scholarly journals An integrated rural health system baseline assessment of COVID-19 preparedness in Siaya Kenya

2021 ◽  
Author(s):  
Neema Kaseje ◽  
Dan Kaseje ◽  
Kennedy Oruenjo ◽  
Penina Ocholla Odhiambo ◽  
Margaret Kaseje ◽  
...  
Keyword(s):  
Case Management ◽  
Health System ◽  
Rural Health ◽  
Health Facility ◽  
Health Facilities ◽  
Baseline Assessment ◽  
Review Committee ◽  
Western Kenya ◽  
Ethics Review ◽  
Pulse Oximeters

AbstractObjectiveOur aim was to assess Siaya county COVID-19 preparedness at community and health facility levels and measure baseline household prevalences of fever and cough.DesignThere was retrospective and prospective data collection using standard tools. We determined the prevalence of fever and cough in households. We evaluated household knowledge about COVID-19 prevention and adherence to preventive measures. We evaluated the presence of a workforce, essential infrastructure and equipment needed for COVID-19 case management, and the availability of essential maternal and child health services in health facilities.SettingSiaya in rural Western KenyaParticipantshouseholds and health facilities in SiayaResultsWe visited 19’474 households and assessed 152 facilities. The prevalences of fever and cough ranged from 1.4% to 4.3% and 0.2 to 0.8% respectively; 97% and 98% of households had not received a guest from nor travelled outside Siaya respectively; 97% knew about frequent handwashing, 66% knew about keeping distance, and 80% knew about wearing a mask; 63% washed their hands countless times; 53% remained home; and 74% used a mask when out in public. The health facility assessment showed: 93.6% were dispensaries and health centers; 90.4% had nurses; 40.5% had oxygen capacity; 13.5% had pulse oximeters; and 2 ventilators were available; 94.2% of facilities did not have COVID-19 testing kits; 94% and 91% of facilities continued to provide antenatal care and immunization services respectively. Health care worker training in COVID-19 had been planned.ConclusionsHousehold prevalence of fever and cough was low suggesting Siaya had not entered the active community transmission phase in June 2020. Our assessment revealed a need for training in COVID-19 case management, and a need for basic equipment and supplies including pulse oximeters and oxygen. Future interventions should address these gaps.Strengths and limitationsThis study provides an example of how to successfully carry out an integrated rural health system baseline assessment of COVID-19 preparedness; an approach that would be useful for any country experiencing COVID-19 with a significant rural population.Some of our data were retrospective in nature and therefore vulnerable to multiple sources of bias including: recall bias and misclassification.Clinical Trial registrationClinicaltrials.govNCT04501458 5/8/2020ProtocolThe full protocol has been accepted for publication: Kaseje N, Kaseje D, Oruenjo K, Milambo J and Kaseje M: Engaging community health workers, technology, and youth in the COVID-19 response with concurrent critical care capacity building: A protocol for an integrated community and health system intervention to reduce mortality related to COVID-19 infection in Western Kenya. Wellcome Open Research.Ethical review approvalsreceived from the University of Nairobi Ethics Review Committee and Jaramogi Oginga Odinga Teaching and Referral Hospital Ethics Review Committee (approval number IERC/JOOTR/219/20)

scholarly journals Engaging community health workers, technology, and youth in the COVID-19 response with concurrent critical care capacity building: A protocol for an integrated community and health system intervention to reduce mortality related to COVID-19 infection in Western Kenya

2021 ◽  
Vol 6 ◽  
pp. 15
Author(s):  
Neema Kaseje ◽  
Dan Kaseje ◽  
Kennedy Oruenjo ◽  
Joel Milambo ◽  
Margaret Kaseje
Keyword(s):  
Health Care ◽  
Critical Care ◽  
Health Services ◽  
Health System ◽  
Community Health ◽  
Health Facility ◽  
Health Workers ◽  
Baseline Assessment ◽  
Western Kenya ◽  
Care Capacity

