scholarly journals A Qualitative Study of the Development and Utilization of Health Facility-based Immunization Microplans in Uganda.

2021 ◽  
Author(s):  
David Kaawa-Mafigiri ◽  
Constance Iradukunda ◽  
Catherine Atumanya ◽  
Michael Odie ◽  
Arielle Mancuso ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Health Facility ◽  
Planning Process ◽  
Health Workers ◽  
Immunization Coverage ◽  
Health Facilities ◽  
Optimal Development ◽  
Limited Knowledge ◽  
Catchment Areas ◽  
Development And Utilization

Abstract Background: In 2006, Uganda adopted the Reaching Every District strategy with the goal of attaining at least 80% coverage for routine immunizations in every district. The development and utilization of health facility/district immunization microplans is the key to the strategy. A number of reports have shown sub-optimal development and use of microplans in Uganda. This study explores factors associated with sub-optimal development and use of microplans in two districts in Uganda to pinpoint challenges encountered during the microplanning process.Methods: A qualitative study was conducted comparing two districts, Kapchorwa with low immunization coverage and Luwero with high immunization coverage. Data were collected through multilevel observation of health facilities, planning sessions and planning meetings; records review of microplans, micromaps, and meeting minutes; 57 interviews with health workers at the Ministry level and lower cadre health facility workers. Data were analyzed using NVivo 8 qualitative text analysis software. Transcripts were coded, memos and display matrices were developed to examine the process of developing and utilization of microplans, including experiences of health workers (implementers). Results: Three key findings emerged from this study. First, there are significant knowledge gaps about the microplanning process among health workers at all levels (community and district health facility and nationally). Limited knowledge about communities and program catchment areas greatly hinders the planning process by limiting the ability to identify hard-to-reach areas as well as prioritize areas according to need. Secondly, the microplanning tool is bulky and complex. Finally, microplanning is being implemented in the context of already over-tasked health personnel who have to conduct several other activities as part of their daily routines.Conclusions: In order to achieve quality improvement of the Reaching Every District campaign, the microplanning process should be revised. Health workers’ misunderstanding and limited knowledge about the microplanning process, especially at peripheral health facilities, coupled with the complex, bulky nature of the microplanning tool reduces the effectiveness of microplanning in improving routine immunization in Uganda. The study reveals the need to reduce the complexity of the tool and identify ways to train and support workers in the use of the revised tool, including support in incorporating the microplanning process into their busy schedules.

scholarly journals A qualitative study of the development and utilization of health facility-based immunization microplans in Uganda

2021 ◽  
Vol 19 (S2) ◽  
Author(s):  
David Kaawa Mafigiri ◽  
Constance Iradukunda ◽  
Catherine Atumanya ◽  
Michael Odie ◽  
Arielle Mancuso ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Health Facility ◽  
Planning Process ◽  
Health Workers ◽  
Immunization Coverage ◽  
Health Facilities ◽  
District Health ◽  
Limited Knowledge ◽  
Catchment Areas ◽  
Development And Utilization

Abstract Background In 2006, Uganda adopted the Reaching Every District strategy with the goal of attaining at least 80% coverage for routine immunizations in every district. The development and utilization of health facility/district immunization microplans is the key to the strategy. A number of reports have shown suboptimal development and use of microplans in Uganda. This study explores factors associated with suboptimal development and use of microplans in two districts in Uganda to pinpoint challenges encountered during the microplanning process. Methods A qualitative study was conducted comparing two districts: Kapchorwa, with low immunization coverage, and Luwero with high immunization coverage. Data were collected through multilevel observation of health facilities, planning sessions and planning meetings; records review of microplans, micromaps and meeting minutes; 57 interviews with health workers at the ministry level and lower-level health facility workers. Data were analysed using NVivo 8 qualitative text analysis software. Transcripts were coded, and memos and display matrices were developed to examine the process of developing and utilizing microplans, including experiences of health workers (implementers). Results Three key findings emerged from this study. First, there are significant knowledge gaps with regard to the microplanning process among health workers at all levels (community and district health facility and nationally). Limited knowledge about communities and programme catchment areas greatly hinders the planning process by limiting the ability to identify hard-to-reach areas and to prioritize areas according to need. Secondly, the microplanning tool is bulky and complex. Finally, microplanning is being implemented in the context of already overtasked health personnel who have to conduct several other activities as part of their daily routines. Conclusions In order to achieve quality improvement as outlined in the Reaching Every District campaign, the microplanning process should be revised. Health workers’ misunderstanding and limited knowledge about the microplanning process, especially at peripheral health facilities, coupled with the complex, bulky nature of the microplanning tool, reduces the effectiveness of microplanning in improving routine immunization in Uganda. This study reveals the need to reduce the complexity of the tool and to identify ways to train and support workers in the use of the revised tool, including support in incorporating the microplanning process into their busy schedules.

