scholarly journals Barriers to increase surgical productivity in Sierra Leone: a qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e056784
Author(s):  
Juul Bakker ◽  
A J van Duinen ◽  
Wouter W E Nolet ◽  
Peter Mboma ◽  
Tamba Sam ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Health System ◽  
Sierra Leone ◽  
Health Workers ◽  
Health System Strengthening ◽  
Financial Barriers ◽  
Public And Private ◽  
Factors Influencing ◽  
Surgical Workforce ◽  
Training Opportunities

ObjectiveTo explore factors influencing surgical provider productivity and identify barriers against and opportunities to increase individual surgical productivity in Sierra Leone, in order to explain the observed increase in unmet surgical need from 92.2% to 92.7% and the decrease in surgical productivity to 1.7 surgical procedures per provider per week between 2012 and 2017.Design and methodsThis explanatory qualitative study consisted of in-depth interviews about factors influencing surgical productivity in Sierra Leone. Interviews were analysed with a thematic network analysis and used to develop a conceptual framework.Participants and setting21 surgical providers and hospital managers working in 12 public and private non-profit hospitals in all regions in Sierra Leone.ResultsSurgical providers in Sierra Leone experience a broad range of factors within and outside the health system that influence their productivity. The main barriers involve both patient and facility financial constraints, lack of equipment and supplies, weak regulation of providers and facilities and a small surgical workforce, which experiences a lack of recognition. Initiation of a Free Health Care Initiative for obstetric and paediatric care, collaborations with partners or non-governmental organisations, and increased training opportunities for highly motivated surgical providers are identified as opportunities to increase productivity.DiscussionBroader nationwide health system strengthening is required to facilitate an increase in surgical productivity and meet surgical needs in Sierra Leone. Development of a national strategy for surgery, obstetrics and anaesthesia, including methods to reduce financial barriers for patients, improve supply-mechanisms and expand training opportunities for new and established surgical providers can increase surgical capacity. Establishment of legal frameworks and appropriate remuneration are crucial for sustainability and retention of surgical health workers.

scholarly journals Health System Factors Constrain HIV Care Providers in Delivering High-Quality Care: Perceptions from a Qualitative Study of Providers in Western Kenya

2019 ◽  
Vol 18 ◽  
pp. 232595821882328 ◽  
Author(s):  
Becky Genberg ◽  
Juddy Wachira ◽  
Catherine Kafu ◽  
Ira Wilson ◽  
Beatrice Koech ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Health System ◽  
Working Environment ◽  
Health System Strengthening ◽  
Eastern Africa ◽  
Hiv Care ◽  
Care Providers ◽  
High Quality ◽  
Western Kenya ◽  
System Factors

The burden on health systems due to increased volume of patients with HIV continues to rapidly increase. The goal of this study was to examine the experiences of HIV care providers in a high patient volume HIV treatment and care program in eastern Africa. Sixty care providers within the Academic Model Providing Access to Healthcare program in western Kenya were recruited into this qualitative study. We conducted in-depth interviews focused on providers’ perspectives on health system factors that impact patient engagement in HIV care. Results from thematic analysis demonstrated that providers perceive a work environment that constrained their ability to deliver high-quality HIV care and encouraged negative patient–provider relationships. Providers described their roles as high strain, low control, and low support. Health system strengthening must include efforts to improve the working environment and easing burden of care providers tasked with delivering antiretroviral therapy to increasing numbers of patients in resource-constrained settings.

scholarly journals Lessons from a Health Policy and Systems Research programme exploring the quality and coverage of newborn care in Kenya

2020 ◽  
Vol 5 (1) ◽  
pp. e001937
Author(s):  
Mike English ◽  
David Gathara ◽  
Jacinta Nzinga ◽  
Pratap Kumar ◽  
Fred Were ◽  
...  
Keyword(s):  
Health System ◽  
Low Income ◽  
Health Workers ◽  
Newborn Care ◽  
Well Being ◽  
Public Hospitals ◽  
Urban Setting ◽  
Health System Strengthening ◽  
Research Approach ◽  
Systems Research

