scholarly journals Stakeholders’ perspectives on training over the counter medicine sellers and Community-based Health Planning and Services facilities to dispense antibiotics in Ghana

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Samuel Afari-Asiedu ◽  
Marlies Hulscher ◽  
Martha Ali Abdulai ◽  
Ellen Boamah-Kaali ◽  
Heiman F. L. Wertheim ◽  
...  
Keyword(s):  
Health Services ◽  
Health Planning ◽  
National Level ◽  
Public Health Education ◽  
Antibiotic Use ◽  
District Health ◽  
Community Based ◽  
Over The Counter ◽  
Middle Income ◽  
Pharmacy Council

Abstract Background Dispensing of antibiotics by over the counter medicine sellers (OTCMS) is a major driver of inappropriate use and resistance in low and middle income countries. Recent studies in Ghana revealed the need to consider training OTCMS and Community-based Health Planning and Services (CHPS)/health posts to dispense some antibiotics. Feasibility of training OTCMS and CHPS to dispense some antibiotics was explored in this study. Methods This was an explorative study involving 10 in-depth interviews (IDIs) among staff of Ghana health services (GHS), pharmacy council and the association of OTCMS at the district and regional levels. Next, findings were presented to the Ghana Antimicrobial Resistance (AMR) platform for further discussions at the national level. Five IDIs were also performed among selected members of the AMR platform as a follow-up on emerging issues. Data were thematically analysed and presented as narratives with quotes to support the findings. Results Two opposing views were found in our study. Leadership of OTCMS and GHS staff at the district health directorate supported the suggestion that OTCMS and CHPS should be trained to dispense specific antibiotics because they are already dispensing them. The leadership of OTCMS explained that some of their members are experienced and could be trained to improve their practices. In contrast, participants from pharmacy council, GHS in the region and national AMR platform generally alluded that OTCMS and CHPS should not be trained to dispense antibiotics because their level of education is inadequate. GHS personnel from the region further explained that training OTCMS could further compromise inappropriate antibiotic use in the context of already weak regulation enforcement. GHS and pharmacy council in the region rather suggested that OTCMS and CHPS should focus on public health education on disease prevention and appropriate antibiotic use. Conclusions There is general lack of consensus among stakeholders on whether OTCMS and CHPS should be trained to dispense specific antibiotics. Further stakeholder engagement is required to carefully consider this suggestion as views on feasibility differ. Ministries of health and healthcare agencies in Ghana and LMIC should improve access to approved health services to improve antibiotic use in rural settings.

scholarly journals Implementing evidence-based task-strengthening strategies for hypertension control within Ghana’s Community-based Health Planning Services: a concept mapping analysis

2021 ◽  
Author(s):  
Solomon Nyame ◽  
Juliet Iwelunmor ◽  
Kwaku Poku Asante ◽  
Joyce Gyamfi ◽  
Kwame Adjei ◽  
...  
Keyword(s):  
Capacity Building ◽  
Concept Mapping ◽  
Policy Reform ◽  
Health Planning ◽  
Local Context ◽  
Evidence Based ◽  
Health Coverage ◽  
Hypertension Control ◽  
District Health ◽  
Community Based

Abstract Background As efforts are made to systematically implement an evidence-based task-strengthening strategy for hypertension control (TASSH) in Ghana, understanding their content can help national, regional and district health stakeholders within Ghana’s Health Services (GHS) identify strategies for enhancing intervention uptake and sustainability in their local context. This study sought to describe national, regional and district health stakeholders’ perspectives and characterize the array of strategies needed to enhance the uptake of evidence-based TASSH within Ghana’s Community-based Health and Planning Services (CHPS) zones. Methods This qualitative study was conducted among national, regional and district health stakeholders within GHS serving patients who utilize CHPS zones. The CHPS initiative is Ghana’s flagship strategy for achieving universal health coverage. Semi-structured interviews were conducted with 22 national, regional and district health stakeholders identified via purposive sampling. Interviews were conducted in 2018. Data analysis was conducted between July 2019 and December 2019. Data was analyzed using group concept mapping systems to identify major themes and subthemes. Results About 68 % of participants were male with mean age of 40 years and mean years of experience providing hypertension-related care within GHS of 9 years. A conceptual map emerged, consisting of 46 strategies needed for implementing evidence-based TASSH, organized into 6 clusters: 1) Referral Systems; 2) Availability of Equipment; 3) Protocols and Guidelines; 4) Capacity Building/Training; 5) Policy Reform, and 6) Technical Support and Supervision. Availability of equipment was rated as the most important strategy (mean 4.80 out of 5) needed to implement evidence-based TASSH, while Capacity Building/Training was rated as the most feasible strategy (mean 4.20 out of 5) to address. Although important (mean 4.40 out of 5), Policy reform was rated as the least important and feasible strategy to address. Conclusions These findings demonstrate strategies that can help inform future interventions focused on the adoption and sustainability of evidence-based TASSH within Ghana’s CHPS zones. Also, national, regional and district health stakeholders can support healthcare workers by facilitating access to equipment and strategies for enhancing capacity and training with implementing evidence-based task-shifting hypertension interventions in Ghana.

