scholarly journals Reimagining the role of the nursing workforce in Uganda after more than a decade of ART scale-up

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Henry Zakumumpa
Keyword(s):  
Scale Up ◽  
Nursing Workforce

scholarly journals ‘Oh, she is just a nurse’ Re-imagining the role of the nursing workforce in Uganda after a decade of ART scale-up (2004-2014)

2020 ◽  
Author(s):  
Henry Zakumumpa
Keyword(s):  
Mixed Methods ◽  
Disease Management ◽  
Scale Up ◽  
Task Shifting ◽  
Health Facilities ◽  
Hiv Care ◽  
Scope Of Practice ◽  
Nursing Workforce ◽  
Hiv Disease

Abstract Background The expanding roles and increasing importance of the nursing workforce in health services delivery in resource-limited settings is not adequately documented and sufficiently recognized in the current literature. Drawing upon the theme of 2020 as the international year of the nurse and midwife, we set out to describe how the role of nurses had expanded tremendously in health facilities in Uganda during the era of anti-retroviral therapy (ART) scale-up between 2004 and 2014.Methods A mixed-methods study was conducted in two phases. Phase One entailed a cross-sectional health facility survey (n=195) to assess the extent to which human resource management strategies (such as task shifting) were common. Phase Two entailed qualitative case-studies of 16 (of the 195) health facilities for an in-depth understanding of the strategies adopted (e.g. nurse-centred HIV care). We adopted a qualitatively-led mixed methods approach whereby core thematic analyses were supported by descriptive statistics.Results We found that nurses were the most represented cadre of health workers involved in the overall leadership of HIV clinics across Uganda. Most of nurse-led HIV clinics were based in rural settings although this trend was fairly even across all settings (rural/urban/peri-urban). A number of health facilities in our sample (n=36) deliberately adopted nurse-led HIV care models. Nurses were empowered to be multi-skilled with a wide range of competencies across the HIV care continuum right from HIV testing to mainstream clinical HIV disease management. In several facilities, nursing cadre were the backbone of ART service delivery. A select number of facilities devised differentiated models of task shifting from physicians to doctors to nurses in which the latter handled patients who were stable on ART.Conclusion Overall, our study reveals a wide expansion in the scope-of-practice of nurses during the initial ART scale-up phase in Uganda. Nurses were thrust in roles of HIV disease management that were traditionally the preserve of medical doctors. Our study underscores the importance of reforming regulatory frameworks governing nursing workforce scope of practice in Uganda such as the need for evolving a policy on task shifting which is currently lacking in Uganda.

scholarly journals Reimagining the role of the nursing workforce in Uganda after more than a decade of ART scale-up

2020 ◽  
Author(s):  
Henry Zakumumpa
Keyword(s):  
Disease Management ◽  
Scale Up ◽  
Task Shifting ◽  
Health Facilities ◽  
Hiv Care ◽  
Scope Of Practice ◽  
Nursing Workforce ◽  
Hiv Disease ◽  
Wide Range

Abstract Background The expanding roles and increasing importance of the nursing workforce in health services delivery in resource-limited settings is not adequately documented and sufficiently recognized in the current literature. Drawing upon the theme of 2020 as the international year of the Nurse and Midwife, we set out to describe how the role of nurses expanded tremendously in health facilities in Uganda during the era of anti-retroviral therapy (ART) scale-up that commenced in June 2004.Methods We employed a mixed-methods sequential explanatory research design. Phase One entailed a cross-sectional health facility survey (n=195) to assess the extent to which human resource management strategies (such as task shifting) were common. Phase Two entailed a qualitative multiple case-study of 16 (of the 195) health facilities for an in-depth understanding of the strategies adopted (e.g. nurse-centred HIV care). Descriptive analyses were performed in STATA (v 13) while qualitative data were analyzed by thematic approach.Results We found that nurses were the most represented cadre of health workers involved in the overall leadership of HIV clinics across Uganda. Most nurse-led HIV clinics were based in rural settings however this trend was fairly even across setting (rural/urban/peri-urban). While 181(93%) health facilities allowed non-physician cadre to prescribe ART, a number of health facilities (n=36) or 18% deliberately adopted nurse-led HIV care models. Nurses were empowered to be multi-skilled with a wide range of competencies across the HIV care continuum right from HIV testing to mainstream clinical HIV disease management. In several facilities, nursing cadre were the backbone of ART service delivery. A select number of facilities devised differentiated models of task shifting from physicians to nurses in which the latter handled patients who were stable on ART. Conclusion Overall, our study reveals a wide expansion in the scope-of-practice of nurses during ART scale-up in Uganda. Nurses were thrust in roles of HIV disease management that were traditionally the preserve of physicians. Our study underscores the importance of reforming regulatory frameworks governing nursing workforce scope-of-practice such as the need for developing a policy on task shifting which is currently lacking in Uganda.