scholarly journals ‘I have no love for such people, because they leave us to suffer’: a qualitative study of health workers’ responses and institutional adaptations to absenteeism in rural Uganda

2019 ◽  
Vol 4 (3) ◽  
pp. e001376 ◽  
Author(s):  
Raymond Tweheyo ◽  
Catherine Reed ◽  
Stephen Campbell ◽  
Linda Davies ◽  
Gavin Daker-White
Keyword(s):  
Public Health ◽  
Qualitative Study ◽  
Health Facility ◽  
Health Workforce ◽  
Health Workers ◽  
Well Being ◽  
Task Shifting ◽  
Health Facilities ◽  
Case Study Methodology ◽  
Work Overload

BackgroundAchieving positive treatment outcomes and patient safety are critical goals of the healthcare system. However, this is greatly undermined by near universal health workforce absenteeism, especially in public health facilities of rural Uganda. We investigated the coping adaptations and related consequences of health workforce absenteeism in public and private not-for-profit (PNFP) health facilities of rural Uganda.MethodsAn empirical qualitative study involving case study methodology for sampling and principles of grounded theory for data collection and analysis. Focus groups and in-depth interviews were used to interview a total of 95 healthcare workers (11 supervisors and 84 frontline workers). The NVivo V.10 QSR software package was used for data management.ResultsThere was tolerance of absenteeism in both the public and PNFP sectors, more so for clinicians and managers. Coping strategies varied according to the type of health facility. A majority of the PNFP participants reported emotion-focused reactions. These included unplanned work overload, stress, resulting anger directed towards coworkers and patients, shortening of consultation times and retaliatory absence. On the other hand, various cadres of public health facility participants reported ineffective problem-solving adaptations. These included altering weekly schedules, differing patient appointments, impeding absence monitoring registers, offering unnecessary patient referrals and rampant unsupervised informal task shifting from clinicians to nurses.ConclusionHigh levels of absenteeism attributed to clinicians and health service managers result in work overload and stress for frontline health workers, and unsupervised informal task shifting of clinical workload to nurses, who are the less clinically skilled. In resource-limited settings, the underlying causes of absenteeism and low staff morale require attention, because when left unattended, the coping responses to absenteeism can be seen to compromise the well-being of the workforce, the quality of healthcare and patients’ access to care.

scholarly journals Factors associated with health facility deliveries among mothers living in hospital catchment areas in Rukungiri and Kanungu districts, Uganda

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Richard K. Mugambe ◽  
Habib Yakubu ◽  
Solomon T. Wafula ◽  
Tonny Ssekamatte ◽  
Simon Kasasa ◽  
...  
Keyword(s):  
Health Facility ◽  
Rural Areas ◽  
Health Workers ◽  
Facility Delivery ◽  
Health Facilities ◽  
Public Facility ◽  
Health Facility Delivery ◽  
Cross Sectional ◽  
Factors Associated ◽  
Catchment Areas

Abstract Background Health facility deliveries are generally associated with improved maternal and child health outcomes. However, in Uganda, little is known about factors that influence use of health facilities for delivery especially in rural areas. In this study, we assessed the factors associated with health facility deliveries among mothers living within the catchment areas of major health facilities in Rukungiri and Kanungu districts, Uganda. Methods Cross-sectional data were collected from 894 randomly-sampled mothers within the catchment of two private hospitals in Rukungiri and Kanungu districts. Data were collected on the place of delivery for the most recent child, mothers’ sociodemographic and economic characteristics, and health facility water, sanitation and hygiene (WASH) status. Modified Poisson regression was used to estimate prevalence ratios (PRs) for the determinants of health facility deliveries as well as factors associated with private versus public utilization of health facilities for childbirth. Results The majority of mothers (90.2%, 806/894) delivered in health facilities. Non-facility deliveries were attributed to faster progression of labour (77.3%, 68/88), lack of transport (31.8%, 28/88), and high cost of hospital delivery (12.5%, 11/88). Being a business-woman [APR = 1.06, 95% CI (1.01–1.11)] and belonging to the highest wealth quintile [APR = 1.09, 95% CI (1.02–1.17)] favoured facility delivery while a higher parity of 3–4 [APR = 0.93, 95% CI (0.88–0.99)] was inversely associated with health facility delivery as compared to parity of 1–2. Factors associated with delivery in a private facility compared to a public facility included availability of highly skilled health workers [APR = 1.15, 95% CI (1.05–1.26)], perceived higher quality of WASH services [APR = 1.11, 95% CI (1.04–1.17)], cost of the delivery [APR = 0.85, 95% CI (0.78–0.92)], and availability of caesarean services [APR = 1.13, 95% CI (1.08–1.19)]. Conclusion Health facility delivery service utilization was high, and associated with engaging in business, belonging to wealthiest quintile and having higher parity. Factors associated with delivery in private facilities included health facility WASH status, cost of services, and availability of skilled workforce and caesarean services.

