scholarly journals Health Systems Strengthening Interventions for Perinatal Common Mental Disorders and Experiences of Domestic Violence in Cape Town, South Africa: Protocol for a Pilot Implementation Study

2021 ◽  
Author(s):  
Zulfa Abrahams ◽  
Marguerite Schneider ◽  
Simone Honikman ◽  
Patti Olckers ◽  
Sonet Boisits ◽  
...  
Keyword(s):  
Domestic Violence ◽  
Health Systems ◽  
Healthcare Workers ◽  
Common Mental Disorders ◽  
Health Systems Strengthening ◽  
Implementation Study ◽  
Implementation Phase ◽  
Healthcare Facilities ◽  
Pilot Implementation ◽  
Perinatal Women

Abstract Background: During the perinatal period, common mental disorders (CMDs) such as depression and anxiety are highly prevalent, especially in low resource settings, and are associated with domestic violence, poverty and food insecurity. Perinatal CMDs have been associated with several adverse maternal and child outcomes. While the Department of Health in South Africa provides healthcare workers with the tools to detect psychological distress and experiences of domestic violence, few healthcare workers routinely screen pregnant women at clinic visits, citing discomfort with mental health issues and the lack of standardised referral pathways as the key barriers. The aim of this study is to select and evaluate a set of health systems strengthening (HSS) interventions aimed at improving the care and outcomes for perinatal women with CMDs and experiences of domestic violence, attending public healthcare facilities in Cape Town.Methods: This study consists of a pre-implementation, development, and implementation phase. Contextual barriers identified during the pre-implementation phase included poor patient knowledge and health-seeking behaviour, high levels of stigma, and poor detection, referral and treatment rates. Implementation science determinant frameworks were applied to findings from the pre-implementation phase to identify determinants and gaps in delivering high-quality evidence-informed care. A participatory Theory of Change workshop was used to design a HSS programme, consisting of awareness raising, detection, referral, and treatment. HSS interventions selected to support the delivery of the HSS programme includes training, health promotion, change to the healthcare environment, task-sharing, audit and feedback and performance monitoring. The implementation phase will be used to assess several implementation and clinical outcomes associated with delivery of the HSS programme, which will be piloted at three healthcare facilities. Qualitative and quantitative methods will be used to evaluate the implementation and clinical outcomes. Discussion: This pilot implementation study will inform us about a range of implementation and clinical outcome measures that are relevant for assessing health systems strengthening interventions for perinatal women with depression, anxiety or experiences of domestic violence in low resource settings. Lessons learnt from the pilot study will be incorporated into the design of a cluster randomised control trial for which further funding will be sought.

scholarly journals ‘The nurse did not even greet me’: how informed versus non-informed patients evaluate health systems responsiveness in South Africa

2021 ◽  
Vol 6 (4) ◽  
pp. e004360
Author(s):  
Dumisani MacDonald Hompashe ◽  
Ulf-G Gerdtham ◽  
Carmen S Christian ◽  
Anja Smith ◽  
Ronelle Burger
Keyword(s):  
Health Systems ◽  
Primary Healthcare ◽  
Healthcare Workers ◽  
Quality Care ◽  
Public Healthcare ◽  
Health Coverage ◽  
Access To Health Services ◽  
Healthcare Provision ◽  
Healthcare Facilities ◽  
Patients Experience

