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Mwanza J, Doherty T, Lubeya MK, Gray GE, Mutale W, Kawonga M. Laboratory services in the context of prevention of mother-to-child transmission of HIV testing requirements in Copperbelt Province, Zambia: a qualitative inquiry. BMC Health Serv Res 2023; 23:753. [PMID: 37443064 DOI: 10.1186/s12913-023-09747-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Reliable and timely laboratory results are crucial for monitoring the Prevention of the Mother-to-Child Transmission (PMTCT) cascade, particularly to enable early HIV diagnosis and early intervention. We sought to explore whether and how laboratory services have been prepared to absorb new testing requirements following PMTCT Test-and-Treat policy changes in three districts of Zambia. METHOD We employed in-depth interviews and thematic data analysis, informed by the health system dynamic framework. Twenty-Six health workers were purposively selected and a document review of laboratory services in the context of PMTCT was undertaken. All face-to-face interviews were conducted in three local government areas in the Copperbelt Province (one urban and two rural) between February 2019 and July 2020. We extracted notes and markings from the transcripts for coding. Different codes were sorted into potential themes and the data extracted were put within the identified themes. Trustworthiness was confirmed by keeping records of all data field notes, transcripts, and reflexive journals. RESULTS The findings revealed that the health system inputs (infrastructure and supplies, human resources, knowledge, and information and finance) and service delivery were unequal between the rural and urban sites, and this affected the ability of health facilities to apply the new testing requirements, especially, in the rural-based health facilities. The major barriers identified include gaps in the capacity of the existing laboratory system to perform crucial PMTCT clinical and surveillance functions in a coordinated manner and insufficient skilled human resources to absorb the increased testing demands. The centralized laboratory system for HIV testing of mothers and exposed neonates meant facilities had to send specimens to other facilities and districts which resulted in high turnaround time and hence delayed HIV diagnosis. CONCLUSION New guidelines implemented without sufficient capacitation of health system laboratory capacity severely limited the effectiveness of PMTCT program implementation. This study documented the areas relating to health system inputs and laboratory service delivery where greater support to enable the absorption of the new testing requirements is needed.
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Affiliation(s)
- Jonathan Mwanza
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Tanya Doherty
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Mwansa Ketty Lubeya
- Department of Obstetrics and Gynaecology, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Glenda E Gray
- Office of the President, South Africa Medical Research Council, Cape Town, South Africa
| | - Wilbroad Mutale
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Mary Kawonga
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Community Health, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
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Ali D, Woldegiorgis AGY, Tilaye M, Yilma Y, Berhane HY, Tewahido D, Abelti G, Neill R, Silla N, Gilliss L, Mandal M. Integrating private health facilities in government-led health systems: a case study of the public-private mix approach in Ethiopia. BMC Health Serv Res 2022; 22:1477. [PMID: 36463163 PMCID: PMC9719643 DOI: 10.1186/s12913-022-08769-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/01/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Private health care facilities working in partnership with the public health sector is one option to create sustainable health systems and ensure health and well-being for all in low-income countries. As the second-most populous country in Africa with a rapidly growing economy, demand for health services in Ethiopia is increasing and one-quarter of its health facilities are privately owned. The Private Health Sector Program (PHSP), funded by the United States Agency for International Development, implemented a series of public-private partnership in health projects from 2004 to 2020 to address several public health priorities, including tuberculosis, malaria, HIV/AIDS, and family planning. We assessed PHSP's performance in leadership and governance, access to medicines, health management information systems, human resources, service provision, and finance. METHODS The World Health Organization's health systems strengthening framework, which is organized around six health system building blocks, guided the assessment. We conducted 50 key informant interviews and a health facility assessment at 106 private health facilities supported by the PHSP to evaluate its performance. RESULTS All six building blocks were addressed by the program and key informants shared that several policy and strategic changes were conducive to supporting the functioning of private health facilities. The provision of free medicines from the public pharmaceutical logistics system, relaxation of strict regulatory policies that restricted service provision through the private sector, training of private providers, and public-private mix guidelines developed for tuberculosis, malaria, and reproductive, maternal, newborn, child, and adolescent health helped increase the use of services at health facilities. CONCLUSIONS Some challenges and threats to sustainability remain, including fragile partnerships between public and private bodies, resource constraints, mistrust between the public and private sectors, limited incentives for the private sector, and oversight of the quality of services. To continue with gains in the policy environment, service accessibility, and other aspects of the health system, the government and international communities must work collaboratively to address public-private partnerships in health areas that can be strengthened. Future efforts should emphasize a mechanism to ensure that the private sector is capable, incentivized, and supervised to deliver continuous, high-quality and equitable services.