scholarly journals Evaluation of Infection, Prevention and Control Program in Goromonzi District, Zimbabwe, 2018: A process outcome evaluation

2019 ◽  
Author(s):  
Govha Emmanuel ◽  
Zizhou Simukai Tirivanhu ◽  
Shambira Gerald ◽  
Gombe Tafara Notion ◽  
Tsitsi Juru ◽  
...  
Keyword(s):  
Health Facility ◽  
Prevention And Control ◽  
Infection Prevention ◽  
Health Workers ◽  
Outcome Evaluation ◽  
Hazard Identification ◽  
Health Facilities ◽  
Infection Prevention And Control ◽  
Hiv Test ◽  
And Control

Abstract Background A healthcare-associated infection (HAI) is defined as an infection originating in the environment of a health facility that was not present or incubating at the time of patient admission. HAIs can be prevented through infection, prevention and control (IPC) measures. No hazard identification and risk assessment IPC rounds and monthly meetings were conducted in Goromonzi district since 1st of January to 30th of June 2018. No trainings nor orientation for the new employees was conducted. We therefore evaluated Goromonzi District IPC program. Methods A process-outcome evaluation using the logic model was conducted in Goromonzi district’s 15 health facilities. Checklists, interviewer administered questionnaires and key informant guides were used to collect data on availability of inputs, knowledge of health workers, processes performed, outputs and outcomes achieved. Data were entered into Epi Info 7TM, which was used to generate frequencies and proportions. Qualitative data from checklists and key informants interviews was sorted manually into themes and analysed. Results All 15 health facilities had adequate stocks of HIV test kits and PEP kits. Adequate bins and detergents were found in only 3/15 (20%) of health facilities. All facilities failed to hold a single IPC meeting and none had specific budget for IPC in 2018. No IPC mentorship activities were carried out in the district. Only 7/13 (54%) health workers who had needle pricks received PEP with 2/7 (29%) of them finishing the course. No health facility had a functional HAI surveillance system. The overall knowledge rating was fair. Conclusion The IPC program inputs in Goromonzi district were inadequate hence its failure to achieve the intended outputs and outcomes. Inadequate knowledge, unavailability of health worker training plans, specific budgets and absence of IPC committees reflected non prioritisation of the program.

scholarly journals Why do health workers give anti-malarials to patients with negative rapid test results? A qualitative study at rural health facilities in western Uganda

2016 ◽  
Vol 15 (1) ◽  
Author(s):  
Robin Altaras ◽  
Anthony Nuwa ◽  
Bosco Agaba ◽  
Elizabeth Streat ◽  
James K. Tibenderana ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Rural Health ◽  
Health Workers ◽  
Rapid Test ◽  
Health Facilities ◽  
Test Results ◽  
Western Uganda

scholarly journals ANALYSIS OF THE INFLUENCE OF LOCATION, PROMOTION AND HEALTH OFFICERS IN INFLUENCING DECISION ON SELECTION OF FIRST LEVEL HEALTH FACILITIES (FKTP) PARTICIPANTS OF BPJS HEALTH IN ADVANCED MEDICAL CENTER

2021 ◽  
Vol 2 (2) ◽  
pp. 314-323
Author(s):  
Ekawati Ekawati ◽  
Alugoro Mulyowahyudi
Keyword(s):  
Health Facility ◽  
Health Care Workers ◽  
Health Workers ◽  
Medical Center ◽  
Sampling Technique ◽  
Research Data ◽  
Health Facilities ◽  
Selection Decisions ◽  
Care Workers ◽  
Selection Of

This study aims to analyze the influence of location, promotion and health workers in influencing the decision to choose a First Level health facility (FKTP) for BPJS Kesehatan participants at the Advanced Medical Center. This research is quantitative. The population in the study were BPJS patients who were registered at the Advanced Medical Center. The sampling technique used accidental sampling with a sample size of 100 people. The research data were analyzed using multiple linear regression. The results of the t-test for the variables of location, promotion and health care workers were significant for the decision on choosing health facilities at the Advanced Medical Center. Suggestions for further research are to include other factors that have a strong influence on health facility selection decisions.

