Judgment under uncertainty; a probabilistic evaluation framework for decision-making about sanitation systems in low-income countries

2013 ◽  
Vol 118 ◽  
pp. 106-114 ◽  
Author(s):  
Shirin Malekpour ◽  
Jeroen Langeveld ◽  
Sammy Letema ◽  
François Clemens ◽  
Jules B. van Lier
Keyword(s):  
Decision Making ◽  
Low Income ◽  
Evaluation Framework ◽  
Low Income Countries ◽  
Probabilistic Evaluation ◽  
Sanitation Systems

scholarly journals Economic support, education and sexual decision making among female adolescents in Zambia: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
J. Milimo ◽  
J. M. Zulu ◽  
J. Svanemyr ◽  
E. Munsaka ◽  
O. Mweemba ◽  
...  
Keyword(s):  
Decision Making ◽  
Randomised Controlled Trial ◽  
Low Income ◽  
Controlled Trial ◽  
Community Support ◽  
Female Adolescents ◽  
Low Income Countries ◽  
Sexual Decision Making ◽  
Economic Support ◽  
Randomised Controlled

Abstract Background The importance of educating female adolescents has been recognized as critical to the development of any country. However, in low income countries like Zambia they often drop out of school due to poverty, early pregnancy and early marriages. Some studies indicate that economic support such as Social Cash Transfers (SCTs) can mitigate the effects of poverty on female adolescents by improving their school participation and helping postpone pregnancy and marriage. This study aimed to explore the role of economic support in influencing education and sexual decision making among female adolescents in a randomised controlled trial in Zambia. Methods The study adopted a qualitative approach. It utilized purposive and convenient sampling. Data were collected from 6 schools using 18 in-depth interviews (IDIs) and 4 focus group discussions (FGDs) comprising 48 school-going female adolescents in grade 8 aged 14 to 17. All participants received economic support in form of SCTs and payment of school fees as part of the Research Initiative to Support the Empowerment of Girls (RISE), a Cluster Randomised Controlled Trial. Data were analyzed using thematic analysis. Results Findings suggested several benefits of the economic support for the female adolescents such as economic independence and empowerment; increased assertiveness and autonomy; reduced desire for sexual relationships with boys in exchange for cash and gifts; increased motivation for school; enhanced parental and community support for female adolescents’ education and; reduced school dropouts. However, they also experienced jealousy from those who did not benefit from the economic support. Conclusion Economic support played a significant role in influencing both educational and sexual decision making among female adolescents. Trial registration ISRCTN Registry: ISRCTN12727868, (4 March 2016).

scholarly journals Counseling at all contacts for postpartum contraceptive use: can paper-based tools help community health workers improve continuity of care? A qualitative study from Ethiopia

2019 ◽  
Vol 3 ◽  
pp. 1652 ◽  
Author(s):  
Muluneh Yigzaw Mossie ◽  
Anne Pfitzer ◽  
Yousra Yusuf ◽  
China Wondimu ◽  
Eva Bazant ◽  
...  
Keyword(s):  
Decision Making ◽  
Health System ◽  
Community Health ◽  
Low Income ◽  
Health Workers ◽  
Continuum Of Care ◽  
Low Income Countries ◽  
Health Extension Workers ◽  
Pregnancy Risk ◽  
The Continuum