Globally, the number of COVID-19 infections is approaching 63 million; more than 1 million individuals have lost their lives. In Kenya, the number of infections has surpassed 80,000 and 1469 people have lost their lives. In Kenya, the community health strategy has been used to deliver essential health services since 2007. Furthermore, the population in Kenya is young (the median age is 21 years old) and Kenya is recognized as a technology hub in the East African region. Community-based health care, youth, and technology, are assets within the Kenyan context that can be leveraged to respond to the COVID-19 pandemic with concurrent strengthening of the critical care capacity at the health system level. This is a quasi-experimental study with quantitative and qualitative methods of data collection to complete a baseline assessment of community health unit and health facility service readiness in the study site of Siaya County in western Kenya. Following the baseline assessment, service ready community health units and health facilities with oxygen capacity will form intervention groups. At the community level, the intervention will consist of training youth, community health assistants and community health workers in screening, case detection, prevention, management and referral of COVID-19 cases with maintenance of essential health services. The community intervention will be enhanced by youth and use of digital tools. At the health facility level, the intervention will consist of training health care workers in basic critical care and caring for severe COVID-19 patients with maintenance of essential health services. The primary outcome measure will be mortality related to COVID-19 infection both at community and health facility levels. This study would be the first study to evaluate the effectiveness of an integrated approach in preparing for and implementing a robust pandemic response. Registration: ClinicalTrials.gov ID NCT04501458; registered on 6 August 2020.

scholarly journals Health systems readiness to provide geriatric friendly care services in Uganda: a cross-sectional study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jude Thaddeus Ssensamba ◽  
Moses Mukuru ◽  
Mary Nakafeero ◽  
Ronald Ssenyonga ◽  
Suzanne N. Kiwanuka
Keyword(s):  
Public Health ◽  
Health System ◽  
Health Facility ◽  
Health Systems ◽  
Building Blocks ◽  
Health Facilities ◽  
Health Centers ◽  
World Health ◽  
Care Services ◽  
Southern Central

Abstract Background As ageing emerges as the next public health threat in Africa, there is a paucity of information on how prepared its health systems are to provide geriatric friendly care services. In this study, we explored the readiness of Uganda’s public health system to offer geriatric friendly care services in Southern Central Uganda. Methods Four districts with the highest proportion of old persons in Southern Central Uganda were purposively selected, and a cross-section of 18 randomly selected health facilities (HFs) were visited and assessed for availability of critical items deemed important for provision of geriatric friendly services; as derived from World Health Organization’s Age-friendly primary health care centres toolkit. Data was collected using an adapted health facility geriatric assessment tool, entered into Epi-data software and analysed using STATA version 14. Kruskal-Wallis and Dunn’s post hoc tests were conducted to determine any associations between readiness, health facility level, and district. Results The overall readiness index was 16.92 (SD ±4.19) (range 10.8–26.6). This differed across districts; Lwengo 17.91 (SD ±3.15), Rakai 17.63 (SD ±4.55), Bukomansimbi 16.51 (SD ±7.18), Kalungu 13.74 (SD ±2.56) and facility levels; Hospitals 26.62, Health centers four (HCIV) 20.05 and Health centers three (HCIII) 14.80. Low readiness was due to poor scores concerning; leadership (0%), financing (0%), human resources (1.7%) and health management information systems (HMIS) (11.8%) WHO building blocks. Higher-level HFs were statistically significantly friendlier than lower-level HFs (p = 0.015). The difference in readiness between HCIIIs and HCIVs was 2.39 (p = 0.025). Conclusion There is a low readiness for public health facilities to provide geriatric friendly care services in Uganda. This is due to gaps in all of the health system building blocks. There is a need for health system reforms in Uganda to adequately cater for service provision for older adults if the 2020 global healthy ageing goal is to be met.

scholarly journals Implementation research on sustainable electrification of rural primary care facilities in Ghana and Uganda

2020 ◽  
Vol 35 (Supplement_2) ◽  
pp. ii124-ii136
Author(s):  
Dena Javadi ◽  
John Ssempebwa ◽  
John Bosco Isunju ◽  
Lucy Yevoo ◽  
Alberta Amu ◽  
...  
Keyword(s):  
Health Services ◽  
Rural Health ◽  
Health Facility ◽  
Health Systems ◽  
Implementation Research ◽  
Health Facilities ◽  
Service Availability ◽  
Community Satisfaction ◽  
Energy Infrastructure ◽  
Implementation Factors

