in LMICs. Health sector decentralization continues to be promoted for its perceived ability to improve efficiency, relevance and participation in health sector priority setting. Following the 2013 devolution in Kenya, both health service delivery and human resource management were decentralized to county level. Little is known about priority setting practices and outcomes of HRH within decentralized health systems in LMICs. Our study sought to examine if and how the Kenyan devolution has improved health sector priority setting practices and outcomes for HRH. METHODS We used a mixed methods case study design to examine health sector priority setting practices and outcomes at county level in Kenya. We used three sources of data. First, we reviewed all relevant national and county level policy and guidelines documents relating to HRH management. We then accessed and reviewed county records of HRH recruitment and distribution between 2013 and 2018. We finally conducted eight key informant interviews with various stakeholder involved in HRH priority setting within our study county. RESULTS We found that HRH numbers in the county increased by almost two-fold since devolution. The county had two forms of HRH recruitment: one led by the County Public Services Board as outlined by policy and guidelines and a parallel, politically-driven recruitment done directly by the County Department of Health. Though there were clear guidelines on HRH recruitment, there were no similar guidelines on allocation and distribution of HRH. Since devolution, the county has preferentially staffed higher level hospitals over primary care facilities. Additionally, there has been local county level innovations to address some HRH management challenges, including recruiting doctors and other highly specialized staff on fixed term contract as opposed to permanent basis; and implementation of local incentives to attract and retain HRH to remote areas within the county. CONCLUSION Devolution has significantly increased county level decision-space for HRH priority setting in Kenya. However, HRH management and accountability challenges still exist at the county level. There is need for interventions to strengthen county level HRH management capacity and accountability mechanisms beyond additional resources allocation. This will boost the realization of the country's efforts for promoting service delivery equity as a key goal - both for the devolution and the country's quest towards Universal Health Coverage (UHC).
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Affiliation(s)
- Joshua Munywoki
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kilifi, Kenya.
- Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi, Kenya.
| | - Nancy Kagwanja
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kilifi, Kenya
| | - Jane Chuma
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kilifi, Kenya
- The World Bank Group, Kenya Country Office, Nairobi, Kenya
| | - Jacinta Nzinga
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kilifi, Kenya
| | - Edwine Barasa
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kilifi, Kenya
| | - Benjamin Tsofa
- KEMRI Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research Coast, Kilifi, Kenya.
- Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi, Kenya.
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Geberemichael SG, Tannor AY, Asegahegn TB, Christian AB, Vergara-Diaz G, Haig AJ. Rehabilitation in Africa. Phys Med Rehabil Clin N Am 2019; 30:757-768. [PMID: 31563167 DOI: 10.1016/j.pmr.2019.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In Africa, rehabilitation services are insufficient and marred with inadequate political commitments and collaborations of stakeholders. Infrastructures and expertise for rehabilitation are scarce and poorly coordinated. Community-based rehabilitation programs are fragmented and fractured and lack working partnership with rehabilitation services in health care systems. Locally responsive policy frameworks, service delivery models, and health governance practices are prerequisites for meeting rehabilitation needs of the ever-increasing number of persons with chronic disabling conditions. Concerted global efforts are required for equitable and accessible coordinated continuum of rehabilitation care at various levels of health services and the community in most Sub-Saharan African countries.
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Affiliation(s)
- Sisay Gizaw Geberemichael
- Department of Neurology, St. Paul's Hospital Millennium Medical College, PO Box 1271, Addis Ababa, Ethiopia.
