Politique de l’évaluation, évaluation de la politique

Lorsqu’un pays subit une transformation sociétale et éducative majeure, la question de la qualité de l’éducation et l’accroissement de cette qualité demeurent une priorité. De plus, la qualité du processus de transformation doit également être évaluée. Cet article aborde certains nouveaux mécanismes de contrôle de la qualité en Afrique du Sud, les difficultés rencontrées pour mettre en place un système novateur d’indicateurs qualitatifs et quantitatifs et les effets de ces mesures sur le système éducatif.When a country undergoes major societal and education transformation the question of quality in education and the improvement of quality remains a priority. Furthermore, the quality of the transformation process also needs to be evaluated. This article discusses some of the new mechanisms and processes of quality assurance in South Africa, the difficulties of developing a new system of qualitative and quantitative indicators and the effect of new measures of quality assurance on the education system.Cuando un país sufre una transformación de la sociedad y educativa importante, la calidad de la educación y su incremento son asuntos prioritarios. Además, también conviene evaluar la calidad del proceso de transformación. Este artículo enfoca nuevos mecanismos de control de la calidad en Africa del Sur, las dificultades superadas para elaborar un sistema novedoso de indicadores cualitativos y cuantitativos y los efectos de estas medidas en el sistema educativo

Creating person-al space for unspoken voices during diagnostic medical imaging examinations: a qualitative study

BACKGROUND: There is emerging interest in person-centred care within a short-lived yet complex medical imaging encounter. This study explored this event from the viewpoint of patients referred for an imaging examination, with a focus on the person and their person-al space. METHODS: We used convenience sampling to conduct semi-structured interviews with 21 patients in a private medical imaging practice in Australia. The first phase of data analysis was conducted deductively, using the six elements of the person-centred, patient-journey framework of the Australian Commission on Safety and Quality in Healthcare: transition in; engagement; decisions; well-being; experience; and transition out. This was followed by inductive content analysis to identify overarching themes that span a patient’s journey into, through and out of an imaging encounter. RESULTS: The transition-in phase began with an appointment and the first point of contact with the imaging department at reception. Engagement focused on patient-radiographer interactions and explanations to the patient on what was going to happen. Decisions related primarily to radiographers’ decisions on how to conduct a particular examination and how to get patient cooperation. Participants’ well-being related to their appreciation of gentle treatment; they also referred to past negative experiences that had made a lasting impression. Transitioning out of the imaging encounter included the sending of the results to the referring medical practitioner. Person-al vulnerabilities emerged as a cross-cutting theme. Patients’ vulnerability, for which they needed reassurance, pertained to uncertainties about the investigation and the possible results. Healthcare professionals were vulnerable because of patient expectations of a certain demeanour and of pressure to perform optimal quality investigations. Lastly, patients’ personal lives, concerns and pressures – their person-al ‘baggage’ – shaped their experience of the imaging encounter. CONCLUSION: To add value to the quality of the service they deliver, radiography practitioners should endeavour to create a person-al space for clients. Creating these spaces is complex as patients are not in a position to judge the procedures required by technical imaging protocols and the quality control of equipment. A reflective tool is proposed for radiographers to use in discussions with their team and its leaders on improving person-centred care and the quality of services in their practice

Helping small babies survive: an evaluation of facility-based Kangaroo Mother Care implementation progress in Uganda

Abstract Introduction: Prematurity is the leading cause of newborn death in Uganda, accounting for 38% of the nation's 39,000 annual newborn deaths

Neonatal nurses's role in kangaroo mother care

No abstract available.http://www.pntonline.co.za/index.php/PN

Stages of change: A qualitative study on the implementation of a perinatal audit programme in South Africa

