scholarly journals Which mechanisms explain motivation the of primary health workers? Insights from the realist evaluation of a maternal and child health programme in Nigeria

2020 ◽  
Vol 5 (8) ◽  
pp. e002408
Author(s):  
Bassey Ebenso ◽  
Chinyere Mbachu ◽  
Enyi Etiaba ◽  
Reinhard Huss ◽  
Ana Manzano ◽  
...  
Keyword(s):  
Child Health ◽  
Maternal And Child Health ◽  
Health Workers ◽  
Healthcare Delivery ◽  
Realist Evaluation ◽  
Future Research ◽  
Health Coverage ◽  
Worker Motivation ◽  
The Impact ◽  
And Child Health

IntroductionWell-trained, adequately skilled and motivated primary healthcare (PHC) workers are essential for attaining universal health coverage (UHC). While there is abundant literature on the drivers of workforce motivation, published knowledge on the mechanisms of motivation within different contexts is limited, particularly in resource-limited countries. This paper contributes to health workforce literature by reporting on how motivation works among PHC workers in a maternal and child health (MCH) programme in Nigeria.MethodsWe adopted a realist evaluation design combining document review with 56 in-depth interviews of PHC workers, facility managers and policy-makers to assess the impact of the MCH programme in Anambra State, Nigeria. A realist process of theory development, testing and consolidation was used to understand how and under what circumstances the MCH programme impacted on workers’ motivation and which mechanisms explain how motivation works. We drew on Herzberg’s two-factor and Adam’s equity theories to unpack how context shapes worker motivation.ResultsA complex and dynamic interaction between the MCH programme and organisational and wider contexts triggered five mechanisms which explain PHC worker motivation: (1) feeling supported, (2) feeling comfortable with work environment, (3) feeling valued, (4) morale and confidence to perform tasks and (5) companionship. Some mechanisms were mutually reinforcing while others operated in parallel. Other conditions that enabled worker motivation were organisational values of fairness, recognition of workers’ contributions and culture of task-sharing and teamwork.ConclusionsPolicy designs and management strategies for improving workforce performance, particularly in resource-constrained settings should create working environments that foster feelings of being valued and supported while enabling workers to apply their knowledge and skills to improve healthcare delivery and promote UHC. Future research can test the explanatory framework generated by this study and explore differences in motivational mechanisms among different cadres of PHC workers to inform cadre-related motivational interventions.

scholarly journals Which mechanisms explain motivation of primary health workers? Insights from realist evaluation of a maternal and child health programme in Nigeria

2019 ◽  
Author(s):  
Bassey E. EBENSO ◽  
Chinyere Mbachu ◽  
Enyi Etiaba ◽  
Reinhard Huss ◽  
Ana Manzano ◽  
...  
Keyword(s):  
Child Health ◽  
Maternal And Child Health ◽  
Health Workers ◽  
Healthcare Delivery ◽  
Well Being ◽  
Realist Evaluation ◽  
Future Research ◽  
Worker Motivation ◽  
The Impact ◽  
And Child Health

Abstract Background: Well-trained, adequately skilled and motivated primary healthcare (PHC) workers are essential for attaining universal health coverage and the Sustainable Development Goal 3 of ensuring healthy lives and promoting well-being for all. While there is abundant literature on drivers of workforce motivation, published knowledge on the mechanisms of how motivation works within different contexts is limited, particularly from low- and middle-income countries. This paper contributes to health workforce literature by reporting on how motivation works among PHC workers in a maternal and child health (MCH) programme in Nigeria. Methods: We adopted a realist evaluation design including scoping review of literature, document review of policies and MCH programme handbook, and in-depth interviews of PHC workers (n=25), facility managers (n=16), policymakers (n=12) and programme managers (n=10) to assess the impact of the MCH programme in Anambra State, Nigeria. A realist process of theory development, testing, verification and consolidation was used to understand how and under what circumstances the MCH programme impacted on workers’ motivation and which mechanisms helped explain how motivation works. The developed programme theory drew upon Herzberg’s two-factor and Adam’s equity theories to unpack the influences of contextual conditions on worker motivation. Results: A complex and dynamic interaction between the MCH programme and organizational, societal and policy contexts triggered five mechanisms which explain PHC worker motivation: i) feeling supported, ii) feeling valued and committed to work, iii) morale and confidence to perform tasks, iv) companionship and v) feeling comfortable with work environment. Some mechanisms were mutually reinforcing while others operated in parallel. Further analysis showed that the conditions that enabled worker motivation to occur were organisational values of fairness, recognition of health workers’ contributions and a culture of task-sharing and teamwork. Conclusions: Policy designs and management strategies for improving performance of health workers, particularly in resource-constrained settings should create working environments that foster feelings of being valued and supported while enabling workers to apply their knowledge and skills to improve healthcare delivery. Future research can test the explanatory framework generated by this study and explore differences in motivational mechanisms among different cadres of PHC workers to inform cadre-related motivational interventions.

