scholarly journals The Views of Health Workforce Managers on the Implementation of Workload Indicators of Staffing Need (WISN) Method in Primary Healthcare Settings in South Africa

2017 ◽  
Vol 3 (1) ◽  
pp. 132
Author(s):  
Ntshengedzeni M. Ravhengani ◽  
Ntombifikile G. Mtshali
Keyword(s):  
South Africa ◽  
Health Workforce ◽  
Primary Healthcare ◽  
Workforce Planning ◽  
Implementation Process ◽  
Health Systems Strengthening ◽  
Management Approach ◽  
Successful Implementation ◽  
Implementation Barriers ◽  
African Countries

Background: Several African countries, including South Africa, are using the Workload Indicators of Staffing Need (WISN) method, as the preferred health workforce planning and management approach. Ineffective implementation of this method can however mean that health outcomes are not improved.Objectives: This study explored the views of health workforce managers regarding potential barriers and enablers to implementation of the WISN method in South African primary healthcare (PHC) settings.Method: This study adopted a qualitative approach and Grounded Theory research design. Following ethics clearance, a total of fourteen participants, PHC nurse managers and WISN coordinators were purposefully selected to participate in the study. Data were collected through focus group interviews and document analysis. Open, axial and selective coding was conducted to analyse data, including the use of Nvivo data analysis software to assist with the analysis.Findings: Participants in this study highlighted a number of conditions necessary for the successful implementation of the WISN method. These included political will and leadership, provision of necessary support to enable implementation process, collaborative and consultative approach by stakeholders, clear, efficient and consistent communication, resources availability, continued support in implementing WISN and stability in leadership and staff in PHC settings.Conclusions: The study concludes that successful WISN implementation requires addressing implementation barriers, such as unavailability of financial and human resources, and enhancing enablers, such as normative guides implementation guideline, technical capacity and availability of continuous support to implementers. This study’s results can be used to enhance WISN implementation and health systems strengthening.

scholarly journals Addressing the quality and scope of paediatric primary care in South Africa: Evaluating contextual impacts of the introduction of the Practical Approach to Care Kit for children (PACK Child)

2020 ◽  
Author(s):  
Jamie Murdoch ◽  
Robyn Curran ◽  
Ruth Cornick ◽  
Sandy Picken ◽  
Max Bachmann ◽  
...  
Keyword(s):  
South Africa ◽  
Primary Care ◽  
Primary Healthcare ◽  
Routine Care ◽  
Health Systems Strengthening ◽  
Psychosocial Issues ◽  
Healthcare Facilities ◽  
Contextual Features ◽  
Child Intervention

Abstract Background: Despite significant reductions in mortality, preventable and treatable conditions remain leading causes of death and illness in children in South Africa. The PACK Child intervention, comprising clinical decision support tool (guide), training strategy and health systems strengthening components, was developed to expand on WHO’s Integrated Management of Childhood Illness programme, extending care of children under 5 years to those aged 0-13 years, those with chronic conditions needing regular follow-up, integration of curative and preventive measures and routine care of the well child. In 2017-2018, PACK Child was piloted in 10 primary healthcare facilities in the Western Cape Province. Here we report findings from an investigation into the contextual features of South African primary care that shaped how clinicians delivered the PACK Child intervention within clinical consultations.Methods: Process evaluation using linguistic ethnographic methodology which provides analytical tools for investigating human behaviour, and the shifting meaning of talk and text within context. Methods included semi-structured interviews, focus groups, ethnographic observation, audio-recorded consultations and documentary analysis. Analysis focused on how mapped contextual features structured clinician-caregiver interactions. Results: Primary healthcare facilities demonstrated an institutionalised orientation to minimising risk upheld by provincial documentation, providing curative episodic care to children presenting with acute symptoms, and preventive care including immunisations, feeding and growth monitoring, all in children 5 years or younger. Children with chronic illnesses such as asthma rarely receive routine care. These contextual features constrained the ability of clinicians to use the PACK Child guide to facilitate diagnosis of long-term conditions, elicit and manage psychosocial issues, and navigate use of the guide alongside provincial documentation. Conclusion: Our findings provide evidence that PACK Child is catalysing a transition to an approach that strikes a balance between assessing and minimising risk on the day of acute presentation and a larger remit of care for children over time. However, optimising success of the intervention requires reviewing priorities for paediatric care which will facilitate enhanced skills, knowledge and deployment of clinical staff to better address acute illnesses and long-term health conditions of children of all ages, as well as complex psychosocial issues surrounding the child.

