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Stoneham M, Coller L, Napolitano J, Scolyer MM, Pollard C. Filling gaps - a case study in building advocacy capacity in the health promotion workforce. Glob Health Promot 2024:17579759241246778. [PMID: 38708854 DOI: 10.1177/17579759241246778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Public health advocacy is a fundamental part of public health and health promotion practice. However, gaps exist in the provision of public health advocacy knowledge and skill acquisition both in the tertiary environment and within ongoing professional development programmes. The Goulburn Valley Public Health Unit partnered with the Public Health Advocacy Institute to build the skills of 49 public health and promotion professionals in their regions, to enable them to lead an advocacy project that aimed to promote state-wide initiatives. This involved a series of face-to-face skills-based public health advocacy workshops and post workshop e-mentoring. Results included the creation of locally relevant public health advocacy projects and a community of practice.
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Affiliation(s)
- Melissa Stoneham
- Public Health Advocacy Institute Western Australia, Curtin University, Perth, Australia
| | - Lee Coller
- Goulburn Valley Public Health Unit, Shepparton, Australia
| | | | | | - Christina Pollard
- Public Health Advocacy Institute Western Australia, Curtin University, Perth, Australia
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Afulani PA, Getahun M, Okiring J, Ogolla BA, Oboke EN, Kinyua J, Oluoch I, Odiase O, Ochiel D, Mendes WB, Ongeri L. Mixed methods evaluation of the Caring for Providers to Improve Patient Experience intervention. Int J Gynaecol Obstet 2024; 165:487-506. [PMID: 38146777 PMCID: PMC11021171 DOI: 10.1002/ijgo.15301] [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: 08/28/2023] [Revised: 11/09/2023] [Accepted: 11/29/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE To assess the impact of the Caring for Providers to Improve Patient Experience (CPIPE) intervention, which sought to improve person-centered maternal care (PCMC) by addressing two key drivers: provider stress and bias. METHODS CPIPE was successfully piloted over 6 months in two health facilities in Migori County, Kenya, in 2022. The evaluation employed a mixed-methods pretest-posttest nonequivalent control group design. Data are from surveys with 80 providers (40 intervention, 40 control) at baseline and endline and in-depth interviews with 20 intervention providers. We conducted bivariate, multivariate, and difference-in-difference analysis of quantitative data and thematic analysis of qualitative data. RESULTS In the intervention group, average knowledge scores increased from 7.8 (SD = 2.4) at baseline to 9.5 (standard deviation [SD] = 1.8) at endline for stress (P = 0.001) and from 8.9 (SD = 1.9) to 10.7 (SD = 1.7) for bias (P = 0.001). In addition, perceived stress scores decreased from 20.9 (SD = 3.9) to 18.6 (SD = 5.3) (P = 0.019) and burnout from 3.6 (SD = 1.0) to 3.0 (SD = 1.0) (P = 0.001), with no significant change in the control group. Qualitative data indicated that CPIPE had an impact at multiple levels. At the individual level, it improved provider knowledge, skills, self-efficacy, attitudes, behaviors, and experiences. At the interpersonal level, it improved provider-provider and patient-provider relationships, leading to a supportive work environment and improved PCMC. At the institutional level, it created a system of accountability for providing PCMC and nondiscriminatory care, and collective action and advocacy to address sources of stress. CONCLUSION CPIPE impacted multiple outcomes in the theory of change, leading to improvements in both provider and patient experience, including for the most vulnerable patients. These findings will contribute to global efforts to prevent burnout and promote PCMC and equity.
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Affiliation(s)
- Patience A. Afulani
- Epidemiology and Biostatistics Department, University of California, San Francisco, USA
- Institute for Global Health Sciences, University of California, San Francisco, USA
| | - Monica Getahun
- Institute for Global Health Sciences, University of California, San Francisco, USA
| | - Jaffer Okiring
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | | | | | | | - Osamuedeme Odiase
- Institute for Global Health Sciences, University of California, San Francisco, USA
| | - Dan Ochiel
- County Health Directorate, Migori, Kenya
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Yan J, Martins N, Amaral S, Francis JR, Kameniar B, Delany C. "Nothing without connection"-Participant perspectives and experiences of mentorship in capacity building in Timor-Leste. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002112. [PMID: 38457415 PMCID: PMC10923460 DOI: 10.1371/journal.pgph.0002112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 02/15/2024] [Indexed: 03/10/2024]
Abstract
The literature on mentorship approaches to capacity building in global health is limited. Likewise, there are few qualitative studies that describe mentorship in capacity building in global health from the perspective of the mentors and mentees. This qualitative study examined the perspectives and experiences of participants involved in a program of health capacity building in Timor-Leste that was based on a side-by-side, in-country mentorship approach. Semi-structured interviews were conducted with 23 participants (including Timorese and expatriate mentors, and local Timorese colleagues) from across a range of professional health disciplines, followed by a series of member checking workshops. Findings were reviewed using inductive thematic analysis. Participants were included in review and refinement of themes. Four major themes were identified: the importance of trust and connection within the mentoring relationship; the side-by-side nature of the relationship (akompaña); mentoring in the context of external environmental challenges; and the need for the mentoring relationship to be dynamic and evolving, and aligned to a shared vision and goals. The importance of accompaniment (akompaña) as a key element of the mentoring relationship requires further exploration and study. Many activities in global health capacity building remain focused on provision of training, supervision, and supportive supervision of competent task performance. Viewed through a decolonising lens, there is an imperative for global health actors to align with local priorities and goals, and work alongside individuals supporting them in their vision to become independent leaders of their professions. We propose that placing mentoring relationships at the centre of human resource capacity building programs encourages deep learning, and is more likely to lead to long term, meaningful and sustainable change.
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Affiliation(s)
- Jennifer Yan
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Nelson Martins
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Salvador Amaral
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Joshua R. Francis
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Barbara Kameniar
- The University of Melbourne, Melbourne, Australia
- The University of Tasmania, Hobart, Australia
| | - Clare Delany
- The University of Melbourne, Melbourne, Australia
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Sansbury GM, Pence BW, Zimba C, Yanguela J, Landrum K, Matewere M, Mbota M, Malava JK, Tikhiwa H, Morrison AM, Akiba CF, Gaynes BN, Udedi M, Hosseinipour MC, Stockton MA. Improving integrated depression and non-communicable disease care in Malawi through engaged leadership and supportive implementation climate. BMC Health Serv Res 2023; 23:1413. [PMID: 38098079 PMCID: PMC10722817 DOI: 10.1186/s12913-023-10344-7] [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: 06/09/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Low- and middle-income countries often lack access to mental health services, leading to calls for integration within other primary care systems. In sub-Saharan Africa, integration of depression treatment in non-communicable disease (NCD) settings is feasible, acceptable, and effective. However, leadership and implementation climate challenges often hinder effective integration and quality of services. The aim of this study was to identify discrete leadership strategies that facilitate overcoming barriers to the integration of depression care in NCD clinics in Malawi and to understand how clinic leadership shapes the implementation climate. METHODS We conducted 39 in-depth interviews with the District Medical Officer, the NCD coordinator, one NCD provider, and the research assistant from each of the ten Malawian NCD clinics (note one District Medical Officer served two clinics). Based on semi-structured interview guides, participants were asked their perspectives on the impact of leadership and implementation climate on overcoming barriers to integrating depression care into existing NCD services. Thematic analysis used both inductive and deductive approaches to identify emerging themes and compare among participant type. RESULTS The results revealed how engaged leadership can fuel a positive implementation climate where clinics had heightened capacity to overcome implementation barriers. Effective leaders were approachable and engaged in daily operations of the clinic and problem-solving. They held direct involvement with and mentorship during the intervention, providing assistance in patient screening and consultation with treatment plans. Different levels of leadership utilized their respective standings and power dynamics to influence provider attitudes and perceptions surrounding the intervention. Leaders acted by informing providers about the intervention source and educating them on the importance of mental healthcare, as it was often undervalued. Lastly, they prioritized teamwork and collective ownership for the intervention, increasing provider responsibility. CONCLUSION Training that prioritizes leadership visibility and open communication will facilitate ongoing Malawi Ministry of Health efforts to scale up evidence-based depression treatment within NCD clinics. This proves useful where extensive and external monitoring may be limited. Ultimately, these results can inform successful strategies to close implementation gaps to achieve integration of mental health services in low-resource settings through improved leadership and implementation climate. TRIAL REGISTRATION These findings are reported from ClinicalTrials.gov, NCT03711786. Registered on 18/10/2018. https://clinicaltrials.gov/ct2/show/NCT03711786 .