When People Come First

2013 ◽  
Keyword(s):  
Global Health ◽  
Scale Up ◽  
Moral Economy ◽  
Health Science ◽  
Health It ◽  
Left Behind ◽  
New Research ◽  
Health Enterprise ◽  
Conceptual Work

This book critically assesses the expanding field of global health. It brings together an international and interdisciplinary group of scholars to address the medical, social, political, and economic dimensions of the global health enterprise through vivid case studies and bold conceptual work. The book demonstrates the crucial role of ethnography as an empirical lantern in global health, arguing for a more comprehensive, people-centered approach. Topics include the limits of technological quick fixes in disease control, the moral economy of global health science, the unexpected effects of massive treatment rollouts in resource-poor contexts, and how right-to-health activism coalesces with the increased influence of the pharmaceutical industry on health care. The chapters explore the altered landscapes left behind after programs scale up, break down, or move on. We learn that disease is really never just one thing, technology delivery does not equate with care, and biology and technology interact in ways we cannot always predict. The most effective solutions may well be found in people themselves, who consistently exceed the projections of experts and the medical-scientific, political, and humanitarian frameworks in which they are cast. This book sets a new research agenda in global health and social theory and challenges us to rethink the relationships between care, rights, health, and economic futures.

scholarly journals Trends and Clinico-Epidemiological Features of Human Rabies Cases in Bangladesh, 2006–2018

2020 ◽  
Vol 41 (S1) ◽  
pp. s416-s416
Author(s):  
Sumon Ghosh ◽  
Md. Sohel Rana ◽  
Sukanta Chowdhury
Keyword(s):  
Effective Means ◽  
Scale Up ◽  
Traditional Healers ◽  
Human Rabies ◽  
Epidemiological Analysis ◽  
Increasing Trend ◽  
The Mean ◽  
Death Cases ◽  
Death Data

Background: Vaccinating dogs against rabies is an effective means of reducing human rabies. Methods: We analyzed 1,327 clinically diagnosed human rabies deaths and mass dog vaccination (MDV) data during 2006–2018 to quantify the impacts of MDV on human rabies incidence in Bangladesh and a subset of rabies death data (n = 422) for clinico-epidemiological analysis. Results: We found a positive and increasing trend of dog population vaccination (P = .01 and τ = 0.71) and a negative and declining trend (P < .001 and τ = −0.88) of human rabies cases (correlation coefficient, −0.82). Among 422 human rabies death cases, most victims (78%) sought treatment from traditional healers, and 12% received postexposure prophylaxis (PEP). The mean incubation period of rabies cases with exposure sites on the head and neck (35 days) was shorter than the upper limb (mean, 64 days; P = .02) and lower limb (mean, 89 days; P < .01). MDV is effective for reducing human rabies cases in Bangladesh. Conclusions: Creating awareness among the animal bite victims to stop relying on traditional healers rather seeking PEP, addressing the role of traditional healers through an awareness education program in respect to the treatment of dog bites, ensuring availability of PEP, and continuing to scale up MDV can help prevent human rabies deaths.Funding: NoneDisclosures: None

The role of reaction calorimetry in the development and scale-up of aromatic nitrations

1996 ◽  
Vol 289 (2) ◽  
pp. 143-154 ◽  
Author(s):  
D.J. am Ende ◽  
P.J. Clifford ◽  
D.L. Northrup
Keyword(s):  
Scale Up ◽  
Reaction Calorimetry

scholarly journals Biogas Generation from Co-Digestion Waste Systems: The Role of Water Hyacinth

2022 ◽  
Author(s):  
Adedeji A. Adelodun ◽  
Temitope M. Olajire ◽  
Ochuko Mary Ojo
Keyword(s):  
Water Hyacinth ◽  
Aquatic Macrophyte ◽  
Biogas Production ◽  
Scale Up ◽  
Environmentally Benign ◽  
Organic Loading Rate ◽  
Eichornia Crassipes ◽  
Poultry Droppings ◽  
Pig Wastes

Using biomass as a renewable energy source has earned tremendous interest from researchers in recent decades, especially because the technology is environmentally benign. This article reviews the recent methods for generating biogas from water hyacinth (WH, Eichornia crassipes), arguably the world’s most evasive aquatic macrophyte. Therefore, various economic, environmentally benign, and renewable procedures that enhance biogas production from WH biomass are reviewed. WH has been co-digested with numerous waste types, including poultry droppings, municipal wastes, animal tissue wastes, pig wastes, cow dungs, etc., recording varying success degrees. Other studies focused on optimizing the operation parameters, such as mixing ratio, contact time, pH, temperature, organic loading rate, etc. We observed that most attempts to generate biogas from WH alone were not promising. However, when co-digested with other biomasses or wastes, WH either increases the process rate or improves the methane yield content. Also, the potential of WH as a phytoremdiator-cum-biogas source was investigated. This chapter provides mathematical models, scale-up installation models, and specific experimental results from various studies to guide future study plans toward optimizing CH4 generation from WH co-digestion.