scholarly journals Contextualizing and pilot testing the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) to primary healthcare workers in Kilifi, Kenya

2020 ◽  
Vol 7 ◽  
Author(s):  
Mary A. Bitta ◽  
Symon M. Kariuki ◽  
Anisa Omar ◽  
Leonard Nasoro ◽  
Monica Njeri ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Healthcare ◽  
Implementation Process ◽  
Research Programme ◽  
Rank Test ◽  
Situational Analysis ◽  
Successful Implementation ◽  
Pilot Testing ◽  
Health Gap ◽  
Action Programme

Abstract Background Little data exists about the methodology of contextualizing version two of the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) in resource-poor settings. This paper describes the contextualisation and pilot testing of the guide in Kilifi, Kenya. Methods Contextualisation was conducted as a collaboration between the KEMRI-Wellcome Trust Research Programme (KWTRP) and Kilifi County Government's Department of Health (KCGH) between 2016 and 2018. It adapted a mixed-method design and involved a situational analysis, stakeholder engagement, local adaptation and pilot testing of the adapted guide. Qualitative data were analysed using content analysis to identify key facilitators and barriers to the implementation process. Pre- and post-training scores of the adapted guide were compared using the Wilcoxon signed-rank test. Results Human resource for mental health in Kilifi is strained with limited infrastructure and outdated legislation. Barriers to implementation included few specialists for referral, unreliable drug supply, difficulty in translating the guide to Kiswahili language, lack of clarity of the roles of KWTRP and KCGH in the implementation process and the unwillingness of the biomedical practitioners to collaborate with traditional health practitioners to enhance referrals to hospital. In the adaptation process, stakeholders recommended the exclusion of child and adolescent mental and behavioural problems, as well as dementia modules from the final version of the guide. Pilot testing of the adapted guide showed a significant improvement in the post-training scores: 66.3% (95% CI 62.4–70.8) v. 76.6% (95% CI 71.6–79.2) (p < 0.001). Conclusion The adapted mhGAP-IG version two can be used across coastal Kenya to train primary healthcare providers. However, successful implementation in Kilifi will require a review of new evidence on the burden of disease, improvements in the mental health system and sustained dialogue among stakeholders.

scholarly journals Using a mentorship model to localise the Practical Approach to Care Kit (PACK): from South Africa to Nigeria

2018 ◽  
Vol 3 (Suppl 5) ◽  
pp. e001079 ◽  
Author(s):  
Ajibola Awotiwon ◽  
Charlie Sword ◽  
Tracy Eastman ◽  
Christy Joy Ras ◽  
Prince Ana ◽  
...  
Keyword(s):  
South Africa ◽  
Primary Healthcare ◽  
Healthcare Services ◽  
Health Systems Strengthening ◽  
Added Value ◽  
Practical Approach ◽  
Continuous Learning ◽  
Healthcare Facilities ◽  
Face To Face ◽  
User Friendly

Nigeria, in its quest to strengthen its primary healthcare system, is faced with a number of challenges including a shortage of clinicians and skills. Methods are being sought to better equip primary healthcare clinicians for the clinical demands that they face. Using a mentorship model between developers in South Africa and Nigerian clinicians, the Practical Approach to Care Kit (PACK) for adult patients, a health systems strengthening programme, has been localised and piloted in 51 primary healthcare facilities in three Nigerian states. Lessons learnt from this experience include the value of this remote model of localisation for rapid localisation, the importance of early, continuous stakeholder engagement, the need expressed by Nigeria’s primary healthcare clinicians for clinical guidance that is user friendly and up-to-date, a preference for the tablet version of the PACK Adult guide over hard copies and the added value of WhatsApp groups to complement the programme of face-to-face continuous learning. Introduction of the PACK programme in Nigeria prompted uptake of evidence-informed recommendations within primary healthcare services.

scholarly journals An exploration into the problematic public policies and the leadership challenge for socio-economic transformation in South Africa