scholarly journals What will it cost to prevent violence against women and girls in low- and middle-income countries? Evidence from Ghana, Kenya, Pakistan, Rwanda, South Africa and Zambia

2020 ◽  
Vol 35 (7) ◽  
pp. 855-866 ◽  
Author(s):  
Sergio Torres-Rueda ◽  
Giulia Ferrari ◽  
Stacey Orangi ◽  
Regis Hitimana ◽  
Emmanuelle Daviaud ◽  
...  
Keyword(s):  
South Africa ◽  
Violence Against Women ◽  
National Level ◽  
Cost Data ◽  
Community Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
Unit Costs ◽  
Prevention Interventions ◽  
Women And Girls

Abstract Violence against women and girls (VAWG) is a global problem with profound consequences. Although there is a growing body of evidence on the effectiveness of VAWG prevention interventions, economic data are scarce. We carried out a cross-country study to examine the costs of VAWG prevention interventions in low- and middle-income countries. We collected primary cost data on six different pilot VAWG prevention interventions in six countries: Ghana, Kenya, Pakistan, Rwanda, South Africa and Zambia. The interventions varied in their delivery platforms, target populations, settings and theories of change. We adopted a micro-costing methodology. We calculated total costs and a number of unit costs common across interventions (e.g. cost per beneficiary reached). We used the pilot-level cost data to model the expected total costs and unit costs of five interventions scaled up to the national level. Total costs of the pilots varied between ∼US $208 000 in a small group intervention in South Africa to US $2 788 000 in a couples and community-based intervention in Rwanda. Staff costs were the largest cost input across all interventions; consequently, total costs were sensitive to staff time use and salaries. The cost per beneficiary reached in the pilots ranged from ∼US $4 in a community-based intervention in Ghana to US $1324 for one-to-one counselling in Zambia. When scaled up to the national level, total costs ranged from US $32 million in Ghana to US $168 million in Pakistan. Cost per beneficiary reached at scale decreased for all interventions compared to the pilots, except for school-based interventions due to differences in student density per school between the pilot and the national average. The costs of delivering VAWG prevention vary greatly due to differences in the geographical reach, number of intervention components and the complexity of adapting the intervention to the country. Cost-effectiveness analyses are necessary to determine the value for money of interventions.

scholarly journals Impact of national interventions to promote responsible antibiotic use: a systematic review

2019 ◽  
Vol 75 (1) ◽  
pp. 14-29 ◽  
Author(s):  
Jane Mingjie Lim ◽  
Shweta Rajkumar Singh ◽  
Minh Cam Duong ◽  
Helena Legido-Quigley ◽  
Li Yang Hsu ◽  
...  
Keyword(s):  
Systematic Review ◽  
National Level ◽  
Public Health Problem ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Middle Income ◽  
Middle Income Countries ◽  
Policy Interventions ◽  
The Impact

Abstract Background Global recognition of antimicrobial resistance (AMR) as an urgent public health problem has galvanized national and international efforts. Chief among these are interventions to curb the overuse and misuse of antibiotics. However, the impact of these initiatives is not fully understood, making it difficult to assess the expected effectiveness and sustainability of further policy interventions. We conducted a systematic review to summarize existing evidence for the impact of nationally enforced interventions to reduce inappropriate antibiotic use in humans. Methods We searched seven databases and examined reference lists of retrieved articles. To be included, articles had to evaluate the impact of national responsible use initiatives. We excluded studies that only described policy implementations. Results We identified 34 articles detailing interventions in 21 high- and upper-middle-income countries. Interventions addressing inappropriate antibiotic access included antibiotic committees, clinical guidelines and prescribing restrictions. There was consistent evidence that these were effective at reducing antibiotic consumption and prescription. Interventions targeting inappropriate antibiotic demand consisted of education campaigns for healthcare professionals and the general public. Evidence for this was mixed, with several studies showing no impact on overall antibiotic consumption. Conclusions National-level interventions to reduce inappropriate access to antibiotics can be effective. However, evidence is limited to high- and upper-middle-income countries, and more evidence is needed on the long-term sustained impact of interventions. There should also be a simultaneous push towards standardized outcome measures to enable comparisons of interventions in different settings.

