scholarly journals ‘We have a plan for that’: a qualitative study of health system resilience through the perspective of health workers managing antenatal and childbirth services during floods in Cambodia

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e054145
Author(s):  
Dell D Saulnier ◽  
Dawin Thol ◽  
Ir Por ◽  
Claudia Hanson ◽  
Johan von Schreeb ◽  
...  
Keyword(s):  
Public Sector ◽  
Qualitative Study ◽  
Health Services ◽  
Health System ◽  
Health Workers ◽  
Local Level ◽  
Structured Interviews ◽  
Healthcare Facilities ◽  
System Resilience ◽  
A Minor

ObjectiveHealth system resilience can increase a system’s ability to deal with shocks like floods. Studying health systems that currently exhibit the capacity for resilience when shocked could enhance our understanding about what generates and influences resilience. This study aimed to generate empirical knowledge on health system resilience by exploring how public antenatal and childbirth health services in Cambodia have absorbed, adapted or transformed in response to seasonal and occasional floods.DesignA qualitative study using semi-structured interviews and thematic analysis and informed by the Dimensions of Resilience Governance framework.SettingPublic sector healthcare facilities and health departments in two districts exposed to flooding.ParticipantsTwenty-three public sector health professionals with experience providing or managing antenatal and birth services during recent flooding.ResultsThe theme ‘Collaboration across the system creates adaptability in the response’ reflects how collaboration and social relationships among providers, staff and the community have delineated boundaries for actions and decisions for services during floods. Floods were perceived as having a modest impact on health services. Knowing the boundaries on decision-making and having preparation and response plans let staff prepare and respond in a flexible yet stable way. The theme was derived from ideas of (1) seasonal floods as a minor strain on the system compared with persistent, system-wide organisational stresses the system already experiences, (2) the ability of the health services to adjust and adapt flood plans, (3) a shared purpose and working process during floods, (4) engagement at the local level to fulfil a professional duty to the community, and (5) creating relationships between health system levels and the community to enable flood response.ConclusionThe capacity to absorb and adapt to floods was seen among the public sector services. Strategies that enhance stability and flexibility may foster the capacity for health system resilience.

scholarly journals “Most of what they do, we cannot do!” How lay health workers respond to barriers to uptake and retention in HIV care among pregnant and breastfeeding mothers in Malawi

2020 ◽  
Vol 5 (6) ◽  
pp. e002220
Author(s):  
Stephanie M Topp ◽  
Nicole B Carbone ◽  
Jennifer Tseka ◽  
Linda Kamtsendero ◽  
Godfrey Banda ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Health System ◽  
Social Connectedness ◽  
Health Workers ◽  
Retention In Care ◽  
Hiv Care ◽  
Lay Health Workers ◽  
Structured Interviews ◽  
Retention In Hiv Care ◽  
Treat All

BackgroundIn the era of Option B+ and ‘treat all’ policies for HIV, challenges to retention in care are well documented. In Malawi, several large community-facility linkage (CFL) models have emerged to address these challenges, training lay health workers (LHW) to support the national prevention of mother-to-child transmission (PMTCT) programme. This qualitative study sought to examine how PMTCT LHW deployed by Malawi’s three most prevalent CFL models respond to known barriers to access and retention to antiretroviral therapy (ART) and PMTCT.MethodsWe conducted a qualitative study, including 43 semi-structured interviews with PMTCT clients; 30 focus group discussions with Ministry of Health (MOH)-employed lay and professional providers and PMTCT LHWs; a facility CFL survey and 2–4 hours of onsite observation at each of 8 sites and in-depth interviews with 13 programme coordinators and MOH officials. Thematic analysis was used, combining inductive and deductive approaches.ResultsAcross all three models, PMTCT LHWs carried out a number of ‘targeted’ activities that respond directly to a range of known barriers to ART uptake and retention. These include: (i) fulfilling counselling and educational functions that responded to women’s fears and uncertainties; (ii) enhancing women’s social connectedness and participation in their own care and (iii) strengthening service function by helping clinic-based providers carry out duties more efficiently and effectively. Beyond absorbing workload or improving efficiency, however, PMTCT LHWs supported uptake and retention through foundational but often intangible work to strengthen CFL, including via efforts to strengthen facility-side responsiveness, and build community members’ recognition of and trust in services.ConclusionPMTCT LHWs in each of the CFL models examined, addressed social, cultural and health system factors influencing client access to, and engagement with, HIV care and treatment. Findings underscore the importance of person-centred design in the ‘treat-all’ era and the contribution LHWs can make to this, but foreground the challenges of achieving person-centredness in the context of an under-resourced health system. Further work to understand the governance and sustainability of these project-funded CFL models and LHW cadres is now urgently required.