There are global calls for research to support health system strengthening in low-income and middle-income countries (LMICs). To examine the nature and magnitude of gaps in access and quality of inpatient neonatal care provided to a largely poor urban population, we combined multiple epidemiological and health services methodologies. Conducting this work and generating findings was made possible through extensive formal and informal stakeholder engagement linked to flexibility in the research approach while keeping overall goals in mind. We learnt that 45% of sick newborns requiring hospital care in Nairobi probably do not access a suitable facility and that public hospitals provide 70% of care accessed with private sector care either poor quality or very expensive. Direct observations of care and ethnographic work show that critical nursing workforce shortages prevent delivery of high-quality care in high volume, low-cost facilities and likely threaten patient safety and nurses’ well-being. In these challenging settings, routines and norms have evolved as collective coping strategies so health professionals maintain some sense of achievement in the face of impossible demands. Thus, the health system sustains a functional veneer that belies the stresses undermining quality, compassionate care. No one intervention will dramatically reduce neonatal mortality in this urban setting. In the short term, a substantial increase in the number of health workers, especially nurses, is required. This must be combined with longer term investment to address coverage gaps through redesign of services around functional tiers with improved information systems that support effective governance of public, private and not-for-profit sectors.

scholarly journals Factors influencing the performance of community health workers: A qualitative study of Anganwadi Workers from Bihar, India

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242460
Author(s):  
Aparna John ◽  
Nicholas Nisbett ◽  
Inka Barnett ◽  
Rasmi Avula ◽  
Purnima Menon
Keyword(s):  
Qualitative Study ◽  
Community Health ◽  
Large Scale ◽  
Health Workers ◽  
Seasonal Migration ◽  
High Coverage ◽  
Factors Affecting ◽  
Community Factors ◽  
Factors Influencing ◽  
The Individual

Globally, there remain significant knowledge and evidence gaps around how to support Community Health Worker (CHW) programmes to achieve high coverage and quality of interventions. India’s Integrated Child Development Services scheme employs the largest CHW cadre in the world—Anganwadi Workers (AWWs). However, factors influencing the performance of these workers remain under researched. Lessons from it have potential to impact on other large scale global CHW programmes. A qualitative study of AWWs in the Indian state of Bihar was conducted to identify key drivers of performance in 2015. In-depth interviews were conducted with 30 AWWs; data was analysed using both inductive and deductive thematic analysis. The study adapted and contextualised existing frameworks on CHW performance, finding that factors affecting performance occur at the individual, community, programme and organisational levels, including factors not previously identified in the literature. Individual factors include initial financial motives and family support; programme factors include beneficiaries’ and AWWs’ service preferences and work environment; community factors include caste dynamics and community and seasonal migration; and organisational factors include corruption. The initial motives of the worker (the need to retain a job for family financial needs) and community expectations (for product-oriented services) ensure continued efforts even when her motivation is low. The main constraints to performance remain factors outside of her control, including limited availability of programme resources and challenging relationships shaped by caste dynamics, seasonal migration, and corruption. Programme efforts to improve performance (such as incentives, working conditions and supportive management) need to consider these complex, inter-related multiple determinants of performance. Our findings, including new factors, contribute to the global literature on factors affecting the performance of CHWs and have wide application.

scholarly journals Opportunities and challenges for delivering non-communicable disease management and services in fragile and post-conflict settings: perceptions of policy-makers and health providers in Sierra Leone

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Sophie Witter ◽  
Guanyang Zou ◽  
Karin Diaconu ◽  
Reynold G. B. Senesi ◽  
Ayesha Idriss ◽  
...  
Keyword(s):  
Health System ◽  
Sierra Leone ◽  
Prevention And Control ◽  
Model Building ◽  
Communicable Disease ◽  
Group Model ◽  
Financial Barriers ◽  
Post Conflict ◽  
Conflict Settings ◽  
And Control

