Abstract:BackgroundThere is a growing emphasis on the need to tackle inadequate human resources for health (HRH) as an essential part of strengthening health systems; but the focus is mostly on macro-level issues, such as training, recruitment, skill mix and distribution. Few attempts have been made to understand the capability of health workers, their motivation and other structural and organizational aspects of systems that influence workforce performance. We have examined literature on the roles of mid-level manager… Show more
“…Readiness for change is critical to ensure implementation of the maternity unit activities. Maternity unit activities confronted challenges similar to other studies in Africa, including inadequate knowledge and skills combined with broader health systems failures and low staffing [ 33 , 34 ]. Prior attention to macro issues related to workforce training, recruitment, retention and distribution recently shifted to human resources for health for strengthened health systems [ 35 ].…”
Section: Discussionmentioning
confidence: 99%
“…Prior attention to macro issues related to workforce training, recruitment, retention and distribution recently shifted to human resources for health for strengthened health systems [ 35 ]. Focus has turned to health workers capabilities, their motivations and other structural and organizational aspects of systems that influence and moderate workforce performance including leadership and supervision (mid-level management) and communication [ 34 – 36 ].…”
BackgroundDespite years of growing concern about poor provider attitudes and women experiencing mistreatment during facility based childbirth, there are limited interventions that specifically focus on addressing these issues. The Heshima project is an evidence-based participatory implementation research study conducted in 13 facilities in Kenya. It engaged a range of community, facility, and policy stakeholders to address the causes of mistreatment during childbirth and promote respectful maternity care.MethodsWe used the consolidated framework for implementation research (CFIR) as an analytical lens to describe a complex, multifaceted set of interventions through a reflexive and iterative process for triangulating qualitative data. Data from a broad range of project documents, reports, and interviews were collected at different time points during the implementation of Heshima. Assessment of in-depth interview data used NVivo (Version 10) and Atlas.ti software to inductively derive codes for themes at baseline, supplemental, and endline. Our purpose was to generate categories of themes for analysis found across the intervention design and implementation stages.ResultsThe implementation process, intervention characteristics, individual champions, and inner and outer settings influenced both Heshima’s successes and challenges at policy, facility, and community levels. Implementation success stemmed from readiness for change at multiple levels, constant communication between stakeholders, and perceived importance to communities. The relative advantage and adequacy of implementation of the Respectful Maternity Care (RMC) resource package was meaningful within Kenyan politics and health policy, given the timing and national promise to improve the quality of maternity care.ConclusionWe found the CFIR lens a promising and flexible one for understanding the complex interventions. Despite the relatively nascent stage of RMC implementation research, we feel this study is an important start to understanding a range of interventions that can begin to address issues of mistreatment in maternity care; replication of these activities is needed globally to better understand if the Heshima implementation process can be successful in different countries and regions.
“…Readiness for change is critical to ensure implementation of the maternity unit activities. Maternity unit activities confronted challenges similar to other studies in Africa, including inadequate knowledge and skills combined with broader health systems failures and low staffing [ 33 , 34 ]. Prior attention to macro issues related to workforce training, recruitment, retention and distribution recently shifted to human resources for health for strengthened health systems [ 35 ].…”
Section: Discussionmentioning
confidence: 99%
“…Prior attention to macro issues related to workforce training, recruitment, retention and distribution recently shifted to human resources for health for strengthened health systems [ 35 ]. Focus has turned to health workers capabilities, their motivations and other structural and organizational aspects of systems that influence and moderate workforce performance including leadership and supervision (mid-level management) and communication [ 34 – 36 ].…”
BackgroundDespite years of growing concern about poor provider attitudes and women experiencing mistreatment during facility based childbirth, there are limited interventions that specifically focus on addressing these issues. The Heshima project is an evidence-based participatory implementation research study conducted in 13 facilities in Kenya. It engaged a range of community, facility, and policy stakeholders to address the causes of mistreatment during childbirth and promote respectful maternity care.MethodsWe used the consolidated framework for implementation research (CFIR) as an analytical lens to describe a complex, multifaceted set of interventions through a reflexive and iterative process for triangulating qualitative data. Data from a broad range of project documents, reports, and interviews were collected at different time points during the implementation of Heshima. Assessment of in-depth interview data used NVivo (Version 10) and Atlas.ti software to inductively derive codes for themes at baseline, supplemental, and endline. Our purpose was to generate categories of themes for analysis found across the intervention design and implementation stages.ResultsThe implementation process, intervention characteristics, individual champions, and inner and outer settings influenced both Heshima’s successes and challenges at policy, facility, and community levels. Implementation success stemmed from readiness for change at multiple levels, constant communication between stakeholders, and perceived importance to communities. The relative advantage and adequacy of implementation of the Respectful Maternity Care (RMC) resource package was meaningful within Kenyan politics and health policy, given the timing and national promise to improve the quality of maternity care.ConclusionWe found the CFIR lens a promising and flexible one for understanding the complex interventions. Despite the relatively nascent stage of RMC implementation research, we feel this study is an important start to understanding a range of interventions that can begin to address issues of mistreatment in maternity care; replication of these activities is needed globally to better understand if the Heshima implementation process can be successful in different countries and regions.