scholarly journals Community health worker models in South Africa: a qualitative study on policy implementation of the 2018/19 revised framework

2020 ◽  
Author(s):  
Joshua P Murphy ◽  
Aneesa Moolla ◽  
Sharon Kgowedi ◽  
Constance Mongwenyana ◽  
Sithabile Mngadi ◽  
...  
Keyword(s):  
South Africa ◽  
Qualitative Study ◽  
Policy Implementation ◽  
Community Health ◽  
Resource Constraints ◽  
Health Workers ◽  
Healthcare Providers ◽  
Successful Implementation ◽  
Programme Implementation ◽  
Healthcare Facilities

Abstract South Africa has a long history of community health workers (CHWs). It has been a journey that has required balancing constrained resources and competing priorities. CHWs form a bridge between communities and healthcare service provision within health facilities and act as the cornerstone of South Africa’s Ward-Based Primary Healthcare Outreach Teams. This study aimed to document the CHW policy implementation landscape across six provinces in South Africa and explore the reasons for local adaptation of CHW models and to identify potential barriers and facilitators to implementation of the revised framework to help guide and inform future planning. We conducted a qualitative study among a sample of Department of Health Managers at the National, Provincial and District level, healthcare providers, implementing partners [including non-governmental organizations (NGOs) who worked with CHWs] and CHWs themselves. Data were collected between April 2018 and December 2018. We conducted 65 in-depth interviews (IDIs) with healthcare providers, managers and experts familiar with CHW work and nine focus group discussions (FGDs) with 101 CHWs. We present (i) current models of CHW policy implementation across South Africa, (ii) facilitators, (iii) barriers to CHW programme implementation and (iv) respondents’ recommendations on how the CHW programme can be improved. We chronicled the differences in NGO involvement, the common facilitators of purpose and passion in the CHWs’ work and the multitude of barriers and resource limitations CHWs must work under. We found that models of implementation vary greatly and that adaptability is an important aspect of successful implementation under resource constraints. Our findings largely aligned to existing research but included an evaluation of districts/provinces that had not previously been explored together. CHWs continue to promote health and link their communities to healthcare facilities, in spite of lack of permanent employment, limited resources, such as uniforms, and low wages.

Evaluation of the effectiveness of community health workers in the fight against malaria in the Central African Republic (2012–2017)

2019 ◽  
Vol 114 (3) ◽  
pp. 173-184
Author(s):  
Djerandouba Yotobumbeti Ferdinand ◽  
Bessimbaye Nadlaou ◽  
Nzalapan Samuel ◽  
Bekaka Youlet Oscar ◽  
Mbailao Raphael ◽  
...  
Keyword(s):  
Health Services ◽  
Community Health ◽  
Community Health Workers ◽  
Health Care Access ◽  
Central African Republic ◽  
Health Workers ◽  
Preventive Health Services ◽  
Structured Interviews ◽  
Adequate Treatment ◽  
Care Access

Abstract Background This last decade’s ongoing conflict in the Central African Republic (CAR) has led to gradual and continuous destruction of health services. With severe gaps in qualified health professionals, community health workers (CHWs) have become essential to ensuring health care access to the affected population. This article aims to evaluate the effectiveness of a 10-y CHW program in the CAR. Methods Routine case management data from CHWs were collected in the Paoua district from January 2012 to December 2017 and analysed. Structured interviews were conducted in the Paoua and Carnot health districts among individuals from three different groups (health service beneficiaries, CHWs and health facility managers). Results From 2012 to 2017, 353 948 people consulted for malaria suspicion with CHWs and 86% were found to be malaria positive after a rapid diagnostic test. Among those diagnosed patients, 98.5% received adequate treatment and nearly 1.5% were referred to health facilities. Also, 94.5% of respondents identified fever as the major malaria symptom. About 70% of the population could identify three malaria signs/symptoms and 84.4% accepted and used CHW services. Interviews with CHWs revealed that 45.8% of them received at least four training sessions per month as part of their capacity building. Conclusions CHWs can be a resourceful solution when other health professional are scarce. This study showed that CHWs are not only able to deliver curative and preventive health services, but they are also well accepted by the served communities.

scholarly journals Knowledge, Attitudes and Expectations of Physicians with Respect to Palliative Care in Ecuador: A Qualitative Study

2020 ◽  
Vol 17 (11) ◽  
pp. 3906 ◽  
Author(s):  
Viviana Dávalos-Batallas ◽  
Vinita Mahtani-Chugani ◽  
Carla López-Núñez ◽  
Víctor Duque ◽  
Fatima Leon-Larios ◽  
...  
Keyword(s):  
Palliative Care ◽  
Health Policy ◽  
Qualitative Study ◽  
Health Services ◽  
Human Resources ◽  
Thematic Analysis ◽  
Medical Professional ◽  
Structured Interviews ◽  
Unequal Distribution