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Affiliation(s)
- Griffin M Sansbury
- Tidziwe Centre, University of North Carolina Project-Malawi, Private Bag A-104, Lilongwe, Malawi.
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599-7440, USA
| | - Chifundo Zimba
- Tidziwe Centre, University of North Carolina Project-Malawi, Private Bag A-104, Lilongwe, Malawi
| | - Juan Yanguela
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 1101 McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC, 27599-7411, USA
| | - Kelsey Landrum
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599-7440, USA
| | - Maureen Matewere
- Tidziwe Centre, University of North Carolina Project-Malawi, Private Bag A-104, Lilongwe, Malawi
| | - MacDonald Mbota
- Tidziwe Centre, University of North Carolina Project-Malawi, Private Bag A-104, Lilongwe, Malawi
| | - Jullita K Malava
- Malawi Epidemiology and Intervention Research Unit (MEIRU), P.O. Box 46, Chilumba, Karonga District, Malawi
| | - Harriet Tikhiwa
- Tidziwe Centre, University of North Carolina Project-Malawi, Private Bag A-104, Lilongwe, Malawi
| | - Abigail M Morrison
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599-7440, USA
| | - Christopher F Akiba
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Bradley N Gaynes
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599-7440, USA
- Division of Global Mental Health, Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, 101 Manning Dr #1, Chapel Hill, NC, 27514, USA
| | - Michael Udedi
- Malawi Ministry of Health and Population, Non-Communicable Diseases and Mental Health Clinical Services, P.O. Box 30377, Lilongwe, 3, Malawi
| | - Mina C Hosseinipour
- Tidziwe Centre, University of North Carolina Project-Malawi, Private Bag A-104, Lilongwe, Malawi
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, 101 Manning Dr #1, Chapel Hill, NC, 27514, USA
| | - Melissa A Stockton
- Tidziwe Centre, University of North Carolina Project-Malawi, Private Bag A-104, Lilongwe, Malawi
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599-7440, USA
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Namale-Matovu J, Kusolo R, Serunjogi R, Barlow-Mosha L, Mumpe-Mwanja D, Niombi N, Kalibbala D, Williamson D, Valencia D, Moore CA, Mwambi K, Nelson LJ, Namukanja-Mayambala PM, Williams JL, Mai CT, Qi YP, Musoke P. Strengthening capacity of health workers to diagnose birth defects in Ugandan hospitals from 2015 to 2021. BMC MEDICAL EDUCATION 2023; 23:766. [PMID: 37833686 PMCID: PMC10576368 DOI: 10.1186/s12909-023-04760-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/10/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Limited diagnostic capabilities, resources and health worker skills have deterred the advancement of birth defects surveillance systems in most low- and middle-income countries (LMICs). Empowering health workers to identify and diagnose major external birth defects (BDs) is crucial to establishing effective hospital-based BD surveillance. Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration BD Surveillance System consists of three diagnostic levels: (1) surveillance midwives, (2) MU-JHU clinical team, and (3) U.S. Centers for Disease Control and Prevention (CDC) birth defects subject matter experts (SMEs) who provide confirmatory diagnosis. The diagnostic concordance of major external BDs by surveillance midwives or MU-JHU clinical team with CDC birth defects SMEs were estimated. METHODS Study staff went through a series of trainings, including birth defects identification and confirmation, before surveillance activities were implemented. To assess the diagnostic concordance, we analyzed surveillance data from 2015 to 2021 for major external BDs: anencephaly, iniencephaly, encephalocele, spina bifida, craniorachischisis, microcephaly, anophthalmia/microphthalmia, anotia/microtia, cleft palate alone, cleft lip alone, cleft lip with cleft palate, imperforate anus, hypospadias, talipes equinovarus, limb reduction, gastroschisis, and omphalocele. Positive predictive value (PPV) as the proportion of BDs diagnosed by surveillance midwives or MU-JHU clinical team that were confirmed by CDC birth defects SMEs was computed. PPVs between 2015 and 2018 and 2019-2021 were compared to assess the accuracy of case diagnosis over time. RESULTS Of the 204,332 infants examined during 2015-2021, 870 infants had a BD. Among the 1,245 BDs identified, 1,232 (99.0%) were confirmed by CDC birth defects SMEs. For surveillance midwives, PPV for 7 of 17 BDs was > 80%. For the MU-JHU clinical team, PPV for 13 of 17 BDs was > 80%. Among surveillance midwives, PPV improved significantly from 2015 to 2018 to 2019-2021, for microcephaly (+ 50.0%), cleft lip with cleft palate (+ 17.0%), imperforate anus (+ 30.0%), and talipes equinovarus (+ 10.8%). Improvements in PPV were also observed among MU-JHU clinical team; however, none were significant. CONCLUSION The diagnostic accuracy of the midwives and clinical team increased, highlighting that BD surveillance, by front-line health care workers (midwives) in LMICs is possible when midwives receive comprehensive training, technical support, funding and continuous professional development.
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Affiliation(s)
- Joyce Namale-Matovu
- Makerere University, Johns Hopkins University Research Collaboration (MU-JHU), P.O. Box 23491, Kampala, Uganda.
| | - Ronald Kusolo
- Makerere University, Johns Hopkins University Research Collaboration (MU-JHU), P.O. Box 23491, Kampala, Uganda
| | - Robert Serunjogi
- Makerere University, Johns Hopkins University Research Collaboration (MU-JHU), P.O. Box 23491, Kampala, Uganda
| | - Linda Barlow-Mosha
- Makerere University, Johns Hopkins University Research Collaboration (MU-JHU), P.O. Box 23491, Kampala, Uganda
| | - Daniel Mumpe-Mwanja
- Makerere University, Johns Hopkins University Research Collaboration (MU-JHU), P.O. Box 23491, Kampala, Uganda
| | | | - Dennis Kalibbala
- Makerere University, Johns Hopkins University Research Collaboration (MU-JHU), P.O. Box 23491, Kampala, Uganda
| | - Dhelia Williamson
- Division of Global HIV and TB, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Diana Valencia
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | | | | | - Lisa J Nelson
- Division of Global HIV and TB, US CDC, Kampala, Uganda
| | | | - Jennifer L Williams
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | - Cara T Mai
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | - Yan Ping Qi
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | - Philippa Musoke
- Makerere University, Johns Hopkins University Research Collaboration (MU-JHU), P.O. Box 23491, Kampala, Uganda
- Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda
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Anderson R, Zaman SB, Jimmy AN, Read JM, Limmer M. Strengthening quality in sexual, reproductive, maternal, and newborn health systems in low- and middle-income countries through midwives and facility mentoring: an integrative review. BMC Pregnancy Childbirth 2023; 23:712. [PMID: 37798690 PMCID: PMC10552246 DOI: 10.1186/s12884-023-06027-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND There is an urgent global call for health systems to strengthen access to quality sexual, reproductive, maternal, newborn and adolescent health, particularly for the most vulnerable. Professional midwives with enabling environments are identified as an important solution. However, a multitude of barriers prevent midwives from fully realizing their potential. Effective interventions to address known barriers and enable midwives and quality sexual, reproductive, maternal, newborn and adolescent health are less well known. This review intends to evaluate the literature on (1) introducing midwives in low- and middle-income countries, and (2) on mentoring as a facilitator to enable midwives and those in midwifery roles to improve sexual, reproductive, maternal, newborn and adolescent health service quality within health systems. METHODS An integrative systematic literature review was conducted, guided by the Population, Intervention, Comparison, Outcome framework. Articles were reviewed for quality and relevance using the Gough weight-of-evidence framework and themes were identified. A master table categorized articles by Gough score, methodology, country of focus, topic areas, themes, classification of midwives, and mentorship model. The World Health Organization health systems building block framework was applied for data extraction and analysis. RESULTS Fifty-three articles were included: 13 were rated as high, 36 as medium, and four as low according to the Gough criteria. Studies that focused on midwives primarily highlighted human resources, governance, and service delivery while those focused on mentoring were more likely to highlight quality services, lifesaving commodities, and health information systems. Midwives whose pre-service education met global standards were found to have more efficacy. The most effective mentoring packages were comprehensive, integrated into existing systems, and involved managers. CONCLUSIONS Effectively changing sexual, reproductive, maternal, newborn and adolescent health systems is complex. Globally standard midwives and a comprehensive mentoring package show effectiveness in improving service quality and utilization. TRIAL REGISTRATION The protocol is registered in PROSPERO (CRD42022367657).
