Scaling up interventions for depression in sub-Saharan Africa: lessons from Zimbabwe

BackgroundThere is a dearth of information on how to scale-up evidence-based psychological interventions, particularly within the context of existing HIV programs. This paper describes a strategy for the scale-up of an intervention delivered by lay health workers (LHWs) to 60 primary health care facilities in Zimbabwe.MethodsA mixed methods approach was utilized as follows: (1) needs assessment using a semi-structured questionnaire to obtain information from nurses (n = 48) and focus group discussions with District Health Promoters (n = 12) to identify key priority areas; (2) skills assessment to identify core competencies and current gaps of LHWs (n = 300) employed in the 60 clinics; (3) consultation workshops (n = 2) with key stakeholders to determine referral pathways; and (4) in-depth interviews and consultations to determine funding mechanisms for the scale-up.ResultsFive cross-cutting issues were identified as critical and needing to be addressed for a successful scale-up. These included: the lack of training in mental health, unavailability of psychiatric drugs, depleted clinical staff levels, unavailability of time for counseling, and poor and unreliable referral systems for people suffering with depression. Consensus was reached by stakeholders on supervision and support structure to address the cross-cutting issues described above and funding was successfully secured for the scale-up.ConclusionKey requirements for success included early buy-in from key stakeholders, extensive consultation at each point of the scale-up journey, financial support both locally and externally, and a coherent sustainability plan endorsed by both government and private sectors.

Download Full-text

Strengthening Health Systems for Chronic Care: Leveraging HIV Programs to Support Diabetes Services in Ethiopia and Swaziland

Journal of Tropical Medicine ◽

10.1155/2012/137460 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 36

Author(s):

Miriam Rabkin ◽

Zenebe Melaku ◽

Kerry Bruce ◽

Ahmed Reja ◽

Alison Koler ◽

...

Keyword(s):

Chronic Care ◽

Rapid Assessment ◽

Scale Up ◽

Sub Saharan Africa ◽

Hiv Care ◽

The Status ◽

Care Systems ◽

Care And Treatment ◽

Sub Saharan ◽

Hiv Programs

The scale-up of HIV services in sub-Saharan Africa has catalyzed the development of highly effective chronic care systems. The strategies, systems, and tools developed to support life-long HIV care and treatment are locally owned contextually appropriate resources, many of which could be adapted to support continuity care for noncommunicable chronic diseases (NCD), such as diabetes mellitus (DM). We conducted two proof-of-concept studies to further the understanding of the status of NCD programs and the feasibility and effectiveness of adapting HIV program-related tools and systems for patients with DM. In Swaziland, a rapid assessment illustrated gaps in the approaches used to support DM services at 15 health facilities, despite the existence of chronic care systems at HIV clinics in the same hospitals, health centers, and clinics. In Ethiopia, a pilot study found similar gaps in DM services at baseline and illustrated the potential to rapidly improve the quality of care and treatment for DM by adapting HIV-specific policies, systems, and tools.

Download Full-text

Reducing Geographical Imbalances of Health Workers in Sub-Saharan Africa

10.1596/978-0-8213-8599-9 ◽

2010 ◽

Cited By ~ 7

Author(s):

Christophe Lemiere ◽

Christopher Herbst ◽

Negda Jahanshahi ◽

Ellen Smith ◽

Agnest Souca

Keyword(s):

Health Workers ◽

Sub Saharan Africa ◽

Sub Saharan

Download Full-text

Neonatal care practices in Buikwe District, Uganda: a qualitative study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03699-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Marte Bodil Roed ◽

Ingunn Marie Stadskleiv Engebretsen ◽

Robert Mangeni

Keyword(s):

Health Workers ◽

Post Partum ◽

Newborn Care ◽

Neonatal Care ◽

Sub Saharan Africa ◽

Cord Clamping ◽

Care Practices ◽

Sub Saharan ◽

Skin To Skin ◽

User Perspectives

Abstract Background Sub-Saharan Africa is the region with the highest neonatal mortality rate, with Uganda reporting 20 deaths per 1000 live births. The Uganda Clinical Guidelines (UCG) from 2016 have detailed descriptions on care for mothers and their newborns during pregnancy, delivery and the post-partum period. The objective of the study was to identify provider and user perspectives regarding the knowledge of and adherence to the UCG recommendations in aspects of delivery and newborn care, both in cases of normal as well as complicated births. Methods The study used qualitative methods with data collection from participant observations, interviews with key-informants and focus group discussions. Malterud’s Systematic Text Condensation (STC) was used for analysis. Results The study found low knowledge about the UCG among the health workers. Various discrepancies between performed hands-on-procedures and the UCG were found related to neonatal care practices, including low use of partograms, uncertainty around timing for cord clamping, routine oronasopharyngeal suction of newborns and inadequate implementation of skin-to-skin care. Conclusions Continued focus on systemic strategies for further implementation of the UCG is recommended.