Background: The worldwide need for palliative care is high, especially in mid- income countries like Ecuador, where the percentage of patients receiving such care is very small due to the scarcity of infrastructure and specialized personnel and to the unequal distribution in the country. The objective of this study is to explore the knowledge, attitudes and expectations related to palliative care of the physicians in Ecuador. Methods: A qualitative study based on 28 semi-structured interviews, from March 2014 to November 2016, with physicians working in four cities in Ecuador recruited through the snowball technique. Thematic analysis was developed supported by the ATLAS.ti software. Results: Five core themes were identified: (1) training, (2) health policy, (3) professionals’ activities, (4) health services and (5) development of palliative care in Ecuador. Conclusions: Strategies are needed which intensify the training of medical professional in palliative care, as well as avail the human resources and materials for providing it.

scholarly journals How a Communication Intervention in Zambia Re-Oriented Health Services to the Needs of the Least-Supported

Healthcare ◽  
2018 ◽  
Vol 6 (3) ◽  
pp. 114 ◽  
Author(s):  
Tony Klouda ◽  
Cathy Green ◽  
Miniratu Soyoola ◽  
Paula Quigley ◽  
Tendayi Kureya ◽  
...  
Keyword(s):  
Health Services ◽  
Health Workers ◽  
Newborn Health ◽  
Maternal Health Services ◽  
Global Strategy ◽  
Health Facilities ◽  
Maternal And Newborn Health ◽  
Small Scale ◽  
Structured Interviews ◽  
Experiential Training

Despite decades of training health workers in communication, complaints from clients and communities about poor health worker attitudes abound. This was found to be so in Zambia where the More Mobilizing Access to Maternal Health Services in Zambia (MORE MAMaZ) program was trying to ensure the inclusion of under-supported women in a community-based maternal and newborn health program in five intervention districts. Under-supported women suffer a disproportionate burden of child mortality and are poor users of health services. An exploratory small-scale qualitative survey involving nurses from training schools and health facilities found that nurses knew how to communicate well, but were selective with whom and in what circumstances they did this. In general, those who received the worst communication were under-supported and had low confidence—the very people who needed the best communication. An experiential training program was started to help health workers reflect on the reasons for their poor communication. The training was evaluated after 14 months using semi-structured interviews and focus group discussions with staff at participating health facilities. The results showed improved inclusion of under-supported women but also increased attendance generally for ante-natal clinics, deliveries and under-five clinics. Another outcome was improved communication between, and a sense of job satisfaction among, the health workers themselves. The program demonstrated an effective way to improve the inclusion and involvement of the least-supported women and girls. There are important lessons for other health programs that aim to operationalize the goals of the Global Strategy for Women’s, Children’s and Adolescent’s Health, which include an emphasis on reaching every woman.

Patient Safety Communication Among Differently Educated Nurses: Converging and Diverging Meaning Systems

2017 ◽  
Vol 41 (2) ◽  
pp. 171-190 ◽  
Author(s):  
Allison Brandt Anbari ◽  
Amy Vogelsmeier ◽  
Debbie S. Dougherty
Keyword(s):  
Patient Safety ◽  
Qualitative Study ◽  
Health System ◽  
Local Level ◽  
Interview Data ◽  
Safety Communication ◽  
Meaning Systems ◽  
Systemic Level ◽  
Theory Of Language ◽  
System Factors

Studies that suggest an increased number of bachelor’s prepared nurses (BSNs) at the bedside improves patient safety do not stratify their samples into traditional bachelor’s and associates (ADN) to BSN graduates. This qualitative study investigated potential differences in patient safety meaning among BSNs and ADN to BSN graduates. Guided by the theory of Language Convergence/Meaning Divergence, interview data from eight BSN and eight ADN to BSN graduates were analyzed. Findings indicate there are two meaning levels or systems, the local level and the systemic level. At the local level, the meaning of patient safety is focused at the patient’s bedside and regulated by the nurse. The systemic level included the notion that health system factors such as policies and staffing are paramount to keeping patients safe. More frequently, ADN to BSN graduates’ meaning of patient safety was at the local level, while BSNs’ meaning centered at the systemic level.

scholarly journals Changing Home: Experiences of the Indigenous when Receiving Care in Hospital

2020 ◽  
Vol 38 (3) ◽  
Author(s):  
Juan Guillermo Rojas ◽  
Raquel Herrero Hahn
Keyword(s):  
Qualitative Study ◽  
Health Services ◽  
Low Complexity ◽  
Ethics Committee ◽  
Outpatient Services ◽  
Structured Interviews ◽  
Analysis Process ◽  
Ethnographic Approach ◽  
Methodological Rigor ◽  
Adaptation And Learning

