Getting Human Resource Information Systems Right: A Case Presentation of Uganda

BackgroundHuman resources information systems (HRIS) are a key tool for collecting and analyzing health workforce data at the country level and the specific focus of milestones 4.1 and 4.2 of the Global Strategy on Human Resources for Health (HRH). Yet documentation on the capabilities of HRIS in low- and middle-income countries (LMICs) is limited. Vital Wave, with IntraHealth International and Cooper/Smith, conducted a targeted scan of the HRIS landscape in 20 countries and “deep-dive” assessments in Burkina Faso, Mozambique, and Uganda. Here we present the case of Uganda’s workforce information ecosystem. Case PresentationSince 2006, Uganda has seen investment in HRIS from different donors, overseen by the Ministry of Health (MOH) and accompanied by the rollout of IntraHealth’s open-source iHRIS software. Despite this history of investment, mapping of the country’s multiple information systems revealed uneven adoption and engagement nationally and sub-nationally, with high levels of data fragmentation due to lack of interoperability and data-sharing practices. We also mapped the administrative processes and data flows for three priority use cases: recruitment and deployment, salary payments, and performance management. What emerges is a complex, decentralized information ecosystem driven by years of donor investment, but one that still sees uneven ownership and data use across the health system. Challenges include:· Limited interoperability between systems, specifically payroll, iHRIS, and the district health information system (DHIS2)· Complex HRH planning and management policy context, with variable implementation of numerous policies and no single reference to guide investments and implementation· Limited visibility into the private and community health workforce. ConclusionsUganda’s progress in developing its HRH information ecosystem underscores the importance of continuously aligning system capabilities, incentives, and motivations to an ever-evolving country context. However, as evidenced in Uganda and our broader assessment findings, robustness of the information ecosystem itself is insufficient to making substantive strides toward the Global Strategy’s milestones 4.1 and 4.2—governance oversight and ownership are critical to success. With a better understanding of what good looks like in terms of HRIS functionality in LMICs and ensuring interventions are addressing the causal issues, there can be many pathways to making systems work.

Implementation of Management of Pulmonary Tuberculosis with the Directly Observed Treatment Short course Strategy

The purpose of this study was to describe the implementation of pulmonary TB disease management with the DOTS strategy at the Jagong Health Center, Central Aceh Regency.The implementation of Pulmonary TB Management with the DOTS (Directly Observed Treatment Shortcourse) strategy in the working area of the Jagong Health Center, Central Aceh Regency has been maximized. by facilitating and providing motivation so that patients want treatment in a complete and integrated manner, case detection can be carried out by health workers or cadres who have been given training to recognize the symptoms of pulmonary TB. The distribution of drugs is distributed to each puskesmas in Central Aceh Regency, from the Puskesmas the drugs are arranged directly by P2TB officers then given directly to the PMO or the patient himself. PMO performance has never been given special training about treatment, PMO only received direction from P2TB Pulmonary officers. Recording and reporting carried out at the Jagong Health Center includes case finding, treatment, and recovery. Suspected pulmonary TB will be recorded and then monitored until the results of the examination have been obtained. Recording and reporting will be reported every month in a meeting at the Central Aceh District Health Office. For the Central Aceh Regency government to further enhance the development and improvement of infrastructure in the health sector so that health services are more easily accessible to people in remote areas.

What makes an effective Quality Improvement Manager? A qualitative study in the New Zealand Health System

Purpose Quality improvement is an international priority, and health organisations invest heavily in this endeavour. Little, however, is known of the role and perspectives of Quality Improvement Managers who are responsible for quality improvement implementation. We explored the quality improvement managers’ accounts of what competencies and qualities they require to achieve day-to-day and long-term quality improvement objectives. Design Qualitative exploratory design using an interpretivist approach with semi-structured interviews analysed thematically. Setting and participants. Interviews were conducted with 56 quality improvement managers from 15 (out of 20) New Zealand District Health Boards. Participants were divided into two groups: traditional and clinical quality improvement managers. The former group consisted of those with formal quality improvement education—typically operations managers or process engineers. The latter group was represented by clinical staff—physicians and nurses—who received on-the-job training. Results Three themes were identified: quality improvement expertise, leadership competencies and interpersonal competencies. Effective quality improvement managers require quality improvement experience and expertise in healthcare environments. They require leadership competencies including sense-giving, taking a long-term view and systems thinking. They also require interpersonal competencies including approachability, trustworthiness and supportiveness. Traditional and clinical quality improvement managers attributed different value to these characteristics with traditional quality improvement managers emphasising leadership competencies and interpersonal skills more than clinical quality improvement managers. Conclusions We differentiate between traditional and clinical quality improvement managers, and suggest how both groups can be better prepared to be effective in their roles. Both groups require a comprehensive socialisation and training process designed to meet specific learning needs.