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Affiliation(s)
- Disha Ali
- John Snow, Inc. (JSI), Arlington, VA, USA
| | | | - Mesfin Tilaye
- USAID/Ethiopia, Entoto Street, Addis Ababa, Ethiopia
| | - Yonas Yilma
- Independent Consultant, Addis Ababa, Ethiopia
| | - Hanna Y Berhane
- Addis Continental Institute of Public Health, Ayat, Addis Ababa, Ethiopia
| | - Dagmawit Tewahido
- Addis Continental Institute of Public Health, Ayat, Addis Ababa, Ethiopia
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Role of Public-Private Partnerships in Primary Healthcare Services Worldwide: A Scoping Review. HEALTH SCOPE 2022. [DOI: 10.5812/jhealthscope-129176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The public health system is currently facing a shortage of resources, and the demand for healthcare has increased, indicating the need to use the capacities of other sectors through public-private partnership (PPP) strategies to improve the quantity and quality of health services. Objectives: The purpose is to identify PPPs' role in providing primary healthcare worldwide. Methods: This study was conducted in 2020. The Arksey O’Malley framework was used, along with a systematic literature search on five databases, including Web of Science (ISI), Scopus, Pubmed, ProQuest, and Google Scholar. Data were gathered from 2000 to 2020. Results: The findings presented in this study are reported based on 16 selected studies. The findings point to the positive impacts of cooperation between the public and private sectors in health care systems on matters of provision, coverage, and performance of services, as well as improvements in responsiveness to providers towards enhancing health referral systems. The provision of participatory services in countries varied according to their level of development, and further interactions between the government and the private sector resulted in better coverage and reduced inequality in service delivery. Conclusions: Public-private partnership is an effective way to achieve sustainable development goals. Public-private partnerships can be strengthened by integrating public and private sector facilities and aligning the interests and motivations of service providers with public health goals. Also, awareness of the plans and capacity of public and private sectors, along with conscious and mutual interaction, can strengthen health on a larger scale. Scientific approaches and correct participation can also relieve the part of governmental responsibilities to focus on more primary measures so that it can carry out its core tasks, including stewardship, policy-making, and supervision, with greater focus and power to facilitate the achievement of goals.
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Strasser S, Stauber C, Shrivastava R, Riley P, O’Quin K. Collective insights of public-private partnership impacts and sustainability: A qualitative analysis. PLoS One 2021; 16:e0254495. [PMID: 34283847 PMCID: PMC8291689 DOI: 10.1371/journal.pone.0254495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 06/29/2021] [Indexed: 11/18/2022] Open
Abstract
The global Coronavirus or COVID-19 pandemic exposed the weakness of healthcare systems including laboratory systems and is a call to action for unprecedented collaboration and partnerships to deal with the global crisis. The United States (U.S.) President’s Emergency Plan for AIDS Relief (PEPFAR) establishes the global HIV/AIDS treatment agenda in alignment with the UNAIDS 90-90-90 treatment targets to achieve epidemic control related to enhanced testing, treatment, and viral suppression. A strategic PEPFAR priority area recognizes that large-scale collective efforts and sharing of resources bear greater potential impact for lasting change than any single organization or entity can achieve alone. An important vehicle utilized within the global public health context is the public-private partnership (PPP) model whereby multiple international organizations forge unified project charters to collectively reach mutually agreed goals. While touted as an ideal mechanism to synthesize resources and maximize gain in numerous applications, little is known from a seasoned stakeholder perspective regarding PPP implementation and sustainability issues. The purpose of this research is to holistically examine perceptions of PPP model sustainability related to inputs and impacts among a collective network of stakeholders experienced with PEPFAR workforce development, laboratory-system strengthening project implementation. Interviews were conducted with frontline stakeholders from public and private sector organizations based in the US and select PEPFAR-supported priority countries. Analysis revealed three dominant themes: PPP impacts, keys of successful collaboration, and logistical challenges and opportunities to enhance sustainability of PPP outcomes in the future.