2019 ◽  
Vol 1 (1) ◽  
pp. 37-47
Author(s):  
Ken Kalala Ndalamba
Keyword(s):  
South Africa ◽  
Public Policies ◽  
Implementation Process ◽  
Economic Transformation ◽  
Successful Implementation ◽  
Public Servants ◽  
Content Type ◽  
Economic Agents ◽  
Trust In Leadership ◽  
Leadership Strategy

Purpose This paper aims to explore the problematic of public policies and leadership challenges for socio-economic transformation in South Africa. The paper illustrates that policies and laws of socio-economic reform have been introduced in democratic South Africa. However, socio-economic transformation remains a challenge. Lack of trust in the leadership relationships amongst political and economic agents is pointed as a contributing factor. Hence, LE emerges as a leadership strategy to help mitigate the problem. Design/methodology/approach The paper starts by presenting the current economic situation of South Africa touching on some important economic indicators to illustrate the consequences of poor leadership in public policy implementation process. The paper then analyses the leadership challenges to drive socio-economic reforms that have been introduced in South Africa since the end of apartheid with focus on the current National Development Plan. Lack of trust in leadership is identified as a problematic factor and leadership ethos (LE) emerges as a leadership strategy to enable the building of trust in leadership for the purpose of a successful implementation of public policies. Findings Lack of trust in leadership is identified as a problematic factor contributing in the absence of cooperation and collaboration in the leadership relationship amongst public servants (from up to bottom) and citizens for the purpose of successful implementation of public policies. Hence, there is need for a new leadership paradigm that would enable the building of trust in these leadership relationships. LE emerges as such a leadership strategy. Practical implications The paper calls for an exploration into the understanding and practice of LE and its inherent critical success factors (CSFs) considered as a leadership strategy that can help drive particularly public policies implementation process. LE intends to promote moral leadership that helps public servants to build good character and thus the will to do the right thing, and mutually trusting relationship is a CSF of LE. Therefore LE enables build the much needed trust in leadership relationships for a successful organisational leadership and management. Originality/value This paper provides significant implications by identifying lack of trust as a problematic factor in the leadership relationships amongst political and economic agents in South Africa, contributing thus in the poor implementation of public policies. LE emerges as a leadership strategy that would help mitigate the problem by enabling the building, the maintenance and restoration of trust in organisational and or institutional management for a successful public policy implementation process.

scholarly journals Lessons Learnt during the Implementation of WISN for Comprehensive Primary Health Care in India, South Africa and Peru

2021 ◽  
Vol 18 (23) ◽  
pp. 12541
Author(s):  
Sikhumbuzo A. Mabunda ◽  
Mona Gupta ◽  
Wezile W. Chitha ◽  
Ntombifikile G. Mtshali ◽  
Claudia Ugarte ◽  
...  
Keyword(s):  
South Africa ◽  
Primary Care ◽  
Health Workforce ◽  
Health Centre ◽  
Workforce Planning ◽  
Ministry Of Health ◽  
Health Workforce Planning ◽  
Primary Health ◽  
Lessons Learnt ◽  
Context Specific

Introduction: The World Health Organization introduced the workload indicators of staffing needs (WISN) in 1998 to improve country-level health workforce planning. This study presents the primary care health workforce planning experiences of India, South Africa and Peru. Methods: A case study approach was used to explore the lessons learnt in the implementation of WISN in India and South Africa. It also describes the methods developed and implemented to estimate health workforce in Peru. We identify the barriers and facilitators faced by countries during the implementation phase through the triangulation of literature, government reports and accounts of involved health planners in the three countries. Results: India implemented WISN in a referral pathway of three district health facilities, including a primary health centre, community health centre and district hospital. Implementation was impeded by limited technical support, poor stakeholder consultation and information systems challenges. South Africa implemented WISN for health workforce planning in primary care and found the skills mix and staff determinations to be unaffordable. The Peruvian Ministry of Health considered using WISN but decided to develop a context-specific tool to estimate the health workforce needed using its available resources such as the National Register of Health Personnel. The main challenge in using WISN was the insufficient information on its inputs. Conclusion: While India and South Africa had unique experiences with the integration of WISN in their health system, none of the countries has yet benefited from the implementation of WISN due to financial, infrastructure and technical challenges. Since the methodology developed by the Peruvian Ministry of Health is context-specific, its implementation has been promising for health workforce planning. The learnings from these countries’ experiences will prove useful in bringing future changes for the health workforce.