Background: Globally, there has been a resurgence of interest in postpartum family planning (PPFP) to advance reproductive health outcomes. Few programs have systematically utilized all contacts a woman and her baby have with the health system, from pregnancy through the first year postpartum, to promote PPFP. Nested into a larger study covering two districts, this study assessed the use, acceptability, and feasibility of tools for tracking women’s decision-making and use of PPFP in the community health system in Oromia region, Ethiopia. Community-level tracking tools included a modified Integrated Maternal and Child Health (IMCH) card with new PPFP content, and a newly developed tool for pregnant and postpartum women for use by Women Development Armies (WDAs). Proper completion of the tools was monitored during supervision visits. Methods: In-depth interviews and focus group discussions were conducted with health officials, health extension workers, and volunteers. A total of 34 audio-files were transcribed and translated into English, double-coded using MAXQDA, and analyzed using a thematic approach. Results: The results describe how HEWs used the modified IMCH card to track women’s decision making through the continuum of care, to assess pregnancy risk and to strengthen client-provider interaction. Supervision data demonstrated how well HEWs completed the modified IMCH card. The WDA tool was intended to promote PPFP and encourage multiple contacts with facilities from pregnancy to extended postpartum period. HEWs have reservations about the engagement of WDAs and their use of the WDA tool. Conclusions: To conclude, the IMCH card improves counseling practices through the continuum of care and is acceptable and feasible to apply. Some elements have been incorporated into a revised national tool and can serve as example for other low-income countries with similar community health systems. Further study is warranted to determine how to engage WDAs in promoting PPFP.

scholarly journals Challenges to effective governance in a low income healthcare system: a qualitative study of stakeholder perceptions in Malawi

2020 ◽  
Author(s):  
Sarah C Masefield ◽  
Alan Msosa ◽  
Jean Grugel
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Health System ◽  
National Health ◽  
Low Income ◽  
Service Providers ◽  
Health Sector ◽  
National Health System ◽  
Low Income Countries ◽  
Health Coverage

Abstract BackgroundAll countries face challenging decisions about healthcare coverage. Malawi has committed to achieving Universal Health Coverage (UHC) by 2030, the timeframe set out by the Sustainable Development Goals (SDGs). As in other low income countries, scarce resources stand in the way of more equitable health access and quality in Malawi. Its health sector is highly dependent on donor contributions, and recent poor governance of government-funded healthcare saw donors withdraw funding, limiting services and resources. The 2017 National Health Plan II and accompanying Health Strategic Plan II identify the importance of improved governance and strategies to achieve more effective cooperation with stakeholders. This study explores health sector stakeholders’ perceptions of the challenges to improving governance in Malawi’s national health system within the post-2017 context of government attempts to articulate a way forward.MethodsA qualitative study design was used. Interviews were conducted with 22 representatives of major international and faith-based non-government organisations, civil society organisations, local government and government-funded organisations, and governance bodies operating in Malawi. Open questions were asked about experiences and perceptions of the functioning of the health system and healthcare decision-making. Content relating to healthcare governance was identified in the transcripts and field notes and analysed using inductive content analysis.ResultsStakeholders view governance challenges as a significant barrier to achieving a more effective and equitable health system. Three categories were identified: accountability (enforceability; answerability; stakeholder-led initiatives); health resource management (healthcare financing; drug supply); influence in decision-making (unequal power; stakeholder engagement).ConclusionsHealth sector stakeholders see serious political, structural, and financial challenges to improving governance in the national health system in Malawi which will impact the government’s goal of achieving UHC by 2030. Stakeholders identify the need for improved oversight, implementation, service delivery and social accountability of government-funded service providers to communities. Eighteen months after the introduction of the policy documents, they see little evidence of improved governance and have little or no confidence in the government’s ability to deliver UHC. The difficulties stakeholders perceive in relation to building equitable and effective healthcare governance in Malawi have relevance for other resource-limited countries which have also committed to the goal of UHC.

scholarly journals Participatory Design and Process Testing to Optimize Utility, Usability, and Acceptability of a Mobile Game for Promoting Evidence-Driven Public Health Decision-Making in Resource-Constrained Settings

2022 ◽  
Vol 3 ◽  
Author(s):  
James Douglas Sinnatwah ◽  
Hajah Kenneh ◽  
Alvan A. Coker ◽  
Wahdae-Mai Harmon-Gray ◽  
Joelyn Zankah ◽  
...  
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Low Income ◽  
Participatory Design ◽  
End Users ◽  
Low Income Countries ◽  
Design Team ◽  
Training Methods ◽  
Design Development ◽  
Mobile Game