| | - Abena Yeboaa Tannor
- Disability and Rehabilitation Studies, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, PO Box: 1934, Kumasi, Ghana
| | - Tesfaye Berhe Asegahegn
- Department of Neurology, St. Paul's Hospital Millennium Medical College, PO Box 1271, Addis Ababa, Ethiopia
| | - Asare B Christian
- Good Shepherd Rehabilitation Hospital, PO Box: 850 South 5th Street, Allentown, PA 18103, USA
| | - Gloria Vergara-Diaz
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Andrew J Haig
- The University of Michigan, Ann Arbor, MI, USA; Haig Consulting PLC, MI, USA
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Tweheyo R, Reed C, Campbell S, Davies L, Daker-White G. 'I have no love for such people, because they leave us to suffer': a qualitative study of health workers' responses and institutional adaptations to absenteeism in rural Uganda. BMJ Glob Health 2019; 4:e001376. [PMID: 31263582 PMCID: PMC6570979 DOI: 10.1136/bmjgh-2018-001376] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/16/2019] [Accepted: 04/21/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Achieving positive treatment outcomes and patient safety are critical goals of the healthcare system. However, this is greatly undermined by near universal health workforce absenteeism, especially in public health facilities of rural Uganda. We investigated the coping adaptations and related consequences of health workforce absenteeism in public and private not-for-profit (PNFP) health facilities of rural Uganda. METHODS An empirical qualitative study involving case study methodology for sampling and principles of grounded theory for data collection and analysis. Focus groups and in-depth interviews were used to interview a total of 95 healthcare workers (11 supervisors and 84 frontline workers). The NVivo V.10 QSR software package was used for data management. RESULTS There was tolerance of absenteeism in both the public and PNFP sectors, more so for clinicians and managers. Coping strategies varied according to the type of health facility. A majority of the PNFP participants reported emotion-focused reactions. These included unplanned work overload, stress, resulting anger directed towards coworkers and patients, shortening of consultation times and retaliatory absence. On the other hand, various cadres of public health facility participants reported ineffective problem-solving adaptations. These included altering weekly schedules, differing patient appointments, impeding absence monitoring registers, offering unnecessary patient referrals and rampant unsupervised informal task shifting from clinicians to nurses. CONCLUSION High levels of absenteeism attributed to clinicians and health service managers result in work overload and stress for frontline health workers, and unsupervised informal task shifting of clinical workload to nurses, who are the less clinically skilled. In resource-limited settings, the underlying causes of absenteeism and low staff morale require attention, because when left unattended, the coping responses to absenteeism can be seen to compromise the well-being of the workforce, the quality of healthcare and patients' access to care.
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Affiliation(s)
- Raymond Tweheyo
- Department of Public Health, Lira University, Lira, Uganda
- Centre for Primary Care, Division of Population Health, The University of Manchester, Manchester, UK
| | - Catherine Reed
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, The University of Manchester, Manchester, UK
| | - Linda Davies
- Centre for Health Economics, Division of Population Health, The University of Manchester, Manchester, UK
| | - Gavin Daker-White
- Centre for Primary Care, Division of Population Health, The University of Manchester, Manchester, UK
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Mateen FJ, McKenzie ED, Rose S. Medical Schools in Fragile States: Implications for Delivery of Care. Health Serv Res 2018; 53:1335-1348. [PMID: 29368334 DOI: 10.1111/1475-6773.12709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To report on medical schools in fragile states, countries with severe development challenges, and the impact on the workforce for health care delivery. DATA SOURCES 2007 and 2012 World Bank Harmonized List of Fragile Situations; 1998-2012 WHO Global Health Observatory; 2014 World Directory of Medical Schools. DATA EXTRACTION Fragile classification established from 2007 and 2012 World Bank status. Population, gross national income, health expenditure, and life expectancy were 2007 figures. Physician density was most recently available from WHO Global Health Observatory (1998-2012), with number of medical schools from 2014 World Directory of Medical Schools. STUDY DESIGN Regression analyses assessed impact of fragile state status in 2012 on the number of medical schools in 2014. PRINCIPAL FINDINGS Fragile states were 1.76 (95 percent CI 1.07-2.45) to 2.37 (95 percent CI 1.44-3.30) times more likely to have fewer than two medical schools than nonfragile states. CONCLUSIONS Fragile states lack the infrastructure to train sufficient numbers of medical professionals to meet their population health needs.