Factors Influencing Choice of Delivery Place among Mothers in Rukungiri and Kanungu Districts, South Western Uganda: A Cross Sectional Study

2020 ◽  
Author(s):  
Richard Mugambe ◽  
Habib Yakubu ◽  
Solomon Wafula ◽  
Tonny Ssekamatte ◽  
Simon Kasasa ◽  
...  
Keyword(s):  
Health Facility ◽  
Rural Areas ◽  
Health Workers ◽  
Public Health Facility ◽  
Facility Delivery ◽  
Health Facilities ◽  
Public Facility ◽  
Cross Sectional ◽  
Western Uganda ◽  
Delivery Place

Abstract Background: Child birth in health facilities is generally associated with lower risk of maternal and neonatal mortality. However, in Uganda, little is known about factors that influence use of health facilities for delivery especially in rural areas. In this study, we examined the determinants of mothers’ decision of the choice of child delivery place in Western Uganda.Methods: Cross-sectional data was collected from 894 randomly-sampled mothers within the catchment of two private hospitals in Rukungiri and Kanungu districts. Data was collected on the place of delivery for the most recent child, mothers’ sociodemographic characteristics, health facility water, sanitation and hygiene (WASH) status. Modified Poisson regression was used to estimate prevalence ratios (PRs) for the determinants of mothers’ choice of delivery place as well as determinants for the choice of private versus public facility for delivery at 95% confidence intervals. Results: Majority of mothers (90.2%) delivered in health facilities. Non-facility deliveries were attributed to fast progression of labour (77.3%), lack of transport (31.8%) and high cost of hospital delivery (12.5%). Being engaged in business as an occupation [APR = 1.06, 95% CI (1.01 – 1.11)] and belonging to the highest wealth quintile [APR = 1.09, 95% CI (1.02 – 1.17)] favoured facility delivery while higher parity of 3 – 4 [APR = 0.93, 95% CI (0.88 – 0.99)] was inversely associated with facility delivery as compared to parity of 1-2. Choice of private facility over public facility was influenced by how mothers valued factors such as high skilled health workers [APR = 1.15, 95% CI (1.05 – 1.26)], higher quality of WASH services [APR = 1.11, 95% CI (1.04 – 1.17)], cost of the delivery [APR = 0.85, 95% CI (0.78 – 0.92)] and availability of caesarean services [APR = 1.13, 95% CI (1.08 – 1.19)].Conclusion: Utilization of health facility child delivery services was high. Health facility delivery service utilization was influenced by engaging in business, belonging to wealthiest quintile and being multiparous. Choice of private versus public health facility for child delivery was influenced by health facility WASH status, cost of services, and availability of skilled workforce and caesarean services.

scholarly journals Geographic location of health facility and immunization program performance in Hoima district, western Uganda: a health facility level assessment

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Nicholas Kwikiriza Magambo ◽  
Francis Bajunirwe ◽  
Fred Bagenda
Keyword(s):  
Health Facility ◽  
Urban Areas ◽  
Health Workers ◽  
Geographic Location ◽  
Health Facilities ◽  
Urban Setting ◽  
World Health ◽  
Program Performance ◽  
Immunization Program ◽  
Western Uganda

Abstract Background Globally, immunization coverage for childhood vaccines is below the immunization target of achieving at least 90% coverage with the pentavalent vaccine. In Uganda, a recent survey shows 80% of districts had poor immunization program performance. However, there is significant variation in performance within and between districts. We hypothesized that geographic location of a health facility may influence performance of its immunization programs. Therefore, the purpose of this study was to examine whether geographical location of a health facility within a district is associated with performance of the immunization program in Hoima district, western Uganda. Methods We conducted a cross sectional study using a mixed methods approach. The main study unit was a health center and we also interviewed health workers in-charge of the facilities and reviewed their health facility records. We reviewed the Uganda Health Management Information System (HMIS) 105 reports of six months to obtain data on immunization program performance. Performance was categorized using World Health Organization’s Reach Every District (RED) criteria and classified as poor if a facility fell in category 3 or 4 and good if 1 or 2. We also conducted key informant interviews with immunization focal persons in the district. We examined the association between dependent and independent variables using Fisher’s exact test. Results We collected data at 49 health facilities. Most of these facilities (55.1%) had poor immunization program performance. Proximal location to the central district headquarters was significantly associated with poor immunization program performance (p < 0.05). Attitudes of health workers in the more urban areas, differences in strategies for outreach site selection and community mobilization in the rural and urban areas were suggested as possible explanations. Conclusions Proximal location to the urban setting near district headquarters was strongly associated with poor immunization program performance. To be able to reach larger numbers of children for vaccination, interventions to improve performance should target health facilities in urban settings.