scholarly journals Community health workers impact on maternal and child health outcomes in rural South Africa – a non-randomized two-group comparison study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Karl W. le Roux ◽  
Ellen Almirol ◽  
Panteha Hayati Rezvan ◽  
Ingrid M. le Roux ◽  
Nokwanele Mbewu ◽  
...  
Keyword(s):  
Child Health ◽  
Health Outcomes ◽  
Maternal And Child Health ◽  
Home Visiting ◽  
Health Workers ◽  
Group Comparison ◽  
Comparison Study ◽  
Child Health Outcomes ◽  
The Impact ◽  
And Child Health

Abstract Background Home visits by paraprofessional community health workers (CHWs) has been shown to improve maternal and child health outcomes in research studies in many countries. Yet, when these are scaled or replicated, efficacy disappears. An effective CHW home visiting program in peri-urban Cape Town found maternal and child health benefits over the 5 years point but this study examines if these benefits occur in deeply rural communities. Methods A non-randomized, two-group comparison study evaluated the impact of CHW in the rural Eastern Cape from August 2014 to May 2017, with 1310 mother-infant pairs recruited in pregnancy and 89% were reassessed at 6 months post-birth. Results Home visiting had limited, but important effects on child health, maternal wellbeing and health behaviors. Mothers reported fewer depressive symptoms, attended more antenatal visits and had better baby-feeding practices. Intervention mothers were significantly more likely to exclusively breastfeed for 6 months (OR: 1.8; 95% CI: 1.1, 2.9), had lower odds of mixing formula with baby porridge (regarded as detrimental) (OR: 0.4; 95% CI: 0.2, 0.8) and were less likely to consult traditional healers. Mothers living with HIV were more adherent with co-trimoxazole prophylaxis (p < 0.01). Intervention-group children were significantly less likely to be wasted (OR: 0.5; 95% CI 0.3–0.9) and had significantly fewer symptoms of common childhood illnesses in the preceding two weeks (OR: 0.8; 95% CI: 0.7,0.9). Conclusion The impact of CHWs in a rural area was less pronounced than in peri-urban areas. CHWs are likely to need enhanced support and supervision in the challenging rural context.

scholarly journals A retrospective study of the impact of health worker strikes on maternal and child health care utilization in western Kenya

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Michael L. Scanlon ◽  
Lauren Y. Maldonado ◽  
Justus E. Ikemeri ◽  
Anjellah Jumah ◽  
Getrude Anusu ◽  
...  
Keyword(s):  
Child Health ◽  
Health Services ◽  
Maternal And Child Health ◽  
Health Workers ◽  
Child Health Services ◽  
Control Group ◽  
Western Kenya ◽  
The Impact ◽  
And Child Health ◽  
Risk Ratios

Abstract Background There have been dozens of strikes by health workers in Kenya in the past decade, but there are few studies of their impact on maternal and child health services and outcomes. We conducted a retrospective survey study to assess the impact of nationwide strikes by health workers in 2017 on utilization of maternal and child health services in western Kenya. Methods We utilized a parent study to enroll women who were pregnant in 2017 when there were prolonged strikes by health workers (“strike group”) and women who were pregnant in 2018 when there were no major strikes (“control group”). Trained research assistants administered a close-ended survey to retrospectively collect demographic and pregnancy-related health utilization and outcomes data. Data were collected between March and July 2019. The primary outcomes of interest were antenatal care (ANC) visits, delivery location, and early child immunizations. Generalized estimating equations were used to estimate risk ratios between the strike and control groups, adjusting for socioeconomic status, health insurance status, and clustering. Adjusted risk ratios (ARR) were calculated with 95% confidence intervals (95%CI). Results Of 1341 women recruited in the parent study in 2017 (strike group), we re-consented 843 women (63%) to participate. Of 924 women recruited in the control arm of the parent study in 2018 (control group), we re-consented 728 women (79%). Women in the strike group were 17% less likely to attend at least four ANC visits during their pregnancy (ARR 0.83, 95%CI 0.74, 0.94) and 16% less likely to deliver in a health facility (ARR 0.84, 95%CI 0.76, 0.92) compared to women in the control group. Whether a child received their first oral polio vaccine did not differ significantly between groups, but children of women in the strike group received their vaccine significantly longer after birth (13 days versus 7 days, p = 0.002). Conclusion We found that women who were pregnant during nationwide strikes by health workers in 2017 were less likely to receive WHO-recommended maternal child health services. Strategies to maintain these services during strikes are urgently needed.