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Affiliation(s)
- Farrah J Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Erica D McKenzie
- School of Medicine, Queen's University, Kingston, ON, Canada.,Massachusetts General Hospital, Department of Neurology, Harvard Medical School, Boston, MA
| | - Sherri Rose
- Harvard Medical School, Department of Health Care Policy, Boston, MA
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Agho AO, John EB. Occupational therapy and physiotherapy education and workforce in Anglophone sub-Saharan Africa countries. HUMAN RESOURCES FOR HEALTH 2017; 15:37. [PMID: 28606103 PMCID: PMC5469184 DOI: 10.1186/s12960-017-0212-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 06/02/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Sub-Saharan Africa (SSA) countries are faced with the challenge of educating a critical mass of occupational therapists (OTs) and physiotherapists (PTs) to meet the growing demand for health and rehabilitation services. The World Federation of Occupational Therapy (WFOT) and World Confederation of Physical Therapy (WCPT) have argued for the need of graduate-level training for OTs and PTs for decades. However, very few studies have been conducted to determine the availability of OT and PT training programs and practitioners in SSA countries. METHODS Initial data were collected and compiled from an extensive literature search conducted using MEDLINE and PubMed to examine the availability of OT and PT education and training programs in SSA countries. Additional data were collected, compiled, and collated from academic institutions, ministries of health, health professions associations, and licensing authorities in SSA countries. Secondary data were also collected from the websites of organizations such as the World Bank, World Health Organization (WHO), WFOT, and WCPT. RESULTS This investigation revealed that there are limited number of OT and PT training programs and that these training programs in Anglophone SSA countries are offered at or below the bachelor's level. More than half of the countries do not have OT or PT training programs. The number of qualified OTs and PTs appears to be insufficient to meet the demand for rehabilitation services. Nigeria and South Africa are the only countries offering post-entry-level masters and doctoral-level training programs in physiotherapy and occupational therapy. CONCLUSIONS Higher learning institutions in SSA countries need to collaborate and partner with other regional and foreign universities to elevate the educational training and increase the supply of PTs and OTs in the region.
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Affiliation(s)
- Augustine O. Agho
- Office of Academic Affairs, Old Dominion University, Norfolk, VA United States of America
| | - Emmanuel B. John
- Department of Physical Therapy, Chapman University, Irvine, CA United States of America
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Dlungwane T, Voce A, Searle R, Stevens F. Master of Public Health programmes in South Africa: issues and challenges. Public Health Rev 2017; 38:5. [PMID: 29450077 PMCID: PMC5810082 DOI: 10.1186/s40985-017-0052-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The demand for highly skilled public health personnel in low- and middle-income countries has been recognised globally. In South Africa, the need to train more public health professionals has been acknowledged. The Human Resource for Health (HRH) Strategy for South Africa includes the establishment of public health units at district and provincial levels. Programmes such as Master of Public Health (MPH) programmes are viewed as essential contributors in equipping health practitioners with adequate public health skills to meet the demands of the health care system. All MPH programmes have been instituted independently; there is no systematic information or comparison of programmes and requirements across institutions. This study aims to establish a baseline on MPH programmes in South Africa in terms of programme characteristics, curriculum, teaching workforce and graduate output. METHODS A mixed method design was implemented. A document analysis and cross-sectional descriptive survey, comprising both quantitative and qualitative data collection, by means of questionnaires, of all MPH programmes active in 2014 was conducted. The MPH programme coordinators of the 10 active programmes were invited to participate in the study via email. Numeric data were summarized in frequency distribution tables. Non-numeric data was captured, collated into one file and thematically analysed. RESULTS A total of eight MPH programmes responded to the questionnaire. Most programmes are affiliated to medical schools and provide a wide range of specialisations. The MPH programmes are run by individual universities and tend to have their own quality assurance, validation and assessment procedures with minimal external scrutiny. National core competencies for MPH programmes have not been determined. All programmes are battling to provide an appropriate supply of well-trained public health professionals as a result of drop-out, low throughput and delayed time to completion. CONCLUSION The MPH programmes have consistently graduated MPH candidates, although the numbers differ by institution. The increasing number of enrolments coupled by insufficient teaching personnel and low graduate output are key challenges impacting on the production of public health professionals. Collaboration amongst the MPH programmes, standardization, quality assurance and benchmarking needs considerable attention.