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Affiliation(s)
- Rondi Anderson
- The Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
| | - Sojib Bin Zaman
- Department of Health Sciences, James Madison University, Harrisonburg, Virginia, USA
| | - Abdun Naqib Jimmy
- Environmental Science Department, Jahangirnagar University, Dhaka, Bangladesh
| | - Jonathan M Read
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Mark Limmer
- The Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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De Rosa S, Battaglini D, Bennett V, Rodriguez-Ruiz E, Zaher AMS, Galarza L, Schaller SJ. Key steps and suggestions for a promising approach to a critical care mentoring program. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2023; 3:30. [PMID: 37644586 PMCID: PMC10464173 DOI: 10.1186/s44158-023-00116-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/19/2023] [Indexed: 08/31/2023]
Abstract
In critical care medicine, where there is a demanding career with a problematic work-life balance, mentoring is an important support tool to grow professionally, creating a network of support throughout the career. The mentoring process consists of evidence-based steps to guide critical care mentors and mentees and pair them with each other according to the correct selection and matching of participants.In order to focus on the active role of a young intensivist selected as a mentee at any level and to support their success in a mentoring relationship, the NEXT Committee of the European Society of Intensive Care Medicine (ESICM) developed 2012 a mentoring program.The critical steps of the mentoring program start from establishing a policy and program objectives, passing through the selection of participants, and matching with mentors up to the definition of the personal development plan supported by checklists, worksheets, and evaluation forms. The present manuscript provides key steps and tips for a good, essential based on our experience in the ESICM NEXT-Mentoring Program so that they guide for future mentoring programs conducted by other scientific societies. In addition, we discuss common challenges and how to avoid them.
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Affiliation(s)
- Silvia De Rosa
- Centre for Medical Sciences (CISMed), University of Trento, 38122, Trento, Italy.
- Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS Trento, Trento, Italy.
| | - Denise Battaglini
- Department of Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Victoria Bennett
- Department of Intensive Care Medicine, St George's University Hospital NHS Foundation Trust, London, UK
| | - Emilio Rodriguez-Ruiz
- Intensive Care Medicine Department, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain
| | - Ahmed Mohamed Sabri Zaher
- Adult Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, Level 1, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Laura Galarza
- Department of Intensive Care, Hospital General Universitari de Castelló, Castelló de La Plana, Spain
| | - Stefan J Schaller
- Department of Anesthesiology and Surgical Intensive Care, Charité - Universitätsmedizin, Berlin Institute of Health, Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
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Fitzgerald L, Tibyehabwa L, Varallo J, Ernest E, Patted A, Bertram MM, Alidina S, Mshana S, Katoto A, Simba D, Charles K, Smith V, Cainer M, Hellar A. Mentoring approaches in a safe surgery program in Tanzania: Lessons learned during COVID-19 and recommendations for the future. Surg Open Sci 2023; 14:109-113. [PMID: 37577254 PMCID: PMC10413135 DOI: 10.1016/j.sopen.2023.07.014] [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: 04/28/2023] [Accepted: 07/18/2023] [Indexed: 08/15/2023] Open
Abstract
Background COVID-19 has dramatically affected the delivery of health care and technical assistance. This is true in Tanzania, where maternal mortality and surgical infection rates are significantly higher than in high-income countries. This paper describes lessons learned about the optimal application of in-person and virtual mentorship in the Safe Surgery 2020 program to improve the quality of surgical services in Tanzania before and after the COVID-19 pandemic. Methods From January 2018 through December 2020, Safe Surgery 2020 supported 40 health facilities in Tanzania's Lake Zone to improve the quality of surgical care. A blended surgical mentorship model, employing both onsite and virtual mentorship, was central to the program's capacity development approach. With COVID-19, the program pivoted to full virtual mentorship. Through continuous learning and adaptation processes, including a human-centered design workshop, surveys assessing mentors' confidence with different competencies, and focus group discussions with mentors, mentees and safe surgery program staff, the program distilled the optimal use of mentorship models. Results Developing complex surgical skills, addressing contextual considerations, problem-solving, and building trusting relationships were best suited to in-person mentorship, whereas virtual mentorship was most effective in supporting mentees' quality improvement projects, data use, case discussions, and reinforcing clinical practices. Leading successful virtual learning required enhanced facilitation skills and active engagement of health facility leadership. Conclusions In-person and virtual mentorship offer distinct benefits and complement each other when combined. Investing more in-person mentorship at the beginning of programs allows for the establishment of trust that is foundational to effective mentorship.
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Affiliation(s)
| | | | - John Varallo
- Jhpiego, 1615 Thames St, Baltimore, MD, United States
| | - Edwin Ernest
- Safe Surgery 2020 Project, Jhpiego Tanzania, Dar es Salaam, Tanzania
| | - Anmol Patted
- Jhpiego, 1615 Thames St, Baltimore, MD, United States
| | | | - Shehnaz Alidina
- Harvard T. H. Chan School of Public Health, Boston, MA, United States1
Current affiliation. - Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States2
Former affiliation.
| | - Stella Mshana
- Safe Surgery 2020 Project, Jhpiego Tanzania, Mara, Tanzania
| | - Adam Katoto
- Safe Surgery 2020 Project, Jhpiego Tanzania, Kagera, Tanzania
| | - Dorcas Simba
- Safe Surgery 2020 Project, Jhpiego Tanzania, Dar es Salaam, Tanzania
| | | | | | | | - Augustino Hellar
- Safe Surgery 2020 Project, Jhpiego Tanzania, Dar es Salaam, Tanzania
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Anderson R, Zaman SB, Limmer M. The Impact of Introducing Midwives and also Mentoring on the Quality of Sexual, Reproductive, Maternal, Newborn, and Adolescent Health Services in Low- and Middle-Income Countries: An Integrative Review Protocol. Methods Protoc 2023; 6:mps6030048. [PMID: 37218908 DOI: 10.3390/mps6030048] [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: 03/06/2023] [Revised: 04/28/2023] [Accepted: 05/01/2023] [Indexed: 05/24/2023] Open
Abstract
INTRODUCTION Midwives have the potential to significantly contribute to health-delivery systems by providing sexual, reproductive, maternal, newborn, and adolescent health (SRMNAH) care. However, scant research finds barriers to understanding what midwives need to realize their full potential. There are gaps in the definition of a midwife and an understanding of effective means to support the implementation of midwifery care. Mentorship has been found to support systems and healthcare providers to improve care availability and quality. OBJECTIVES We describe the methodology of an integrative review that aims to generate evidence of the impact of introducing midwives and also on-site facility mentoring to better understand facilitators and barriers to implementation of the quality and availability of SRMNAH services in low- and middle-income countries (LMICs). METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines will be used to carry out the integrative review. Four electronic bibliographic databases, PubMed MEDLINE, EMBASE, Scopus, and CINAHL, will be used to identify eligible studies. All types of qualitative or quantitative studies will be considered. Eligible studies will be screened according to Population, Intervention, Comparison, and Outcome (PICO) inclusion criteria, and data will be extracted against a predetermined format. The aspects of health system strengthening in providing improved SRMNCH care will be examined in this review to generate evidence on how midwives and mentorship can improve routine care and health outcomes using the World Health Organization's Six Building Blocks approach. The quality of the articles will be thematically analyzed in four areas: coherence and integrity, appropriateness for answering the question, relevance and focus, and overall assessment using the Gough weight-of-evidence framework. EXPECTED RESULTS The literature review will consider assessing both upstream health systems regulators and downstream effectors for implementing midwifery interventions. Within this building block framework, this research will report on the outcomes and experiences of introducing midwives and the effectiveness of mentoring midwives and other staff in midwives' roles in improving care quality and health outcomes.
