Workplace wellness programming in low-and middle-income countries: a qualitative study of corporate key informants in Mexico and India

Abstract Performance-based financing (PBF) is being implemented across low- and middle-income countries to improve the availability and quality of health services, including medicines. Although a few studies have examined the effects of PBF on the availability of essential medicines (EMs) in low- and middle-income countries, there is limited knowledge of the mechanisms underlying these effects. Our research aimed to explore how PBF in Cameroon influenced the availability of EMs, and to understand the pathways leading to the experiential dimension related with the observed changes. The design was an exploratory qualitative study. Data were collected through in-depth interviews, using semi-structured questionnaires. Key informants were selected using purposive sampling. The respondents (n = 55) included health services managers, healthcare providers, health authorities, regional drugs store managers and community members. All interviews were recorded, transcribed and analysed using qualitative data analysis software. Thematic analysis was performed. Our findings suggest that the PBF programme improved the perceived availability of EMs in three regions in Cameroon. The change in availability of EMs experienced by stakeholders resulted from several pathways, including the greater autonomy of facilities, the enforced regulation from the district medical team, the greater accountability of the pharmacy attendant and supply system liberalization. However, a sequence of challenges, including delays in PBF payments, limited autonomy, lack of leadership and contextual factors such as remoteness or difficulty in access, was perceived to hinder the capacity to yield optimal changes, resulting in heterogeneity in performance between health facilities. The participants raised concerns regarding the quality control of drugs, the inequalities between facilities and the fragmentation of the drug management system. The study highlights that some specific dimensions of PBF, such as pharmacy autonomy and the liberalization of drugs supply systems, need to be supported by equity interventions, reinforced regulation and measures to ensure the quality of drugs at all levels.

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What are the barriers to scaling up health interventions in low and middle income countries? A qualitative study of academic leaders in implementation science

Globalization and Health ◽

10.1186/1744-8603-8-11 ◽

2012 ◽

Vol 8 (1) ◽

pp. 11 ◽

Cited By ~ 62

Author(s):

Gavin Yamey

Keyword(s):

Qualitative Study ◽

Implementation Science ◽

Scaling Up ◽

Health Interventions ◽

Academic Leaders ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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New vaccine adoption: qualitative study of national decision-making processes in seven low- and middle-income countries

Health Policy and Planning ◽

10.1093/heapol/czs035 ◽

2012 ◽

Vol 27 (suppl 2) ◽

pp. ii5-ii16 ◽

Cited By ~ 17

Author(s):

H. E. D. Burchett ◽

S. Mounier-Jack ◽

U. K. Griffiths ◽

R. Biellik ◽

P. Ongolo-Zogo ◽

...

Keyword(s):

Decision Making ◽

Qualitative Study ◽

Middle Income ◽

Middle Income Countries ◽

Decision Making Processes ◽

Low And Middle Income

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Improving Care for Cancer-Related and Other Forms of Lymphoedema in Low- and Middle-Income Countries: A Qualitative Study

10.21203/rs.3.rs-1102233/v1 ◽

2021 ◽

Author(s):

Eric Torgbenu ◽

Tim Luckett ◽

Mark A. Buhagiar ◽

Cecilia Mauricio Requena ◽

Jane L. Phillips

Keyword(s):

Qualitative Study ◽

Health Professional ◽

Health Care Professionals ◽

World Health ◽

Self Management ◽

Pathways To Care ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income ◽

Current Practices

Abstract Background: Lymphoedema is a common, distressing and debilitating condition that can be related to cancer and its treatment or other conditions. Little is known about current practices in the diagnosis, assessment and management of lymphoedema in low- and middle-income countries (LMIC). Aim: To describe current practices in diagnosing, assessing and managing cancer-related and other forms of lymphoedema in LMIC, and related barriers and facilitators.Methods: An exploratory-descriptive qualitative study. Participants were lymphoedema experts or health care professionals identified via published lymphoedema papers and professional organizations respectively. Sampling was purposive to ensure a diversity of perspectives and experience. Data collection was via semi-structured telephone/video interviews, and questions canvassed participants’ experiences and perceptions of lymphoedema care in LMIC. Interviews were audio-recorded and transcribed verbatim. Analysis proceeded via inductive coding before mapping codes to the World Health Organization’s (WHO) Innovative Care for Chronic Conditions Framework. Results:Nineteen participants were interviewed, most of whom were physiotherapists (n = 11). Ten participants worked permanently in a LMIC, while the remainder were based in a high-income country (HIC) and had been involved in initiatives to improve lymphoedema care across multiple LMIC. Participants indicated that management of cancer versus non-cancer related lymphoedema was similar, but that pathways to care were more straight-forward for those receiving cancer care, leading to earlier diagnosis. Key facilitators to optimizing lymphoedema care in LMIC included: 1) joining forces to overcome lymphoedema-related stigma; 2) building workforce capabilities; and 3) partnering with patients and families to support self-management. Ideas for building workforce included developing health professional knowledge, supporting a commitment to multidisciplinary team care, and adapting HIC guidelines for lymphoedema care to LMIC. Partnering with patients and families to support self-management involved following the person-centred approach, establishing clear communication, promoting adherence to management, adapting management to available resources, and involving patient family and friends in lymphoedema care.Conclusion: Raising community and health professional awareness regarding lymphoedema and its management is a key first step to improving care outcomes. Resources for clinicians and patients/families developed for lymphoedema care in HIC need to be adapted for low resource settings.

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Barriers and enablers to pulmonary rehabilitation in low- and middle-income countries: a qualitative study of healthcare professionals

10.21203/rs.3.rs-1034007/v1 ◽

2021 ◽

Author(s):

Fanuel Bickton ◽

Harriet Shannon

Keyword(s):

Qualitative Study ◽

Pulmonary Rehabilitation ◽

Respiratory Diseases ◽

Healthcare Professionals ◽

Successful Implementation ◽

Middle Income ◽

Chronic Respiratory Diseases ◽

Middle Income Countries ◽

Barriers And Enablers ◽

Low And Middle Income

Abstract Low- and middle-income countries bear a disproportionately high burden of global morbidity and mortality caused by chronic respiratory diseases. Pulmonary rehabilitation is recommended as a core intervention in the management of people with chronic respiratory diseases. However, the intervention remains poorly accessed/utilised globally, especially in low- and middle-income countries. This qualitative study explored barriers and enablers to pulmonary rehabilitation in low- and middle-income countries from the perspective of healthcare professionals with pulmonary rehabilitation experience in these settings. Online-based semi-structured in-depth interviews with healthcare professionals were undertaken to data saturation, exploring lived barriers and enablers to pulmonary rehabilitation in their low- or middle-income country. Anonymised Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis. A total of seven healthcare professionals from seven low- and middle-income countries representing Africa, Asia, and South America, were interviewed. They included five physiotherapists (four females), one family physician (male), and one pulmonologist (female). Themes for barriers to pulmonary rehabilitation included limited resources, low awareness, Coronavirus Disease 2019, and patient access-related costs. Themes for enablers included local adaptation, motivated patients, Coronavirus Disease 2019 (which spanned both enablers and barriers), better awareness/recognition, provision of PR training, and resource support. Successful implementation of these enablers will require engagement with multiple stakeholders. The findings of this study are a necessary step towards developing strategies that can overcome the existing pulmonary rehabilitation evidence-practice gap in low- and middle-income countries and alleviating the burden of chronic respiratory diseases in these countries.

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