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Affiliation(s)
- Thembelihle Dlungwane
- College of Health Sciences, School of Nursing and Public Health, Howard College Campus, University of KwaZulu-Natal, Glenwood, Durban, South Africa
| | - Anna Voce
- College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Ruth Searle
- College of Humanities, School of Education, University of KwaZulu-Natal, Durban, South Africa
| | - Fred Stevens
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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Shrivastava R, Gadde R, Nkengasong JN. Importance of Public-Private Partnerships: Strengthening Laboratory Medicine Systems and Clinical Practice in Africa. J Infect Dis 2016; 213 Suppl 2:S35-40. [PMID: 27025696 DOI: 10.1093/infdis/jiv574] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
After the launch of the US President's Emergency Plan for AIDS Relief in 2003, it became evident that inadequate laboratory systems and services would severely limit the scale-up of human immunodeficiency virus infection prevention, care, and treatment programs. Thus, the Office of the US Global AIDS Coordinator, Centers for Disease Control and Prevention, and Becton, Dickinson and Company developed a public-private partnership (PPP). Between October 2007 and July 2012, the PPP combined the competencies of the public and private sectors to boost sustainable laboratory systems and develop workforce skills in 4 African countries. Key accomplishments of the initiative include measurable and scalable outcomes to strengthen national capacities to build technical skills, develop sample referral networks, map disease prevalence, support evidence-based health programming, and drive continuous quality improvement in laboratories. This report details lessons learned from our experience and a series of recommendations on how to achieve successful PPPs.
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Affiliation(s)
- Ritu Shrivastava
- International Laboratory Branch, Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Renuka Gadde
- Becton, Dickinson, and Company, Franklin Lakes, New Jersey
| | - John N Nkengasong
- International Laboratory Branch, Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Poku NK. How should the post-2015 response to AIDS relate to the drive for universal health coverage? Glob Public Health 2016; 13:765-779. [PMID: 27498555 DOI: 10.1080/17441692.2016.1215486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The drive for universal health coverage (UHC) now has a great deal of normative impetus, and in combination with the inauguration of the sustainable development goals, has come to be regarded as a means of ensuring the financial basis for the struggle against HIV and AIDS. The argument of this paper is that such thinking is a case of 'the right thing at the wrong time': it seriously underestimates the scale of the work against HIV and AIDS, and the speed with which we need to undertake it, if we are to consolidate the gains we have made to date, let alone reduce it to manageable proportions. The looming 'fiscal crunch' makes the challenges all the more daunting; even in the best circumstances, the time required to establish UHCs capable of providing both essential health services and a very rapid scale-up of the fight against HIV and AIDS is insufficient when set against the urgency of ensuring that AIDS does not eventuate as a global health catastrophe.
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Affiliation(s)
- Nana K Poku
- a Health Economics and HIV/AIDS Research Division (HEARD) , University of KwaZulu-Natal , Durban , South Africa
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Hay SI, McHugh G. Measuring progress in global health. Trans R Soc Trop Med Hyg 2014; 108:521-2. [PMID: 25122731 PMCID: PMC4131733 DOI: 10.1093/trstmh/tru125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Simon I Hay
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, South Parks Road, Oxford, OX1 3PS, UK
| | - Gerri McHugh
- Royal Society of Tropical Medicine and Hygiene, Northumberland House, 303-306 High Holborn, London, WC1V 7JZ, UK
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