Download Full-text

Maintaining paediatric cardiac services during the COVID-19 pandemic in a developing country in sub-Saharan Africa: guidelines for a “scale up” in the face of a global “scale down”

Cardiology in the Young ◽

10.1017/s1047951120003650 ◽

2020 ◽

Vol 30 (11) ◽

pp. 1588-1594

Author(s):

Ogochukwu J. Sokunbi ◽

Ogadinma Mgbajah ◽

Augustine Olugbemi ◽

Bassey O. Udom ◽

Ariyo Idowu ◽

...

Keyword(s):

Scale Up ◽

Global Scale ◽

International Travel ◽

Sub Saharan Africa ◽

African Continent ◽

Tertiary Centre ◽

The Face ◽

Scale Down ◽

Sub Saharan ◽

International Experts

AbstractThe COVID-19 pandemic is currently ravaging the globe and the African continent is not left out. While the direct effects of the pandemic in regard to morbidity and mortality appear to be more significant in the developed world, the indirect harmful effects on already insufficient healthcare infrastructure on the African continent would in the long term be more detrimental to the populace. Women and children form a significant vulnerable population in underserved areas such as the sub-Saharan region, and expectedly will experience the disadvantages of limited healthcare coverage which is a major fall out of the pandemic. Paediatric cardiac services that are already sparse in various sub-Saharan countries are not left out of this downsizing. Restrictions on international travel for patients out of the continent to seek medical care and for international experts into the continent for regular mission programmes leave few options for children with cardiac defects to get the much-needed care.There is a need for a region-adapted guideline to scale-up services to cater for more children with congenital heart disease (CHD) while providing a safe environment for healthcare workers, patients, and their caregivers. This article outlines measures adapted to maintain paediatric cardiac care in a sub-Saharan tertiary centre in Nigeria during the COVID-19 pandemic and will serve as a guide for other institutions in the region who will inadvertently need to provide these services as the demand increases.

Download Full-text

Promoting Scale-Up Across a Global Project Platform: Lessons from the Evidence to Action Project

Global Implementation Research and Applications ◽

10.1007/s43477-021-00013-4 ◽

2021 ◽

Author(s):

Laura Ghiron ◽

Eric Ramirez-Ferrero ◽

Rita Badiani ◽

Regina Benevides ◽

Alexis Ntabona ◽

...

Keyword(s):

Family Planning ◽

Scale Up ◽

Scaling Up ◽

Sub Saharan Africa ◽

Health System Strengthening ◽

Country Level ◽

Look Ahead ◽

Republic Of The Congo ◽

Sub Saharan ◽

Multi Stakeholder

AbstractThe USAID-funded flagship family planning service delivery project named Evidence to Action (E2A) worked from 2011 to 2021 to improve family planning and reproductive health for women and girls across seventeen nations in sub-Saharan Africa using a “scaling-up mindset.” The paper discusses three key lessons emerging from the project’s experience with applying ExpandNet’s systematic approach to scale up. The methodology uses ExpandNet/WHO’s scaling-up framework and guidance tools to design and implement pilot or demonstration projects in ways that look ahead to their future scale-up; develop a scaling-up strategy with local stakeholders; and then strategically manage the scaling-up process. The paper describes how a scaling-up mindset was engendered, first within the project’s technical team in Washington and then how they subsequently sought to build capacity at the country level to support scale-up work throughout E2A’s portfolio of activities. The project worked with local multi-stakeholder resource teams, often led by government officials, to equip them to lead the scale-up of family planning and health system strengthening interventions. Examples from project experience in the Democratic Republic of the Congo, Kenya, Nigeria, and Uganda illustrating key concepts are discussed. E2A also established a community of practice on systematic approaches to scale up as a platform for sharing learning across a variety of technical agencies engaged in scale-up work and to create learning opportunities for interacting with thought leaders around critical scale-up issues.

Download Full-text

Factors influencing access to and utilisation of youth-friendly sexual and reproductive health services in sub-Saharan Africa: a systematic review

Reproductive Health ◽

10.1186/s12978-021-01183-y ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Lesley Rose Ninsiima ◽

Isabel Kazanga Chiumia ◽

Rawlance Ndejjo

Keyword(s):