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Affiliation(s)
- Sheryl Strasser
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Christine Stauber
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, United States of America
| | - Ritu Shrivastava
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Patricia Riley
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Karen O’Quin
- Department of Sustainable Development, Region Värmland, Karlstad, Sweden
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Shrivastava R, Poxon R, Rottinghaus E, Essop L, Sanon V, Chipeta Z, van-Schalkwyk E, Sekwadi P, Murangandi P, Nguyen S, Devos J, Nesby-Odell S, Stevens T, Umaru F, Cox A, Kim A, Yang C, Parsons LM, Malope-Kgokong B, Nkengasong JN. Leveraging gains from African Center for Integrated Laboratory Training to combat HIV epidemic in sub-Saharan Africa. BMC Health Serv Res 2021; 21:22. [PMID: 33407442 PMCID: PMC7787229 DOI: 10.1186/s12913-020-06005-8] [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: 07/14/2020] [Accepted: 12/08/2020] [Indexed: 11/24/2022] Open
Abstract
Background In sub-Saharan Africa, there is dearth of trained laboratorians and strengthened laboratory systems to provide adequate and quality laboratory services for enhanced HIV control. In response to this challenge, in 2007, the African Centre for Integrated Laboratory Training (ACILT) was established in South Africa with a mission to train staffs from countries with high burdens of diseases in skills needed to strengthen sustainable laboratory systems. This study was undertaken to assess the transference of newly gained knowledge and skills to other laboratory staff, and to identify enabling and obstructive factors to their implementation. Methods We used Kirkpatrick model to determine training effectiveness by assessing the transference of newly gained knowledge and skills to participant’s work environment, along with measuring enabling and obstructive factors. In addition to regular course evaluations at ACILT (pre and post training), in 2015 we sent e-questionnaires to 867 participants in 43 countries for course participation between 2008 and 2014. Diagnostics courses included Viral Load, and systems strengthening included strategic planning and Biosafety and Biosecurity. SAS v9.44 and Excel were used to analyze retrospective de-identified data collected at six months pre and post-training. Results Of the 867 participants, 203 (23.4%) responded and reported average improvements in accuracy and timeliness in Viral Load programs and to systems strengthening. For Viral Load testing, frequency of corrective action for unsatisfactory proficiency scores improved from 57 to 91%, testing error rates reduced from 12.9% to 4.9%; 88% responders contributed to the first national strategic plan development and 91% developed strategies to mitigate biosafety risks in their institutions. Key enabling factors were team and management support, and key obstructive factors included insufficient resources and staff’s resistance to change. Conclusions Training at ACILT had a documented positive impact on strengthening the laboratory capacity and laboratory workforce and substantial cost savings. ACILT’s investment produced a multiplier effect whereby national laboratory systems, personnel and leadership reaped training benefits. This laboratory training centre with a global clientele contributed to improve existing laboratory services, systems and networks for the HIV epidemic and is now being leveraged for COVID-19 testing that has infected 41,332,899 people globally. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-06005-8.
