Quality of sick child care delivered by Health Surveillance Assistants in Malawi

Objective To assess the quality of care provided by Health Surveillance Assistants (HSAs)—a cadre of community-based health workers—as part of a national scale-up of community case management of childhood illness (CCM) in Malawi. Methods Trained research teams visited a random sample of HSAs (n = 131) trained in CCM and provided with initial essential drug stocks in six districts, and observed the provision of sick child care. Trained clinicians conducted ‘gold-standard' reassessments of the child. Members of the survey team also interviewed caregivers and HSAs and inspected drug stocks and patient registers. Findings HSAs provided correct treatment with antimalarials to 79% of the 241 children presenting with uncomplicated fever, with oral rehydration salts to 69% of the 93 children presenting with uncomplicated diarrhoea and with antibiotics to 52% of 58 children presenting with suspected pneumonia (cough with fast breathing). About one in five children (18%) presented with danger signs. HSAs correctly assessed 37% of children for four danger signs by conducting a physical exam, and correctly referred 55% of children with danger signs. Conclusion Malawi's CCM programme is a promising strategy for increasing coverage of sick child treatment, although there is much room for improvement, especially in the correct assessment and treatment of suspected pneumonia and the identification and referral of sick children with danger signs. However, HSAs provided sick child care at levels of quality similar to those provided in first-level health facilities in Malawi, and quality should improve if the Ministry of Health and partners act on the results of this assessmen

Development partner support to the health sector at the local level in Morogoro region, Tanzania

Background: The Tanzanian health sector receives large amounts of funding from multiple international development partners to support a broad range of population-health interventions. However, little is known about the partners’ level of commitment to sustain funding, and the implications of uncertainties created by these funding mechanisms.  This study had the following objectives: 1) To present a theoretical model for assessing funding commitments by health development partners in a specified region; 2) to describe development partner funding commitments against this framework, using a case study example of Morogoro Region, Tanzania; and 3) to discuss policy considerations using this framework for district, regional and national level.Methods: Qualitative case study methodology was used to assess funding commitments of health-related development partners in Morogoro Region, Tanzania. Using qualitative data, collected as part of an evaluation of maternal and child health programs in Morogoro Region, key informants from all development partners were interviewed and thematic analysis was conducted for the assessment. Results: Our findings show that decisions made on where to commit and direct funds were based on recipient government and development partner priorities. These decisions were based on government directives, such as the need to provide health services to vulnerable populations; the need to contribute towards alleviation of disease burden and development partner interests, including humanitarian concerns. Poor coordination of partner organizations and their funding priorities may undermine benefits to target populations. This weakness poses a major challenge on development partner investments in health, leading to duplication of efforts and resulting in stagnant disease burden levels.Conclusion: Effective coordination mechanisms between all stakeholders at each level should be advocated to provide a forum to discuss interests and priorities, so as to harmonize them and facilitate the implementation of development partner funded activities in the recipient countries

Program assessment of efforts to improve the quality of postpartum counselling in health centers in Morogoro region, Tanzania

BACKGROUND: The postpartum period represents a critical window where many maternal and child deaths occur. We assess the quality of postpartum care (PPC) as well as efforts to improve service delivery through additional training and supervision in Health Centers (HCs) in Morogoro Region, Tanzania. METHODS: Program implementers purposively selected nine program HCs for assessment with another nine HCs in the region remaining as comparison sites in a non-randomized program evaluation. PPC quality was assessed by examining structural inputs; provider and client profiles; processes (PNC counselling) and outcomes (patient knowledge) through direct observations of equipment, supplies and infrastructure (n = 18) and PPC counselling (n = 45); client exit interviews (n = 41); a provider survey (n = 62); and in-depth provider interviews (n = 10). RESULTS: While physical infrastructure, equipment and supplies were comparable across study sites (with water and electricity limitations), program areas had better availability of drugs and commodities. Overall, provider availability was also similar across study sites, with 63% of HCs following staffing norms, 17% of Reproductive and Child Health (RCH) providers absent and 14% of those providing PPC being unqualified to do so. In the program area, a median of 4 of 10 RCH providers received training. Despite training and supervisory inputs to program area HCs, provider and client knowledge of PPC was low and the content of PPC counseling provided limited to 3 of 80 PPC messages in over half the consultations observed. Among women attending PPC, 29 (71%) had delivered in a health facility and sought care a median of 13 days after delivery. Barriers to PPC care seeking included perceptions that PPC was of limited benefit to women and was primarily about child health, geographic distance, gaps in the continuity of care, and harsh facility treatment. CONCLUSIONS: Program training and supervision activities had a modest effect on the quality of PPC. To achieve broader transformation in PPC quality, client perceptions about the value of PPC need to be changed; the content of recommended PPC messages reviewed along with the location for PPC services; gaps in the availability of human resources addressed; and increased provider-client contact encouraged

Theory-Informed Course Design: Applications of Bloom’s Taxonomy in Undergraduate Public Health Courses

The public health workforce needs an array of knowledge and skills to effectively address current and future public health challenges. While existing competency models establish educational objectives for public health degree programs, there is insufficient guidance on how academic programs should develop these competencies, and workforce assessments continue to identify skills gaps in areas such as critical thinking and problem analysis. In this article, we describe an approach for designing undergraduate public health courses based on the hierarchy of cognitive processes in Bloom’s taxonomy. Course activities are sequenced to provide students with opportunities to attain increasing mastery of course concepts and analytical skills, from remembering new concepts to applying them in case studies and creating original analyses and proposals. This simple approach has been applied to three separate courses taught by multiple instructors over 3 years and has received positive feedback from students. By explicitly communicating the theoretical basis for course activities, this approach also promotes metacognitive knowledge in students that can foster their continued learning success.The programs of the Faculty Development Center (FDC) at the University of Maryland, Baltimore County, were instrumental in the development of the course designs described in this paper. The authors would like to thank Dr. Jennifer Harrison of the FDC for her review of this paper and helpful suggestionshttps://journals.sagepub.com/doi/abs/10.1177/2373379920979684?journalCode=php

Theory-Informed Course Design: Applications of Bloom’s Taxonomy in Undergraduate Public Health Courses

The public health workforce needs an array of knowledge and skills to effectively address current and future public health challenges. While existing competency models establish educational objectives for public health degree programs, there is insufficient guidance on how academic programs should develop these competencies, and workforce assessments continue to identify skills gaps in areas such as critical thinking and problem analysis. In this article, we describe an approach for designing undergraduate public health courses based on the hierarchy of cognitive processes in Bloom’s taxonomy. Course activities are sequenced to provide students with opportunities to attain increasing mastery of course concepts and analytical skills, from remembering new concepts to applying them in case studies and creating original analyses and proposals. This simple approach has been applied to three separate courses taught by multiple instructors over 3 years and has received positive feedback from students. By explicitly communicating the theoretical basis for course activities, this approach also promotes metacognitive knowledge in students that can foster their continued learning success. </jats:p

Relationships between internal facilitation processes and implementation outcomes among hospitals participating in a quality improvement collaborative to reduce cesarean births: a mixed-methods embedded case study

Quality improvement collaboratives (QICs) are a common strategy for implementing evidence-based practices; however, there is often variable performance between participating organizations. Few studies of QICs assess the internal facilitation (IF) processes engaged in by participating organizations, which may be key to understanding and enhancing the effectiveness of QICs as an implementation strategy. We examined IF processes among hospitals participating in Maryland’s perinatal QIC to implement national guidelines for reducing primary cesarean births.Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health and Development of the National Institutes of Health under award number R03HD096397https://link.springer.com/article/10.1186/s43058-025-00735-