Innovative game-based training methods that leverage the ubiquity of cellphones and familiarity with phone-based interfaces have the potential to transform the training of public health practitioners in low-income countries such as Liberia. This article describes the design, development, and testing of a prototype of the Figure It Out mobile game. The prototype game uses a disease outbreak scenario to promote evidence-based decision-making in determining the causative agent and prescribing intervention measures to minimize epidemiological and logistical burdens in resource-limited settings. An initial prototype of the game developed by the US team was playtested and evaluated by focus groups with 20 University of Liberia Masters of Public Health (UL MPH) students. Results demonstrate that the learning objectives—improving search skills for identifying scientific evidence and considering evidence before decision-making during a public health emergency—were considered relevant and important in a setting that has repeatedly and recently experienced severe threats to public health. However, some of the game mechanics that were thought to enhance engagement such as trial-and-error and choose-your-own-path gameplay, were perceived by the target audience as distracting or too time-consuming, particularly in the context of a realistic emergency scenario. Gameplay metrics that mimicked real-world situations around lives lost, money spent, and time constraints during public health outbreaks were identified as relatable and necessary considerations. Our findings reflect cultural differences between the game development team and end users that have emphasized the need for end users to have an integral part of the design team; this formative evaluation has critically informed next steps in the iterative development process. Our multidisciplinary, cross-cultural and cross-national design team will be guided by Liberia-based public health students and faculty, as well as community members who represent our end user population in terms of experience and needs. These stakeholders will make key decisions regarding game objectives and mechanics, to be vetted and implemented by game design experts, epidemiologists, and software developers.

Developing Training Tools for Clinicians in LICs: Using Hidden Markov Modeling to Study the Decision-Making Strategies of Expert and Novice Prosthetists

2020 ◽  
Author(s):  
Pratima Saravanan ◽  
Michael Walker ◽  
Jessica Menold
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Low Income ◽  
Decision Support Tool ◽  
Low Income Countries ◽  
Controlled Study ◽  
Clear Understanding ◽  
Care Providers ◽  
Support Tool ◽  
Expert And Novice

Abstract Approximately, 40 million amputees reside in the rural parts of Low-Income Countries (LICs), and 95% of this population do not have proper access to prosthetic devices and rehabilitation services. A proper prosthetic prescription requires a clear understanding of the patient’s ambulation, goals, cultural and societal norms, locally available prosthetic materials, etc., which can be accomplished only by a local prosthetist. However, due to the lack of prosthetic schools and training centers in LICs, the rural parts lack well-trained amputee care providers. Hence there is a need to educate the prosthetists and prosthetic technicians in the LIC, specifically in the rural regions. To accomplish this, the current research proposes a decision-support tool to aid decision-making during prescription and educate prosthetists. A controlled study was conducted with expert and novice prosthetists to compare effective decision-making strategies. Results suggest that experts leverage distinct decision-making strategies when prescribing prosthetic and orthotic devices; in comparison, novices exhibited less consistent patterns of decision-making tendencies. By modeling the decision-making strategies of expert prosthetists, this work lays the foundation to develop an automated decision support tool to support decision-making for prosthetists in LICs, improving overall amputee care.

scholarly journals Scaling up Dietary Data for Decision-Making in Low-Income Countries: New Technological Frontiers

2017 ◽  
Vol 8 (6) ◽  
pp. 916-932 ◽  
Author(s):  
Winnie Bell ◽  
Brooke A Colaiezzi ◽  
Cathleen S Prata ◽  
Jennifer C Coates
Keyword(s):  
Decision Making ◽  
Low Income ◽  
Scaling Up ◽  
Low Income Countries ◽  
Dietary Data

scholarly journals Barriers inhibiting effective detection and management of postpartum hemorrhage during facility-based births in Madagascar: findings from a qualitative study using a behavioral science lens