“…Another important aspect is the need to involve and communicate clearly with health workers and managers about the policy vision and goals, as well as about what and when actions will be taken [ 25 , 36 ]. It is recognized that leadership, supervision, information dissemination and communication are major mediators and moderators of the quality and effectiveness of health care [ 37 ]. It is also important to increase human resource strength in the facilities in order to address workload issues and improve quality of services that will attract and retain the high number of mothers seeking skilled delivery following the initiation of the program.…”
BackgroundGlobally, there are increasing efforts to improve maternal health outcomes including the reduction in maternal mortality rates. Improved access to skilled care utilisation during pregnancy and delivery has been one of the strategies employed to improve maternal health outcomes. In Kenya, more than half of the women deliver without the assistance of a skilled attendant and this has contributed to high maternal mortality rates. The free maternal healthcare services policy in all public facilities was initiated as a strategy to improve access to skilled care and reduce poor maternal health outcomes. This study aimed to explore the perspectives of the service providers and facility administrators of the free maternal health care service policy that was introduced in Kenya in 2013.MethodsA qualitative inquiry using semi-structured one-on-one interviews was conducted in Malindi District, Kenya. The participants included maternal health service providers and facility administrators recruited from five different healthcare facilities. Data were analysed using a thematic framework analysis.ResultsFree maternal healthcare service provision was perceived to boost skilled care utilisation during pregnancy and delivery. However, challenges including; delays in the reimbursement of funds by the government to the facilities, stock outs of essential commodities in the facilities to facilitate service provision, increased workload amidst staff shortage and lack of consultation and sensitisation of key stakeholders were perceived as barriers to effective implementation of this policy.ConclusionFree maternal healthcare services can be one of the strategies to improve a range of maternal health outcomes. However, the implementation of this policy would be more effective if; the healthcare facilities were upgraded, equipped with adequate supplies, funds and staff; the community are continually sensitized on the importance of seeking skilled care during pregnancy and delivery; and inclusivity and collaboration with other key stakeholders be fostered in addressing poor maternal health outcomes in the country.
“…HWs' availability had an average score of 53.5%. Similarly, despite the fact that policies are in place to ensure the availability of HWs, less than half of HWs were present in their place of work and active at the time of survey [9,19,20]. Contrary, most respondents interviewed reported that the health providers were available in their place of work and that they were productive [16].…”
Sound human resources management (HRM) practices are essential in strengthening the health systems (HS). HRM practices including use of job description (JD) can transform health workers (HWs) into a productive and motivated workforce that improves healthcare services. Kenyan HS miss this nonmonetary motivator of health workers which is correlated with health worker poor job satisfaction and poor performance in service delivery. This study sought to determine how JD influences the performance of health workers (HWs) using descriptive and exploratory research study design. Questionnaires and key informant guides were completed by sampled technical staff and managers working at Mbagathi hospital. Quantitative and qualitative data was analyzed using descriptive statistics and content analysis respectively. Results indicated that the health service managers were not aware of policies on HRM practices. Clear JD, work plans and task description were available to a little extent (54.0%, 53.2% and 52.6% respectively). Established lines of authority were available to a moderate extent (59.3%). The health workers performance was rated at a mean score of 57.6% with a standard deviation of 4.2%. The study concludes that HRM practices were poorly implemented in the hospital. Health service managers needed basic training on JD among other HRM practices including and to establish a department that will implement the practices.
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