Abstract Access to energy is essential for resilient health systems; however, strengthening energy infrastructure in rural health facilities remains a challenge. In 2015–19, ‘Powering Healthcare’ deployed solar energy solutions to off-grid rural health facilities in Ghana and Uganda to improve the availability of maternal and child health services. To explore the links between health facility electrification and service availability and use, the World Health Organization (WHO), in partnership with Dodowa Health Research Centre and Makerere University School of Public Health, carried out an implementation research study. The objectives of this study were to (1) capture changes in service availability and readiness, (2) describe changes in community satisfaction and use and (3) examine the implementation factors of sustainable electrification that affect these changes. Data were collected through interviews with over 100 key informants, focus group discussions with over 800 community members and health facility assessment checklist adapted from the WHO’s Service Availability and Readiness Assessment tool. Implementation factors were organized using Normalization Process Theory constructs. The study found that access to energy is associated with increased availability of health services, access to communication technologies, appropriate storage of vaccines and medicines, enhanced health worker motivation and increased community satisfaction. Implementation factors associated with improved outcomes include stakeholder engagement activities to promote internalization, provision of materials and information to encourage participation, and establishment of relationships to support integration. Barriers to achieving outcomes are primarily health systems challenges—such as drug stockouts, lack of transportation and poor amenities—that continue to affect service availability, readiness and use, even where access to energy is available. However, through appropriate implementation and integration of sustainable electrification, strengthened energy infrastructure can be leveraged to catalyze investment in other components of functioning health systems. Improving access to energy in health facilities is, therefore, necessary but not sufficient for strengthening health systems.

Evaluation of the impact of a simple hand-washing and water-treatment intervention in rural health facilities on hygiene knowledge and reported behaviours of health workers and their clients, Nyanza Province, Kenya, 2008

2014 ◽  
Vol 143 (4) ◽  
pp. 873-880 ◽  
Author(s):  
N. SREENIVASAN ◽  
S. A. GOTESTRAND ◽  
S. OMBEKI ◽  
G. OLUOCH ◽  
T. K. FISCHER ◽  
...  
Keyword(s):  
Drinking Water ◽  
Water Treatment ◽  
Rural Health ◽  
Health Workers ◽  
Health Facilities ◽  
Hand Washing ◽  
Treatment Intervention ◽  
Treatment Procedure ◽  
Western Kenya ◽  
The Impact

SUMMARYMany clinics in rural western Kenya lack access to safe water and hand-washing facilities. To address this problem, in 2005 a programme was initiated to install water stations for hand washing and drinking water in 109 health facilities, train health workers on water treatment and hygiene, and motivate clients to adopt these practices. In 2008, we evaluated this intervention's impact by conducting observations at facilities, and interviewing staff and clients about water treatment and hygiene. Of 30 randomly selected facilities, 97% had water stations in use. Chlorine residuals were detectable in at least one container at 59% of facilities. Of 164 interviewed staff, 79% knew the recommended water-treatment procedure. Of 298 clients, 45% had received training on water treatment at a facility; of these, 68% knew the recommended water-treatment procedure. Use of water stations, water treatment, and client training were sustained in some facilities for up to 3 years.

scholarly journals Health systems readiness to provide geriatric friendly care services in Uganda: a cross-sectional study

2019 ◽  
Author(s):  
Jude Thaddeus Ssensamba ◽  
Moses Mukuru ◽  
Mary Nakafeero ◽  
Ronald Ssenyonga ◽  
Suzanne N Kiwanuka
Keyword(s):  
Public Health ◽  
Health System ◽  
Health Facility ◽  
Health Systems ◽  
Building Blocks ◽  
Health Facilities ◽  
Health Centers ◽  
World Health ◽  
Care Services ◽  
Southern Central

Abstract Background As ageing emerges as the next public health threat in Africa, there is a paucity of information on how prepared its health systems are to provide geriatric friendly care services. In this study, we explored the readiness of Uganda’s public health system to provide geriatric friendly care services in Southern Central Uganda. Methods Four districts with the highest proportion of old persons in Southern Central Uganda were purposively selected, and a cross section of 18 randomly selected health facilities (HFs) were visited and assessed for availability of key items deemed important for provision of geriatric friendly services; as derived from World Health Organization’s Age-friendly primary health care centres toolkit. Data was collected using an adapted health facility geriatric assessment tool, entered into Epi-data software and analysed using STATA version 14. Kruskal-Wallis and Dunn’s post hoc tests were conducted to determine any associations between readiness, health facility level and district. Results The overall readiness index was 16.92 (SD ±4.19) (range 10.8 - 26.6). This differed across districts; Lwengo 17.91 (SD ±3.15), Rakai 17.63 (SD ±4.55), Bukomansimbi 16.51 (SD ±7.18), Kalungu 13.74 (SD ±2.56) and facility levels; Hospitals 26.62, Health centers four (HCIV) 20.05 and Health centers three (HCIII) 14.80. Low readiness was due to poor scores with regard to; leadership (0%), financing (0%), human resources (1.7%) and health management information systems (HMIS) (11.8%) WHO building blocks. Higher level HFs were statistically significantly friendlier than lower level HFs (p= 0.015). The difference in readiness between HCIIIs and HCIVs was 2.39 (p=0.025). Conclusion There is low readiness of public health facilities to provide geriatric friendly care services in Uganda. This is due to gaps in all of the health system building blocks. There is a need for health system reforms in Uganda to adequately cater for service provision for old people if the 2020 global healthy ageing goal is to be met.