<p>Abstract</p> <p>Background</p> <p>Audit and feedback is an established strategy for improving maternal, neonatal and child health. The Perinatal Problem Identification Programme (PPIP), implemented in South African public hospitals in the late 1990s, measures perinatal mortality rates and identifies avoidable factors associated with each death. The aim of this study was to elucidate the processes involved in the implementation and sustainability of this programme.</p> <p>Methods</p> <p>Clinicians' experiences of the implementation and maintenance of PPIP were explored qualitatively in two workshop sessions. An analytical framework comprising six stages of change, divided into three phases, was used: pre-implementation (create awareness, commit to implementation); implementation (prepare to implement, implement) and institutionalisation (integrate into routine practice, sustain new practices).</p> <p>Results</p> <p>Four essential factors emerged as important for the successful implementation and sustainability of an audit system throughout the different stages of change: 1) drivers (agents of change) and team work, 2) clinical outreach visits and supervisory activities, 3) institutional perinatal review and feedback meetings, and 4) communication and networking between health system levels, health care facilities and different role-players.</p> <p>During the pre-implementation phase high perinatal mortality rates highlighted the problem and indicated the need to implement an audit programme (stage 1). Commitment to implementing the programme was achieved by obtaining buy-in from management, administration and health care practitioners (stage 2).</p> <p>Preparations in the implementation phase included the procurement and installation of software and training in its use (stage 3). Implementation began with the collection of data, followed by feedback at perinatal review meetings (stage 4).</p> <p>The institutionalisation phase was reached when the results of the audit were integrated into routine practice (stage 5) and when data collection had been sustained for a longer period (stage 6).</p> <p>Conclusion</p> <p>Insights into the factors necessary for the successful implementation and maintenance of an audit programme and the process of change involved may also be transferable to similar low- and middle-income public health settings where the reduction of the neonatal mortality rate is a key objective in reaching Millennium Development Goal 4. A tool for reflecting on the implementation and maintenance of an audit programme is also proposed.</p

Roles and responsibilities in the transition to working independently : a qualitative study of recently graduated radiographers’ perspectives in Australia

BACKGROUND : Medical imaging features along the entire healthcare continuum and is known for its fast-paced technological evolution which enables it to keep up with the demands of the healthcare system to provide safe, quality services. The overall efficacy and efficiency of the system depends on practitioners’ clinical competence, achieved through professional education and continuous professional development. Recent studies have revealed concerns regarding newly graduated healthcare professionals’ preparedness and readiness to handle actual practice. METHODS : We conducted qualitative face-to-face and telephonic interviews with a convenient and purposive sample of 23 participants consisting of recently graduated radiographers (n=14), radiography students (n=5) and supervising radiographers (n=4) in Australia. Verbatim transcriptions were analyzed inductively to identify themes pertaining to perspectives and experiences of the work readiness of novice radiographers. RESULTS : The findings of our study suggest that the workplace immersion and transitioning of recently graduated radiographers into their professional roles requires a process of experiential learning and honing of knowledge and skills if they are to function efficiently and independently in a team-oriented workplace. Radiographic services are spread across various levels of care and are an integral part of the organizational structure of a healthcare system. Maladaptive transitions to the workplace may be the result of low selfconfidence, a lack of support, uncertainty in inter-collegial interactions, or unrealistic performance expectations. The overarching themes of communication and interaction emerged clearly as recently graduated radiographers navigated the four roles of coordinator, collaborator, mediator, and advocate. CONCLUSION : The application of radiographic skills is embedded in a workplace culture of communication and safety. Transitioning to independent practice takes place in a complex, multifaceted environment and is accompanied by internal and external expectations. Because each workplace has a unique context, system and culture, no novice radiographic professional can ever be fully prepared through pre-service training and workplace induction.http://www.dovepress.com/journal-of-multidisciplinary-healthcare-journalam2024Paediatrics and Child HealthSDG-03:Good heatlh and well-bein

Patients’ journeys through multi-level diagnostic imaging referrals

BACKGROUND : Diagnostic imaging plays an integral role in disease diagnosis and patient treatment. The challenge in the context of diagnostic imaging referrals is how to collectively navigate patients through these services, intra- and inter-institutionally. OBJECTIVE : To map the referral processes and procedures that lead to access to diagnostic imaging services within the embedded multi-level medico-clinical pathways up to the point of an ultimate diagnosis as part of a patient’s treatment and management plan. METHODS : This study was part of a larger qualitative study conducted at a district hospital situated in an academic hospital complex. A total of 24 conveniently selected patients were ‘shadowed’ from entry until discharge. Data collection methods included observations of the various types of consultations and individual and focus group interviews with multiple healthcare providers. FINDINGS : Two main themes pertaining to referrals for diagnostic imaging were identified. The first relates to the decisions that a medical officer or specialist has to make about the sequence of activities and procedures related to each patient’s condition. The second theme refers to the multi-level routing of patients. CONCLUSION : The informational interactions between providers that takes place during a patient’s journey inform the mapping approach to referral pathways for diagnostic imaging investigations from a systemic point of view. This process can also enhance the strategic management of the system.http://www.sorsa.org.zaam201

