BackgroundUganda has a severe health worker shortage and a high demand for health care services. This study aimed to assess the policy and programmatic implications of task shifting in Uganda.MethodsThis was a qualitative, descriptive study through 34 key informant interviews and eight (8) focus group discussions, with participants from various levels of the health system.ResultsPolicy makers understood task shifting, but front-line health workers had misconceptions on the meaning and intention(s) of task shifting. Examples were cited of task shifting within the Ugandan health system, some formalized (e.g. psychiatric clinical officers), and some informal ones (e.g. nurses inserting IV lines and initiating treatment). There was apparently high acceptance of task shifting in HIV/AIDS service delivery, with involvement of community health workers (CHW) and PLWHA in care and support of AIDS patients.There was no written policy or guidelines on task shifting, but the policy environment was reportedly conducive with plans to develop a policy and guidelines on task shifting.Factors favouring task shifting included successful examples of task shifting, proper referral channels, the need for services, scarcity of skills and focused initiatives such as home based management of fever. Barriers to task shifting included reluctance to change, protection of professional turf, professional boundaries and regulations, heavy workload and high disease burden, poor planning, lack of a task shifting champion, lack of guidelines, the name task shifting itself, and unemployed health professionals.There were both positive and negative views on task shifting: the positive ones cast task shifting as one of the solutions to the dual problem of lack of skills and high demand for service, and as something that is already happening; while negative ones saw it as a quick fix intended for the poor, a threat to quality care and likely to compromise the health system.ConclusionThere were widespread examples of task in Uganda, and task shifting was mainly attributed to HRH shortages coupled with the high demand for healthcare services. There is need for clear policy and guidelines to regulate task shifting and protect those who undertake delegated tasks.
BackgroundLittle is known about the process of knowledge translation in low- and middle-income countries. We studied policymaking processes in Mozambique, South Africa and Zimbabwe to understand the factors affecting the use of research evidence in national policy development, with a particular focus on the findings from randomized control trials (RCTs). We examined two cases: the use of magnesium sulphate (MgSO4) in the treatment of eclampsia in pregnancy (a clinical case); and the use of insecticide treated bed nets and indoor residual household spraying for malaria vector control (a public health case).MethodsWe used a qualitative case-study methodology to explore the policy making process. We carried out key informants interviews with a range of research and policy stakeholders in each country, reviewed documents and developed timelines of key events. Using an iterative approach, we undertook a thematic analysis of the data.FindingsPrior experience of particular interventions, local champions, stakeholders and international networks, and the involvement of researchers in policy development were important in knowledge translation for both case studies. Key differences across the two case studies included the nature of the evidence, with clear evidence of efficacy for MgSO4 and ongoing debate regarding the efficacy of bed nets compared with spraying; local researcher involvement in international evidence production, which was stronger for MgSO4 than for malaria vector control; and a long-standing culture of evidence-based health care within obstetrics. Other differences were the importance of bureaucratic processes for clinical regulatory approval of MgSO4, and regional networks and political interests for malaria control. In contrast to treatment policies for eclampsia, a diverse group of stakeholders with varied interests, differing in their use and interpretation of evidence, was involved in malaria policy decisions in the three countries.ConclusionTranslating research knowledge into policy is a complex and context sensitive process. Researchers aiming to enhance knowledge translation need to be aware of factors influencing the demand for different types of research; interact and work closely with key policy stakeholders, networks and local champions; and acknowledge the roles of important interest groups.
Introduction Indoor residual spraying (IRS) and insecticide-treated nets (ITNs), two principal malaria control strategies, are similar in cost and efficacy. We aimed to describe recent policy development regarding their use in Mozambique, South Africa and Zimbabwe.Methods Using a qualitative case study methodology, we undertook semi-structured interviews of key informants from May 2004 to March 2005, carried out document reviews and developed timelines of key events. We used an analytical framework that distinguished three broad categories: interests, ideas and events.Results A disparate mix of interests and ideas slowed the uptake of ITNs in Mozambique and Zimbabwe and prevented uptake in South Africa. Most respondents strongly favoured one strategy over the other. In all three countries, national policy makers favoured IRS, and only in Mozambique did national researchers support ITNs. Outside interests in favour of IRS included manufacturers who supplied the insecticides and groups opposing environmental regulation. International research networks, multilateral organizations, bilateral donors and international NGOs supported ITNs. Research evidence, local conditions, logistic feasibility, past experience, reaction to outside ideas, community acceptability, the role of government and NGOs, and harm from insecticides used in spraying influenced the choice of strategy. The end of apartheid permitted a strongly pro-IRS South Africa to influence the region, and in Mozambique and Zimbabwe, floods provided conditions conducive to ITN distribution.Conclusions Both IRS and ITNs have a place in integrated malaria vector management, but pro-IRS interests and ideas slowed or prevented the uptake of ITNs. Policy makers needed more than evidence from trials to change from the time-honoured IRS strategy that they perceived was working. Those intending to promote new policies such as ITNs should examine the interests and ideas motivating key stakeholders and their own institutions, and identify where shifts in thinking or coalitions among the like-minded may be possible.