scholarly journals Operational Challenges of Engaging Development Partners in District Health Planning in Tanzania

2021 ◽  
Author(s):  
James Charles ◽  
Kusirye Ukio ◽  
Axel Hoffman ◽  
Albino Kalolo
Keyword(s):  
Quantitative Data ◽  
Health Planning ◽  
Descriptive Analysis ◽  
Health Financing ◽  
Health Priorities ◽  
District Health ◽  
Middle Income ◽  
Non Governmental Organizations ◽  
Donor Coordination ◽  
The Government

Abstract BackgroundDevelopment assistance for health represents an important source of health financing in many low and middle-income countries. However, there are few accounts on how priorities funded through Development assistance for health are integrated with district health priorities. This study aimed at understanding the operational challenges of engaging development partners in district health planning in Tanzania MethodsThis explanatory mixed methods study was conducted in Kinondoni and Bahi districts. A structured checklist to 35 participants collected quantitative data whereas a semi-structured guide collected qualitative from 20 key informants (the council health planning team members and the development partners) to obtain information related to engagement of development partners in the planning processes and subsequent implementation of the district plan. We used descriptive analysis for quantitative data and thematic analysis for qualitative data ResultsMajority (86%) of the development partners delivering aid in the studied districts were Non Governmental Organizations. We found high engagement of Development partners (DPs) (87.5%) in Bahi district and very low in Kinondoni district (37.5%). Guidance on district priorities to be included in Development partner’s plans as part of the Comprehensive Council Health Plan (CCHP) was given to 36% of the Development partners. Submission of written plans to be integrated in the District plans was done by only 56% of Development partners, with majority (77.7%) from Kinondoni district not submitting their plans. Only 8% of the submitted plans appeared in the final District plan document. Qualitative findings reported operational challenges to engagements such as differences in planning cycles between the government and donors, uncertainties in funding from the prime donors, lack of transparency, limited skills of district planning teams, technical practicalities on planning tools and processes, inadequate knowledge on planning guidelines among DPs and poor donor coordination at the district level. ConclusionsWe found low engagement of Development partners in planning. To be resolved are operational challenges related to differences in planning cycles, articulations and communication of local priorities, donor coordination, and technical skills on planning and stakeholder engagement.

scholarly journals Challenges to achieving universal health coverage through community-based health planning and services delivery approach: a qualitative study in Ghana

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e024845 ◽  
Author(s):  
Abraham Assan ◽  
Amirhossein Takian ◽  
Moses Aikins ◽  
Ali Akbarisari
Keyword(s):  
Qualitative Study ◽  
Universal Health Coverage ◽  
Low Income ◽  
Health Planning ◽  
National Level ◽  
Health Coverage ◽  
Community Based ◽  
Services Delivery ◽  
Universal Health ◽  
Local Levels

ObjectiveCommunity-based initiatives have enormous potential to facilitate the attainment of universal health coverage (UHC) and health system development. Yet key gaps exist and threaten its sustainability in many low-income and middle-income countries. This study is first of its kind (following the launch of the Sustainable Developments Goal [SDG]) and aimed to holistically explore the challenges to achieving UHC through the community-based health planning and service (CHPS) initiative in Ghana.DesignA qualitative study design was adopted to explore the phenomenon. Face-to-face indepth interviews were conducted from April 2017 until February 2018 through purposive and snowball sampling techniques. Data were analysed using inductive and deductive thematic analysis approach.SettingData were gathered at the national level, in addition to the regional, district and subdistrict/local levels of four regions of Ghana. Sampled regions were Central Region, Greater Accra Region, Upper East Region and Volta Region.ParticipantsIn total, 67 participants were interviewed: national level (5), regional levels (11), district levels (9) and local levels (42). Interviewees were mainly stakeholders—people whose actions or inactions actively or passively influence the decision-making, management and implementation of CHPS, including policy makers, managers of CHPS compound and health centres, politicians, academics, health professionals, technocrats, and community health management committee members.ResultsBased on our findings, inadequate understanding of CHPS concept, major contextual changes with stalled policy change to meet growing health demands, and changes in political landscape and leadership with changed priorities threaten CHPS sustainability.ConclusionUHC is a political choice which can only be achieved through sustainable and coherent efforts. Along countries’ pathways to reach UHC, coordinated involvement of all stakeholders, from community members to international partners, is essential. To achieve UHC within the time frame of SDGs, Ghana has no choice but to improve its national health governance to strengthen the capacity of existing CHPS.