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Affiliation(s)
- Rondi Anderson
- The Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YW, UK
| | - Sojib Bin Zaman
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne 3800, Australia
| | - Mark Limmer
- Centre for Health Inequalities Research, Division of Health Research, Lancaster University, Lancaster LA1 4YW, UK
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Amod HB, Mkhize SW. Clinical support and perceived competency levels of midwifery students: A descriptive analysis. Health SA 2022; 27:1783. [PMID: 36483515 PMCID: PMC9724025 DOI: 10.4102/hsag.v27i0.1783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 04/28/2022] [Indexed: 11/07/2023] Open
Abstract
Background Midwifery students in South Africa place great value on the clinical support they receive from midwifery practitioners. Adequate clinical support should help midwifery students to practice procedures safely and independently, allowing them to be competent upon degree completion. Aim To describe the clinical support and perceived competency levels of midwifery students. Setting Public hospitals in KwaZulu-Natal. Methods The researcher chose a quantitative research method using a descriptive design. An all-inclusive purposive and convenience sampling method was undertaken to recruit midwifery students from an undergraduate nursing programme at a university in KwaZulu-Natal. Gatekeepers permission and ethics approval was obtained from the university's registrar and research ethics committee. A self-evaluation questionnaire describing the clinical support and perceived competency levels was completed by 60 respondents. Data were analysed using International Business Machines Corporation Statistical Package for Social Sciences (IBM-SPSS) Version 27. Results The results highlighted that the clinical support midwifery students received, was beneficial to their clinical learning outcomes. Eighty per cent of clinical support offered to midwifery students was obtained through clinical supervision. Ninety-three per cent of respondents revealed that the clinical support they received were from midwifery practitioners (without a speciality qualification). Although students rated themselves as competent in 88.6% of midwifery procedures, poor outcomes were identified in 11.4% procedures. Conclusion Midwifery practitioners play a significant role in supporting midwifery students during clinical placement. Advancing the roles of midwifery practitioners through mentorship training is likely to strengthen the quality of clinical support provided and thus improve the competence levels of midwifery students. Contribution The findings in this paper are valuable in developing clinical support training guidelines for midwifery practitioners.
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Affiliation(s)
- Hafaza B Amod
- Department of Nursing, Faculty of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Sipho W Mkhize
- Department of Nursing, Faculty of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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11
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Barasche-Berdah D, Wetzler S, Greenshtein I, Greenberg KL, Leiter E, Donchin M, Zwas DR. Municipal community centers as healthy settings: evaluation of a real-world health promotion intervention in Jerusalem. BMC Public Health 2022; 22:1870. [PMID: 36207706 PMCID: PMC9540711 DOI: 10.1186/s12889-022-14220-7] [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: 12/01/2021] [Accepted: 09/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background This study presents an intervention designed to foster the implementation of health promotion programs within District Municipality Community Centers (DMCCs) in Jerusalem, and the creation of a peer network of healthy settings with a shared aspiration of collaborating and implementing health-promoting policies at the community level. We also present the evaluation strategy, based on the EQUIHP and RE-AIM frameworks. Methods Twenty DMCCs completed our program. This evaluation research involved a comprehensive seminar during the first year for DMCCs coordinators, teaching them the principles of health promotion. An educational kit was distributed during the second year. The evaluation strategy included a process evaluation and annual evaluations based on the EQUIHP and RE-AIM frameworks. The EQUIHP tool was divided into four dimensions of evaluation: 1) Framework of health promotion principles, 2) Project development and implementation, 3) Project management, and 4) Sustainability; while the RE-AIM domains included: 1)Reach, 2)Effectiveness, 3)Adoption, 4)Implementation and 5)Maintenance. Results The program led to high responsiveness among DMCCs and to the implementation of diverse health promotion initiatives, with a participation of approximately 29,191 residents. The EQUIHP evaluation showed an improvement in program quality in Year 2. The final RE-AIM evaluation presented a total median score of 0.61 for all domains, where 0 was non-performance and 1.0 was full performance. The ‘Framework of health promotion principles’ and ‘Reach’ components received the highest median score (0.83, 1.0 and 0.87), while the ‘Sustainability and ‘Maintenance’ components received the lowest (0.5). Conclusions This innovative program adapts the Healthy Cities approach (initiated by the World Health Organization in 1986) to the development of community center health-promoting settings within the larger municipal framework, training local community center staff members to assess and address local health concerns and build community capacity. The local focus and efforts may help community actors to create health promotion programs more likely to be adopted, feasible in the ‘real-world’ and able to produce public health impact in the communities where people live. Moreover, collaboration and cooperation among DMCCs may lead to a broader community health vision, forging coalitions that can advocate more powerfully for health promotion. Trial registration NIH trial registration number: NCT04470960. Retrospectively registered on: 14/07/2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14220-7.
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Affiliation(s)
- Deborah Barasche-Berdah
- The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, Ein Kerem, P.O.B. 12000, 91120, Jerusalem, Israel
| | - Sima Wetzler
- The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, Ein Kerem, P.O.B. 12000, 91120, Jerusalem, Israel
| | - Iva Greenshtein
- The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, Ein Kerem, P.O.B. 12000, 91120, Jerusalem, Israel
| | - Keren L Greenberg
- The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, Ein Kerem, P.O.B. 12000, 91120, Jerusalem, Israel
| | - Elisheva Leiter
- The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, Ein Kerem, P.O.B. 12000, 91120, Jerusalem, Israel
| | - Milka Donchin
- Israel Healthy Cities Network and Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem, Israel
| | - Donna R Zwas
- The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, Ein Kerem, P.O.B. 12000, 91120, Jerusalem, Israel.
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12
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Alidina S, Sydlowski MM, Ahearn O, Andualem BG, Barash D, Bari S, Barringer E, Bekele A, Beyene AD, Burssa DG, Derbew M, Drown L, Gulilat D, Gultie TK, Hayirli TC, Meara JG, Staffa SJ, Workineh SE, Zanial N, Zeleke ZB, Mengistu AE, Ashengo TA. Implementing surgical mentorship in a resource-constrained context: a mixed methods assessment of the experiences of mentees, mentors, and leaders, and lessons learned. BMC MEDICAL EDUCATION 2022; 22:653. [PMID: 36045356 PMCID: PMC9434847 DOI: 10.1186/s12909-022-03691-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND A well-qualified workforce is critical to effective functioning of health systems and populations; however, skill gaps present a challenge in low-resource settings. While an emerging body of evidence suggests that mentorship can improve quality, access, and systems in African health settings by building the capacity of health providers, less is known about its implementation in surgery. We studied a novel surgical mentorship intervention as part of a safe surgery intervention (Safe Surgery 2020) in five rural Ethiopian facilities to understand factors affecting implementation of surgical mentorship in resource-constrained settings. METHODS We designed a convergent mixed-methods study to understand the experiences of mentees, mentors, hospital leaders, and external stakeholders with the mentorship intervention. Quantitative data was collected through a survey (n = 25) and qualitative data through in-depth interviews (n = 26) in 2018 to gather information on (1) intervention characteristics including areas of mentorship, mentee-mentor relationships, and mentor characteristics, (2) organizational context including facilitators and barriers to implementation, (3) perceived impact, and (4) respondent characteristics. We analyzed the quantitative and qualitative data using frequency analysis and the constant comparison method, respectively; we integrated findings to identify themes. RESULTS All mentees (100%) experienced the intervention as positive. Participants perceived impact as: safer and more frequent surgical procedures, collegial bonds between mentees and mentors, empowerment among mentees, and a culture of continuous learning. Over 70% of all mentees reported their confidence and job satisfaction increased. Supportive intervention characteristics included a systems focus, psychologically safe mentee-mentor relationships, and mentor characteristics including generosity with time and knowledge, understanding of local context, and interpersonal skills. Supportive organizational context included a receptive implementation climate. Intervention challenges included insufficient clinical training, inadequate mentor support, and inadequate dose. Organizational context challenges included resource constraints and a lack of common understanding of the intervention. CONCLUSION We offer lessons for intervention designers, policy makers, and practitioners about optimizing surgical mentorship interventions in resource-constrained settings. We attribute the intervention's success to its holistic approach, a receptive climate, and effective mentee-mentor relationships. These qualities, along with policy support and adapting the intervention through user feedback are important for successful implementation.