scholarly journals Examining Health Facility Financing in Kenya in the Context of Devolution

2021 ◽  
Author(s):  
Angela Kairu ◽  
Stacey Orangi ◽  
Boniface Mbuthia ◽  
Joanne Ondera ◽  
Nirmala Ravishankar ◽  
...  
Keyword(s):  
Health System ◽  
Health Facility ◽  
Descriptive Analysis ◽  
Health Facilities ◽  
Public Hospitals ◽  
Health Centers ◽  
User Fees ◽  
Public Facility ◽  
Cross Sectional ◽  
Financial Autonomy

Abstract Background: How health facilities are financed affects their performance and health system goals. We examined how health facilities in the public sector are financed in Kenya, within the context of a devolved health system.Methods: We carried out a cross-sectional study in five purposely selected counties in Kenya, using a mixed methods approach. We collected data using document reviews and in-depth interviews (no=20). In each county, we interviewed county department of health managers and health facility managers from two and one purposely selected public hospitals and health center respectively. We analyzed qualitive data using thematic analysis and conducted descriptive analysis of quantitative data.Results: Planning and budgeting: Planning and budgeting processes by hospitals and health centers were not standardized across counties. Budgets were not transparent and credible, but rather were regarded as “wish lists” since they did not translate to actual resources. Sources of funds: Public hospitals relied on user fees, while health centers relied on donor funds as their main sources of funding. Funding flows: Hospitals in four of the five study counties had no financial autonomy. Health centers in all study counties had financial autonomy. Flow of funds to hospitals and health centers in all study counties was characterized by unpredictability of amounts and timing. Health facility expenditure: Staff salaries accounted for over 80% of health facility expenditure. This crowded out other expenditure and led to frequent stock outs of essential health commodities. Conclusion: The national and county government should consider improving health facility financing in Kenya by 1) standardizing budgeting and planning processes, 2) transitioning public facility financing away from a reliance on user fees and donor funding 3) reforming public finance management laws and carry out political engagement to facilitate direct facility financing and financial autonomy of public hospitals, and 4) assess health facility resource needs to guide appropriate levels resource allocation.

scholarly journals Facilitators and Barriers To The Integration of Integrated Community Case Management Into The Health System in Zambia: A Case Study of Kapiri Mposhi District

2021 ◽  
Author(s):  
Johnson Vonje Riri ◽  
Adam Silumbwe ◽  
Chris Mweemba ◽  
Joseph Mumba Zulu
Keyword(s):  
Case Management ◽  
Health System ◽  
Health Facility ◽  
District Level ◽  
Significant Shift ◽  
Community Case Management ◽  
District Health ◽  
Integrated Community Case Management ◽  
Specific Implementation ◽  
Health Managers

Abstract Background Zambia adopted the Integrated Community Case Management of childhood illness (ICCM) strategy in May 2010, targeting populations in rural communities and hard-to-reach areas. However, evidence suggests that ICCM integration into local health systems has been suboptimal, particularly at the district level. This study sought to explore factors that shape ICCM integration into the district health system in Kapiri Mposhi district, Zambia. Methods Data were gathered through 19 key informant interviews with district health managers, ICCM supervisors, health facility managers, and district health co-operating partners. The study was conducted in Kapiri Mposhi district, Zambia. Interviews were translated and transcribed verbatim. Data were were analyzed using thematic analysis in NVivo 11(QSR International). Results Facilitators to intergration of ICCM into the health system consisted of community involvement and support for the program, active community case detection and timeliness of health services, the program was not considered a significant shift from other community-based health interventions, district leadership and ownership of the program, availability of national and district-level policies supporting ICCM and engagement of international co-operating partners. Program incompatibility with some socio-cultural and religious cotexts, stock-out of prerequisite drugs and supplies, staff reshuffle and redeployment, inadequate supervision of health facilities, and nonpayment of community health worker incentives inhibited intergration of ICCM into the health system. Conclusion The study findings highlight key faciliators and barriers that should be considered by policy-makers, district health managers, ICCM supervisors, health facility managers, and co-operating partners, in designing context-specific implementation strategies, to ensure full integration of ICCM into the health system.