Helping small babies survive: an evaluation of facility-based Kangaroo Mother Care implementation progress in Uganda

Introduction: Prematurity is the leading cause of newborn death in Uganda, accounting for 38% of the nation's 39,000 annual newborn deaths. Kangaroo mother care is a high-impact; cost-effective  intervention that has been prioritized in policy in Uganda but implementation has been limited. Methods: A standardised, cross-sectional, mixed-method evaluation design was used, employing  semi-structured key-informant interviews and observations in 11 health care facilities implementing kangaroo mother care in Uganda. Results: The facilities visited scored between 8.28 and 21.72 out of the possible 30 points with a median  score of 14.71. Two of the 3 highest scoring hospitals were private, not-for-profit hospitals whereas the second highest scoring hospital was a central teaching hospital. Facilities with KMC services are not  equally distributed throughout the country. Only 4 regions (Central 1, Central 2, East-Central and Southwest) plus the City of Kampala were identified as having facilities providing KMC services. Conclusion: KMC services are not instituted with consistent levels of quality and are often dependent on  private partner support. With increasing attention globally and in country, Uganda is in a unique position  to accelerate access to and quality of health services for small babies across the country.Key words: Delivery of health care, implementation, infant premature, Kangaroo Mother Care, neonatal, newborn, preterm, program evaluation, Ugand

What is the impact of multi-professional emergency obstetric and neonatal care training?

This paper reviews evidence regarding change in health-care provider behaviour and maternal and neonatal outcomes as a result of emergency obstetric and neonatal care (EmONC) training. A refined version of the Kirkpatrick classification for programme evaluation was used to focus on change in efficiency and impact of training (levels 3 and 4). Twenty-three studies were reviewed e five randomised controlled trials, two quasi-experimental studies and 16 before-and-after observational studies. Training programmes had all been developed in high-income countries and adapted for use in low- and middle-income countries. Nine studies reported on behaviour change and 13 on process and patient outcomes. Most showed positive results. Every maternity unit should provide EmONC teamwork training, mandatory for all health-care providers. The challenges are as follows: scaling up such training to all institutions, sustaining regular in-service training, integrating training into institutional and health-system patient safety initiatives and ‘thinking out of the box’ in evaluation research.Medical Research Council of South Africa and the University of Pretoria.http://www.elsevier.com/locate/bpobgyn2016-11-30hb201

Changing priorities in maternal and perinatal health in Gert Sibande District, South Africa

Gert Sibande District is a predominantly rural district in Mpumalanga Province, South Africa (SA), with a population of just over 1.1 million. It has a high prevalence of HIV infection and pregnancy-related hypertensive disease. In 2010 the district was one of the worst-performing health districts in SA, with a maternal mortality ratio of 328.0 per 100 000 births. Various programmes were introduced between 2010 and 2017 to address major causes of maternal and perinatal morbidity and mortality in the district. The focus has been on HIV-related morbidity, the direct obstetric causes of maternal and perinatal morbidity and mortality, and health systems strengthening. During the period 2010 - 2017, there was a steady decline in institutional maternal mortality with a drop of 71% in maternal deaths over a period of 6 years, from 328.0 per 100 000 births to 95.0. However, the ratio levelled off in 2016 and 2017, mainly as a result of a changing disease profile. The stillbirth rate showed a decline of 24.4% over a period of 8 years. With perseverance, rapid response and evidence-based strategies it was possible to more than halve the institutional maternal mortality ratio within 6 years. However, with the changing disease profile, conditions such as hypertensive disease in pregnancy should be prioritised and new strategies developed to further reduce maternal and perinatal mortality and morbidity.http://www.samj.org.zaam2020Family MedicineObstetrics and Gynaecolog