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Affiliation(s)
- Shehnaz Alidina
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA.
| | - Meaghan M Sydlowski
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
| | - Olivia Ahearn
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
| | - Bizuayehu G Andualem
- Amhara Regional Health Bureau, Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Sehrish Bari
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
| | | | - Abebe Bekele
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Andualem D Beyene
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Miliard Derbew
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Laura Drown
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
| | - Dereje Gulilat
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Tuna C Hayirli
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Steven J Staffa
- Department of Anesthesiology and Surgery, Boston Children's Hospital, Boston, MA, USA
| | | | - Noor Zanial
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
| | - Zebenay B Zeleke
- Amhara Regional Health Bureau, Federal Ministry of Health, Addis Ababa, Ethiopia
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13
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Rashid S, ElSalhy M. A cross-sectional study of dental students perception of dental faculty gender differences. PLoS One 2022; 17:e0271570. [PMID: 35905091 PMCID: PMC9337690 DOI: 10.1371/journal.pone.0271570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 07/04/2022] [Indexed: 11/19/2022] Open
Abstract
Objective
The objective of this study was to evaluate students’ perceptions of differences in learning from faculty of different gender.
Method
This cross-sectional study involved pre-doctoral dental students (years 2 to 4) who had a simulation and/or clinical experience working with dental faculty for at least one year. Students completed a self-administered questionnaire with three sections: demographic, difference between faculty related to their knowledge, skill, critical thinking, acceptance of cultural differences, and students’ preferences in working with faculty in specialty clinics.
Results
A total of 136 students completed the survey (75.4% response rate). Participants were 52.6% women, 62.2% self-identified as Caucasian/White. Students reported that female faculty are more understanding (p = 0.001) and accepting of cultural differences (p<0.001) compared to male faculty (p<0.05). Students reported perceiving female faculty more as being a role model than male faculty (p = 0.034). When comparing male and female students, male student’s perception of male faculty as a role model was significantly higher than female students (p<0.05). There was no significant difference in student’s perceptions between male and female faculty in their knowledge, skills, compassion, critical thinking, providing feedback, communication skills, and grading (p>0.05). Caucasian/White students perceived female faculty as more encouraging for discussions and male faculty as more rigid/inflexible (p<0.05).
Conclusions
Students perceived female faculty as more understanding and culturally competent compared to male faculty. There were no significant differences in student’s perceptions of male and female faculty in their knowledge, skills, compassion, critical thinking, feedback, communication skills, and grading. Students perceived female faculty as role models more than male faculty.
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Affiliation(s)
- Shaista Rashid
- A.T. Still University - Missouri School of Dentistry & Oral Health, St Louis, Missouri, United States of America
- * E-mail:
| | - Mohamed ElSalhy
- College of Dental Medicine, University of New England, Portland, Maine, United States of America
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Basil L, Thompson M, Marx MA, Frost E, Mohan D, Traore S, Zanre J, Coulibaly B, Gueye BY, Nkurabagaya T, Poda G, Moussa K, El-Kalaawy F, Angelaksi C. Comparing program supervision with an external RADAR evaluation of quality of care in integrated community case management for childhood illnesses in Mali. Glob Health Action 2022; 15:2006424. [PMID: 36098951 PMCID: PMC9481102 DOI: 10.1080/16549716.2021.2006424] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Many countries have adopted integrated community case management (iCCM) to reduce mortality among children under five years from common childhood illnesses. The 2016-2020 Malian Red Cross iCCM program trained 441 Community Health Workers (CHWs) to treat malaria, pneumonia, diarrhea, and malnutrition for children under five years of age in six districts. Implementation strength and quality of care (QoC) were assessed through the program's supervision function, using the Malian Ministry of Health's system. OBJECTIVE This paper compares methods and results of program supervision data and an independent evaluation to assess the effectiveness of program implementation and supervision and inform program improvement. It also presents the benefits and limitations of each method. METHOD An independent QoC evaluation was conducted using tools developed by the Real Accountability: Data Analysis for Results (RADAR) project, hereafter referred to as the RADAR evaluation. RADAR evaluation data collected in July and August 2018 were compared with program supervision data collected mostly between May and December 2018. RESULTS The RADAR evaluation provided detailed findings on correct assessment, classification, and treatment per illness, medication type, and dosage. Program supervision combined the findings for all illnesses, medication type, and dosage due to limitations in the data collection process. Six indicators were comparable between both methods. Findings were similar for temperature and mid-upper arm circumference measurements but diverged between program supervision and the RADAR evaluation, respectively, on correct classification for all illnesses (87.1% vs. 65.3%), correct treatment for all illnesses (69.5% vs. 39.8%), correct respiratory rate counting (88.5% vs. 54.7%), and administering the first dose by CHW (75.4% vs. 65.0%). Findings from the RADAR evaluation guided improvements in program supervision. CONCLUSIONS A robust program supervision system can serve as a credible method to assess QoC. However, a rigorous independent QoC evaluation provides a valuable benchmark to gauge the effectiveness of the supervisory process.
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Affiliation(s)
- Luay Basil
- Global Programs, Canadian Red Cross, Ottawa, Canada
| | | | - Melissa A Marx
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Emily Frost
- Office of Science and Strategy, March of Dimes, Arlington, VA, USA
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sinaly Traore
- Department of Health, Malian Red Cross, Bamako, Mali
| | - Jules Zanre
- Global Programs, Canadian Red Cross, Ottawa, Canada
| | | | | | | | | | - Kone Moussa
- Department of Health, Malian Red Cross, Bamako, Mali
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15
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Okoroafor SC, Ahmat A, Asamani JA, Millogo JJS, Nyoni J. An overview of health workforce education and accreditation in Africa: implications for scaling-up capacity and quality. HUMAN RESOURCES FOR HEALTH 2022; 20:37. [PMID: 35525955 PMCID: PMC9077809 DOI: 10.1186/s12960-022-00735-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/26/2022] [Indexed: 05/29/2023]
Abstract
BACKGROUND For countries to achieve universal health coverage, they need to have well-functioning and resilient health systems. Achieving this requires a sufficient number of qualified health workers and this necessitates the importance of investments in producing and regulating health workers. It is projected that by 2030, Africa would need additional 6.1 million doctors, nurses, and midwives. However, based on the current trajectory, only 3.1 million would be trained and ready for service delivery. To reduce current shortages of the health workforce, Africa needs to educate and train 3.0 million additional health workers by 2030. This study was conducted to describe the distribution and ownership of the health training institutions, production of health workers, and the availability of accreditation mechanisms for training programmes in the WHO African Region. METHODS A cross-sectional study was conducted using a standardized questionnaire from January 2018 to April 2019. All the 47 countries in the Region were invited to complete a structured questionnaire based on available secondary information from health sector reports, annual HRH reports, country health workforce profiles, and HRH observatories and registries. RESULTS Data from 43 countries in the World Health Organization African Region in 2018 show that there were 4001 health training institutions with 410, 1469 and 2122 being medical, health sciences, and nursing and midwifery schools, respectively, and 2221, 1359 and 421 institutions owned by the public, private for-profit and private not-for-profit sectors, respectively. A total of 148 357 health workers were produced in Region with 40% (59, 829) being nurses and midwives, 19% (28, 604) other health workers, and 14% (20 470) physicians. Overall, 31 countries (79%) in the Region have an accreditation framework for the health training institutions and seven countries do not have any accreditation mechanism. CONCLUSION To achieve universal health coverage, matching of competencies with population needs, as well as increasing capacities for health worker production to align with demand (numbers and skill-mix) for improved service delivery should be prioritized, as this would improve the availability of skilled health workforce in the Region.
