scholarly journals Systematic review of performance-enhancing health worker supervision approaches in low- and middle-income countries

2022 ◽  
Vol 20 (1) ◽  
Author(s):  
Rachel Deussom ◽  
Doris Mwarey ◽  
Mekdelawit Bayu ◽  
Sarah S. Abdullah ◽  
Rachel Marcus
Keyword(s):  
Health System ◽  
Health Worker ◽  
Human Resources For Health ◽  
Data Systems ◽  
Middle Income ◽  
Middle Income Countries ◽  
Continuous Quality ◽  
Quality Health ◽  
System Data ◽  
Health System Data

Abstract Background The strength of a health system—and ultimately the health of a population—depends to a large degree on health worker performance. However, insufficient support to build, manage and optimize human resources for health (HRH) in low- and middle-income countries (LMICs) results in inadequate health workforce performance, perpetuating health inequities and low-quality health services. Methods The USAID-funded Human Resources for Health in 2030 Program (HRH2030) conducted a systematic review of studies documenting supervision enhancements and approaches that improved health worker performance to highlight components associated with these interventions’ effectiveness. Structured by a conceptual framework to classify the inputs, processes, and results, the review assessed 57 supervision studies since 2010 in approximately 29 LMICs. Results Of the successful supervision approaches described in the 57 studies reviewed, 44 were externally funded pilots, which is a limitation. Thirty focused on community health worker (CHW) programs. Health worker supervision was informed by health system data for 38 approaches (67%) and 22 approaches used continuous quality improvement (QI) (39%). Many successful approaches integrated digital supervision technologies (e.g., SmartPhones, mHealth applications) to support existing data systems and complement other health system activities. Few studies were adapted, scaled, or sustained, limiting reports of cost-effectiveness or impact. Conclusion Building on results from the review, to increase health worker supervision effectiveness we recommend to: integrate evidence-based, QI tools and processes; integrate digital supervision data into supervision processes; increase use of health system information and performance data when planning supervision visits to prioritize lowest-performing areas; scale and replicate successful models across service delivery areas and geographies; expand and institutionalize supervision to reach, prepare, protect, and support frontline health workers, especially during health emergencies; transition and sustain supervision efforts with domestic human and financial resources, including communities, for holistic workforce support. In conclusion, effective health worker supervision is informed by health system data, uses continuous quality improvement (QI), and employs digital technologies integrated into other health system activities and existing data systems to enable a whole system approach. Effective supervision enhancements and innovations should be better integrated, scaled, and sustained within existing systems to improve access to quality health care.

scholarly journals The Governance of National Community Health Worker Programmes in Low- and Middle-Income Countries: An Empirically Based Framework of Governance Principles, Purposes and Tasks

2018 ◽  
Vol 8 (1) ◽  
pp. 18-27 ◽  
Author(s):  
Helen Schneider
Keyword(s):  
Health System ◽  
Community Health ◽  
Health Worker ◽  
Community Health Worker ◽  
Political Support ◽  
Community Based ◽  
Middle Income ◽  
National Community ◽  
Middle Income Countries ◽  
Low And Middle Income

Background: National community health worker (CHW) programmes are increasingly regarded as an integral component of primary healthcare (PHC) in low- and middle-income countries (LMICs). At the interface of the formal health system and communities, CHW programmes evolve in context specific ways, with unique cadres and a variety of vertical and horizontal relationships. These programmes need to be appropriately governed if they are to succeed, yet there is little evidence or guidance on what this entails in practice. Based on empirical observations of South Africa’s community-based health sector and informed by theoretical insights on governance, this paper proposes a practical framework for the design and strengthening of CHW programme governance at scale. Methods: Conceptually, the framework is based on multi-level governance thinking, that is, the distributed, negotiated and iterative nature of decision-making, and the rules, processes and relationships that support this in health systems. The specific purposes and tasks of CHW programme governance outlined in the framework draw from observations and published case study research on the formulation and early implementation of the Ward Based Outreach Team strategy in South Africa. Results: The framework is presented as a set of principles and a matrix of 5 key governance purposes (or outputs). These purposes are: a negotiated fit between policy mandates and evidence, histories and strategies of community-based services; local organisational and accountability relationships that provide community-based actors with sufficient autonomy and power to act; aligned and integrated programme management systems; processes that enable system learning, adaptation and change; and sustained political support. These purposes are further elaborated into 17 specific tasks, distributed across levels of the health system (national, regional, and local). Conclusion: In systematising the governance functions in CHW programmes, the paper seeks to shed light on how best to support and strengthen these functions at scale.