Reproductive Health ◽

Health Services ◽

Sexual And Reproductive Health ◽

Health Workers ◽

Sub Saharan Africa ◽

Inclusion Criteria ◽

Reproductive Health Services ◽

Factors Influencing ◽

Sub Saharan ◽

Youth Friendly

Abstract Background Despite the global agreements on adolescents’ sexual and reproductive health and rights, access to and utilisation of these services among the youth/adolescents remain unsatisfactory in low- and middle-income countries which are a significant barrier to progress in this area. This review established factors influencing access and utilisation of youth-friendly sexual and reproductive health services (YFSRHS) among the youth in sub-Saharan Africa to inform programmatic interventions. Methodology A systematic review of studies published between January 2009 and April 2019 using PubMed, Web of Science, EMBASE, Medline, and Cochrane Library, and Google Scholar databases was conducted. Studies were screened based on the inclusion criteria of barriers and facilitators of implementation of YFSRHS, existing national policies on provision of YFSRHS, and youth’s perspectives on these services. Findings A total of 23,400 studies were identified through database search and additional 5 studies from other sources. After the full-text screening, 20 studies from 7 countries met the inclusion criteria and were included in the final review. Structural barriers were the negative attitude of health workers and their being unskilled and individual barriers included lack of knowledge among youth regarding YFSRHS. Facilitators of utilisation of the services were mostly structural in nature which included community outreaches, health education, and policy recommendations to improve implementation of the quality of health services and clinics for adolescents/youth to fit their needs and preferences. Conclusion Stakeholder interventions focusing on implementing YFSRHS should aim at intensive training of health workers and put in place quality implementation standard guidelines in clinics to offer services according to youth’s needs and preferences. In addition, educating the youth through community outreaches and health education programs for those in schools can facilitate utilisation and scale up of the service.

Download Full-text

Primary Health Care Facilities in Sub-Saharan Africa Found to Provide Poor Basic Maternal Care

International Perspectives on Sexual and Reproductive Health ◽

10.1363/intsexrephea.42.3.161 ◽

2016 ◽

Vol 42 (3) ◽

pp. 161

Keyword(s):

Health Care ◽

Primary Health Care ◽

Maternal Care ◽

Health Care Facilities ◽

Sub Saharan Africa ◽

Primary Health ◽

Care Facilities ◽

Sub Saharan ◽

Primary Health Care Facilities

Download Full-text

Readiness of Sub-Saharan Africa Healthcare Systems for the New Pandemic, Diabetes: A Systematic Review

Journal of Diabetes Research ◽

10.1155/2018/9262395 ◽

2018 ◽

Vol 2018 ◽

pp. 1-12 ◽

Cited By ~ 2

Author(s):

Bernardo Nuche-Berenguer ◽

Linda E. Kupfer

Keyword(s):

Systematic Review ◽

Health Systems ◽

Diabetes Care ◽

Healthcare Workers ◽

Scale Up ◽

Sub Saharan Africa ◽

Diagnostic Tools ◽

Inclusion Criteria ◽

Care Health ◽

Sub Saharan

Background. Effective health systems are needed to care for the coming surge of diabetics in sub-Saharan Africa (SSA). Objective. We conducted a systematic review of literature to determine the capacity of SSA health systems to manage diabetes. Methodology. We used three different databases (Embase, Scopus, and PubMed) to search for studies, published from 2004 to 2017, on diabetes care in SSA. Results. Fifty-five articles met the inclusion criteria, covering the different aspects related to diabetes care such as availability of drugs and diagnostic tools, the capacity of healthcare workers, and the integration of diabetes care into HIV and TB platforms. Conclusion. Although chronic care health systems in SSA have developed significantly in the last decade, the capacity for managing diabetes remains in its infancy. We identified pilot projects to enhance these capacities. The scale-up of these pilot interventions and the integration of diabetes care into existing robust chronic disease platforms may be a feasible approach to begin to tackle the upcoming pandemic in diabetes. Nonetheless, much more work needs to be done to address the health system-wide deficiencies in diabetes care. More research is also needed to determine how to integrate diabetes care into the healthcare system in SSA.

Download Full-text

Developing learning diaries for action research on healthcare management in Ghana, Tanzania and Uganda

Action Research ◽

10.1177/1476750315626780 ◽

2016 ◽

Vol 14 (4) ◽

pp. 412-434 ◽

Cited By ~ 3

Author(s):

Comfort Mshelia ◽

Gillian Lê ◽

Tolib Mirzoev ◽

Samuel Amon ◽

Ambrose Kessy ◽

...

Keyword(s):

Action Research ◽

Health Management ◽

Healthcare Management ◽

Sub Saharan Africa ◽

District Health ◽

The People ◽

Effective Form ◽

Recording Process ◽

Specific Practice ◽

Sub Saharan

Action research (AR) can be an effective form of ‘on the job’ training. However, it is critical that AR cycles can be appropriately recorded in order to contribute to reflection and learning. One form of recording is for coresearchers to keep a diary. We found no previous literature describing the use of diaries in AR in sub-Saharan Africa. We therefore use this paper to reflect on how diaries were used by district health management teams in the PERFORM project. We share five lessons from our experience. First, it is important to foster ownership of the diary by the people who are responsible for filling it in. Second, the purpose of keeping a diary needs to be clear and shared between researchers and practitioners from the very beginning. Third, diaries should be allowed to evolve. Fourth, it is a challenge for busy practitioners to record the reflection and learning processes that they go through. Last, diaries on their own are not sufficient to capture reflection and learning. In conclusion, there is no best way for practitioners to keep a diary; rather the focus should be on ensuring that an AR recording process (whether diary or otherwise) is locally owned and complements the specific practice setting.

Download Full-text