Epidemiology and Primary Health Care

2021 ◽  
pp. 1-19
Author(s):  
J Patrick Vaughan ◽  
Cesar Victora ◽  
A Mushtaque R Chowdhury
Keyword(s):  
Public Health ◽  
Health Care ◽  
Primary Health Care ◽  
Health Services ◽  
Systems Approach ◽  
Health Planning ◽  
District Health ◽  
The Sustainable Development ◽  
Primary Health ◽  
Local Decision Making

This chapter introduces the Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC) and the central role of epidemiological concepts, knowledge, and skills in planning, management, and evaluation of district health systems in support of primary health care. It focuses on interventions to improve the health status of whole populations and shows how epidemiology is essential to support local decision-making for improvements in the population’s health. Health planning is outlined using a systems approach for high-priority health services and public health programmes delivered by district health services and programmes. The differences between interventions for clinical medicine and public health are explained. The systems approach to district planning are also explained.

scholarly journals Implementing Evidence-Based Task Strengthening Strategies for Hypertension Control within Ghana’s Community-Based Health Planning Services: A Concept Mapping Analysis

2021 ◽  
Author(s):  
Solomon Nyame ◽  
Juliet Iwelunmor ◽  
Kwaku Poku Asante ◽  
Joyce Gyamfi ◽  
Kwame Adjei ◽  
...  
Keyword(s):  
Capacity Building ◽  
Concept Mapping ◽  
Policy Reform ◽  
Health Planning ◽  
Local Context ◽  
Evidence Based ◽  
Health Coverage ◽  
Hypertension Control ◽  
District Health ◽  
Community Based

Abstract Background: As efforts are made to systematically implement an evidence-based task-strengthening strategy for hypertension control (TASSH) in Ghana, understanding their content can help national, regional and district health stakeholders within Ghana’s Health Services (GHS) identify strategies for enhancing intervention uptake and sustainability in their local context. This study sought to describe national, regional and district health stakeholders’ perspectives and characterize the array of strategies needed to enhance the uptake of evidence-based TASSH within Ghana’s Community-based Health and Planning Services (CHPS) zones. Methods: This qualitative study was conducted among national, regional and district health stakeholders within GHS serving patients who utilize CHPS zones. The CHPS initiative is Ghana’s flagship strategy for achieving universal health coverage. Semi-structured interviews were conducted with 22 national, regional and district health stakeholders identified via purposive sampling. Interviews were conducted in 2018. Data analysis was conducted between July 2019 and December 2019. Data was analyzed using group concept mapping systems to identify major themes and subthemes.Results: About 68 % of participants were male with mean age of 40 years and mean years of experience providing hypertension-related care within GHS of 9 years. A conceptual map emerged, consisting of 46 strategies needed for implementing evidence-based TASSH, organized into 6 clusters: 1) Referral Systems; 2) Availability of Equipment; 3) Protocols and Guidelines; 4) Capacity Building/Training; 5) Policy Reform, and 6) Technical Support and Supervision. Availability of equipment was rated as the most important strategy (mean 4.80 out of 5) needed to implement evidence-based TASSH, while Capacity Building/Training was rated as the most feasible strategy (mean 4.20 out of 5) to address. Although important (mean 4.40 out of 5), Policy reform was rated as the least important and feasible strategy to address. Conclusions: These findings demonstrate strategies that can help inform future interventions focused on the adoption and sustainability of evidence-based TASSH within Ghana’s CHPS zones. Also, national, regional and district health stakeholders can support healthcare workers by facilitating access to equipment and strategies for enhancing capacity and training with implementing evidence-based task-shifting hypertension interventions in Ghana.

scholarly journals Uptake of Task-Strengthening Strategy for Hypertension (TASSH) control within Community-Based Health Planning Services in Ghana: study protocol for a cluster randomized controlled trial