scholarly journals Role of the Global Fund in national HIV/AIDS response in Myanmar: a qualitative study

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Zarni Htun ◽  
Yingxi Zhao ◽  
Hannah Gilbert ◽  
Chunling Lu
Keyword(s):  
Civil Society ◽  
Qualitative Study ◽  
Health System ◽  
Global Fund ◽  
Scale Up ◽  
Building Blocks ◽  
Key Informants ◽  
The Impact ◽  
Hiv Aids

Abstract Background The Global Fund has been a major funding source for HIV/AIDS programs in Myanmar. In this qualitative study, we aim to understand the impact of Global Fund on national HIV/AIDS response in Myanmar during the era of Millennium Development Goals (MDGs). Methods We conducted individual in-depth interviews by recruiting key informants through purposive snowball sampling. The respondents were engaged in the national/subnational response to HIV/AIDS in Myanmar and worked for the United Nations agencies, non-governmental organizations (NGOs), and civil society. Interview questions were organized around the role of Global Fund in strengthening national response to HIV/AIDS in the six building blocks of the Myanmar’s health system. Transcripts from the key informants were synthesized into specific themes through a deductive approach. Results We found that the Global Fund has provided substantial support to (1) finance the national HIV/AIDS response in Myanmar, and (2) strengthen leadership and governance at the central level through improving coordination and collaboration, including more stakeholders (e.g. civil society, NGOs) in decision making process, and catalyzing policy changes on scaling-up key interventions. Yet, its role remains limited in addressing new demands at the township level in terms of capacity building, staffing, and medical supply resulting from rapid scale-up of HIV interventions and decentralization of service delivery in the public sector. Conclusion There was a missed opportunity for Myanmar to capitalize on the use of the Global Fund’s funding to strengthen the health system. Deliberate planning is required to optimize the use of those scarce resources to provide universal coverage for HIV/AIDS.

scholarly journals Evaluating farmers’ perception toward the effectiveness of agricultural extension services in Ghana and Zambia

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Albert Novas Somanje ◽  
Geetha Mohan ◽  
Osamu Saito
Keyword(s):  
Agricultural Research ◽  
Scale Up ◽  
Agricultural Practices ◽  
Household Survey ◽  
Agricultural Extension ◽  
Mixed Method Research ◽  
Extension Services ◽  
Factors Affecting ◽  
Access To Credit

Abstract Background In this study, we present the current situation and the role of agricultural extension services for farmers and indicates the potential solutions for the optimum effectiveness of these services. Thus, we investigate the vital determinants influencing the farmers’ attitudes toward using agricultural extension services in Ghana and Zambia. Methods In this study, we used a mixed-method research analysis of data from a household survey of 240 farmers and 8 key informant interviews in the Upper West Region of Ghana and the Southern Province of Zambia. Results The significant factors affecting the association of agricultural extension officers with farmers are regular meetings, demand for services and productivity, and the adoption rate of technology. Notably, approaches based on information communication technology indicators include owning cell phones; further, having radio access significantly affects agricultural practices. However, the role of gender, access to credit, and owning a television would influence food safety and nutrition. Conclusions Understanding the critical determinants will provide potential solutions to national agricultural research institutes, private research entities, and policymakers to scale-up the effectiveness of agricultural extension services, particularly in Ghana and Zambia.

Prototyping of microbial chassis for the biomanufacturing of high-value chemical targets

2021 ◽  
Author(s):  
Christopher J. Robinson ◽  
Jonathan Tellechea-Luzardo ◽  
Pablo Carbonell ◽  
Adrian J. Jervis ◽  
Cunyu Yan ◽  
...  
Keyword(s):  
Metabolic Engineering ◽  
Potential Role ◽  
Design Space ◽  
Scale Up ◽  
Combinatorial Design ◽  
Design Build ◽  
Biological Circuits ◽  
Genetic Constructs ◽  
Host Strains

Metabolic engineering technologies have been employed with increasing success over the last three decades for the engineering and optimization of industrial host strains to competitively produce high-value chemical targets. To this end, continued reductions in the time taken from concept, to development, to scale-up are essential. Design–Build–Test–Learn pipelines that are able to rapidly deliver diverse chemical targets through iterative optimization of microbial production strains have been established. Biofoundries are employing in silico tools for the design of genetic parts, alongside combinatorial design of experiments approaches to optimize selection from within the potential design space of biological circuits based on multi-criteria objectives. These genetic constructs can then be built and tested through automated laboratory workflows, with performance data analysed in the learn phase to inform further design. Successful examples of rapid prototyping processes for microbially produced compounds reveal the potential role of biofoundries in leading the sustainable production of next-generation bio-based chemicals.

Sign in / Sign up

Export Citation Format

Share Document