scholarly journals How prepared is Mozambique to treat COVID-19 patients? A new approach for estimating oxygen service availability, oxygen treatment capacity, and population access to oxygen-ready treatment facilities

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Langan Denhard ◽  
Parisa Kaviany ◽  
Sérgio Chicumbe ◽  
Cláudio Muianga ◽  
Guitunga Laisse ◽  
...  
Keyword(s):  
Health System ◽  
Health Facility ◽  
Oxygen Therapy ◽  
Health Facilities ◽  
Gis Mapping ◽  
Oxygen Treatment ◽  
Driving Time ◽  
Mapping Software ◽  
Study Team ◽  
Maputo City

Abstract Background This study aims to assess the COVID-19 response preparedness of the Mozambican health system by 1) determining the location of oxygen-ready public health facilities, 2) estimating the oxygen treatment capacity, and 3) determining the population coverage of oxygen-ready health facilities in Mozambique. Methods This analysis utilizes information on the availability of oxygen sources and delivery apparatuses to determine if a health facility is ready to deliver oxygen therapy to patients in need, and estimates how many patients can be treated with continuous oxygen flow for a 7-day period based on the available oxygen equipment at health facilities. Using GIS mapping software, the study team modeled varying travel times to oxygen-ready facilities to estimate the proportion of the population with access to care. Results 0.4% of all health facilities in Mozambique are prepared to deliver oxygen therapy to patients, for a cumulative total of 283.9 to 406.0 patients-weeks given the existing national capacity, under varying assumptions including ability to divert oxygen from a single source to multiple patients. 35% of the population in Mozambique has adequate access within one-hour driving time of an oxygen-ready health facility. This varies widely by region; 89.1% of the population of Maputo City was captured by the one-hour driving time network, as compared ot 4.4% of the population of Niassa province. Conclusions The Mozambican health system faces the dual challenges of under-resourced health facilities and low geographic accessibility to healthcare as it prepares to confront the COVID-19 pandemic. This analysis also illustrates the disparity between provinces in preparedness to deliver oxygen therapy to patient, with Cabo Delgado and Nampula being particularly under-resourced.

scholarly journals Health systems readiness to provide geriatric friendly care services in Uganda: a cross-sectional study

2019 ◽  
Author(s):  
Jude Thaddeus Ssensamba ◽  
Moses Mukuru ◽  
Mary Nakafeero ◽  
Ronald Ssenyonga ◽  
Suzanne N Kiwanuka
Keyword(s):  
Public Health ◽  
Health System ◽  
Health Facility ◽  
Health Systems ◽  
Building Blocks ◽  
Health Facilities ◽  
Health Centers ◽  
World Health ◽  
Care Services ◽  
Southern Central

Abstract Background As ageing emerges as the next public health threat in Africa, there is a paucity of information on how prepared its health systems are to provide geriatric friendly care services. In this study, we explored the readiness of Uganda’s public health system to provide geriatric friendly care services in Southern Central Uganda. Methods Four districts with the highest proportion of old persons in Southern Central Uganda were purposively selected, and a cross section of 18 randomly selected health facilities (HFs) were visited and assessed for availability of key items deemed important for provision of geriatric friendly services; as derived from World Health Organization’s Age-friendly primary health care centres toolkit. Data was collected using an adapted health facility geriatric assessment tool, entered into Epi-data software and analysed using STATA version 14. Kruskal-Wallis and Dunn’s post hoc tests were conducted to determine any associations between readiness, health facility level and district. Results The overall readiness index was 16.92 (SD ±4.19) (range 10.8 - 26.6). This differed across districts; Lwengo 17.91 (SD ±3.15), Rakai 17.63 (SD ±4.55), Bukomansimbi 16.51 (SD ±7.18), Kalungu 13.74 (SD ±2.56) and facility levels; Hospitals 26.62, Health centers four (HCIV) 20.05 and Health centers three (HCIII) 14.80. Low readiness was due to poor scores with regard to; leadership (0%), financing (0%), human resources (1.7%) and health management information systems (HMIS) (11.8%) WHO building blocks. Higher level HFs were statistically significantly friendlier than lower level HFs (p= 0.015). The difference in readiness between HCIIIs and HCIVs was 2.39 (p=0.025). Conclusion There is low readiness of public health facilities to provide geriatric friendly care services in Uganda. This is due to gaps in all of the health system building blocks. There is a need for health system reforms in Uganda to adequately cater for service provision for old people if the 2020 global healthy ageing goal is to be met.

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