Implementing an Evidence-Based Exercise Program for Breast Cancer Survivors

2018 ◽  
Author(s):  
Kathryn H. Schmitz ◽  
Rinad Beidas
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Exercise Program ◽  
Implementation Process ◽  
Future Research ◽  
Successful Implementation ◽  
Evidence Based ◽  
Referral Process ◽  
Implementation Barriers

Multiple persistent adverse effects of breast cancer treatment are improved with regular exercise. This case study describes a safe and effective exercise program for breast cancer survivors that was adapted into an evidence-based intervention offered through physical therapy (Strength After Breast Cancer). The program was successfully translated and implemented, and it showed equal safety and efficacy as the parent program with regard to lymphedema symptoms, muscular strength, quality of life, and body image. Evaluation of the implementation process revealed multiple facilitators and barriers to implementation. Barriers included the intervention characteristics and challenges with the referral process from oncology. Facilitators included getting the program covered by insurance, a champion in the outpatient clinic, and adaptations to the program and referral process that resulted in successful implementation. Future research is needed to further the goal of ensuring all breast cancer survivors are connected to safe and effective exercise programming.

Replication or Innovation? Structuration in Policy Implementation

2020 ◽  
Vol 3 (2) ◽  
pp. 141-154
Author(s):  
Jodi R Sandfort ◽  
Stephanie Moulton
Keyword(s):  
Large Body ◽  
Implementation Process ◽  
Public Affairs ◽  
Management Approach ◽  
Successful Implementation ◽  
Structural Elements ◽  
Endogenous Factors ◽  
Program Policy ◽  
Institutional System ◽  
Or Organization

Abstract Why does a program, policy, or management approach implemented with success in one jurisdiction or organization fail to achieve similar results in another context? There is a large body of literature in public affairs and related fields that wrestle with this question. Scholars place varying emphasis on the constraints of the institutional system relative to humans’ agency in bringing about successful outcomes, and there is a tendency to generate lists of factors that enable or impede successful implementation. In this article, we present an alternative theoretical approach grounded in structuration processes. We turn to recent empirical scholarship and theory to re-examine what is known about structural elements that influence the implementation process: rules, routines, culture, and resources. This literature emphasizes that the work of these mechanisms is fundamentally shaped by endogenous factors within a system, fueled by the agency of actors within the setting. This is a more robust way to understand how microdynamics shape meso conditions in organizations and networks. Rather than understanding the implementation puzzle as how to replicate effective ideas, this frame suggests more attention to how to support innovation and learning is warranted.

Transfer of Lean Manufacturing to China – Lessons from Two German-Chinese Production Plants

2011 ◽  
Vol 110-116 ◽  
pp. 2087-2093
Author(s):  
Marc Bollbach
Keyword(s):  
Lean Manufacturing ◽  
Production Systems ◽  
Lean Production ◽  
Implementation Process ◽  
Successful Implementation ◽  
National Context ◽  
Implementation Barriers ◽  
Lean Principles ◽  
Context Factors ◽  
Comprehensive Compilation

The purpose of this paper is to provide a greater understanding of the implementation process of lean production in China. In particular, it will investigate the main barriers when implementing lean production in China. The aim is to evaluate if implementation barriers can be explained by Chinese national context factors. Case studies of two auto-parts production plants of a German multinational company in China were used to evaluate lean barriers within China. During a two month research trip to China, sixty interviews with Chinese and Western employees were conducted to evaluate barriers when implementing Lean in China. Strong evidence is found that Chinese context factors do significantly influence the implementation process of lean in China. The paper proposes the necessity for organizations to consider cultural, socio-political and economic context factors of China when applying lean principles. The fieldwork leads the author to develop a model of barriers which restrain the successful implementation of lean production systems in China. Beside a comprehensive compilation of barriers, the model indicates Chinese cultural, socio-and economic national context factors which may influence the implementation barriers.

scholarly journals Addressing the quality and scope of paediatric primary care in South Africa: Evaluating contextual impacts of the introduction of the Practical Approach to Care Kit for children (PACK Child)