Implementasi Health Belief Model terhadap pelaksanaan vaksinasi untuk penanggulangan pandemi Corona Virus Diseases-19 (Covid-19) pada tenaga kesehatan Kabupaten Nagan Raya

Background: World Health Organization (WHO) has declared Coronavirus Disease 2019 (COVID-19) as a pandemic. Interventions are needed not only in terms of implementing health protocols but also other effective interventions to decrease the transmission of disease through vaccination efforts which are aimed at reducing transmission/transmission of COVID-19, reducing morbidity and mortality due to COVID-19, and achieving group immunity in the community society (herd immunity).Objective: The purpose of this study was to identify the implementation of a health belief model for the implementation of vaccination in the context of overcoming the COVID-19 pandemic in health workers within the Nagan Raya District Health Office.Method: The type of research used a descriptive-analytic approach with a cross-sectional study design with a total sampling method of sampling. The sample in this study was 76 health workers from a population of 76 health workers at the Nagan Raya District Health Office. This study was conducted from March to September 2021. Data analysis used Chi-Square statistical test and Binary Logistic Regression with a significance level of 95%.Results: The results of this study indicate that there is a significant relationship between perceived susceptibility (p = 0.041), perceived benefits (p = 0.047), and cues to action (p = 0.037) with the implementation of vaccination in the context of dealing with the COVID-19 pandemic for health workers. There is no relationship between perceived severity (p = 1,000) and perceived barriers (p = 0,280) with the implementation of vaccination in the context of dealing with the COVID-19 pandemic in health workers.Conclusion: The dimension of the health belief model that is highly dominant related to the implementation of vaccination in the context of dealing with the COVID-19 pandemic in health workers is the perceived susceptibility variable with a value of p= 0.041 and Exp (B) = 5.376.

Analisis pelaksanaan program indonesia sehat dengan pendekatan keluarga (PIS-PK) pada Puskesmas di Kabupaten Nagan Raya

Background: The achievement indicators of the healthy Indonesia program with a family approach (PIS-PK) at the Nagan Raya District Health Center was still low. The implementation of the PIS-PK program was only training, preparation, analysis of the initial healthy family index. In contrast, further intervention and analysis have not run optimally, so the existing data has not been used appropriately.Objective: The purpose of the study, to analyze the implementation of the healthy Indonesia program with a family approach at the Public Health Centers (PHC) in Nagan Raya Regency.Method: This research design is a cross sectional study conducted in Nagan Raya Regency in 2021. The data were collected using a questionnaire with a sample size of 70 officers. The measurement of the variables of government support, infrastructure, community support, human resources for health workers, monitoring and evaluation, was measured using a questionnaire sheet. Data analysis used Chi-Square statistical test and Binary Logistic Regression with a significance level of 95%.Results: The results was showed that there was a relationship between community support (p= 0.010, OR = 3.72), facilities and infrastructure (p= 0.019, OR= 3.2),, government support (p= 0.00, OR= 6.15), health personnel resources (p=0.008, OR= 4.8), monitoring evaluation (p= 0.007, OR= 4.52) with the implementation of the PIS-PK program. Based on the multivariate test, the dominant variable associated with the PIS-PK program was government support.Conclusion: The good government support is 6.15 times related to the success of the PIS-PK program implementation program compared to less government support.

