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van Niekerk L, Fosiko N, Likaka A, Blauveldt CP, Msiska B, Manderson L. From idea to systems solution: enhancing access to primary care in Malawi. BMC Health Serv Res 2023; 23:547. [PMID: 37231399 DOI: 10.1186/s12913-023-09349-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 03/28/2023] [Indexed: 05/27/2023] Open
Abstract
Malawi, like many other countries, faces challenges in providing accessible, affordable, and quality health services to all people. The Malawian policy framework recognizes the value of communities and citizens, as co-creators of health and leaders of localized and innovative initiatives, such as social innovations.Social innovations involve and include communities and citizens, as well as bring about changes in the institutions responsible for care delivery. In this article, we describe the institutionalization process of a citizen-initiated primary care social innovation, named Chipatala Cha Pa Foni, focused on extending access to health information and appropriate service-seeking behavior.An interdisciplinary multi-method qualitative case study design was adopted, drawing on data collected from key informant interviews, observations, and documents over an 18-month period. A composite social innovation framework, informed by institutional theory and positive organizational scholarship, guided the thematic content analysis. Institutional-level changes were analyzed in five key dimensions as well as the role of actors, operating as institutional entrepreneurs, in this process.A subset of actors matched the definition of operating as Institutional Entrepreneurs. They worked in close collaboration to bring about changes in five institutional dimensions: roles, resource flows, authority flows, social identities and meanings. We highlight the changing role of nurses; redistribution and decentralization of health information; shared decision-making, and greater integration of different technical service areas.From this study, the social innovation brought about key institutional and socio-cultural changes in the Malawi health system. These changes supported strengthening the system's integrity for achieving Universal Health Coverage by unlocking and cultivating dormant human-based resources. As a fully institutionalized social innovation, Chipatala Cha Pa Foni has enhanced access to primary care and especially as part of the Covid-19 response.
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Affiliation(s)
- L van Niekerk
- London School of Hygiene and Tropical Medicine, London, UK.
- Chembe Collaborative, Los Angeles, USA.
| | - N Fosiko
- The Malawi Ministry of Health, Lilongwe, Malawi
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - A Likaka
- The Malawi Ministry of Health, Lilongwe, Malawi
| | | | - B Msiska
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - L Manderson
- University of the Witwatersrand, Johannesburg, South Africa
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Kasenda S, Meland E, Hetlevik Ø, Mildestvedt T, Dullie L. Factors associated with self-rated health in primary care in the South-Western health zone of Malawi. BMC PRIMARY CARE 2022; 23:88. [PMID: 35439944 PMCID: PMC9016970 DOI: 10.1186/s12875-022-01686-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 04/04/2022] [Indexed: 11/30/2022]
Abstract
Background Self-rated health (SRH) is a single-item measure of current health, which is often used in community surveys and has been associated with various objective health outcomes. The prevalence and factors associated with SRH in Sub-Saharan Africa remain largely unknown. This study sought to investigate: (1) the prevalence of poor SRH, (2) possible associations between SRH, and socio-demographic and clinical parameters, and (3) associations between SRH and the patients’ assessment of the quality of primary care. Methods A cross-sectional study was conducted in 12 primary care facilities in Blantyre, Neno, and Thyolo districts of Malawi among 962 participants who sought care in these facilities. An interviewer-administered questionnaire containing the Malawian primary care assessment tool, and questions on socio-demographic characteristics and self-rated health was used for data collection. Descriptive statistics were used to determine the distribution of variables of interest and binary logistic regression was used to determine factors associated with poor SRH. Results Poor SRH was associated with female sex, increasing age, decreasing education, frequent health care attendance, and with reported disability. Patients content with the service provided and who reported higher scores of relational continuity from their health care providers reported better SRH as compared with others. Conclusion This study reports findings from a context where SRH is scarcely examined. The prevalence of poor SRH in Malawi is in line with findings from clinical populations in other countries. The associations between poor SRH and socio-demographic factors are also known from other populations. SRH might be improved by emphasizing continuity of care in primary care services.