scholarly journals Approaches to motivate physicians and nurses in low- and middle-income countries: a systematic literature review

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Jaya Gupta ◽  
Mariya C. Patwa ◽  
Angel Khuu ◽  
Andreea A. Creanga
Keyword(s):  
Systematic Review ◽  
Randomized Trial ◽  
Health Worker ◽  
Work Motivation ◽  
Health Workers ◽  
Trial Group ◽  
Middle Income ◽  
Group Design ◽  
Middle Income Countries ◽  
Worker Motivation

AbstractPoor health worker motivation, and the resultant shortages and geographic imbalances of providers, impedes the provision of quality care in low- and middle-income countries (LMICs). This systematic review summarizes the evidence on interventions used to motivate health workers in LMICs. A standardized keyword search strategy was employed across five databases from September 2007 -September 2017. Studies had to meet the following criteria: original study; doctors and/or nurses as target population for intervention(s); work motivation as study outcome; study design with clearly defined comparison group; categorized as either a supervision, compensation, systems support, or lifelong learning intervention; and conducted in a LMIC setting. Two independent reviewers screened 3845 titles and abstracts and, subsequently, reviewed 269 full articles. Seven studies were retained from China (n = 1), Ghana (n = 2), Iran (n = 1), Mozambique (n = 1), and Zambia (n = 2). Study data and risk of bias were extracted using a standardized form. Though work motivation was the primary study outcome, four studies did not provide an outcome definition and five studies did not describe use of a theoretical framework in the ascertainment. Four studies used a randomized trial—group design, one used a non-randomized trial—group design, one used a cross-sectional design, and one used a pretest–posttest design. All three studies that found a significant positive effect on motivational outcomes had a supervision component. Of the three studies that found no effects on motivation, two were primarily compensation interventions and the third was a systems support intervention. One study found a significant negative effect of a compensation intervention on health worker motivation. In conducting this systematic review, we found there is limited evidence on successful interventions to motivate health workers in LMICs. True effects on select categories of health workers may have been obscured given that studies included health workers with a wide range of social and professional characteristics. Robust studies that use validated and culturally appropriate tools to assess worker motivation are greatly needed in the Sustainable Development Goals era.

scholarly journals Assessing trauma care systems in low-income and middle-income countries: a systematic review and evidence synthesis mapping the Three Delays framework to injury health system assessments

2021 ◽  
Vol 6 (5) ◽  
pp. e004324
Author(s):  
John Whitaker ◽  
Nollaig O'Donohoe ◽  
Max Denning ◽  
Dan Poenaru ◽  
Elena Guadagno ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health System ◽  
Evidence Synthesis ◽  
Rapid Assessment ◽  
Sub Saharan Africa ◽  
Trauma Systems ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries ◽  
Three Delays