Objective. To understand the meaning of the experience of the indigenous when receiving care in a low-complexity hospital. Methods. Qualitative study with ethnographic approach conducted in a hospital of Antioquia, Colombia. The study had 12 indigenous participants who underwent semi-structured interviews. Observation was carried out in hospitalization wards, emergency, and outpatient services of the institution during 40 hours. The analysis process was performed descriptively. The methodological rigor was maintained by applying criteria of confirmability, credibility, transferability, and consistency. The study was approved by the Ethics Committee and authorized by the indigenous authorities to enter the field. Results. Five themes emerged: the context of caring for the indigenous, the need to consult the hospital, changes experienced by the indigenous in the hospital, experiences in relation with treatments, and relations established within the hospital. The meaning is constructed from a dichotomous perspective based on the favorable or unfavorable aspects of the situations and experiences, which for the indigenous is like “changing home”. Conclusion. The meaning of the experience of receiving care in hospital for the indigenous is constructed from the context in which they live and receive health services, the changes they live in the dimension of space by virtue of their traveling from their vital space to another space that, due to their physical characteristics, results strange and different, even not healing. Upon the difficulties, the indigenous develop strategies and actions to overcome limitations, whether through adaptation and learning.

scholarly journals Community Empowerment in Health: An Exploratory Study in Rural Community of a District of West Bengal

2020 ◽  
pp. 11-19
Author(s):  
Dipta Kanti Mukhopadhyay ◽  
Sujishnu Mukhopadhyay ◽  
Nivedita Das ◽  
Tarun Kumar Sarkar ◽  
Fasihul Akbar ◽  
...  
Keyword(s):  
Health Services ◽  
Health System ◽  
National Health ◽  
Rural Areas ◽  
West Bengal ◽  
Health Workers ◽  
Community Empowerment ◽  
Current Status ◽  
Health Staff ◽  
Key Informants

Background: Community empowerment is the process and outcome where community itself is able to identify, prioritize health problems and address them. It has been considered as the key strategy for scalability and sustainability of health services. Objectives: To explore the status of community empowerment in health in rural areas in West Bengal, India and the interplay of different stakeholders. Methods: A cross-sectional, qualitative study was conducted in 2017 – 2018 among the people residing in rural areas of Birbhum district in West Bengal, India who utilized the public health system (lay informants), formal and informal leaders of the community, community level health workers and peripheral health staff (key informants). Three community blocks, two sub-centers from each block and one village from each sub-center were selected randomly. In-depth interviews were conducted among 36 lay and 36 key informants using Laverack’s nine dimension model of community empowerment. Framework analysis was done to summarize data. Results: Participation of people was restricted to awareness and utilization of existing health services. Unmet aspiration for greater participation was noted among a small section of the community. They were mostly fitted to the role of beneficiaries. Functioning of village level organization to promote communitization as envisaged in national health programmes was largely deficient. The community health workers acted as the most peripheral appendages of formal health system rather than the health activists to empower community regarding community’s health. Conclusion: Although, every national health programme advocated community empowerment, the current status and the process of empowerment in health is in nascent stage.

scholarly journals “…the availability of contraceptives is everywhere.”: Coordinated Family Planning Service Delivery in Rwanda Facilitates Integration of Family Planning into Other Health Services

2020 ◽  
Author(s):  
Adriana Scanteianu ◽  
HILARY MEGAN SCHWANDT ◽  
Angel Boulware ◽  
Julia Corey ◽  
Ana Herrera ◽  
...  
Keyword(s):  
Family Planning ◽  
Health Services ◽  
Service Delivery ◽  
Health Workers ◽  
Family Planning Service ◽  
Local Level ◽  
Child Health Services ◽  
High Fertility ◽  
Planning Service ◽  
Contraceptive Usage

Abstract BackgroundHigh fertility rates pose health risks to both mothers and children and impede economic growth; therefore, family planning use is vital to achieving sustainable population growth and to help build thriving communities. Contraceptive use in Rwanda has tripled since 2005. This study aims to understand the role of coordinated and integrated family planning service delivery in achieving this unparalleled success in Rwanda. MethodsThis qualitative study in 2018 included eight focus group discussions with family planning providers and 32 in-depth interviews with experienced family planning users.ResultsResults indicate a well-coordinated family planning service delivery system with community health workers and nurses filling different and complementary roles in meeting family planning client needs at the local level. In addition, integration of family planning into other maternal and child health services is the norm. ConclusionsThe coordination and integration of family planning across both providers and services may help explain the extraordinary increase in Rwanda’s contraceptive usage, and has potential applications for enhancing family planning service delivery in other settings as well.

Sign in / Sign up

Export Citation Format

Share Document