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Kasenda S, Meland E, Hetlevik Ø, Mildestvedt T, Dullie L. Factors associated with self-rated health in primary care in the South-Western health zone of Malawi. BMC PRIMARY CARE 2022; 23:88. [PMID: 35439944 PMCID: PMC9016970 DOI: 10.1186/s12875-022-01686-y#citeas] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Self-rated health (SRH) is a single-item measure of current health, which is often used in community surveys and has been associated with various objective health outcomes. The prevalence and factors associated with SRH in Sub-Saharan Africa remain largely unknown. This study sought to investigate: (1) the prevalence of poor SRH, (2) possible associations between SRH, and socio-demographic and clinical parameters, and (3) associations between SRH and the patients' assessment of the quality of primary care. METHODS A cross-sectional study was conducted in 12 primary care facilities in Blantyre, Neno, and Thyolo districts of Malawi among 962 participants who sought care in these facilities. An interviewer-administered questionnaire containing the Malawian primary care assessment tool, and questions on socio-demographic characteristics and self-rated health was used for data collection. Descriptive statistics were used to determine the distribution of variables of interest and binary logistic regression was used to determine factors associated with poor SRH. RESULTS Poor SRH was associated with female sex, increasing age, decreasing education, frequent health care attendance, and with reported disability. Patients content with the service provided and who reported higher scores of relational continuity from their health care providers reported better SRH as compared with others. CONCLUSION This study reports findings from a context where SRH is scarcely examined. The prevalence of poor SRH in Malawi is in line with findings from clinical populations in other countries. The associations between poor SRH and socio-demographic factors are also known from other populations. SRH might be improved by emphasizing continuity of care in primary care services.
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Affiliation(s)
- Stephen Kasenda
- grid.512477.2Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Eivind Meland
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway
| | - Øystein Hetlevik
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway
| | - Thomas Mildestvedt
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway
| | - Luckson Dullie
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway ,Partners in health, Neno, Malawi
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Mariani J, Ferrante D, Battistella G, Langsam M, Pérez F, Macchia A. Evaluation of the first level of care for tuberculosis control in Buenos Aires, Argentina. Rev Panam Salud Publica 2021; 45:e22. [PMID: 33552149 PMCID: PMC7860151 DOI: 10.26633/rpsp.2021.22] [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: 06/30/2020] [Accepted: 10/06/2020] [Indexed: 12/25/2022] Open
Abstract
Objective. Evaluate primary health care functions from the perspective of patients with tuberculosis from slums in the city of Buenos Aires, Argentina. Methods. Cross-sectional observational study with adult patients with tuberculosis (TB) and without TB (NoTB), living in slums (S) and outside them (NoS). Participants’ perceptions were evaluated using the Primary Care Assessment Tool for users (abbreviated version), which measures four main domains (first contact, ongoing care, coordination with specialists, and comprehensiveness) and selected secondary domains. A Likert scale was used, ranging from “No, not at all” (1 point) to “Yes, definitely” (4 points). Scores ≥ 3 were considered to indicate adequate performance of functions. Averages were calculated for each domain, as well as two overall scores: with and without secondary domains. Results. 83 participants were included (20 TB-S, 21 TB-NoS, 19 NoTB-S, and 23 NoTB-NoS). The evaluated functions were perceived as inadequate. The TB-S group gave the lowest overall scores, not reaching 3 points in any domain. There were no significant differences in domains or overall scores between groups. Participants with TB gave lower scores in all domains, except in family-centered care, where they gave a significantly higher score than NoTB participants. The overall score without secondary domains was lower for TB participants than for the NoTB groups. Conclusions. According to the perception of participants with TB and without TB, primary health care functions are not satisfactory, either in slums or outside them.