Introduction Universal Health Coverage is not only about access to health services but also about access to high-quality care, since poor experiences may deter patients from accessing care. Evidence shows that quality of care drives health outcomes, yet little is known about non-clinical dimensions of care, and patients’ experience thereof relative to satisfaction with visits. This paper investigates the role of non-clinical dimensions of care in patient satisfaction. Methods Our study describes the interactions of informed and non-informed patients with primary healthcare workers at 39 public healthcare facilities in two metropolitan centres in two South African provinces. Our analysis included 1357 interactions using standardised patients (for informed patients) and patients’ exit interviews (for non-informed patients). The data were combined for three types of visits: contraception, hypertension and tuberculosis. We describe how satisfaction with care was related to patients’ experiences of non-clinical dimensions. Results We show that when real patients (RPs) reported being satisfied (vs dissatisfied) with a visit, it was associated with a 30% increase in the probability that a patient is greeted at the facilities. Likewise, when the RPs reported being satisfied (vs dissatisfied) with the visit, it was correlated with a 15% increase in the prospect that patients are pleased with healthcare workers’ explanations of health conditions. Conclusion Informed patients are better equipped to assess health-systems responsiveness in healthcare provision. Insights into responsiveness could guide broader efforts aimed at targeted education and empowerment of primary healthcare users to strengthen health systems and shape expectations for appropriate care and conduct.

scholarly journals Assessing the Integrated Community-Based Health Systems Strengthening initiative in northern Togo: a pragmatic effectiveness-implementation study protocol

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Molly E. Lauria ◽  
Kevin P. Fiori ◽  
Heidi E. Jones ◽  
Sesso Gbeleou ◽  
Komlan Kenkou ◽  
...  
Keyword(s):  
Public Sector ◽  
Health Service ◽  
Community Health ◽  
Health Systems ◽  
Implementation Strategy ◽  
Health Systems Strengthening ◽  
Implementation Study ◽  
Community Based ◽  
Under Five ◽  
Public Sector Health

Abstract Background Over the past decade, prevalence of maternal and child morbidity and mortality in Togo, particularly in the northern regions, has remained high despite global progress. The causes of under-five child mortality in Togo are diseases with effective and low-cost prevention and/or treatment strategies, including malaria, acute lower respiratory infections, and diarrheal diseases. While Togo has a national strategy for implementing the integrated management of childhood illness (IMCI) guidelines, including a policy on integrated community case management (iCCM), challenges in implementation and low public sector health service utilization persist. There are critical gaps to access and quality of community health systems throughout the country. An integrated facility- and community-based initiative, the Integrated Community-Based Health Systems Strengthening (ICBHSS) initiative, seeks to address these gaps while strengthening the public sector health system in northern Togo. This study aims to evaluate the effect and implementation strategy of the ICBHSS initiative over 48 months in the catchment areas of 21 public sector health facilities. Methods The ICBHSS model comprises a bundle of evidence-based interventions targeting children under five, women of reproductive age, and people living with HIV through (1) community engagement and feedback; (2) elimination of point-of-care costs; (3) proactive community-based IMCI using community health workers (CHWs) with additional services including family planning, HIV testing, and referrals; (4) clinical mentoring and enhanced supervision; and (5) improved supply chain management and facility structures. Using a pragmatic type II hybrid effectiveness-implementation study, we will evaluate the ICBHSS initiative with two primary aims: (1) determine effectiveness through changes in under-five mortality rates and (2) assess the implementation strategy through measures of reach, adoption, implementation, and maintenance. We will conduct a mixed-methods assessment using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. This assessment consists of four components: (1) a stepped-wedge cluster randomized control trial using a community-based household survey, (2) annual health facility assessments, (3) key informant interviews, and (4) costing and return-on-investment assessments for each randomized cluster. Discussion Our research is expected to contribute to continuous quality improvement initiatives, optimize implementation factors, provide knowledge regarding health service delivery, and accelerate health systems improvements in Togo and more broadly. Trial registration ClinicalTrials.gov, NCT03694366, registered 3 October 2018

scholarly journals A cross-sectional study on the pursuit of happiness among healthcare workers in the context of health systems strengthening: The case of Meru County, Kenya.