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Kwaku Poku Asante ◽  
Juliet Iwelunmor ◽  
Kingsley Apusiga ◽  
Joyce Gyamfi ◽  
Solomon Nyame ◽  
...  
Keyword(s):  
Primary Care ◽  
Community Health ◽  
Health Planning ◽  
Empirical Literature ◽  
Evidence Based ◽  
Community Based ◽  
Middle Income ◽  
Major Barrier ◽  
Similar Action ◽  
Middle Income Countries

Abstract Background Physician shortage is a major barrier to hypertension (HTN) control in Ghana, with only one physician to 10,000 patients in 2015, thus limiting its capacity for HTN control at the primary care level such as the Community Health Planning and Services (CHPS) compounds, where most Ghanaians receive care. A Task-Shifting Strategy for HTN control (TASSH) based on the WHO Cardiovascular (CV) Risk Package is an evidence-based strategy for mitigating provider- and systems-level barriers to optimal HTN control. Despite its effectiveness, TASSH remains untested in CHPS zones. Additionally, primary care practices in low- and middle-income countries (LMICs) lack resources and expertise needed to coordinate multilevel system changes without assistance. The proposed study will evaluate the effectiveness of practice facilitation (PF) as a quality improvement strategy for implementing TASSH within CHPS zones in Ghana. Methods Guided by the Consolidated Framework for Implementation Research and the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, we will evaluate, in a hybrid clinical effectiveness-implementation design, the effect of PF on the uptake of an evidence-based TASSH, among 700 adults who present to 70 CHPS zones with uncontrolled HTN. Components of the PF strategy include (a) an advisory board that provides leadership support for implementing the intervention within the CHPS zones and (b) trained task-strengthening facilitators (TSFs) who serve as practice coaches to provide training, and performance feedback to community health officers (CHOs) who will deliver TASSH at the CHPS zones. For this purpose, the TSFs are trained to identify, counsel, and refer adults with uncontrolled HTN to community health centers in Bono East Region of Ghana. Discussion Uptake of community-based evidence-supported interventions for hypertension control in Ghana is urgently needed to address the CVD epidemic and its associated morbidity, mortality, and societal costs. Findings from this study will provide policymakers and other stakeholders the “how to do it” empirical literature on the uptake of evidence-based task-strengthening interventions for HTN control in Ghana and will serve as a model for similar action in other low, middle-income countries. Trial registration ClinicalTrials.gov, NCT03490695. Registered on 6 April 2018. Protocol version and date Version 1, date: 21 August, 2019.

scholarly journals Community based approach to address health disparities among Roma in North Macedonia

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
B Pavlovski ◽  
J Frishchikj
Keyword(s):  
Health Services ◽  
National Level ◽  
Access To Health Services ◽  
Community Members ◽  
Community Based ◽  
Access To Health ◽  
Health Related ◽  
Self Reported Health Status ◽  
Health Rights

Abstract Issue Roma represent vulnerable group regarding health and health outcomes. Most health research and policies perceive Roma as a coherent group, although there are disparities within different subgroups. This is due to social determinants of health and other causes. Perceiving Roma community as monolith group may result in provision of activities for persons that don’t have need and leaving behind the vulnerable. Situation is similar with other marginalized and vulnerable populations. Description In 2016 started community based intervention including social accountability and legal empowerment regarding coverage,quality of health services and health rights violation. Work conducted in ShutoOrizari municipality with estimated 30.000 Roma. In 4 localities where most vulnerable Roma live, each comprised of 200 households. 2 persons from Roma NGOs and 4 community members work as team in 1 locality. Mapping of the community conducted and community inquiry. Findings shared with the community members. Findings used to conduct education of community and toconduct advocacy on local and national level with community participation in 2018for improvement of coverage and quality of services. Results Approach identified disparities among Roma.1256 persons surveyed from 4 localities. 4 localities have high unemployment rate (above 70%),monthly income related to the locality (p < 0.0002). Disparities in health and access to health services among localities noted. Self-reported health status is related to locality(p < 0.002). Coverage with health services also,including having registered gynecologist(p < 0.001),regular gynecological examinations(p < 0.00001),antenatal care(p < 0.0003). Lessons Identifying needs among Roma living in smaller localities enables tailoring of health interventions based on needs. Identification of the problems on micro level is relevant for the community concerned,increasing their involvement in demanding improvement and advocacy. Key messages Working in strictly defined localities/groups from Roma communities provides accurate insight in the health related issues. Working with defined localities/groups enables greater involvement of the community in advocacy for fulfillment of their rights.

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