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sara V. Flanagan ◽  
Tina Razafinamanana ◽  
Charlotte Warren ◽  
Jana Smith
Keyword(s):  
Decision Making ◽  
Best Practices ◽  
Low Income ◽  
Postpartum Hemorrhage ◽  
Clinical Decision Making ◽  
Behavioral Science ◽  
Low Risk ◽  
Low Income Countries ◽  
Care Providers ◽  
Clinical Practices

Abstract Background Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in low-income countries, and is the most common direct cause of maternal deaths in Madagascar. Studies in Madagascar and other low-income countries observe low provider adherence to recommended practices for PPH prevention and treatment. Our study addresses gaps in the literature by applying a behavioral science lens to identify barriers inhibiting facility-based providers’ consistent following of PPH best practices in Madagascar. Methods In June 2019, we undertook a cross-sectional qualitative research study in peri-urban and rural areas of the Vatovavy-Fitovinany region of Madagascar. We conducted 47 in-depth interviews in 19 facilities and five communities, with facility-based healthcare providers, postpartum women, medical supervisors, community health volunteers, and traditional birth attendants, and conducted thematic analysis of the transcripts. Results We identified seven key behavioral insights representing a range of factors that may contribute to delays in appropriate PPH management in these settings. Findings suggest providers’ perceived low risk of PPH may influence their compliance with best practices, subconsciously or explicitly, and lead them to undervalue the importance of PPH prevention and monitoring measures. Providers lack clear feedback on specific components of their performance, which ultimately inhibits continuous improvement of compliance with best practices. Providers demonstrate great resourcefulness while operating in a challenging context with limited equipment, supplies, and support; however, overcoming these challenges remains their foremost concern. This response to chronic scarcity is cognitively taxing and may ultimately affect clinical decision-making. Conclusions Our study reveals how perception of low risk of PPH, limited feedback on compliance with best practices and consequences of current practices, and a context of scarcity may negatively affect provider decision-making and clinical practices. Behaviorally informed interventions, designed for specific contexts that care providers operate in, can help improve quality of care and health outcomes for women in labor and childbirth.

scholarly journals Embedding research into health services in Latin America and the Caribbean: experiences and challenges of the Technical Support Center

2021 ◽  
Vol 45 ◽  
pp. 1
Author(s):  
Víctor Becerril-Montekio ◽  
Pilar Torres-Pereda ◽  
Luis Alberto García-Bello ◽  
Jacqueline Alcalde-Rabanal
Keyword(s):  
Decision Making ◽  
Latin America ◽  
Low Income ◽  
Technical Support ◽  
Low Income Countries ◽  
Joint Work ◽  
The Sustainable Development ◽  
Health Related ◽  
Development Goals ◽  
The Caribbean

This article describes the main models for embedding research and the successful experiences and challenges faced in joint work by researchers and decisionmakers who participated in the Embedding Research for the Sustainable Development Goals (ER-SDG) initiative, and the experience of the Technical Support Center. In June 2018, funding was granted to 13 pre-selected research projects from 11 middle- and low-income countries in Latin America and the Caribbean (Argentina, Bolivia, Brazil, Colombia, Dominican Republic, Ecuador, Guatemala, Guyana, Haiti, Paraguay, and Peru). The projects focused on the system-, policy-, or program-level changes required to improve health and build on the joint work of researchers and decisionmakers, with a view to bringing together evidence production and decision-making in health systems and services. The Technical Support Center supported and guided the production of quality results useful for decision-making. This experience confirmed the value of initiatives such as ER-SDG in consolidating bridges between research on the implementation of health policies, programs, and systems, and the officials responsible for operating health-related programs, services, and interventions. It highlighted the importance of both respecting and taking advantage of each context—and the specific arrangements and patterns in the relationships between researchers and decisionmakers—through incentives for embedded research.

scholarly journals Parents’ Decision-making for Childhood Immunization and Prevention of Childhood Diseases – A Cross-Sectional Survey

