Background Continuous quality improvement processes in health care were developed for use at health facility level, and that is where they have been used the most, often addressing defined care processes. However, in different settings different factors have been important to support institutionalization. This study explores how continuous quality improvement processes were institutionalized at the district level and at the health facility level in Uganda. Methods This qualitative study was carried out in seven districts in Uganda. Semi-structured interviews with key informants from the district health management teams and document review were conducted. Thematic analysis was used to analyze the data. Results All districts that participated in the study formed Continuous Quality Improvement (CQI) teams both at the district level and at the health facilities. The district CQI teams comprised of members from different departments within the district health office. District level CQI teams were mandated to take the lead in addressing management gaps and follow up CQI activities at the health facility level. Acceptability of quality improvement processes by the district leadership was identified across districts as supporting the successful implementation of CQI. However, high turnover of staff at health facility level was also reported as a detrimental to the successful implementation of quality improvement processes. Also the district health management teams did not engage much in addressing their own roles using continuous quality improvement. Conclusion The leadership and management provided by the district health management team was an important factor for the use of Continuous Quality Improvement principles within the district. The key roles of the district health team revolved around the institutionalisation of CQI at different levels of the health system, monitoring results of continuous quality improvement implementation, mobilising resources and health care delivery hence promoting the culture of quality, direct implementation of CQI, and creating an enabling environment for the lower-level health facilities to engage in CQI. High turnover of staff at health facility level was also reported as one of the challenges to the successful implementation of continuous quality improvement. The DHT did not engage much in addressing gaps in their own roles using continuous quality improvement.
Introduction: Self-medication is defined as medication taken on one's own initiative or on the advice of pharmacist or any other lay person. It is one of the leading cause for the ever threatening drug resistance for various drugs. Medical students are future physicians and prescribers. It is important to know how they use medicines and what the pattern is. Hence, assessing their practice on this sensitive issue will help in planning interventions to prevent irrational use of medicines. Objective: To determine the prevalence and pattern of self-medication among medical students. Methods: A cross-sectional study was done among the medical students of a private college in Central Kerala using a pre-tested semi-structured questionnaire which had questions regarding common drugs used for self-medication, ailments, reasons, source & also awareness about dose, course & side effects of the drug used. Results: Prevalence of self-medication was 95%. Commonly self-medicated drugs include antipyretics 253(78.06%) and analgesics 158(58.8%). Diseases which are commonly self-medicated are fever 273(84.4%) and aches & pain 184(56.4%). Majority of students were self-medicating due to mild nature of illness 236(72.9%). Common source of self-medicated drugs were pharmacy for 248(76.5%), family &friends for 137(42.2%). Conclusions: Prevalence of self-medication was found to be very high among medical students. Considering the fact that the respondents are future prescribers, correct, timely use of drugs need to be stressed. But they were using the drugs only for common ailments and not for serious diseases.
Introduction: Health workforce shortage is a major threat to global public health with a greater implication for low-resourced countries. The right placement of the available staff in many health facilities remains a challenge due to inadequate information on exact workload and work pressure that staff undergo in course of work. This study aimed to determine the need for key health workforce cadre in Kuluva hospital using Workload Indicators of Staffing Need (WISN) methodology. Method: The study followed a predominantly quantitative approach of Workload Indicator Staffing Needs (WISN) methodology. We held a meeting with hospital management to understand policy issues and procedures. The key staff were interviewed in departments, available records reviewed, practices observed to establish the available working time, activity standards and time taken to perform other supportive activities. Service statistics was generated from HMIS data of 2016/17. Data was analyzed manually using calculator and Microsoft Excel spreadsheet. Results All cadre categories had the same available working time of 1,504 hours in a year with 105 staff of the studied cadres required to perform all activities in Kuluva hospital based on WISN calculation. Although overall work pressure was 30%, 5 out of 7 staff cadre categories experienced work pressure of varying degrees – medical officers (70%), laboratory staff (70%) and clinical officers (60%) were most affected compared to nurses (30%) and midwives (10%). There was perfect number of anesthetists but surplus nursing assistants than needed by the hospital. Amidst shortage, the critical cadres still spent significant time on non-professional activities; medical officers (24%) and midwives (25%). Conclusion These findings can provide insight into the management of Kuluva hospital to address the current disparities in the health workforce in terms of numbers and skill mix for continuous improvement of health service delivery to the population it serves.
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