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Affiliation(s)
- Sunny C Okoroafor
- Health Workforce Unit, Universal Health Coverage - Life Course Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo.
| | - Adam Ahmat
- Health Workforce Unit, Universal Health Coverage - Life Course Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - James Avoka Asamani
- Health Workforce Unit, Universal Health Coverage - Life Course Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Jean Jacques Salvador Millogo
- Health Workforce Unit, Universal Health Coverage - Life Course Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Jennifer Nyoni
- Health Workforce Unit, Universal Health Coverage - Life Course Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo
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16
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Broekhuizen H, Ifeanyichi M, Cheelo M, Drury G, Pittalis C, Rouwette E, Mbambiko M, Kachimba J, Brugha R, Gajewski J, Bijlmakers L. Policy options for surgical mentoring: Lessons from Zambia based on stakeholder consultation and systems science. PLoS One 2021; 16:e0257597. [PMID: 34587196 PMCID: PMC8480833 DOI: 10.1371/journal.pone.0257597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 09/03/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Supervision by surgical specialists is beneficial because they can impart skills to district hospital-level surgical teams. The SURG-Africa project in Zambia comprises a mentoring trial in selected districts, involving two provincial-level mentoring teams. The aim of this paper is to explore policy options for embedding such surgical mentoring in existing policy structures through a participatory modeling approach. METHODS Four group model building workshops were held, two each in district and central hospitals. Participants worked in a variety of institutions and had clinical and/or administrative backgrounds. Two independent reviewers compared the causal loop diagrams (CLDs) that resulted from these workshops in a pairwise fashion to construct an integrated CLD. Graph theory was used to analyze the integrated CLD, and dynamic system behavior was explored using the Method to Analyse Relations between Variables using Enriched Loops (MARVEL) method. RESULTS The establishment of a provincial mentoring faculty, in collaboration with key stakeholders, would be a necessary step to coordinate and sustain surgical mentoring and to monitor district-level surgical performance. Quarterly surgical mentoring reviews at the provincial level are recommended to evaluate and, if needed, adapt mentoring. District hospital administrators need to closely monitor mentee motivation. CONCLUSIONS Surgical mentoring can play a key role in scaling up district-level surgery but its implementation is complex and requires designated provincial level coordination and regular contact with relevant stakeholders.
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Affiliation(s)
- Henk Broekhuizen
- Dept. Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
- Dept. Health and Society, Wageningen University and Research, Wageningen, The Netherlands
- * E-mail:
| | - Martilord Ifeanyichi
- Dept. Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
- EMAI Health Systems and Health Services Consulting, Nijmegen, The Netherlands
| | - Mweene Cheelo
- Department of Surgery, Surgical Society of Zambia, University Teaching Hospital, Lusaka, Zambia
| | - Grace Drury
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Chiara Pittalis
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Etiënne Rouwette
- Institute for Management Research, Radboud University, Nijmegen, The Netherlands
| | - Michael Mbambiko
- Department of Surgery, Surgical Society of Zambia, University Teaching Hospital, Lusaka, Zambia
| | - John Kachimba
- Department of Surgery, Surgical Society of Zambia, University Teaching Hospital, Lusaka, Zambia
| | - Ruairí Brugha
- Department of Epidemiology & Public Health, Royal College of Surgeons in Ireland Division of Population Health Sciences, Dublin, Ireland
| | - Jakub Gajewski
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Leon Bijlmakers
- Dept. Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
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Alidina S, Tibyehabwa L, Alreja SS, Barash D, Bien-Aime D, Cainer M, Charles K, Ernest E, Eyembe J, Fitzgerald L, Giiti GC, Hellar A, Hussein Y, Kahindo F, Kenemo B, Kihunrwa A, Kisakye S, Kissima I, Meara JG, Reynolds C, Staffa SJ, Sydlowski M, Varallo J, Zanial N, Kapologwe NA, Mayengo CD. A multimodal mentorship intervention to improve surgical quality in Tanzania's Lake Zone: a convergent, mixed methods assessment. HUMAN RESOURCES FOR HEALTH 2021; 19:115. [PMID: 34551758 PMCID: PMC8458007 DOI: 10.1186/s12960-021-00652-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/01/2021] [Indexed: 05/11/2023]
Abstract
BACKGROUND Safe, high-quality surgical care in many African countries is a critical need. Challenges include availability of surgical providers, improving quality of care, and building workforce capacity. Despite growing evidence that mentoring is effective in African healthcare settings, less is known about its role in surgery. We examined a multimodal approach to mentorship as part of a safe surgery intervention (Safe Surgery 2020) to improve surgical quality. Our goal was to distill lessons for policy makers, intervention designers, and practitioners on key elements of a successful surgical mentorship program. METHODS We used a convergent, mixed-methods design to examine the experiences of mentees, mentors, and facility leaders with mentorship at 10 health facilities in Tanzania's Lake Zone. A multidisciplinary team of mentors worked with surgical providers over 17 months using in-person mentorship, telementoring, and WhatsApp. We conducted surveys, in-depth interviews, and focus groups to capture data in four categories: (1) satisfaction with mentorship; (2) perceived impact; (3) elements of a successful mentoring program; and (4) challenges to implementing mentorship. We analyzed quantitative data using frequency analysis and qualitative data using the constant comparison method. Recurrent and unifying concepts were identified through merging the qualitative and quantitative data. RESULTS Overall, 96% of mentees experienced the intervention as positive, 88% were satisfied, and 100% supported continuing the intervention in the future. Mentees, mentors, and facility leaders perceived improvements in surgical practice, the surgical ecosystem, and in reducing postsurgical infections. Several themes related to the intervention's success emerged: (1) the intervention's design, including its multimodality, side-by-side mentorship, and standardization of practices; (2) the mentee-mentor relationship, including a friendly, safe, non-hierarchical, team relationship, as well as mentors' understanding of the local context; and (3) mentorship characteristics, including non-judgmental feedback, experience, and accessibility. Challenges included resistance to change, shortage of providers, mentorship dose, and logistics. CONCLUSIONS Our study suggests a multimodal mentorship approach is promising in building the capacity of surgical providers. By distilling the experiences of the mentees, mentors, and facility leaders, our lessons provide a foundation for future efforts to establish effective surgical mentorship programs that build provider capacity and ultimately improve surgical quality.
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Affiliation(s)
- Shehnaz Alidina
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | - Leopold Tibyehabwa
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | - Sakshie Sanjay Alreja
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | | | - Danta Bien-Aime
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | - Monica Cainer
- Assist International, Dar es Salaam, Tanzania and Ripon, CA USA
| | - Kevin Charles
- Assist International, Dar es Salaam, Tanzania and Ripon, CA USA
| | - Edwin Ernest
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | | | - Laura Fitzgerald
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | - Geofrey C. Giiti
- Department of Surgery and Department of Obstetrics and Gynaecology, Bugando Medical Center, Mwanza, Tanzania
| | - Augustino Hellar
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | - Yahaya Hussein
- Department of Health, Social Welfare, and Nutrition Service, President’s Office – Regional Administration and Local Government, Dodoma, Tanzania
| | | | - Benard Kenemo
- Department of Surgery and Department of Obstetrics and Gynaecology, Bugando Medical Center, Mwanza, Tanzania
| | - Albert Kihunrwa
- Department of Surgery and Department of Obstetrics and Gynaecology, Bugando Medical Center, Mwanza, Tanzania
| | - Steve Kisakye
- D-Implement, Dalberg Advisors, Dar es Salaam, Tanzania
| | | | - John G. Meara
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA USA
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Cheri Reynolds
- Assist International, Dar es Salaam, Tanzania and Ripon, CA USA
| | - Steven J. Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA USA
| | - Meaghan Sydlowski
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | - John Varallo
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | - Noor Zanial
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | - Ntuli A. Kapologwe
- Department of Health, Social Welfare, and Nutrition Service, President’s Office – Regional Administration and Local Government, Dodoma, Tanzania
| | - Caroline Damian Mayengo
- Department of Curative Services, Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
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Pelly L, Srivastava K, Singh D, Anis P, Mhadeshwar VB, Kumar R, Crockett M. Readiness to provide child health services in rural Uttar Pradesh, India: mapping, monitoring and ongoing supportive supervision. BMC Health Serv Res 2021; 21:914. [PMID: 34479540 PMCID: PMC8417968 DOI: 10.1186/s12913-021-06909-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2018, 875 000 under-five children died in India with children from poor families and rural communities disproportionately affected. Community health centres are positioned to improve access to quality child health services but capacity is often low and the systems for improvements are weak. METHODS Secondary analysis of child health program data from the Uttar Pradesh Technical Support Unit was used to delineate how program activities were temporally related to public facility readiness to provide child health services including inpatient admissions. Fifteen community health centres were mapped regarding capacity to provide child health services in July 2015. Mapped domains included human resources and training, infrastructure, equipment, drugs/supplies and child health services. Results were disseminated to district health managers. Six months following dissemination, Clinical Support Officers began regular supportive supervision and gaps were discussed monthly with health managers. Senior pediatric residents mentored medical officers over a three-month period. Improvements were assessed using a composite score of facility readiness for child health services in July 2016. Usage of outpatient and inpatient services by under-five children was also assessed. RESULTS The median essential composition score increased from 0.59 to 0.78 between July 2015 and July 2016 (maximum score of 1) and the median desirable composite increased from 0.44 to 0.58. The components contributing most to the change were equipment, drugs and supplies and service provision. Scores for trained human resources and infrastructure did not change between assessments. The number of facilities providing some admission services for sick children increased from 1 in July 2015 to 9 in October 2016. CONCLUSIONS Facility readiness for the provision of child health services in Uttar Pradesh was improved with relatively low inputs and targeted assessment. However, these improvements were only translated into admissions for sick children when clinical mentoring was included in the support provided to facilities.
