Negotiating social norms, the legacy of vertical health initiatives and contradicting health policies: a qualitative study of health professionals’ perceptions and attitudes of providing adolescent sexual and reproductive health care in Arusha and Kilimanjaro region, Tanzania

Bylund, Sara; Peter, Nosim; Wees, Sibylle Herzig van

doi:10.1080/16549716.2020.1775992

Cited by 19 publications

(20 citation statements)

References 26 publications

(53 reference statements)

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“…These difficulties have already been identified in the implementation of other information systems, in Primary Care in Brazil (13) . In addition, the verticalization of policies and regulations (14) can contradict actions at the local level. In this case, such verticalization was permeated with mandatory and punitive aspects that reverberate mainly in the municipal sphere (15) , influencing the change management process.…”

Section: Discussionmentioning

confidence: 99%

Implementation of the e-SUS Primary Care system: Impact on the routine of Primary Health Care professionals

Schönholzer

Pinto

Zacharias

et al. 2021

Rev. Latino-Am. Enfermagem

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Objective: to understand how the implementation of the e-SUS Primary Care system has been processed and its impact on the daily life of the health teams. Method: a qualitative research study, conducted in a municipality in the inland of the state of São Paulo with professionals who work in Primary Health Care and use the e-SUS Primary Care system as a work tool. Semi-structured interviews and thematic data analysis were used with Kotter’s three-phase approach. Results: a total of 17 professionals, nurses, physicians, dentists and community agents were interviewed. The implementation of e-SUS Primary Care and its impact on the daily life of health teams were understood in terms of mandatory implementation; weaknesses for implementation, such as absence of material resources and implicit imposition for the use of the system; fragile training for deployment and learning from experience. Conclusion: a harmful incentive process was observed, conducted from the perspective of institutional pressure, use of the system to justify the work performed and, on the other hand, there was the creation of collaborative learning mechanisms between the teams.

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Section: Discussionmentioning

confidence: 99%

Implementation of the e-SUS Primary Care system: Impact on the routine of Primary Health Care professionals

Schönholzer

Pinto

Zacharias

et al. 2021

Rev. Latino-Am. Enfermagem

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“…The problematic implementation of adolescent SRH policies may result from the complex discursive SRHR landscape that spreads across the restrictive–liberal divide in Tanzania [ 63 ]. According to Bylund et al [ 28 ], complexity in adolescent SRHR may be intensified by contradictory and inconsistent messages regarding SRHR policies, the legal framework for providing services to underaged adolescents; the president’s personal views on SRHR; and community attitudes. The inequalities in the Tanzanian SRH services appear to be rooted into ageism, ableism, and patriarchy, which, according to the results of this study, intersect with disability and female adolescence, but also with marital status, poverty, STI status, social networks, and educational status.…”

Section: Discussionmentioning

confidence: 99%

“…The expanding adolescent population, the negative trend in adolescent fertility rates, and the general status of persons with disabilities in Tanzania makes the disparities in the access of adolescent females with disabilities to SRH services a timely and urgent concern. Substantive research has examined the access to SRH services of different sub-groups of adolescents in Tanzania [ 16 , 17 , 25 , 26 , 27 , 28 , 29 ]. However, there is a scarcity of disability- and SRHR-related studies from Tanzania [ 30 ].…”

Section: Introductionmentioning

confidence: 99%

Disparities in Accessing Sexual and Reproductive Health Services at the Intersection of Disability and Female Adolescence in Tanzania

Mesiäislehto

Katsui

Sambaiga

2021

IJERPH

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Despite at times having greater needs for sexual and reproductive health (SRH) services, adolescents with disabilities often face challenges when trying to access them. This inaccessibility is further exacerbated during female adolescence. The qualitative study examines how SRH services respond to the characteristics of Tanzanian adolescent females with disabilities. We used the method of empathy-based stories to investigate the perceptions of 136 adolescent females with disabilities of their access to SRH services in Tanzania. The study used thematic content analysis and the Levesque model of health care access was applied as an analytical framework. The results demonstrate that discrimination affects access at different phases of care-seeking, that affectionate behaviour of providers is a central enabler of access, and that for this population access relies on a collective effort. We propose that affection, as an enabler of access, is as an additional provider dimension of access to SRH services for adolescents with disabilities, serving as a “reasonable accommodation” to the health care systems in southern contexts and beyond.

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“…The in-depth interview method was selected to allow participants to give their opinion on how key risk indicators can improve PPP risk management frameworks currently used. In-depth interviews have been successfully used to collect data in previous studies in this field (Bylund et al, 2020;Yousaf & Fan, 2020).…”

Section: Methodsmentioning

confidence: 99%

A paradigm shift in risk management in public–private partnership arrangements

2021

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This research sought to determine how public–private partnership (PPP) arrangements can more efficiently address risk management issues using the example of Mozambique as a case study. Analyses of 15 interviews in this country were conducted using the Gioia methodology. The results indicate that integrating key risk indicators into PPP contracts can improve risk management. These measures have been widely used in company risk management. The indicators can serve as monitoring, reviewing and supervising tools, allowing the integration of external factors into PPP contracts at the right time, which is hard to predict when the contracts are signed. Key risk indicators can capture megatrends, track risk evolution and develop future scenarios throughout the entire lifecycle of contracts, preventing conflicts between partners, contract renegotiations or early contract terminations by facilitating an improved understanding of contracts' current realities. The findings suggest that these measures should be applied by PPP units. The proposed approach encourages originality and empirical research-based improvements of PPP risk management frameworks and provides guidelines for future studies.

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Negotiating social norms, the legacy of vertical health initiatives and contradicting health policies: a qualitative study of health professionals’ perceptions and attitudes of providing adolescent sexual and reproductive health care in Arusha and Kilimanjaro region, Tanzania

Cited by 19 publications

References 26 publications

Implementation of the e-SUS Primary Care system: Impact on the routine of Primary Health Care professionals

Implementation of the e-SUS Primary Care system: Impact on the routine of Primary Health Care professionals

Disparities in Accessing Sexual and Reproductive Health Services at the Intersection of Disability and Female Adolescence in Tanzania

A paradigm shift in risk management in public–private partnership arrangements

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