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 163
Author(s):  
Rose Nabi Deborah Karimi Muthuri ◽  
Flavia Senkubuge ◽  
Charles Hongoro
Keyword(s):  
Health System ◽  
Health Systems ◽  
Healthcare Workers ◽  
Public Hospitals ◽  
Health Systems Strengthening ◽  
Physical Work ◽  
Water Type ◽  
Cross Sectional ◽  
Orientations To Happiness ◽  
Significant Factors

Background: Happiness is one of the ultimate goals of every human being. Happiness is a significant factor of health system efficiency. Healthcare workers are at the core of every health system. However, up-to-date literature on happiness among healthcare workers is limited. The purpose of this study is to investigate the factors influencing the self-assessed happiness among healthcare workers in public and mission hospitals in Meru County, Kenya.  Methods: Using a cross-sectional design, a total of 553 healthcare workers in 24 hospitals completed the Orientations to Happiness questionnaire between June and July 2020.   Results: Healthcare workers’ overall happiness was significantly different between hospitals of public and mission ownership (p<0.05). The orientations to happiness mean scores of both pursuits of pleasure and meaning were significantly different between public and mission hospitals  (p<0.05). However, there were no statistically significant differences in the pursuit of engagement among the healthcare workers between public and mission hospitals (p<0.05).  In both public and mission hospitals, income and the type of toiletry facility were significant factors of overall happiness (p<0.05 or p<0.1). In mission hospitals, eight more variables were statistically significant factors of overall happiness namely type of employment, occurrence of water unavailability, safe drinking water, acceptable main source of water, type of toiletry facility, hospital disposal of garbage, availability of water for hand washing, and overall safety of the hospital working environment (p<0.05 or p<0.1). In public hospitals, additional statistically significant factors of overall happiness were qualification level, and a functional workplace safety and health committee (p<0.05 or p<0.1).  Conclusion: Demographic, work-related, and physical work environment factors significantly contribute to healthcare workers overall happiness in both mission and public hospitals. The findings present possible areas of focus for policy and practical implications related to healthcare workers’ happiness aimed at health workforce and health systems strengthening in Kenya.

scholarly journals Integration of Traditional Birth Attendants into Mental Healthcare: A Multistakeholder Qualitative Study Exploration

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Christine W. Musyimi ◽  
Victoria N. Mutiso ◽  
Darius N. Nyamai ◽  
Ikenna D. Ebuenyi ◽  
David M. Ndetei
Keyword(s):  
Qualitative Study ◽  
Healthcare Workers ◽  
Common Mental Disorders ◽  
Mental Healthcare ◽  
Psychosocial Interventions ◽  
Future Generation ◽  
Traditional Birth Attendants ◽  
Mental Wellbeing ◽  
Healthcare Facilities ◽  
Birth Attendants

Background. A significant number of people with common mental disorders are undiagnosed or undetected at primary healthcare facilities. The experience of traditional birth attendants (TBAs) in reassuring perinatal mothers could be utilized in maternal mental healthcare. The aim of this study was to gain insight into the feasibility of integrating TBAs into maternal mental healthcare using multiple stakeholder views. Methods. We conducted an exploratory qualitative study in September 2017 using focus group discussions (FGDs) and in depth interviews in Makueni County, Kenya. A total of 246 participants (TBAs, community health volunteers (CHVs), healthcare workers (HCWs), antenatal and postnatal mothers seeking care from TBAs and those seeking both hospital and TBA services, mothers in law and/or husbands of perinatal mothers, and opinion leaders based in the county) were purposively selected to participate in the discussions. Transcribed data was analyzed using NVivo version 10. Results. Four major themes emerged from the qualitative data and were identified as follows; (a) involving TBAs in perinatal mental healthcare by assigning them roles, (b) utilizing TBAs’ patient rapport and counseling experience, (c) recognition and appreciation of TBAs by the healthcare system, and (d) training and collaboration of TBAs with healthcare workers. Discussion. The findings of this study reveal that although TBAs informally provide psychosocial interventions to pregnant mothers, their roles in mental health are not clearly defined. The importance of TBAs sharing their experience and being recognized as important stakeholders in mental healthcare for perinatal mothers was highlighted. Inclusion of TBAs in dialogue and training them to offer evidence-based mental healthcare were identified as important steps towards improving the mental wellbeing of mothers and the future generation.