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Affiliation(s)
- Lorine Pelly
- Institute for Global Public Health, University of Manitoba, R070 Med Rehab Building, 771 McDermot Avenue, R3E 0T6 Winnipeg, Manitoba Canada
| | - Kanchan Srivastava
- India Health Action Trust, 404, 4th Floor, No. 20-A Ratan Square, Vidhan Sabha Marg, 226001 Lucknow, Uttar Pradesh India
| | - Dinesh Singh
- India Health Action Trust, 404, 4th Floor, No. 20-A Ratan Square, Vidhan Sabha Marg, 226001 Lucknow, Uttar Pradesh India
| | - Parwez Anis
- India Health Action Trust, 404, 4th Floor, No. 20-A Ratan Square, Vidhan Sabha Marg, 226001 Lucknow, Uttar Pradesh India
| | - Vishal Babu Mhadeshwar
- India Health Action Trust, 404, 4th Floor, No. 20-A Ratan Square, Vidhan Sabha Marg, 226001 Lucknow, Uttar Pradesh India
| | - Rashmi Kumar
- Department of Pediatrics, King George’s Medical University, King George’s Medical University Chowk, 226003 Lucknow, Uttar Pradesh India
| | - Maryanne Crockett
- Institute for Global Public Health, University of Manitoba, R070 Med Rehab Building, 771 McDermot Avenue, R3E 0T6 Winnipeg, Manitoba Canada
- Departments of Pediatrics and Child Health, Medical Microbiology and Infectious Diseases and Community Health Sciences, University of Manitoba, Winnipeg, Canada
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Seyoum T, Alemayehu M, Christensson K, Lindgren H. Provider-perceived benefits and constraints of complete adherence to antenatal care guideline among public health facilities, Ethiopia: A qualitative study. PLoS One 2021; 16:e0255297. [PMID: 34370765 PMCID: PMC8351951 DOI: 10.1371/journal.pone.0255297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 07/13/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In Ethiopia, health care providers' level of adherence to the national Antenatal Care (ANC) guideline is relatively low. The reasons why they do not follow the guidelines are not well known. Therefore, this study aimed to explore the provider-perceived benefits and constraints associated with using the guideline for ANC in public health facilities in Gondar town. METHODS A qualitative study was conducted using a semi-structured interview guide. The interview was conducted among a purposive sample of nine health care providers working in four public health facilities in Gondar town. After the interviews were transcribed and coded, a content analysis was done using Atlas ti version 7.5 software packages. RESULT Decreasing provider's workload and maximizing performance, improving safe motherhood, and improving the process of service delivery were reported as the perceived benefits of following ANC guideline. Organizational problems, care providers' existing knowledge, attitude, and skills and availability of training and mentorship were the three main identified groups of factors that hinder complete providers' adherence to ANC guideline. CONCLUSION Although providers acknowledged the benefits of following ANC guideline, the guideline is not fully implemented. Refresher training should be given at the start of the updated eight-contact ANC guideline and continuing education and supervision throughout the implementation process. Health care providers call for profound and urgent revisions of the supply chain system for supplies and equipment.
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Affiliation(s)
- Tewodros Seyoum
- School of Midwifery, College of Medicine Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mekuriaw Alemayehu
- Department of Environmental Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Kyllike Christensson
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Helena Lindgren
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
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Ngabonzima A, Kenyon C, Kpienbaareh D, Luginaah I, Mukunde G, Hategeka C, Cechetto DF. Developing and implementing a model of equitable distribution of mentorship in districts with spatial inequities and maldistribution of human resources for maternal and newborn care in Rwanda. BMC Health Serv Res 2021; 21:744. [PMID: 34315417 PMCID: PMC8314501 DOI: 10.1186/s12913-021-06764-y] [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: 02/03/2021] [Accepted: 07/12/2021] [Indexed: 12/02/2022] Open
Abstract
Background The shortage of health care providers (HCPs) and inequity in their distribution along with the lack of sufficient and equal professional development opportunities in low-income countries contribute to the high mortality and morbidity of women and newborns. Strengthening skills and building the capacity of all HCPs involved in Maternal and Newborn Health (MNH) is essential to ensuring that mothers and newborns receive the required care in the period around birth. The Training, Support, and Access Model (TSAM) project identified onsite mentorship at primary care Health Centers (HCs) as an approach that could help reduce mortality and morbidity through capacity building of HCPs in Rwanda. This paper presents the results and lessons learnt through the design and implementation of a mentorship model and highlights some implications for future research. Methods The design phase started with an assessment of the status of training in HCs to inform the selection of Hospital-Based Mentors (HBMs). These HBMs took different courses to become mentors. A clear process was established for engaging all stakeholders and to ensure ownership of the model. Then the HBMs conducted monthly visits to all 68 TSAM assigned HCs for 18 months and were extended later in 43 HCs of South. Upon completion of 6 visits, mentees were requested to assist their peers who are not participating in the mentoring programme through a process of peer mentoring to ensure sustainability after the project ends. Results The onsite mentorship in HCs by the HBMs led to equal training of HCPs across all HCs regardless of the location of the HC. Research on this mentorship showed that the training improved the knowledge and self-efficacy of HCPs in managing postpartum haemorrhage (PPH) and newborn resuscitation. The lessons learned include that well trained midwives can conduct successful mentorships at lower levels in the healthcare system. The key challenge was the inconsistency of mentees due to a shortage of HCPs at the HC level. Conclusions The initiation of onsite mentorship in HCs by HBMs with the support of the district health leaders resulted in consistent and equal mentoring at all HCs including those located in remote areas.
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Affiliation(s)
- Anaclet Ngabonzima
- Economic Community for Central African States (ECCAS), Libreville, Gabon.
| | - Cynthia Kenyon
- Neonatal - Perinatal Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Daniel Kpienbaareh
- Department of Geography and Environment, University of Western Ontario, Ontario, N6A 5C1, London, Canada
| | - Isaac Luginaah
- Department of Geography and Environment, University of Western Ontario, Ontario, N6A 5C1, London, Canada
| | - Gisele Mukunde
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, N6A 5C1, London, Ontario, Canada
| | - Celestin Hategeka
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, BC, Vancouver, Canada
| | - David F Cechetto
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, University of Western Ontario, N6A 5C1, London, Ontario, Canada
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21
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Albini A, Peres AM, Almeida MDLD. Contributions of the Simplified Competency Management Model to a Municipal Health Secretariat. Rev Lat Am Enfermagem 2021; 29:e3429. [PMID: 34231788 PMCID: PMC8253350 DOI: 10.1590/1518-8345.3385.3429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/12/2020] [Indexed: 11/22/2022] Open
Abstract
Objective: to present the contributions of the Simplified Competency Management Model
in a municipal health secretariat. Method: research of integrated mixed methods of exploratory-descriptive type. The
model was applied in a southern Brazilian city, in the following stages:
documentary, questionnaire, mapping of gaps and educational proposal. Results: in the first stage, after documentary research, a total of 14 general core
competences were described and a questionnaire with specific core
competences was chosen, with confirmation of correlation among them; in the
second stage, the importance and expression competence at work degrees were
obtained, after the questionnaires were filled out by 74 municipal public
health managers; in the third one, a formula was adopted for the training
priority degree and its classification; the fourth stage presented an
educational proposal for the development of one of the competences with the
highest priority degree. Conclusion: the model brings contributions by describing general core competences, after
documentary research; carrying out the correlation between a questionnaire,
containing specific core competences with the general ones; by mapping gaps;
and by the proposal of learning trails for the development of
competences.