BackgroundThe large burden of injuries falls disproportionately on low/middle-income countries (LMICs). Health system interventions improve outcomes in high-income countries. Assessing LMIC trauma systems supports their improvement. Evaluating systems using a Three Delays framework, considering barriers to seeking (Delay 1), reaching (Delay 2) and receiving care (Delay 3), has aided maternal health gains. Rapid assessments allow timely appraisal within resource and logistically constrained settings. We systematically reviewed existing literature on the assessment of LMIC trauma systems, applying the Three Delays framework and rapid assessment principles.MethodsWe conducted a systematic review and narrative synthesis of articles assessing LMIC trauma systems. We searched seven databases and grey literature for studies and reports published until October 2018. Inclusion criteria were an injury care focus and assessment of at least one defined system aspect. We mapped each study to the Three Delays framework and judged its suitability for rapid assessment.ResultsOf 14 677 articles identified, 111 studies and 8 documents were included. Sub-Saharan Africa was the most commonly included region (44.1%). Delay 3, either alone or in combination, was most commonly assessed (79.3%) followed by Delay 2 (46.8%) and Delay 1 (10.8%). Facility assessment was the most common method of assessment (36.0%). Only 2.7% of studies assessed all Three Delays. We judged 62.6% of study methodologies potentially suitable for rapid assessment.ConclusionsWhole health system injury research is needed as facility capacity assessments dominate. Future studies should consider novel or combined methods to study Delays 1 and 2, alongside care processes and outcomes.

Assessing the impact of Queensland's late‐night alcohol restrictions using health system data

2021 ◽  
Author(s):  
Michael Livingston ◽  
Kerri Coomber ◽  
Dominique de Andrade ◽  
Nicholas Taylor ◽  
Jason Ferris ◽  
...  
Keyword(s):  
Health System ◽  
Late Night ◽  
System Data ◽  
Health System Data ◽  
The Impact

Using Health System Data for Improvement Science: Getting Started

2018 ◽  
Vol 29 (3) ◽  
pp. 348-353 ◽  
Author(s):  
Yanfang Zhao ◽  
Bradi B. Granger
Keyword(s):  
Health System ◽  
Improvement Science ◽  
System Data ◽  
Health System Data

scholarly journals Development and application of a hybrid implementation research framework to understand success in reducing under-5 mortality in Rwanda

2021 ◽  
Vol 5 ◽  
pp. 72
Author(s):  
Lisa R. Hirschhorn ◽  
Miriam Frisch ◽  
Jovial Thomas Ntawukuriryayo ◽  
Amelia VanderZanden ◽  
Kateri Donahoe ◽  
...  
Keyword(s):  
Health System ◽  
Implementation Research ◽  
Contextual Factors ◽  
Common Pathway ◽  
Middle Income ◽  
Middle Income Countries ◽  
Mixed Methods Case Study ◽  
Hybrid Framework ◽  
Successes And Challenges

Background: We describe the development and testing of a hybrid implementation research (IR) framework to understand the pathways, successes, and challenges in addressing amenable under-5 mortality (U5M) – deaths preventable through health system-delivered evidence-based interventions (EBIs) – in low- and middle-income countries (LMICs). Methods: We reviewed existing IR frameworks to develop a hybrid framework designed to better understand U5M reduction in LMICs from identification of leading causes of amenable U5M, to EBI choice, identification and testing of strategies, work to achieve sustainability at scale and key contextual factors. We then conducted a mixed-methods case study of Rwanda using the framework to explore its utility in understanding the steps the country took in EBI-related decision-making and implementation between 2000-2015, key contextual factors which hindered or facilitated success, and extract actionable knowledge for other countries working to reduce U5M. Results: While relevant frameworks were identified, none individually covered the scope needed to understand Rwanda’s actions and success. Building on these frameworks, we combined and adapted relevant frameworks to capture exploration, planning, implementation, contextual factors in LMICs such as Rwanda, and outcomes beyond effectiveness and coverage. Utilizing our hybrid framework in Rwanda, we studied multiple EBIs and identified a common pathway and cross-cutting strategies and contextual factors that supported the country’s success in reducing U5M through the health system EBIs. Using these findings, we identified transferable lessons for other countries working to accelerate reduction in U5M. Conclusions: We found that a hybrid framework building on and adapting existing frameworks was successful in guiding data collection and interpretation of results, emerging new insights into how and why Rwanda achieved equitable introduction and implementation of health system EBIs that contributed to the decline in U5M, and generated lessons for countries working to drop U5M.