scholarly journals The relationship between common mental disorders (CMDs), food insecurity and domestic violence in pregnant women during the COVID-19 lockdown in Cape Town, South Africa

2021 ◽  
Author(s):  
Zulfa Abrahams ◽  
Sonet Boisits ◽  
Marguerite Schneider ◽  
Martin Prince ◽  
Crick Lund
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Domestic Violence ◽  
Mental Disorders ◽  
Food Insecurity ◽  
Poisson Regression ◽  
Common Mental Disorders ◽  
Cape Town ◽  
The Relationship ◽  
Perinatal Women

Abstract Purpose We aimed to explore the relationship between common mental disorders (CMDs), food insecurity and experiences of domestic violence among pregnant women attending public sector midwife obstetric units and basic antenatal care clinics in Cape Town during the COVID-19 lockdown. Methods Perinatal women, attending 14 healthcare facilities in Cape Town, were enrolled in the study during baseline data collection before the COVID-19 lockdown. During the lockdown period, fieldworkers telephonically contacted the perinatal women who were enrolled in the study and had provided contact details. The following data were collected from those who consented to the study: socio-demographic information, mental health assessment, food insecurity status and experiences of domestic violence. Poisson regression was used to model the associations of a number of risk factors with the occurrence of CMDs. Results Of the 2149 women enrolled in the ASSET study, 885 consented to telephonic interviews. We found that 12.5% of women had probable CMDs and 43% were severely food insecure. Psychological distress increased significantly during the lockdown period, compared to before the COVID-19 outbreak. Using multivariate Poisson regression modelling, we showed that the risk of CMDs was increased in women who were severely food insecure or who experienced psychological or sexual abuse. Conclusions This study provides evidence of the effect of the COVID-19 lockdown on the mental health status of perinatal women living in low-resource settings in Cape Town and highlights how a crisis such as the COVID-19 lockdown amplifies the psycho-social risk factors associated with CMDs in perinatal women.

Descriptive and Psychometric Characteristics of START-AV Assessments: Findings from a Pilot Implementation Study

2012 ◽  
Author(s):  
Sarah L. Desmarais ◽  
Brian Gregory Sellers ◽  
Joel Dvoskin ◽  
Jodi L. Viljoen ◽  
Keith Cruise ◽  
...  
Keyword(s):  
Implementation Study ◽  
Psychometric Characteristics ◽  
Pilot Implementation

scholarly journals Exploring the role of gender and women in the political economy of health in armed conflict: a narrative review

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Kristen Meagher ◽  
Bothaina Attal ◽  
Preeti Patel
Keyword(s):  
Political Economy ◽  
Health Systems ◽  
Armed Conflict ◽  
Narrative Review ◽  
Health Systems Strengthening ◽  
The Political ◽  
Systems Research ◽  
Political Economy Of Health ◽  
And Gender

Abstract Background The ripple effects of protracted armed conflicts include: significant gender-specific barriers to accessing essential services such as health, education, water and sanitation and broader macroeconomic challenges such as increased poverty rates, higher debt burdens, and deteriorating employment prospects. These factors influence the wider social and political determinants of health for women and a gendered analysis of the political economy of health in conflict may support strengthening health systems during conflict. This will in turn lead to equality and equity across not only health, but broader sectors and systems, that contribute to sustainable peace building. Methods The methodology employed is a multidisciplinary narrative review of the published and grey literature on women and gender in the political economy of health in conflict. Results The existing literature that contributes to the emerging area on the political economy of health in conflict has overlooked gender and specifically the role of women as a critical component. Gender analysis is incorporated into existing post-conflict health systems research, but this does not extend to countries actively affected by armed conflict and humanitarian crises. The analysis also tends to ignore the socially constructed patriarchal systems, power relations and gender norms that often lead to vastly different health system needs, experiences and health outcomes. Conclusions Detailed case studies on the gendered political economy of health in countries impacted by complex protracted conflict will support efforts to improve health equity and understanding of gender relations that support health systems strengthening.