scholarly journals ‘We just look at the well-being of the baby and not the money required’: a qualitative study exploring experiences of quality of maternity care among women in Nairobi’s informal settlements in Kenya

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e036966 ◽  
Author(s):  
Jackline Oluoch-Aridi ◽  
Francis Wafula ◽  
Gilbert Kokwaro ◽  
Mary B Adam
Keyword(s):  
Qualitative Study ◽  
Health Facility ◽  
Maternity Care ◽  
Informal Settlement ◽  
Perceived Quality ◽  
Poor Quality ◽  
Health Facilities ◽  
Public Facility ◽  
Clinical Services

ObjectiveTo examine how women living in an informal settlement in Nairobi perceive the quality of maternity care and how it influences their choice of a delivery health facility.DesignQualitative study.SettingsDandora, an informal settlement, Nairobi City in Kenya.ParticipantsSix focus group discussions with 40 purposively selected women aged 18–49 years at six health facilities.ResultsFour broad themes were identified: (1) perceived quality of the delivery services, (2) financial access to delivery service, (3) physical amenities at the health facility, and (4) the 2017 health workers’ strike.The four facilitators that influenced women to choose a private health facility were: (1) interpersonal treatment at health facilities, (2) perceived quality of clinical services, (3) financial access to health services at the facility, and (4) the physical amenities at the health facility. The three barriers to choosing a private facility were: (1) poor quality clinical services at low-cost health facilities, (2) shortage of specialist doctors, and (3) referral to public health facilities during emergencies.The facilitators that influenced women to choose a public facility were: (1) physical amenities for dealing with obstetric emergencies and (2) early referral to public maternity during antenatal care services. Barriers to choosing a public facility were: (1) perception of poor quality clinical services, (2) concerns over security for newborns at tertiary health facilities, (3) fear of mistreatment during delivery, (4) use of unsupervised trainee doctors for deliveries, (5) poor quality of physical amenities, and (6) inadequate staffing.ConclusionThe study provides insights into decision-making processes for women when choosing a delivery facility by identifying critical attributes that they value and how perceptions of quality influence their choices.

scholarly journals Missed opportunities for vaccination among children aged 0–23 months visiting health facilities in a southwest State of Nigeria, December 2019

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0252798
Author(s):  
Akinola Ayoola Fatiregun ◽  
Laura Nic Lochlainn ◽  
Lassané Kaboré ◽  
Modupeola Dosumu ◽  
Elvis Isere ◽  
...  
Keyword(s):  
Health Service ◽  
Health Workers ◽  
Immunization Coverage ◽  
Cross Sectional Study ◽  
Health Facilities ◽  
Service Encounter ◽  
Childhood Immunization ◽  
Cross Sectional ◽  
Missed Opportunities ◽  
Attitudes And Practices

Background Despite efforts to improve childhood immunization coverage in Nigeria, coverage has remained below the national acceptable level. In December 2019, we conducted an assessment of Missed Opportunities for Vaccination (MOV) in Ondo State, in Southwest Nigeria. The objectives were to determine the magnitude of, explore the reasons for, as well as possible solutions for reducing MOV in the State. Methods This was a cross-sectional study using a mixed-methods approach. We purposively selected 66 health facilities in three local government authorities, with a non-probabilistic sampling of caregivers of children 0–23 months for exit interviews, and health workers for knowledge, attitudes, and practices (KAP) surveys. Data collection was complemented with focus group discussions and in-depth interviews with caregivers and health workers. The proportion of MOV among children with documented vaccination histories were determined and thematic analysis of the qualitative data was carried out. Results 984 caregivers with children aged 0–23 months were interviewed, of which 869 were eligible for inclusion in our analysis. The prevalence of MOV was 32.8%. MOV occurred among 90.8% of children during non-vaccination visits, and 7.3% during vaccination visits. Vaccine doses recommended later in the immunization series were given in a less timely manner. Among 41.0% of health workers, they reported their vaccination knowledge was insufficient. Additionally, 57.5% were concerned about and feared adverse events following immunization. Caregivers were found to have a low awareness about vaccination, and issues related to the organization of the health system were found to contribute towards MOV. Conclusions One in three children experienced a MOV during a health service encounter. Potential interventions to reduce MOV include training of health workers about immunization policies and practices, improving caregivers’ engagement and screening of vaccination documentation by health workers during every health service encounter.

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