scholarly journals Dampak COVID-19 Terhadap Pelayanan KIA di Kota Cilegon

2021 ◽  
Vol 6 (2) ◽  
Author(s):  
Zulfa Kevaladandra ◽  
Evi Martha
Keyword(s):  
Child Health ◽  
Health Services ◽  
Maternal And Child Health ◽  
Health Workers ◽  
Child Health Services ◽  
Live Streaming ◽  
Immunization Services ◽  
The Impact ◽  
The City ◽  
And Child Health

Objective: The COVID-19 pandemic has challenged maternal and child health services in all regions of Indonesia, including the city of Cilegon. Various efforts have been made by the Cilegon City Health Office to suppress the decline in MCH services. The purpose of this study was to determine the impact of COVID-19 on MCH services in Cilegon City.Methods: This article used a qualitative descriptive method by collecting data through focus group discussions (FGD) in the second week of October 2020. The informants of this study collected by purposive sampling with the number of informants. 4 informants, including the Head of the Cilegon City Health Office, the Head of the Family Health Section (Kesga), and 2 Kesga staff.Results: The results showed that there were 7 indicators affected by COVID-19 in the city of Cilegon, including K1 coverage, K4 coverage, delivery assistance at health facilities, maternal mortality rate (MMR), neonatal visits, complete basic immunization services, and monitoring of toddler growth and development. The cause of the obstruction of MCH services was the existence of the PSBB policy and the concerns of the public and health workers of contracting the SARS-CoV-2 virus.Conclusion: Several inovasions made by the Cilegon City Health Office include implementing health protocols in health services outside buildings, making appointments for antenatal and immunization services, conducting home visits, conducting classes for pregnant women and toddlers through live streaming, and providing isolation places for OTGs. It can be concluded that the COVID-19 pandemic has caused a challenges in MCH services. However, various efforts have also been made to increase the coverage of MCH services and improve maternal and child health in the city of Cilegon. 

scholarly journals What mechanisms drive uptake of family planning when integrated with childhood immunisation in Ethiopia? A realist evaluation

2021 ◽  
Author(s):  
Shari Krishnaratne ◽  
Jessie K. Hamon ◽  
Jenna Hoyt ◽  
Tracey Chantler ◽  
Justine Landegger ◽  
...  
Keyword(s):  
Family Planning ◽  
Child Health ◽  
Maternal And Child Health ◽  
Realist Evaluation ◽  
Religious Leaders ◽  
Community Members ◽  
Theoretical Frameworks ◽  
Programme Theory ◽  
Integrated Delivery ◽  
And Child Health

Abstract Background: Maternal and child health are key priorities among the Sustainable Development Goals, which include a particular focus on reducing morbidity and mortality among women of reproductive age, newborns, and children under the age of five. Two components of maternal and child health are family planning (FP) and immunisation. Providing these services through an integrated delivery system could increase the uptake of vaccines and modern contraceptive methods (MCMs) particularly during the post-partum period. Methods: A realist evaluation was conducted in two woredas in Ethiopia to determine the key mechanisms and their triggers that drive successful implementation and service uptake of an intervention of integrated delivery of immunisations and FP. The methodological approach included the development of an initial programme theory and the selection of relevant, published implementation related theoretical frameworks to aid organisation and cumulation of findings. Data from 23 semi-structured interviews were then analysed to determine key empirical mechanisms and drivers and to test the initial programme theory. These mechanisms were mapped against published theoretical frameworks and a revised programme theory comprised of context-mechanism-outcome configurations was developed. A critique of theoretical frameworks for abstracting empirical mechanisms was also conducted. Results: Key contextual factors identified were: the use of trained Health Extension Workers (HEWs) to deliver FP services; a strong belief in values that challenged FP among religious leaders and community members; and a lack of support for FP from male partners based on religious values. Within these contexts, empirical mechanisms of acceptability, access, and adoption of innovations that drove decision making and intervention outcomes among health workers, religious leaders, and community members were identified to describe intervention implementation. Conclusions: Linking context and intervention components to the mechanisms they triggered helped explain the intervention outcomes, and more broadly how and for whom the intervention worked. Linking empirical mechanisms to constructs of implementation related theoretical frameworks provided a level of abstraction through which findings could be cumulated across time, space, and conditions by theorising middle-range mechanisms.