scholarly journals Implementation of the Comprehensive Unit-Based Safety Program to Improve Hand Hygiene in Four NICUs in Pune, India

2020 ◽  
Vol 41 (S1) ◽  
pp. s8-s10
Author(s):  
Julia Johnson ◽  
Asad Latif ◽  
Bharat Randive ◽  
Abhay Kadam ◽  
Uday Rajput ◽  
...  
Keyword(s):  
Patient Safety ◽  
Hand Hygiene ◽  
Safety Culture ◽  
Assessment Tool ◽  
Tertiary Care ◽  
Infection Prevention And Control ◽  
Improvement Strategy ◽  
Implementation Phase ◽  
Healthcare Facilities ◽  
Safety Program

Background: In low- and middle-income country (LMIC) healthcare facilities, gaps in infection prevention and control (IPC) practices increase risk of healthcare-associated infections (HAIs) and mortality among hospitalized neonates. Method: In this quasi-experimental study, we implemented the Comprehensive Unit-based Safety Program (CUSP) to improve adherence to evidence-based IPC practices in neonatal intensive care units (NICUs) in 4 tertiary-care facilities in Pune, India. CUSP is a validated strategy to empower staff to improve unit-level patient safety. Baseline safety culture was measured using the Hospital Survey on Patient Safety Culture (HSOPS). Baseline IPC assessments using the Infection Control Assessment Tool (ICAT) were completed to describe existing IPC practices to identify focus areas, the first of which was hand hygiene (HH). Sites received training in CUSP methodology and formed multidisciplinary CUSP teams, which met monthly and were supported by monthly coaching calls. Staff safety assessments (SSAs) guided selection of multimodal interventions. HH compliance was measured by direct observation using trained external observers. The primary outcome was HH compliance, evaluated monthly during the implementation and maintenance phases. Secondary outcomes included CUSP meeting frequency and HH compliance by healthcare worker (HCW) role. Result: In March 2018, 144 HCWs and administrators participated in CUSP training. Site meetings occurred monthly. During the implementation phase (June 2018–January 2019), HH monitoring commenced, sites formed their teams, completed the SSA, and selected interventions to improve HH based on the WHO’s IPC multimodal improvement strategy: (1) system change; (2) training and education; (3) monitoring and feedback; (4) reminders and communication; and (5) a culture of safety (Fig. 1). During the maintenance phase (February–September 2019), HH was monitored monthly and sites adapted interventions as needed. HH compliance improved from 58% to 70% at participant sites from implementation to maintenance phases (Fig. 2), with an odds ratio (OR) of 1.66 (95% CI, 1.50–1.84; P < .001). HH compliance improved across all HCW roles: (1) physician compliance improved from 55% to 67% (OR, 1.69; 95% CI, 1.42–2.01; P < .001); (2) nurse compliance from 61% to 73% (OR, 1.68; 95% CI, 1.46–1.93; P < .001); and (3) other HCW compliance from 52% to 62% (OR, 1.48; 95% CI, 1.10–1.99; P = .010). Conclusion: CUSP was successfully adapted by 4 diverse tertiary-care NICUs in Pune, India, and it resulted in increased HH compliance at all sites. This multimodal strategy is a promising framework for LMIC healthcare facilities to sustainably address IPC gaps and reduce HAI and mortality in neonates.Funding: NoneDisclosures: Aaron Milstone, Johns Hopkins University, BD (consulting)

scholarly journals COVID‐19 calls for health systems strengthening in Africa: A case of Nigeria

2021 ◽  
Author(s):  
Emmanuel Ebuka Elebesunu ◽  
Gabriel Ilerioluwa Oke ◽  
Yusuff Adebayo Adebisi ◽  
Ifeanyi McWilliams Nsofor
Keyword(s):  
Health Systems ◽  
Health Systems Strengthening
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