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Affiliation(s)
- Javier Mariani
- Fundación GESICA Buenos Aires Argentina Fundación GESICA, Buenos Aires, Argentina
| | - Daniel Ferrante
- Secretariat of Network Health Planning and Management, Ministry of Health of the city of Buenos Aires Buenos Aires Argentina Secretariat of Network Health Planning and Management, Ministry of Health of the city of Buenos Aires, Buenos Aires, Argentina
| | - Gabriel Battistella
- Secretariat of Primary, Outpatient, and Community Care, Ministry of Health of the city of Buenos Aires Buenos Aires Argentina Secretariat of Primary, Outpatient, and Community Care, Ministry of Health of the city of Buenos Aires, Buenos Aires, Argentina
| | - Martín Langsam
- Fundación GESICA Buenos Aires Argentina Fundación GESICA, Buenos Aires, Argentina
| | - Freddy Pérez
- Department of Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization Washington, D.C United States of America Department of Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington, D.C., United States of America
| | - Alejandro Macchia
- Fundación GESICA Buenos Aires Argentina Fundación GESICA, Buenos Aires, Argentina
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Mariani J, Ferrante D, Battistella G, Langsam M, Pérez F, Macchia A. [Evaluation of the first level of care for tuberculosis control in Buenos Aires, ArgentinaAvaliação da atenção primária à saúde no controle da tuberculose em Buenos Aires, Argentina]. Rev Panam Salud Publica 2020; 44:e156. [PMID: 33346252 PMCID: PMC7745725 DOI: 10.26633/rpsp.2020.156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/06/2020] [Indexed: 12/18/2022] Open
Abstract
Objetivo. Evaluar las funciones de la atención primaria de salud desde la perspectiva de los pacientes con tuberculosis (TB) provenientes de villas de emergencia de la Ciudad Autónoma de Buenos Aires, Argentina. Métodos. Estudio observacional transversal con pacientes adultos con TB y sin TB (NoTB), residentes en villas de emergencia (V) y fuera de ellas (NoV). La percepción de los participantes se evaluó mediante el cuestionario Primary Care Assessment Tool-usuarios (versión abreviada) que mide cuatro dimensiones principales (primer contacto, longitudinalidad de los cuidados, coordinación entre servicios e integralidad) y algunas secundarias. Se utilizó una escala de Likert, desde “No, en absoluto” (1 punto) hasta “Sí, sin duda” (4 puntos). Puntajes ≥ 3 se consideraron como cumplimiento adecuado de las funciones. Se calcularon promedios para cada dominio y dos puntajes globales: con y sin dominios secundarios. Resultados. Se incluyeron 83 participantes (20 TB-V, 21 TB-NV, 19 NoTB-V y 23 NoTB-NV). Las funciones evaluadas se percibieron como no adecuadas. El grupo TB-V tuvo los puntajes globales más bajos y en ningún dominio alcanzó 3 puntos. No hubo diferencias significativas en los dominios ni los puntajes globales entre grupos. Los participantes con TB dieron menores puntajes en todos los dominios, excepto en enfoque familiar que fue significativamente mayor que los de los participantes NoTB; el puntaje global sin dominios secundarios fue menor en los participantes con TB que en los NoTB. Conclusiones. Según la percepción de los participantes con TB y sin TB, las funciones de la atención primaria de salud no son satisfactorias, tanto dentro de las villas de emergencia como fuera de ellas.
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Affiliation(s)
- Javier Mariani
- Fundación GESICA Fundación GESICA Buenos Aires Argentina Fundación GESICA, Buenos Aires, Argentina
| | - Daniel Ferrante
- Secretaría de Planificación Sanitaria y Gestión en Red Ministerio de Salud de la Ciudad Autónoma de Buenos Aires Buenos Aires Argentina Secretaría de Planificación Sanitaria y Gestión en Red, Ministerio de Salud de la Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Gabriel Battistella
- Secretaría de Atención Primaria, Ambulatoria y Comunitaria Ministerio de Salud de la Ciudad Autónoma de Buenos Aires Buenos Aires Argentina Secretaría de Atención Primaria, Ambulatoria y Comunitaria, Ministerio de Salud de la Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Martín Langsam
- Fundación GESICA Fundación GESICA Buenos Aires Argentina Fundación GESICA, Buenos Aires, Argentina
| | - Freddy Pérez
- Departamento de Enfermedades Transmisibles y Determinantes Ambientales de la Salud Organización Panamericana de la Salud Washington, DC Estados Unidos de América Departamento de Enfermedades Transmisibles y Determinantes Ambientales de la Salud, Organización Panamericana de la Salud, Washington, DC, Estados Unidos de América
| | - Alejandro Macchia
- Fundación GESICA Fundación GESICA Buenos Aires Argentina Fundación GESICA, Buenos Aires, Argentina
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