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Affiliation(s)
- Ritu Shrivastava
- International Laboratory Branch (ILB), Division of Global HIV and TB (DGHT), Centres for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30333, USA.
| | - Richard Poxon
- African Center for Integrated Laboratory Training at National Health Laboratory Service, Johannesburg, South Africa
| | - Erin Rottinghaus
- International Laboratory Branch (ILB), Division of Global HIV and TB (DGHT), Centres for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30333, USA
| | - Leyya Essop
- African Center for Integrated Laboratory Training at National Health Laboratory Service, Johannesburg, South Africa
| | - Victoria Sanon
- Georgia State University, intern at ILB, DGHT, CDC, Atlanta, USA
| | | | - Elsie van-Schalkwyk
- African Center for Integrated Laboratory Training at National Health Laboratory Service, Johannesburg, South Africa
| | - Phuti Sekwadi
- African Center for Integrated Laboratory Training at National Health Laboratory Service, Johannesburg, South Africa
| | - Pelagia Murangandi
- African Center for Integrated Laboratory Training at National Health Laboratory Service, Johannesburg, South Africa
| | - Shon Nguyen
- International Laboratory Branch (ILB), Division of Global HIV and TB (DGHT), Centres for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30333, USA
| | - Josh Devos
- International Laboratory Branch (ILB), Division of Global HIV and TB (DGHT), Centres for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30333, USA
| | - Shanna Nesby-Odell
- International Laboratory Branch (ILB), Division of Global HIV and TB (DGHT), Centres for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30333, USA
| | - Thomas Stevens
- International Laboratory Branch (ILB), Division of Global HIV and TB (DGHT), Centres for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30333, USA
| | - Farouk Umaru
- Supply Chain Management System, United States Agency for Internationl Development, Atlanta, USA
| | | | | | - Chunfu Yang
- International Laboratory Branch (ILB), Division of Global HIV and TB (DGHT), Centres for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30333, USA
| | - Linda M Parsons
- International Laboratory Branch (ILB), Division of Global HIV and TB (DGHT), Centres for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30333, USA
| | - Babatyi Malope-Kgokong
- African Center for Integrated Laboratory Training at National Health Laboratory Service, Johannesburg, South Africa
| | - John N Nkengasong
- International Laboratory Branch (ILB), Division of Global HIV and TB (DGHT), Centres for Disease Control and Prevention (CDC), 1600 Clifton Road NE, Atlanta, GA, 30333, USA
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Resubun TF, Darmawansyah, Amiruddin R, Palluturi S, Syafar M. Qualitative analysis of financing HIV and AIDS program in Health Office of Jayawijaya District, Papua Province. GACETA SANITARIA 2021; 35 Suppl 1:S64-S66. [PMID: 33832630 DOI: 10.1016/j.gaceta.2020.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/04/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study is to see the financing of HIV and AIDS prevention programs in Jayawijaya District, Papua Province. METHOD This study used a qualitative research design with a case study approach. RESULTS The results of this study indicate that the source of HIV and AIDS prevention programs in the Jayawijaya Health Office comes from the Government (Special Autonomy Fund) and the State Budget (BOK Funds at Puskesmas) and assistance from international NGOs with a very large amount every year. CONCLUSIONS This study concludes that HIV and AIDS from the APBN and APBN data should be reviewed to improve with the decreasing number of donor agencies assisting in the Jayawijaya District. So that the HIV and AIDS program in Jayawijaya Regency, Papua Province, is reliable, balanced with a comprehensive coping program strategy.
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Affiliation(s)
| | - Darmawansyah
- Department of Health Policy and Administration, Faculty of Public Health, Hasanuddin University
| | - Ridwan Amiruddin
- Department of Epidemiology, Faculty of Public Health, Hasanuddin University
| | - Sukri Palluturi
- Department of Health Policy and Administration, Faculty of Public Health, Hasanuddin University
| | - Muhammad Syafar
- Department of Health Promotion and Behavioral Science, Faculty of Public Health, Hasanuddin University
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St George K, Ned-Sykes R, Salerno R, Pentella MA. Advancing the Public Health Laboratory System Through Partnerships. Public Health Rep 2020; 134:3S-5S. [PMID: 31682554 PMCID: PMC6832028 DOI: 10.1177/0033354919882704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kirsten St George
- Laboratory of Viral Diseases, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Renée Ned-Sykes
- Division of Laboratory Systems, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Reynolds Salerno
- Division of Laboratory Systems, Centers for Disease Control and Prevention, Atlanta, GA, USA
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