Edukasi Manfaat Vaksinasi Covid-19 dan Menangkal Hoax

ABSTRAK Vaksianasi Covid-19 menjadi program nasional yang dicanangkan Pemerintah bagi seluruh rakyat Indonesa di ke 34 Provinsi, dimulai sejak 13 Januari 2021 dan ditargetkan rampung pada Desember 2021. Kegiatan Pengabdian kepada masyarakat (PkM) dilakukan pada tanggal 4 Juni 2021 dalam bentuk webinar kesehatan diselenggarakan oleh Fakultas Keperawatan UPH bekerjasama dengan Dinas Kesehatan Kabupaten Tangerang, Dinas Kesehatan Provinsi Bali. Tujuan kegiatan ini untuk mendukung pemerintah dalam capaian vaksinasi Covid-19 melalui peningkatan pengetahuan dan sikap positif masyarakat untuk mengikuti vaksinasi. Kegiatan ditujukan bagi masyarakat umum dan diikuti oleh 227 peserta. Hasil kegiatan menunjukkan hal-hal sebagai berikut: 1) Karakteristik Peserta: berasal dari berbagai Provinsi (mayoritas dari Banten yaitu sebanyak 22%), beragam profesi (mayoritas adalah mahasiswa sebanyak 62,6%), beragam jenjang pendidikan (mayoritas adalah S1 yaitu sebanyak 67,4%) dan berbagai usia (mayoritas adalah 17-25 tahun yaitu sebanyak 66,5%); 2) Gambaran pengetahuan peserta terkait vaksin COVID-19 sudah baik. Hal ini terlihat dari rerata nilai pre-test sebesar 7.28 dan Nilai Median 7 yang kemudian meningkat pada post-test dengan rerata nilai 8.29 dan Nilai Median 9; 3) Sebanyak 207 (91,2%) peserta belum pernah terinfeksi COVID-19, sebanyak 220 (96,9%) peserta memiliki sikap positif (menilai penting) pemberian vaksin COVID-19, sebanyak 106 (46,7%) peserta mendapatkan informasi terkait vaksin COVID-19 dari media sosial, dan sebanyak 122 (53,7%) peserta belum pernah mendapatkan vaksin COVID-19; 4) Peserta antusias mengikuti webinar dari awal sampai akhir dan menilai kegiatan baik (memuaskan). Saran untuk lembaga mitra, agar dapat memanfaatkan media sosial secara maksimal untuk sosialisasi dan edukasi terkait vaksinasi COVID-19. Kata Kunci: COVID-19, Imunitas, Masyarakat, Pemerintah, Vaksin ABSTRACT The Covid-19 vaccination is a national program launched by the government for all Indonesians in 34 provinces beginning January 13, 2021 and expected to be completed in December 2021. A Community Service Activity (PkM) was held on June 4, 2021 in the form of a health webinar organized by The UPH Faculty of Nursing in collaboration with the Tangerang District Health Office and the Bali Provincial Health Office. The purpose of this activity is to support the government in achieving Covid-19 vaccination by increasing public awareness and positive attitudes toward vaccination. The activity was intended for the general public and had 227 participants. The results of the activity showed the following: 1) Characteristics of Participants: came from various provinces (the majority were from Banten, which was 22%), various professions (the majority were students, as many as 62.6%), various levels of education (the majority were Bachelors, namely 67.4%) and various ages (the majority are 17-25 years, which is 66.5%); 2) The description of participants' knowledge regarding the COVID-19 vaccine is good. This can be seen from the average pre-test score of 7.28 and a median value of 7 which then increased in the post-test with an average value of 8.29 and a median value of 9; 3) A total of 207 (91.2%) participants had never been infected with COVID-19, as many as 220 (96.9%) participants had a positive attitude (judged it was important) to administer the COVID-19 vaccine, as many as 106 (46.7%) participants received information related to the COVID-19 vaccine from social media, and as many as 122 (53.7%) participants had never received the COVID-19 vaccine; 4) Participants participated enthusiastically in the webinar from start to finish and rated the activity as good (satisfactory). Suggestions for partner institutions to make the best use of social media for COVID-19 vaccination socialization and education. Keywords: COVID-19, Immunity, Society, Government, Vaccines

A data quality assessment of the first four years of malaria reporting in the Senegal DHIS2, 2014–2017