scholarly journals What mechanisms drive uptake of family planning when integrated with childhood immunisation in Ethiopia? A realist evaluation

2020 ◽  
Author(s):  
Shari Krishnaratne ◽  
Jessie K. Hamon ◽  
Jenna Hoyt ◽  
Tracey Chantler ◽  
Justine Landegger ◽  
...  
Keyword(s):  
Family Planning ◽  
Child Health ◽  
Maternal And Child Health ◽  
Realist Evaluation ◽  
Religious Leaders ◽  
Community Members ◽  
Theoretical Frameworks ◽  
Programme Theory ◽  
Integrated Delivery ◽  
And Child Health

Abstract Background:Maternal and child health are key priorities among the Sustainable Development Goals, which include a particular focus on reducing morbidity and mortality among women of reproductive age, newborns, and children under the age of five. Two components of maternal and child health are family planning (FP) and immunisation. Providing these services through an integrated delivery system could increase the uptake of vaccines and modern contraceptive methods (MCMs) particularly during the post-partum period. Methods:A realist evaluation was conducted in two woredas in Ethiopia to determine the key mechanisms and their triggers that drive successful implementation and service uptake of an intervention of integrated delivery of immunisations and FP. The methodological approach included the development of an initial programme theory and the selection of relevant, published implementation related theoretical frameworks to aid organisation and cumulation of findings. Data from 23 semi-structured interviews were then analysed to determine key empirical mechanisms and drivers and to test the initial programme theory. These mechanisms were mapped against published theoretical frameworks and a revised programme theory comprised of context-mechanism-outcome configurations was developed. A critique of theoretical frameworks for abstracting empirical mechanisms was also conducted. Results:Key contextual factors identified were: the use of trained Health Extension Workers (HEWs) to deliver FP services; a strong belief in values that challenged FP among religious leaders and community members; and a lack of support for FP from male partners based on religious values. Within these contexts, empirical mechanisms of acceptability, access, and adoption of innovations that drove decision making and intervention outcomes among health workers, religious leaders, and community members were identified to describe intervention implementation.Conclusions:Linking context and intervention components to the mechanisms they triggered helped explain the intervention outcomes, and more broadly how and for whom the intervention worked. Linking empirical mechanisms to constructs of implementation related theoretical frameworks provided a level of abstraction through which findings could be cumulated across time, space, and conditions by theorising middle-range mechanisms.

The Impact of Maternal Health Care Utilization on Probability of Child Survival in India

2020 ◽  
Vol 11 (7) ◽  
pp. 1006-1014
Author(s):  
Ajit Kumar Jaiswal
Keyword(s):  
Health Care ◽  
Child Health ◽  
Maternal And Child Health ◽  
Child Survival ◽  
Nutrient Deficiency ◽  
Household Wealth ◽  
Care Utilization ◽  
The Government ◽  
The Impact ◽  
And Child Health

Maternal and child health programmes plays a key role in reducing infant and child mortality in any population. The Government of India started maternal and child health care services in the first five year plan (1951-56). This study uses data from the fourth round of the National Family Health Survey (NFHS, 2015-16). We are interested to examine the effect of child delivery at a healthcare facility, on child survival. We are followed by Mosley and Chen’s framework (1884), according to the framework, several socioeconomic determinants are grouped into some categories, namely, maternal, environmental contamination, nutrient deficiency, and personal illness control. Consequently, we reduced the number of independent variables to women’s age at birth and education, birth order, low child birth weight, household wealth, and healthcare.

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