Abstract Background The growing burden of non-communicable diseases in low- and middle-income countries presents substantive challenges for health systems. This is also the case in fragile, post-conflict and post-Ebola Sierra Leone, where NCDs represent an increasingly significant disease burden (around 30% of adult men and women have raised blood pressure). To date, documentation of health system challenges and opportunities for NCD prevention and control is limited in such settings. This paper aims to identify opportunities and challenges in provision of NCD prevention and care and highlight lessons for Sierra Leone and other fragile states in the battle against the growing NCD epidemic. Methods This paper focuses on the case of Sierra Leone and uses a combination of participatory group model building at national and district level, in rural and urban districts, interviews with 28 key informants and review of secondary data and documents. Data is analysed using the WHO’s health system assessment guide for NCDs. Results We highlight multiple challenges typical to those encountered in other fragile settings to the delivery of preventive and curative NCD services. There is limited government and donor commitment to financing and implementation of the national NCD policy and strategy, limited and poorly distributed health workforce and pharmaceuticals, high financial barriers for users, and lack of access to quality-assured medicines with consequent high recourse to private and informal care seeking. We identify how to strengthen the system within existing (low) resources, including through improved clinical guides and tools, more effective engagement with communities, and regulatory and fiscal measures. Conclusion Our study suggests that NCD prevention and control is of low but increasing priority in Sierra Leone; challenges to addressing this burden relate to huge numbers with NCDs (especially hypertension) requiring care, overall resource constraints and wider systemic issues, including poorly supported primary care services and access barriers. In addition to securing and strengthening political will and commitment and directing more resources and attention towards this area, there is a need for in-depth exploratory and implementation research to shape and test NCD interventions in fragile and post-conflict settings.

scholarly journals Exploring Barriers and Facilitators of Adherence to Artemisinin-Based Combination Therapies for the Treatment of Uncomplicated Malaria in Children in Freetown, Sierra Leone

Healthcare ◽  
2021 ◽  
Vol 9 (9) ◽  
pp. 1233
Author(s):  
Kristin Banek ◽  
Deborah D. DiLiberto ◽  
Emily L. Webb ◽  
Samuel Juana Smith ◽  
Daniel Chandramohan ◽  
...  
Keyword(s):  
Health System ◽  
Sierra Leone ◽  
Perceived Risk ◽  
Uncomplicated Malaria ◽  
Health Workers ◽  
Controlled Trial ◽  
Quality Care ◽  
Medication Administration ◽  
Combination Therapies ◽  
Treatment Cascade

Medication adherence is an essential step in the malaria treatment cascade. We conducted a qualitative study embedded within a randomized controlled trial comparing the adherence to the recommended dosing of two artemisinin-based combination therapies (ACT) to treat uncomplicated malaria in Freetown, Sierra Leone. This study explored the circumstances and factors that influenced caregiver adherence to the ACT prescribed for their child in the trial. In-depth interviews were conducted with 49 caregivers; all interviews were recorded, transcribed, and translated. Transcripts were coded and aggregated into themes, applying a thematic content approach. We identified four key factors that influenced optimal treatment adherence: (1) health system influences, (2) health services, (3) caregivers’ experiences with malaria illness and treatment, and (4) medication characteristics. Specifically, caregivers reported confidence in the health system as facilities were well maintained and care was free. They also felt that health workers provided quality care, leading them to trust the health workers and believe the test results. Ease of medication administration and perceived risk of side effects coupled with caregivers’ prior experience treating malaria influenced how medications were administered. To ensure ACTs achieve maximum effectiveness, consideration of these contextual factors and further development of child-friendly antimalarials are needed.

scholarly journals Health workforce in India: opportunities and challenges

2019 ◽  
Vol 6 (10) ◽  
pp. 4596
Author(s):  
Kesavan Sreekantan Nair
Keyword(s):  
Nursing Education ◽  
Health System ◽  
Health Workforce ◽  
Health Workers ◽  
World Health ◽  
Public And Private ◽  
Better Regulation ◽  
Political Commitments ◽  
Health Organization ◽  
Workforce Density

Health system reforms in India during the past decade yielded an impressive growth of medical, dental and nursing education opportunities, but health workforce density remains low in comparison to the World Health Organization (WHO) norms. Apart from shortage, retaining qualified health workforce in the rural and underserved areas remains a huge challenge. This crisis is likely to persist until and unless health system addresses the fundamental requirements of health workers as envisaged in health policies. Concerted attention and long term political commitments are required to overcome health system barriers to achieve rural recruitment and retention across various cadres in states. As the major share of health workforce belongs to the private sector, their resources need to be harnessed to meet health system goals through partnerships and collaborations. There is an urgent need for better regulation and enforcement of standards in medical education and delivery of health services across the public and private sectors.

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