scholarly journals The Evolution of Measles in Romania Between 2016 and 2018. A comprehesive overview

2019 ◽  
Vol 70 (10) ◽  
pp. 3665-3670
Author(s):  
Simona Nicoleta Musat ◽  
Maria Roxana Nemes ◽  
Cosmin Alec Moldovan ◽  
Tudor Harsovescu ◽  
Ioan Sorin Tudorache ◽  
...  
Keyword(s):  
Public Health ◽  
Health System ◽  
Health Management ◽  
National Health System ◽  
Public Health Issue ◽  
Complication Rates ◽  
Vaccination Rates ◽  
Grand Total ◽  
System Data ◽  
Health System Data

Measles is an ever-growing threat, a major public health issue, being responsible for a large number of deaths, especially in children. This paper aims to study all cases of measles in Romanian hospitals, cases reported by National School of Public Health, Management and Professional Development, Bucharest on a two year period of time; the study focuses on frequency and pattern territorial distribution of cases, temporal evolution, complication rates and the social pressure the such an infectious disease is putting onto the national health system. Data gathered shows a total number of 2,985 for 2016, 10,181 for 2017 and 8,364 for the entire 2018, with a grand total of 21,530 patients analyzed by our study. The analysis clearly shows, on one hand, a descending rate in vaccination coverage, compared with the national assigned target and, on the other hand, a continuous drop in vaccination rates with the first dose of Measles-mumps-rubella vaccine (MMR), both being in equal manner dangerous situations for the entire health system in Romania.

Conclusion

2021 ◽  
pp. 195-202
Author(s):  
Laura Hakimi ◽  
Anne Geniets ◽  
James O’Donovan ◽  
Niall Winters
Keyword(s):  
Community Health ◽  
Case Studies ◽  
Health Worker ◽  
Community Health Worker ◽  
Middle Income ◽  
Middle Income Countries ◽  
Methodological Research ◽  
Training And Supervision ◽  
Low And Middle Income

Training and supervision are paramount to well-functioning, adaptable Community Health Worker (CHW) programmes. Balancing theoretical and methodological research, lessons from health worker practice, and case studies, this volume has sought to provide a resource to practitioners, policymakers and academics striving to design equitable, participatory CHW programmes. Weaving together interdisciplinary and multiregional perspectives, this book has focussed on the design, implementation and evaluation of technology-based programmes for training and supervision of CHWs, particularly in low- and middle income countries. In doing so, it has set out a roadmap for future equitable, pedagogy-driven CHW programmes.

scholarly journals The Perspectives of Programme Staff and Recipients on the Acceptability and Benefits of the Ward-Based Outreach Teams in a South African Province

Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 464
Author(s):  
Cheryl Nelson ◽  
Sphiwe Madiba
Keyword(s):  
Health System ◽  
Treatment Adherence ◽  
Positive Effects ◽  
Multiple Data ◽  
Outreach Services ◽  
Default Rates ◽  
Outreach Programme ◽  
System Data ◽  
Health System Data ◽  
Cure Rates

The re-engineering of primary health care (PHC) called for the establishment of ward-based outreach teams as a reform strategy to bridge the gap between health facilities and communities. The Nkangala district established ward-based outreach teams in 2012. We used process evaluation to assess the acceptability of the outreach teams from the perspectives of those involved in the implementation as well as the clients who are the recipients of the outreach services in order to describe how the programme benefits the recipients, the staff, and the health system. Data were collected through interviews with multiple data sources. A thematic analysis was done using NVivo 11. The outreach programme is acceptable to the recipients and staff. The acceptability translated into measurable benefits for the recipients and the health system. Health benefits included increased access to services, support for treatment adherence, and linkages to various sector departments for social support. Since the inception of outreach teams, the district has recorded low utilisation of PHC services and improved priority indicators such as immunisation coverage, early antenatal bookings, treatment adherence, TB cure rates, and decreased default rates. The positive effects of the outreach teams on indicators underscore the need to roll the programme out to all sub-districts.

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