Objective: Tanzania has a high maternal mortality ratio of 556 per 100,000 live births. Timely caesarean sections avert mortality due to life threatening conditions like obstructed labour. This study assessed capacity of selected health facilities to provide caesarean sections in terms of infrastructure, equipment, essential supplies and skill mix. Methods: A cross-sectional mixed methods design was used to include systematic observations using highly structured checklists to determine the adequacy of infrastructure, functional status of equipment, availability of supplies and skill mix. An interview guide and a key-informant interview guide were used to collect data from assistant medical officers and key informants respectively. Descriptive data analysis was conducted using IBM SPSS software package. Results: Deficit for doctors ranged between 3 (37.5%) and 5 (62.5%) per each district hospital. Two out of 3 health centres did not have doctors. Deficit for assistant medical doctors ranged between 10 (62.5%) and 11 (68.8%) per each district hospital. In terms of absolute numbers, assistant medical doctors were more than doctors. Not all facilities had all the equipment, infrastructure or supplies. Challenges cited by most assistant medical officers were; shortage of theatre-trained nurses (91%; n=21), theatres not functioning (61%; n=14), inadequate blood supply (87%; n=20) and inadequate equipment (96%; n=22). Conclusion: Capacity of health facilities to provide caesarean sections was found to be sub-optimal due to health workforce shortages, inadequate infrastructure, equipment and supplies, thus increasing the risk of maternal deaths. These findings are useful in informing strategies to reduce maternal mortality.
The East, Central and Southern Africa (ECSA) region faces a critical shortage of skilled birth attendants despite high levels of maternal and neonatal mortality. This situation could be improved by training more midwives, but in order to achieve this there is a need for more trainers. However, most countries in the region have no midwifery educators’ programmes to produce people to train the required midwives. To address this gap, the East, Central and Southern Africa College of Nursing (ECSACON), in collaboration with the Commonwealth Secretariat, is implementing a 5-year project aimed at increasing the number of midwifery educators and midwives to contribute to the reduction of maternal and neonatal mortality in the ECSA region. A midwifery master’s prototype curriculum, compliant with regional and international standards for midwifery educators, was developed by regional and international stakeholders which higher education institutions in the region are encouraged to adapt according to country needs. The paper describes promising progress and achievements in the ongoing implementation of this project. Kamuzu College of Nursing (KCN) in Malawi and the University of Central Lancashire (UCLAN) in the UK both adapted the midwifery prototype curriculum and started the programme in 2008 as full time and distance learning, respectively. The University of Makerere in Uganda commenced the programme in August 2011; and the following universities are planning to commence the programme in late 2013: Muhimbili and Tumaini in Tanzania, Zambia, Swaziland, and the National University of Science and Technology in Zimbabwe. Uganda Christian University in Mukono intends to start the programme in 2014.
Background: Lesotho experiences human resources for health crisis, thus creating challenges in accessing specialist surgical services. In 2008, doctor-patient ratio was 1:16298. In mitigation, the ECSA Health Community initiated a south to south collaborative strategy by mobilizing a surgical camp team of 25 specialists from ECSA virtual colleges that conducted an inaugural regional surgical camp. Sixty-five complex surgeries were performed. Objectives: Our aim was to evaluate the camp and document lessons for application in future camps on planning, organization, roles of stakeholders and determine immediate patient outcomes. Methods: We used quantitative and qualitative methods to evaluate the adequacy of planning, organizing, coordinating and executing the camp. We collected data through self-administered questionnaires and focus group discussions. We used qualitative and quantitative methods for data analysis. For qualitative data, we used a multilayered approach of triangulation, data coding and categorizing based on emerging themes. Results: We found that camp objectives were met. Participants were satisfied with organization and coordination of the camp although 91% preferred advance notification of 6-12 months. All patients had successful outcomes. 61.9% rated partners/donors involvement as inadequate. Majority (90.5%) reported adequacy of equipment. Mobilizing participants from various countries ensured a highly qualified experienced surgical team. Conclusion: The ECSA camp was a best practice for fostering south to south cooperation in bridging knowledge and skills gap through pooling of regional expertise. The camp has potential for replication and sustainability. The high calibre and experience of the team may have contributed to the 100% success rate.
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