Background As the global burden of malaria decreases, routine health information systems (RHIS) have become invaluable for monitoring progress towards elimination. The District Health Information System, version 2 (DHIS2) has been widely adopted across countries and is expected to increase the quality of reporting of RHIS. In this study, we evaluated the quality of reporting of key indicators of childhood malaria from January 2014 through December 2017, the first 4 years of DHIS2 implementation in Senegal. Methods Monthly data on the number of confirmed and suspected malaria cases as well as tests done were extracted from the Senegal DHIS2. Reporting completeness was measured as the number of monthly reports received divided by the expected number of reports in a given year. Completeness of indicator data was measured as the percentage of non-missing indicator values. We used a quasi-Poisson model with natural cubic spline terms of month of reporting to impute values missing at the facility level. We used the imputed values to take into account the percentage of malaria cases that were missed due to lack of reporting. Consistency was measured as the absence of moderate and extreme outliers, internal consistency between related indicators, and consistency of indicators over time. Results In contrast to public facilities of which 92.7% reported data in the DHIS2 system during the study period, only 15.3% of the private facilities used the reporting system. At the national level, completeness of facility reporting increased from 84.5% in 2014 to 97.5% in 2017. The percentage of expected malaria cases reported increased from 76.5% in 2014 to 94.7% in 2017. Over the study period, the percentage of malaria cases reported across all districts was on average 7.5% higher (P < 0.01) during the rainy season relative to the dry season. Reporting completeness rates were lower among hospitals compared to health centers and health posts. The incidence of moderate and extreme outlier values was 5.2 and 2.3%, respectively. The number of confirmed malaria cases increased by 15% whereas the numbers of suspected cases and tests conducted more than doubled from 2014 to 2017 likely due to a policy shift towards universal testing of pediatric febrile cases. Conclusions The quality of reporting for malaria indicators in the Senegal DHIS2 has improved over time and the data are suitable for use to monitor progress in malaria programs, with an understanding of their limitations. Senegalese health authorities should maintain the focus on broader adoption of DHIS2 reporting by private facilities, the sustainability of district-level data quality reviews, facility-level supervision and feedback mechanisms at all levels of the health system.

Regulating Midwives: Foreclosing Alternatives in the Policymaking Process in West Java, Indonesia

Promotion of “skilled birth attendants” (SBAs) in global maternal health policy has prompted a range of policy responses to “traditional birth attendants” (TBAs). In Indonesia the response has been to develop a national policy of partnership between SBAs (bidan) and TBAs (dukun bayi). This policy aims to ensure the presence of an SBA at every birth yet offers a role for TBAs. In this chapter I examine the development of a district regulation on partnership, promoted within the context of decentralization policies enacted in Indonesia from 1999. The district regulation aimed to strengthen the national policy in a location in West Java where TBAs remain popular. Drawing on 10 months of fieldwork from 2012 to 2013 at a district health office and on observations of its outreach programs, I elucidate how the regulation on partnership was promoted through the policy entrepreneurship of certain key figures in the district health office. They argued that the partnership regulation was the fastest means to improve maternal health. But casting a spotlight on the relationship between SBAs and TBAs diverted attention away from other health system challenges including under-resourced medical facilities and a weak referral system. Three contexts played into this process of bringing the partnership issue to the fore: global policies promoting SBAs and sidelining TBAs; pressure to achieve the Millennium Development Goal (MDG) on maternal mortality; and the limited financial power and decision space afforded to districts under decentralization in Indonesia. In this context, the regulation offered a viable path for demonstrating commitment to improving maternal health outcomes, yet one that failed to address broader constraints in the health system that contribute to persistent high maternal mortality rates.

Study on the Prevalence and Associated Factors of Perceived Stress on COVID-19 Among Healthcare Providers in Rupandehi District Health Institutions, Western Nepal

INTRODUCTION: Healthcare providers (HCPs) though stood as front-liners during the crisis situation were not themselves immune to the psychological consequences due to COVID-19. The present study aimed to find the prevalence of perceived stress on COVID-19 pandemic and its associated factors among health care providers in Rupandehi district health institutions. MATERIAL AND METHODS: This cross- sectional study was conducted among the HCPs in the institutions of Rupandehi district in Western Nepal, from August to November, 2020. Total 126 subjects were included and probability sampling technique was applied for sample collection. After written consent from participants socio-demographic data were collected and Perceived Stress Scale (PSS-10) was applied. RESULTS: The study showed the prevalence of perceived stress in COVID-19 HCPs found to be 65.1% considering score 20 as cut-off. Age, work place, precaution measures taken and staying with family were statistically significant with the perceived stress level (p<0.05). Multivariate logistic regression showed perceived stress level had statistically significant association with precaution means and work place of HCPs. Healthcare providers who had unsatisfactory precaution means followed at work were 2.66 times more likely to have perceived stress as compared to satisfactory precaution means as adjusted odds ratio (AOR) = 2.66 (1.09-6.51). Healthcare providers who stayed with family members were 2.28 times more likely to have perceived stress level as AOR=2.28 (0.94-5.52). CONCLUSION: The study showed increased prevalence of perceived stress among HCPs during the initial stage of COVID‐19 pandemic in Nepal. Considering the findings, there is urgent need to develop and implement appropriate stress management and coping strategies to the target group.