Authors:
Shayne R. van Aswegen; Mark T. Richards, Brenda M. Morrow Keywords:
Maternal, Newborn, and Child Health
PubDate: 2024-12-20T06:39:28-08:00 DOI: 10.9745/GHSP-D-23-00463 Issue No:Vol. 12, No. 6 (2024)
Authors:
Michael Mugisha; Andrew D. Oxman, Laetitia Nyirazinyoye, Anne Marie Uwitonze, Clarisse Marie Claudine Simbi, Faith Chesire, Ronald Ssenyonga, Matt Oxman, Allen Nsangi, Daniel Semakula, Margaret Kaseje, Nelson K. Sewankambo, Sarah Rosenbaum, Simon Lewin Abstract: ABSTRACTIntroduction:We evaluated the Informed Health Choices secondary school intervention in a cluster randomized trial in Rwanda. The intervention was effective in helping students to think critically about health. In parallel to the trial, we conducted a process evaluation to assess factors affecting the implementation, impacts, and scale-up of the intervention.Methods:We used a mixed methods approach that included quantitative and qualitative methods. We collected quantitative data from teachers to evaluate the teacher training and each lesson. We conducted focus group discussions with students (n=10) and their parents/guardians (n=5). We conducted lesson observations (n=16) and key informant interviews with teachers (n=10) and school administrators (n=10) from intervention schools and policymakers (n=2). We analyzed the quantitative data using descriptive statistics. We used framework analysis and thematic content analysis to analyze the qualitative data.Results:Teachers noted that the teacher training supported their delivery of the intervention and that they made only small adaptations to fit student, teacher, or contextual needs. Students reported obtaining important skills, including recognizing health claims, understanding the need for research, and “thinking twice” before deciding. Participants saw the design of the intervention, students’ and teachers’ motivation, and school and home support as key facilitators for the implementation and impact of the intervention. Implementation barriers identified included the content of the lessons not being included in national examinations, competing priorities, and time constraints. Participants identified several factors that could facilitate intervention scale-up, including the need for the skills taught in the lessons and compatibility of the intervention with the national curriculum.Conclusion:We found that it was feasible to implement the intervention in Rwandan secondary schools and that students benefited from the intervention. Scaling up the intervention will likely require addressing the barriers identified in this study. Keywords:
Behavior Change Communication, Adolescents and Youth
PubDate: 2024-12-20T06:39:28-08:00 DOI: 10.9745/GHSP-D-23-00483 Issue No:Vol. 12, No. 6 (2024)
Authors:
Ronald Ssenyonga; Simon Lewin, Esther Nakyejwe, Faith Chelagat, Michael Mugisha, Matt Oxman, Allen Nsangi, Daniel Semakula, Sarah E. Rosenbaum, Jenny Moberg, Andrew D. Oxman, Heather Munthe-Kaas, Christine Holst, Margaret Kaseje, Laetitia Nyirazinyoye, Nelson Sewankambo Abstract: ABSTRACTIntroduction:We designed the Informed Health Choices (IHC) secondary school intervention and evaluated whether it improves students’ ability to assess the trustworthiness of claims about treatment effects in Uganda. We conducted a process evaluation alongside a randomized trial to identify factors that may affect the implementation, fidelity, and scaling up of the intervention in Uganda. We also explored the potential adverse and beneficial effects of the intervention.Methods:We used mixed methods to collect, triangulate, and report data from a variety of sources. We observed at least 1 lesson in all 40 intervention schools. One teacher from each of these schools completed a teacher training evaluation form and lesson evaluation questionnaires after each lesson. We purposively selected 10 schools where we conducted a total of 10 focus group discussions with students and 1 with parents. We also conducted key informant interviews with policymakers (N=9), teachers (N=10), head teachers (N=4), and parents (N=3). We used a framework analysis approach to analyze the data.Findings:All participants in the process evaluation felt that the IHC intervention was needed, important, and timely. Students were motivated to attend class and learn the content because it spoke to their daily life experiences and their own challenges to decide what to do or believe when faced with health claims. The training workshop gave teachers the confidence to teach the lessons. The participating students demonstrated a clear understanding of the content and use of what was learned. The content improved both students’ and teachers’ appreciation of the critical thinking, communication, and problem-solving competencies in the lower secondary school curriculum.Conclusion:The findings of this process evaluation are consistent with the findings of the trial, which showed that the intervention improved the students’ critical thinking skills. The IHC resources enabled teachers to teach this competency. Keywords:
Behavior Change Communication, Adolescents and Youth
PubDate: 2024-12-20T06:39:28-08:00 DOI: 10.9745/GHSP-D-23-00484 Issue No:Vol. 12, No. 6 (2024)
Authors:
Faith Chesire; Andrew D. Oxman, Margaret Kaseje, Violet Gisore, Michael Mugisha, Ronald Ssenyonga, Matt Oxman, Allen Nsangi, Daniel Semakula, Laetitia Nyirazinyoye, Nelson K. Sewankambo, Heather Munthe-Kaas, Christine Holst, Sarah Rosenbaum, Simon Lewin Abstract: ABSTRACTIntroduction:We evaluated the Informed Health Choices secondary school intervention to help students in Kenya think critically about health choices. We conducted this process evaluation to explore if the intervention was implemented as planned, identify factors that facilitated or hindered implementation, potential benefits of the intervention, and how to scale up the intervention beyond the trial.Methods:This was a mixed methods process evaluation nested in a cluster-randomized trial of the Informed Health Choices intervention. We analyzed quantitative data from teacher training evaluation forms completed by 39 teachers, 10 lesson evaluation forms completed by 40 teachers allocated to the intervention, and 72 structured classroom observation forms. We conducted a framework analysis of qualitative data from 14 group interviews (with 96 students, 23 teachers, and 18 parents) and 22 individual interviews (with 8 teachers, 5 school principals, 6 curriculum developers, and 3 policymakers). We assessed confidence in our findings from the qualitative analysis using a modified version of Confidence in the Evidence from Reviews of Qualitative Research.Results:Lesson objectives were achieved with minimal adaptations. Factors that might have facilitated the implementation of the intervention include teacher training; perceived value of the intervention by students, teachers, and policymakers; and support from school administration. Time constraints, teachers’ heavy workloads, and the lessons not being included in the curriculum or national examination are factors that might have impeded implementation. Both students and teachers demonstrated the ability to apply key concepts that were taught to health choices and other choices. However, they experienced difficulties with 2 of the lessons.Conclusion:Scale-up of this intervention in Kenyan schools is feasible but may depend on adjusting the time allocated to teaching the lessons, modifying the 2 lessons that teachers and students found difficult, and including the lesson objectives and assessment in the national curriculum. Keywords:
Behavior Change Communication, Adolescents and Youth
PubDate: 2024-12-20T06:39:28-08:00 DOI: 10.9745/GHSP-D-23-00485 Issue No:Vol. 12, No. 6 (2024)
Authors:
Alyssa L. Davis; Erica Felker-Kantor, Jehan Ahmed, Zachariah Jezman, Beh Kamate, John Munthali, Noella Umulisa, Oumar Yattara Abstract: ABSTRACTIntroduction:Since 2012, the World Health Organization (WHO) and UNICEF have recommended integrated Community Case Management (iCCM) of childhood illnesses as an intervention delivered by community health workers (CHWs) in areas with limited access to health facilities to increase access to lifesaving interventions for children younger than 5 years with malaria, pneumonia, or diarrhea. In recent years, the importance of institutionalizing iCCM and community health more broadly within national health systems has become increasingly recognized.Methods:This qualitative study sought to identify and describe processes of iCCM institutionalization from the perspectives of health system actors. A total of 51 semistructured interviews were conducted with purposefully selected key informants in 3 countries: Malawi, Mali, and Rwanda. Thematic analysis of coded interview data was conducted, and country documentation was reviewed to provide contextual background for qualitative interpretation. The study was informed by a newly developed iCCM Institutionalization Framework, which conceptualizes the process of institutionalization through a maturity model of phases (i.e., awareness, experimentation, expansion, consolidation, and maturity) with 4 drivers: core values, leadership, resources, and policy.Results:According to key informant narrative descriptions, processes of iCCM institutionalization reflected a progression of maturity phases, which were iterative rather than linear in progression. All 4 drivers of institutionalization as conceptualized within the iCCM Institutionalization Framework were described by key informants as contributing to the advancement of iCCM institutionalization within their countries. Key informants emphasized the need to continually strengthen or reinforce iCCM institutionalization for it to be sustained within the context of wider health system dynamics.Conclusion:Overall, key informants viewed government ownership and integration within national systems to define the status of iCCM institutionalization. Further development of the iCCM Institutionalization Framework and other practical sensemaking models could assist health system actors in advancing institutionalization of iCCM and other health interventions. Keywords:
Maternal, Newborn, and Child Health, Health Systems
PubDate: 2024-12-20T06:39:28-08:00 DOI: 10.9745/GHSP-D-23-00509 Issue No:Vol. 12, No. 6 (2024)
Authors:
Barbara Knittel; Heather M. Marlow, Afrah Mohammedsanni, Abebaw Gebeyehu, Hiwot Belay, Wubshet Denboba Abstract: ABSTRACTHealth information systems (HISs) are essential to a country’s health system as they provide critical support to health policymaking, management, financing, and service delivery. A well-functioning HIS should produce timely and reliable data that are available and easily accessible to decision-makers throughout the health system. Ethiopia has transitioned from a fragmented, paper-based health management information system (HMIS) to a harmonized, digital system used at points of collection and service delivery.In 2016, the Federal Ministry of Health (MOH) launched the Information Revolution (IR), a transformative agenda aimed at enhancing the culture of data use, scaling priority HIS tools and systems, and strengthening HIS governance. Between 2016 and 2022, the MOH, Data Use Partnership, and other partners implemented a series of IR interventions that supported this agenda. These interventions included deploying and harmonizing digital HIS systems; strengthening HIS leadership, coordination, and governance; implementing the IR pathway strategy; enhancing capacity through supportive supervision, mentorship, and training; and improving performance monitoring teams. This article aims to synthesize the key HIS interventions implemented in Ethiopia as part of the IR and document the effects of these interventions on HIS performance.Early studies indicate promising improvements in HIS performance across health facilities in Ethiopia. However, challenges remain. To ensure sustainable progress, it is essential to continue addressing key challenges, such as system interoperability, HIS workforce, and capacity for data use at all levels. By building on the successes of the first Health Sector Transformation Plan and addressing these gaps, Ethiopia can advance its vision of a robust, data-driven health system capable of improving health outcomes and driving evidence-based decision-making. Keywords:
Health Systems
PubDate: 2024-12-20T06:39:28-08:00 DOI: 10.9745/GHSP-D-23-00513 Issue No:Vol. 12, No. 6 (2024)
Authors:
Elijah Chikuse; Christine Hagstrom, Deanna Smith, Thokozire Banda, Harrison Chimbaka, Zinaumaleka Nkhoma, Martin Samuko, John Lichenya, Risa Hoffman, Joseph Njala, Sam Phiri, Khumbo Phiri, Joep J. van Oosterhout Abstract: ABSTRACTMental health (MH) disorders are highly prevalent among people living with HIV and can have a negative impact on antiretroviral therapy (ART) outcomes. Malawi’s Ministry of Health introduced MH screening in national HIV management guidelines in 2022. We describe early experience with integrated MH screening at ART clinics that have scarce human resources and limited capacity of specialist MH units. ART staff in 15 facilities were trained to use the Patient Health Questionnaire-9 (depression) and the Alcohol Use Disorders Identification Test (harmful alcohol use) screening instruments, MH registers were developed for tracking screening results and referrals, and existing MH referral units were engaged. Based on screening results, ART clients received counseling by lay cadre staff (for mild symptoms) or intensive counseling by trained psychosocial counselors and referrals to specialist MH units (for moderate to severe symptoms). From October 2022 through July 2023, 9,826 ART clients were screened from the following priority groups: returning to care after an interruption in treatment (50%), newly diagnosed (38%), and viral load ≥1,000 copies/mL (12%). Of those screened, 59% were female and 14% were aged 12–19 years. Screening coverage was 85% (9,826/11,553) among the 3 priority groups. All of the individuals who screened positive for moderate/severe depression (1.1%; n=106) or high risk for harmful alcohol use (2.3%; n=227) were referred to specialist MH units. In conclusion, thorough preparation led to high MH screening coverage among ART priority groups, and the number of referrals to specialist MH units was low. MH screening was feasible at Malawi ART clinics. Next steps include studying the clinical impact of integrated MH screening on MH outcomes and ART outcomes (retention in care and viral suppression) and scaling up integrated MH screening to all ART clinics. Keywords:
HIV/AIDS, Mental Health
PubDate: 2024-12-20T06:39:28-08:00 DOI: 10.9745/GHSP-D-23-00517 Issue No:Vol. 12, No. 6 (2024)
Authors:
Sarah Rich; Lily Jacobi, Nesrine Talbi, Ashley Wolfington, Kelly McDonald Keywords:
Family Planning and Reproductive Health, Health Systems
PubDate: 2024-12-20T06:39:28-08:00 DOI: 10.9745/GHSP-D-24-00124 Issue No:Vol. 12, No. 6 (2024)
Authors:
Abebaw Gebeyehu Worku; Wubshet Denboba Midekssa, Hibret Alemu Tilahun, Hiwot Tadesse Belay, Zeleke Abebaw, Afrah Mohammedsanni, Naod Wendrad, Mesoud Mohammed, Shemsedin Omer Mohammed, Amanuel Biru, Benti Ejeta Futassa Abstract: ABSTRACTBackground:Health information systems (HIS) are vital in supporting all aspects of managing health systems, financing, policymaking, and service delivery. A package of priority HIS interventions was piloted in selected woredas across all regions in Ethiopia. This study examined the impact of HIS interventions on maternal and child health (MCH) service utilization.Methods:A 2-arm quasi-experimental study was implemented in intervention and control woredas. Baseline and endline household and health facility surveys were conducted for both arms in 2020 and 2022, respectively. At baseline, 3,016 mothers and 167 health facilities were surveyed. At endline, 3,076 mothers and 160 health facilities were surveyed. The study used modified Performance of Routine Information System Management tools for the facility survey and a structured questionnaire for the household survey. Difference-in-difference (DID) analysis using mixed effect modeling was employed to measure changes and to account for clustering and control for likely confounders.Results:Intervention sites showed greater improvements in 75% of key HIS performance indicators. The changes in 90% of the MCH service utilization indicators were higher in the intervention sites. Significant (DID: P Keywords:
Maternal, Newborn, and Child Health, Health Systems
PubDate: 2024-12-20T06:39:28-08:00 DOI: 10.9745/GHSP-D-24-00145 Issue No:Vol. 12, No. 6 (2024)
Authors:
Cheewanan Lertpiriyasuwat; Patsaya Mookleemas, Naparat Pattarapayoon, Darinda Rosa, Viroj Tangcharoensathien Abstract: Background:In 2022, 10% of an estimated 560,000 people living with HIV in Thailand were unaware of their HIV status. A well-established HIV program is a solid platform for integrating HIV self-testing (HST) as part of efforts to end AIDS. We analyzed how HST was integrated into the national HIV program and became a benefit package.Policy Adoption of HST:In 2015, the National AIDS Prevention and Alleviation Committee included HST as a strategy to end HIV/AIDS by 2030. This led to collaboration between the Department of Disease Control (DDC), Food and Drug Administration (FDA), and partner networks, including civil society organizations, to amend policy regulations, allowing HIV testing outside health care facilities and facilitating HST registration. By 2024, 4 HST commercial products were registered by the Thai FDA.Program Pilots:In 2020, the DDC launched pilot programs distributing HST kits through private pharmacies in Bangkok and online platforms. Preliminary findings showed feasibility in reaching key populations and adolescents. In 2023, HST was included in the Universal Health Coverage benefit package, providing free access to all citizens. Guidelines, e-learning, public awareness campaigns, and a reimbursement system of HST were developed and implemented. By September 2024, over 166,000 users had received HST kits.Lessons Learned:Leadership, scientific evidence, feasibility testing through pilots, regulatory adjustments, licensing, price negotiations by the National Health Security Office, and stakeholder and community engagement were key to the program’s success. A nationwide distribution network through public and private health care facilities, including pharmacies, was a key enabling factor for HST delivery.Conclusions:HST is an additional intervention to increase awareness of HIV status and a key component in Thailand’s effort to end HIV/AIDS. Keywords:
HIV/AIDS
PubDate: 2024-12-20T06:39:28-08:00 DOI: 10.9745/GHSP-D-24-00156 Issue No:Vol. 12, No. 6 (2024)
Authors:
Lara Court; Aurelie Nelson, Reghana Taliep, Sarah Schoetz Dean, Rufaro Mvududu, Lucia Knight, Kathryn Dovel, Thomas Coates, Landon Myer, Dvora L. Joseph Davey Abstract: ABSTRACTIntroduction:Oral pre-exposure prophylaxis (PrEP) is an effective and safe option to prevent HIV acquisition and vertical HIV transmission in pregnant and breastfeeding women. Understanding health system factors influencing the integration of PrEP into care for pregnant and breastfeeding women is key to increasing access. We explored managers’ and health care workers’ (HCWs) experiences with integrating PrEP into antenatal care and postnatal care services in primary health care clinics in Cape Town, South Africa.Methods:This exploratory qualitative study used codebook thematic analysis, where HCWs were purposively, heterogeneously sampled from an implementation science study. Semistructured individual interviews were conducted with 9 managerial-level staff, and 3 focus group discussions were conducted with HCWs (nurses, midwives, and HIV counselors) providing PrEP (6–7 HCWs per group) between November 2022 and January 2023 (N=28). Interview guides covered health system facilitators, barriers, and recommendations. The Health Systems Dynamics framework guided data analysis and presentation of results.Results:PrEP integration into antenatal care services was described as acceptable and feasible; however, changes to HIV testing policy and indicators in breastfeeding women are needed to integrate PrEP into postnatal clinics, together with identification of mother and baby as a dyad in visits. Results showed that supportive policies facilitated wider, simplified PrEP provision. The availability and accessibility of prescribing nurses and lay HIV counselors, PrEP (both within facilities and in communities), and information about PrEP for implementers and pregnant and breastfeeding women will be pivotal to facilitating integration.Conclusion:Facilitators for PrEP integration include task-shifting PrEP education and identification of women for PrEP initiation to HIV counselors, changes to national guidelines defining who can prescribe PrEP, revision and integration of PrEP training for HCWs, community-level interventions for PrEP demand creation and stigma reduction, and provision of differentiated PrEP delivery options. Keywords:
HIV/AIDS, Maternal, Newborn, and Child Health, Health Systems
PubDate: 2024-12-20T06:39:28-08:00 DOI: 10.9745/GHSP-D-24-00166 Issue No:Vol. 12, No. 6 (2024)
Authors:
Samuel J.A. Robinson; Angus M.A. Ritchie, Maurizio Pacilli, Debra Nestel, Elizabeth McLeod, Ramesh Mark Nataraja Abstract: ABSTRACTIntroduction:Simulation-based education (SBE) is increasingly used to improve clinician competency and patient care and has been identified as a priority by the World Health Organization for low- and middle-income countries (LMICs). The primary aim of this review was to investigate the global distribution and effectiveness of SBE for health workers in LMICs. The secondary aim was to determine the learning focus, simulation modalities, and additional evaluation conducted in included studies.Methods:A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta Analysis guidelines, searching Ovid (Medline, Embase, and Emcare) and the Cochrane Library from January 1, 2002, to March 14, 2022. Primary research studies reporting evaluation at Level 4 of The Kirkpatrick model were included. Studies on simulation-based assessment and validation were excluded. Quality and risk-of-bias assessments were conducted using appropriate tools. Narrative synthesis and descriptive statistics were used to present the results.Results:A total of 97 studies were included. Of these, 54 were in sub-Saharan Africa (56%). Forty-seven studies focused on neonatology (48%), 29 on obstetrics (30%), and 16 on acute care (16%). Forty-nine used mannequins (51%), 46 used scenario-based simulation (47%), and 21 used synthetic part-task trainers (22%), with some studies using more than 1 modality. Sixty studies focused on educational programs (62%), while 37 used SBE as an adjunct to broader interventions and quality improvement initiatives (38%). Most studies that assessed for statistical significance demonstrated at least partial improvement in Level 4 outcomes (75%, n=81).Conclusion:SBE has been widely applied to improve outcomes in a variety of contexts across LMICs. Modalities of simulation are typically low-technology versions. However, there is a lack of standardized reporting of educational activities, particularly relating to essential features of SBE. Further research is required to determine which approaches are effective in specific contexts. Keywords:
Health Workers
PubDate: 2024-12-20T06:39:28-08:00 DOI: 10.9745/GHSP-D-24-00187 Issue No:Vol. 12, No. 6 (2024)
Authors:
Agustina Mazzoni; Javier Roberti, Marina Guglielmino, Ana Maria Nadal, Yanina Mazzaresi, Andrea Falaschi, Patricia J. Garcia, Laura Espinoza–Paȷuelo, Jesus Medina–Ranilla, Hannah H. Leslie, Juan Manuel Gomez Portillo, Maria Gabriela Masier, Ezequiel Garcia–Elorrio Abstract: ABSTRACTIntroduction:In Argentina, the implementation of a national strategy to reduce the prevalence of noncommunicable diseases (NCDs) has been hampered by challenges at the provincial level. We aimed to design a new model of care for NCDs at the primary care level by conducting a multimodal system assessment and co-design of potential solutions in the province of Mendoza.Methods:We carried out a mixed-methods study with 7 components: evaluation of patterns of care, patient focus groups, cross-sectional standardized population-based phone survey, an electronic cohort follow-up of patients with type 2 diabetes, in-depth interviews with stakeholders, a knowledge test for health care providers on chronic condition management, and a Delphi consensus to provide recommendations from stakeholders.Results:Focus group and in-depth interviews revealed access to primary health care for NCDs was associated with problems with long waiting times and time-consuming procedures for referral to laboratory tests, hospital care, and provision of medication. Mental health care services were particularly limited. Survey respondents (N=1,190) were predominantly covered through public (41%) or social security sectors (54%); 41% fell in the lowest income group. Contact with the health system was high (5.7 annual visits), but 19.7% reported unmet health care needs. Public sector providers perceived they provided high-quality care despite insufficient material and human resources. Within the social security sector, the main challenge was insufficient staff, particularly affecting mental health care. Health care providers showed a higher percentage of correct answers to depression-related questions, but worse results were seen in hypertension and diabetes care. Actions supported by evidence and expert agreement were identified for implementation to guide future system changes.Conclusion:Our research highlights the potential for Argentina’s primary care system to initiate transformative, system-level changes aimed at improving health outcomes. We propose an innovative methodological assessment and co-design for improving primary care. Keywords:
Noncommunicable Diseases, Primary Health Care
PubDate: 2024-12-20T06:39:28-08:00 DOI: 10.9745/GHSP-D-24-00208 Issue No:Vol. 12, No. 6 (2024)
Authors:
Madeleine Short Fabic; Amy Ong Tsui Keywords:
Family Planning and Reproductive Health
PubDate: 2024-12-20T06:39:28-08:00 DOI: 10.9745/GHSP-D-24-00220 Issue No:Vol. 12, No. 6 (2024)
Authors:
Mengjia Liang; Lindsay Katz, Emilie Filmer-Wilson, Priscilla Idele Abstract: ABSTRACTIntroduction:In 1994, the International Conference on Population and Development (ICPD) Programme of Action established the empowerment and autonomy of women as fundamental to achieving sustainable economic and social progress. Three decades later, significant strides have been made in enhancing sexual and reproductive health and rights (SRHR). However, deep-rooted gender inequality continues to impede substantial progress for many. We assess the advancements made under the Sustainable Development Goals, specifically through indicator 5.6.1, which measures women’s SRHR decision-making.Methods:Using data from 76 Demographic and Health Surveys and 1 Multiple Indicator Cluster Survey in 32 low- and middle-income countries from 2006 to 2022, the study analyzed trends in women’s SRHR decision-making and its subcomponents of autonomy on reproductive health care, contraceptive use, and sexual relations—among married or in-union women aged 15–49 years currently using contraception. The analysis also examined trends in decision-making disparities related to household wealth quintiles, women’s education levels, and area of residence, using disaggregated population-weighted percentages.Results:Analysis revealed a generally positive trend in women’s SRHR decision-making, with gains observed in Eastern and Southern Africa and notable declines in West and Central Africa. Subindicator disparities showed variations in autonomy across health care, contraception, and the ability to refuse sex. An inequality analysis highlighted that while some countries saw a narrowing wealth gap in decision-making, others faced growing disparities. Educational and urban-rural divides also shifted, reflecting a complex landscape of progress and challenges in improving women’s SRHR decision-making.Conclusion:The analysis underscores a patchwork of progress in women’s SRHR decision-making while also exposing deep disparities. These data suggest a critical need for interventions tailored to cultural and socioeconomic contexts, particularly in countries and subnational areas lagging behind. Forward-thinking strategies must prioritize enhancing women’s reproductive agency, ensuring interventions are informed by community-tailored priorities and global human rights standards. Keywords:
Family Planning and Reproductive Health
PubDate: 2024-12-20T06:39:28-08:00 DOI: 10.9745/GHSP-D-24-00228 Issue No:Vol. 12, No. 6 (2024)
Authors:
Catherine Birabwa; Lenka Beňova, Josefien van Olmen, Aline Semaan, Peter Waiswa, Aduragbemi Banke–Thomas Abstract: ABSTRACTIntroduction:Timely access to emergency obstetric care (EmOC) remains a challenge in sub-Saharan Africa, influenced by poor health care utilization and rapid urbanization. Studies show poor maternal health outcomes in African cities, reflecting weak health systems. Understanding care-seeking pathways is key to improving service delivery and health outcomes. We examined self-reported care-seeking pathways among women with obstetric complications in Kampala City, Uganda.Methods:In this cross-sectional survey, we collected sequential data from 433 women (15–49 years) from 9 health facilities in Kampala City. We developed typologies of common pathways to EmOC and descriptively analyzed key attributes, including median time spent at each step, comparing pathways across complications and participant characteristics. Provider utilization and service delivery performance issues were also assessed.Results:Participants’ average age was 26 years (standard deviation=6), with 55% (237/433) living outside Kampala. We identified 4 common pathways based on number and location of steps: pathways with 1 step, directly to a facility that provided required care (42%, 183/433); 2 steps, mostly including direct facility referrals (40%, 171/433); 3 steps (14%, 62/433); and 4 or more steps (4%, 17/433). Comprehensive EmOC facilities referred elsewhere 43% (79/184) of women who initially sought care in these facilities. Peripheral facilities referred 65% of women directly to the national referral hospital. A majority (60%, 34/57) of referred women returned home before reaching the final care facility.Conclusions:Our findings suggest that care pathways of women with obstetric complications in Kampala often involve at least 2 formal providers and reflect possible inefficiencies in the referral process, including potential delays and unnecessary steps. Efforts to strengthen urban health and referral systems should adopt multidisciplinary and integrated approaches, supported by clear policies and structures that facilitate effective interfacility and interdistrict care coordination. This should include streamlined care/referral pathways and equitable emergency transportation systems. Keywords:
Maternal, Newborn, and Child Health, Health Systems
PubDate: 2024-12-20T06:39:28-08:00 DOI: 10.9745/GHSP-D-24-00242 Issue No:Vol. 12, No. 6 (2024)
Authors:
Hannaniah Moyo; Sophia Osawe, Charles Nyangulu, Philemon Ndhlovu, Visopo Harawa, Oscar Divala, Malango Msukwa, Talishiea Croxton, Natalia Blanco, Dyson Mwandama, Memory Mkandawire, Elizabeth Kampira, Muluken Kaba, Alice Maida, Andrew F. Auld, Lindsay Kim, Reuben Mwenda, Howard Kress, James Kandulu, Thresa Sumani, Joseph Bitilinyu, Thokozani Kalua, Alash’le Abimiku Abstract: ABSTRACTIntroduction:As part of a laboratory strengthening program in Malawi to achieve and maintain International Organization for Standardization (ISO) 15189 accreditation, we intended to mentor selected HIV molecular laboratories to achieve this accreditation. Due to the COVID-19 pandemic, mentorship pivoted to a hybrid model using an Internet-based approach and on-site mentorships. We describe the implementation of this strategy, successes, and challenges.Methods:We conducted weekly, 1-hour virtual mentorship sessions for the 5 initial laboratories (cohort 1) selected based on their Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) performance score of 3 or more stars. Laboratories presented updates and supporting documents electronically, and trainings were conducted virtually. In September 2020, when travel restrictions were relaxed, we initiated hybrid mentorships and audits for cohort 1 laboratories. The same hybrid approach was used to mentor 4 additional laboratories in cohort 2. We performed descriptive analysis, and the Wilcoxon signed-rank test was used to compare the training pre-and post-test scores.Results:Between March 2020 and May 2023, the team completed a total of 54 virtual mentorship sessions and 20 on-site visits across 9 laboratories. Overall, the team conducted 8 training sessions for 35 laboratory quality officers. Median score improvement (pre-test vs. post-test scores) was observed across individual trainings and across cohorts (P Keywords:
HIV/AIDS
PubDate: 2024-12-20T06:39:28-08:00 DOI: 10.9745/GHSP-D-24-00254 Issue No:Vol. 12, No. 6 (2024)
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