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Affiliation(s)
- Alessandro Albini
- Prefeitura Municipal de São José dos Pinhais, Secretaria Municipal de Saúde, São José dos Pinhais, PR, Brazil
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Getachew T, Abebe SM, Yitayal M, Persson LÅ, Berhanu D. Association between a complex community intervention and quality of health extension workers' performance to correctly classify common childhood illnesses in four regions of Ethiopia. PLoS One 2021; 16:e0247474. [PMID: 33711024 PMCID: PMC7954333 DOI: 10.1371/journal.pone.0247474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 02/07/2021] [Indexed: 12/20/2022] Open
Abstract
Background Due to low care utilization, a complex intervention was done for two years to optimize the Ethiopian Health Extension Program. Improved quality of the integrated community case management services was an intermediate outcome of this intervention through community education and mobilization, capacity building of health workers, and strengthening of district ownership and accountability of sick child services. We evaluated the association between the intervention and the health extension workers’ ability to correctly classify common childhood illnesses in four regions of Ethiopia. Methods Baseline and endline assessments were done in 2016 and 2018 in intervention and comparison areas in four regions of Ethiopia. Ill children aged 2 to 59 months were mobilized to visit health posts for an assessment that was followed by re-examination. We analyzed sensitivity, specificity, and difference-in-difference of correct classification with multilevel mixed logistic regression in intervention and comparison areas at baseline and endline. Results Health extensions workers’ consultations with ill children were observed in intervention (n = 710) and comparison areas (n = 615). At baseline, re-examination of the children showed that in intervention areas, health extension workers’ sensitivity for fever or malaria was 54%, 68% for respiratory infections, 90% for diarrheal diseases, and 34% for malnutrition. At endline, it was 40% for fever or malaria, 49% for respiratory infections, 85% for diarrheal diseases, and 48% for malnutrition. Specificity was higher (89–100%) for all childhood illnesses. Difference-in-differences was 6% for correct classification of fever or malaria [aOR = 1.45 95% CI: 0.81–2.60], 4% for respiratory tract infection [aOR = 1.49 95% CI: 0.81–2.74], and 5% for diarrheal diseases [aOR = 1.74 95% CI: 0.77–3.92]. Conclusion This study revealed that the Optimization of Health Extension Program intervention, which included training, supportive supervision, and performance reviews of health extension workers, was not associated with an improved classification of childhood illnesses by these Ethiopian primary health care workers. Trial registration ISRCTN12040912, http://www.isrctn.com/ISRCTN12040912.
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Affiliation(s)
- Theodros Getachew
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Solomon Mekonnen Abebe
- College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Mezgebu Yitayal
- College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Lars Åke Persson
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Della Berhanu
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Juarez M, Dionicio C, Sacuj N, Lopez W, Miller AC, Rohloff P. Community-Based Interventions to Reduce Child Stunting in Rural Guatemala: A Quality Improvement Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020773. [PMID: 33477580 PMCID: PMC7831302 DOI: 10.3390/ijerph18020773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/07/2021] [Accepted: 01/14/2021] [Indexed: 12/30/2022]
Abstract
Rural Guatemala has one of the highest rates of chronic child malnutrition (stunting) in the world, with little progress despite considerable efforts to scale up evidence-based nutrition interventions. Recent literature suggests that one factor limiting impact is inadequate supervisory support for frontline workers. Here we describe a community-based quality improvement intervention in a region with a high rate of stunting. The intervention provided audit and feedback support to frontline nutrition workers through electronic worklists, performance dashboards, and one-on-one feedback sessions. We visualized performance indicators and child nutrition outcomes during the improvement intervention using run charts and control charts. In this small community-based sample (125 households at program initiation), over the two-year improvement period, there were marked improvements in the delivery of program components, such as growth monitoring services and micronutrient supplements. The prevalence of child stunting fell from 42.4 to 30.6%, meeting criteria for special cause variation. The mean length/height-for-age Z-score rose from −1.77 to −1.47, also meeting criteria for special cause variation. In conclusion, the addition of structured performance visualization and audit and feedback components to an existing community-based nutrition program improved child health indicators significantly through improving the fidelity of an existing evidence-based nutrition package.
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Affiliation(s)
- Michel Juarez
- Center for Research in Indigenous Health, Wuqu’ Kawoq|Maya Health Alliance 2a Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango 04006, Guatemala; (M.J.); (C.D.); (N.S.); (W.L.)
| | - Carlos Dionicio
- Center for Research in Indigenous Health, Wuqu’ Kawoq|Maya Health Alliance 2a Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango 04006, Guatemala; (M.J.); (C.D.); (N.S.); (W.L.)
| | - Neftali Sacuj
- Center for Research in Indigenous Health, Wuqu’ Kawoq|Maya Health Alliance 2a Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango 04006, Guatemala; (M.J.); (C.D.); (N.S.); (W.L.)
| | - Waleska Lopez
- Center for Research in Indigenous Health, Wuqu’ Kawoq|Maya Health Alliance 2a Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango 04006, Guatemala; (M.J.); (C.D.); (N.S.); (W.L.)
| | - Ann C. Miller
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115, USA;
| | - Peter Rohloff
- Center for Research in Indigenous Health, Wuqu’ Kawoq|Maya Health Alliance 2a Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango 04006, Guatemala; (M.J.); (C.D.); (N.S.); (W.L.)
- Division of Global Health Equity, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA
- Correspondence:
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Daka DW, Wordofa MA, Woldie M, Persson LÅ, Berhanu D. Quality of clinical assessment and management of sick children by Health Extension Workers in four regions of Ethiopia: A cross-sectional survey. PLoS One 2020; 15:e0239361. [PMID: 32976508 PMCID: PMC7518593 DOI: 10.1371/journal.pone.0239361] [Citation(s) in RCA: 5] [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: 03/03/2020] [Accepted: 09/06/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Care-seeking for sick children at the Ethiopian primary health care level is low. This problem may partly be due to unfavorable community perceptions of the quality of care provided. There is, however, limited knowledge on the quality of the clinical assessment and management provided by the health extension workers at the health posts. This study aimed to examine the quality of clinical assessment, classification and management provided to sick under-five children by health extension workers in four regions of Ethiopia. METHODS Clinical observations of 620 consultations of sick children by health extension workers were conducted from December 2016 to February 2017. A clinical pathway analysis was performed to analyze whether sick children were appropriately assessed, classified and managed according to the integrated Community Case Management guidelines. RESULTS Most sick children presented with complaints of cough (58%), diarrhea (36%), and fever (26%).Three quarters of children with respiratory complaints had their respiratory rate counted (74%, 95% CI 69-78), while a third (33%, 95% CI 27-40) of children with diarrhea were assessed for dehydration. Half (53%, 95% CI 49-57) of the sick children were assessed for general danger signs, while a majority (89%, 95% CI 86-92) had their arm circumference measured for malnutrition. Half of the sick children received some treatment and less than one-fifth were referred according to the integrated Community Case management guidelines. Comprehensive counseling was provided to 38% (95% CI 35-42) of the caregivers. CONCLUSION The Ethiopian health extension workers' clinical assessment, classification and management of sick children did to a large extent not follow the clinical guidelines. This lack of adherence could lead to misdiagnoses and lack of potentially life-saving treatments.
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Affiliation(s)
- Dawit Wolde Daka
- Faculty of Public Health, Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
- * E-mail:
| | - Muluemebet Abera Wordofa
- Faculty of Public Health, Population and Family Health Department, Jimma University, Jimma, Ethiopia
| | - Mirkuzie Woldie
- Faculty of Public Health, Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
- Fenot Project, Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia
| | - Lars Åke Persson
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- The London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Della Berhanu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- The London School of Hygiene & Tropical Medicine, London, United Kingdom
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