2021 ◽  
Author(s):  
Jonas KEMEUGNI NGANDJON ◽  
Alfred Laengler ◽  
Thomas Ostermann ◽  
Virgile Kenmoue
Keyword(s):  
Decision Making ◽  
Low Income ◽  
Childhood Vaccination ◽  
World Health ◽  
Low Income Countries ◽  
Health Seeking ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Vaccination Programs ◽  
Health Authorities

Abstract Background The childhood vaccination program (EPI) is claimed by the World Health Organization (WHO) to be the most cost-effective intervention to reduce child mortality. Therefore, in low-income countries governments and health authorities invest in vaccination programs to reach herd immunity. However, despite the resources allocated to the EPI, epidemics preventable through vaccines are still reported in these countries. In Cameroon, the Foumbot district in the West region has witnessed measles epidemics since 2010 and in 2013 a polio outbreak was reported. Methods The design of this study is a cross-sectional survey. A total of 160 mothers of children between the ages of 12 to 23 months were selected by simple random sampling technique. Pre-tested structured questionnaire was used for data collection. Data was analyzed using SPSS statistical software. Results The outcome of this survey shows that 60% of the children studied were completely vaccinated, 37.75% were partially vaccinated, and 1.25% had not received any vaccine. The logistic regression analysis shows that a poor knowledge of infectious diseases (OR=0.3) was a significant predictor of partial and no vaccination status in children. Conclusion Parents’ decision-making for EPI was based on the information and experiences available in the community. Therefore, parents who are poorly educated on VPDs and living in a community with missing information and misinformation about vaccination will probably not complete the EPI. Public health authorities should invest in health education programs with the goal of developing skills for health- seeking behavior in individuals and communities.

scholarly journals Challenges to effective governance in a low income healthcare system: a qualitative study of stakeholder perceptions in Malawi

2020 ◽  
Author(s):  
Sarah C Masefield ◽  
Alan Msosa ◽  
Jean Grugel
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Health System ◽  
National Health ◽  
Low Income ◽  
Service Providers ◽  
Health Sector ◽  
National Health System ◽  
Low Income Countries ◽  
Health Coverage

Abstract Background: All countries face challenging decisions about healthcare coverage. The scare resources of low income countries prevent improvements in equitable access and quality. Malawi, one of the poorest countries in the world, has committed to achieving Universal Health Coverage (UHC) by 2030. The health sector is highly dependent on donor contributions, but recent poor governance of government-funded healthcare saw donors withdraw funding, limiting services and resources. The 2017 updated National Health Plan II and accompanying Health Strategic Plan II identify the importance of improved governance and strategies to achieve it, including greater harmonisation with health stakeholders. This study explores health sector stakeholders’ perceptions of challenges to improving governance in the national health system. Methods: A qualitative study design was used. Interviews were conducted with 22 representatives of the major international and faith-based non-government organisations, civil society organisations, local government and government-funded organisations, and governance bodies operating in Malawi. Open questions were asked about experiences and perceptions of the functioning of the health system and healthcare decision-making. The transcripts and field notes were analysed using inductive content analysis.Results: Stakeholders view governance challenges as a barrier to achieving a more effective and equitable health system. Three types of challenges were identified: accountability (enforceability; answerability; stakeholder-led initiatives); health resource management (healthcare financing; drug supply); influence in decision-making (unequal power; stakeholder engagement).Conclusions: Health sector stakeholders see a range of serious challenges to improving governance in the national health system in Malawi which will impact on the government’s goal of achieving UHC by 2030. These can be categorised as political, structural, and financial challenges. Stakeholders identify the need for improved oversight, implementation, service delivery and social accountability of government-funded service providers to communities. Eighteen months after the introduction of the NHP II and HSSP II, they see little evidence of improved governance and have little or no confidence in the government’s ability to deliver UHC in the timeframe set out by the Sustainable Development Goals (SDGs). The difficulties stakeholders perceive in relation to building equitable and effective health governance in Malawi have relevance for other resource-limited countries which have also committed to the goal of UHC.

Sign in / Sign up

Export Citation Format

Share Document