2020 ◽  
Author(s):  
Jamie Murdoch ◽  
Robyn Curran ◽  
Ruth Cornick ◽  
Sandy Picken ◽  
Max Bachmann ◽  
...  
Keyword(s):  
South Africa ◽  
Primary Care ◽  
Primary Healthcare ◽  
Routine Care ◽  
Health Systems Strengthening ◽  
Psychosocial Issues ◽  
Healthcare Facilities ◽  
Contextual Features ◽  
Child Intervention

Abstract Background: Despite significant reductions in mortality, preventable and treatable conditions remain leading causes of death and illness in children in South Africa. The PACK Child intervention, comprising clinical decision support tool (guide), training strategy and health systems strengthening components, was developed to expand on WHO’s Integrated Management of Childhood Illness programme, extending care of children under 5 years to those aged 0-13 years, those with chronic conditions needing regular follow-up, integration of curative and preventive measures and routine care of the well child. In 2017-2018, PACK Child was piloted in 10 primary healthcare facilities in the Western Cape Province. Here we report findings from an investigation into the contextual features of South African primary care that shaped how clinicians delivered the PACK Child intervention within clinical consultations. Methods: Process evaluation using linguistic ethnographic methodology which provides analytical tools for investigating human behaviour, and the shifting meaning of talk and text within context. Methods included semi-structured interviews, focus groups, ethnographic observation, audio-recorded consultations and documentary analysis. Analysis focused on how mapped contextual features structured clinician-caregiver interactions. Results: Primary healthcare facilities demonstrated an institutionalised orientation to minimising risk upheld by provincial documentation, providing curative episodic care to children presenting with acute symptoms, and preventive care including immunisations, feeding and growth monitoring, all in children 5 years or younger. Children with chronic illnesses such as asthma rarely receive routine care. These contextual features constrained the ability of clinicians to use the PACK Child guide to facilitate diagnosis of long-term conditions, elicit and manage psychosocial issues, and navigate use of the guide alongside provincial documentation. Conclusion: Our findings provide evidence that PACK Child is catalysing a transition to an approach that strikes a balance between assessing and minimising risk on the day of acute presentation and a larger remit of care for children over time. However, optimising success of the intervention requires reviewing priorities for paediatric care which will facilitate enhanced skills, knowledge and deployment of clinical staff to better address acute illnesses and long-term health conditions of children of all ages, as well as complex psychosocial issues surrounding the child.

scholarly journals Pre-Implementation Barriers and Facilitators of an mHealth ART Adherence Counselling Intervention: Perspectives of NPO staff in South Africa (Preprint)

2020 ◽  
Author(s):  
Siobhan McCreesh-Toselli ◽  
John Torline ◽  
Hetta Gouse ◽  
Reuben N Robbins ◽  
Claude A Mellins ◽  
...  
Keyword(s):  
South Africa ◽  
Computer Literacy ◽  
High Volume ◽  
Barriers And Facilitators ◽  
Hiv Care ◽  
Successful Implementation ◽  
Art Adherence ◽  
Implementation Barriers ◽  
Persons Living With Hiv ◽  
Adherence Counselling

BACKGROUND Persons living with HIV (PLWH) in South Africa's expanding antiretroviral treatment (ART) program receive readiness counselling provided by Lay Counsellors (LCs). Both the delivery of content and counselling approach are difficult to standardize across multiple sites and providers. mHealth applications offer an opportunity in low resource settings to address these needs. OBJECTIVE The objective of this study was to explore the perceived pre-implementation barriers and facilitators of an mHealth intervention (“Masivukeni”) among staff at a large Cape Town-based HIV care non-profit organisation. METHODS Seven interviews and three focus groups were conducted with experienced LCs, their supervisors and managers. We used the Consolidated Framework for Implementation Research (CFIR) to explore perceived implementation barriers and facilitators of the Masivukeni intervention. RESULTS Several potential facilitators of the Masivukeni were identified, most notably interactive learning and facilitated updates. Barriers to implementation included security risks and costs of equipment, the high volume of patients needing to be counselled and variable computer literacy. CONCLUSIONS mHealth applications, such as Masivukeni, were perceived as being well-placed to address some needs of those who deliver ART adherence counselling in South Africa. However, the successful implementation of mHealth applications appeared to be dependent- on overcoming certain barriers in this setting.

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