6 research outputs found

    Combatir la dependencia y promover la protección infantil en Ruanda

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    Depender constantemente de una ayuda que aumenta y disminuye a lo largo del tiempo y que procede en gran medida de fuentes externas puede producir la sensación de no tener poder alguno, además de menoscabar las iniciativas basadas en las familias y en la comunidad para proteger a los menores

    Support and performance improvement for primary health care workers in low- and middle-income countries: a scoping review of intervention design and methods.

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    Primary health care workers (HCWs) in low- and middle-income settings (LMIC) often work in challenging conditions in remote, rural areas, in isolation from the rest of the health system and particularly specialist care. Much attention has been given to implementation of interventions to support quality and performance improvement for workers in such settings. However, little is known about the design of such initiatives and which approaches predominate, let alone those that are most effective. We aimed for a broad understanding of what distinguishes different approaches to primary HCW support and performance improvement and to clarify the existing evidence as well as gaps in evidence in order to inform decision-making and design of programs intended to support and improve the performance of health workers in these settings. We systematically searched the literature for articles addressing this topic, and undertook a comparative review to document the principal approaches to performance and quality improvement for primary HCWs in LMIC settings. We identified 40 eligible papers reporting on interventions that we categorized into five different approaches: (1) supervision and supportive supervision; (2) mentoring; (3) tools and aids; (4) quality improvement methods, and (5) coaching. The variety of study designs and quality/performance indicators precluded a formal quantitative data synthesis. The most extensive literature was on supervision, but there was little clarity on what defines the most effective approach to the supervision activities themselves, let alone the design and implementation of supervision programs. The mentoring literature was limited, and largely focused on clinical skills building and educational strategies. Further research on how best to incorporate mentorship into pre-service clinical training, while maintaining its function within the routine health system, is needed. There is insufficient evidence to draw conclusions about coaching in this setting, however a review of the corporate and the business school literature is warranted to identify transferrable approaches. A substantial literature exists on tools, but significant variation in approaches makes comparison challenging. We found examples of effective individual projects and designs in specific settings, but there was a lack of comparative research on tools across approaches or across settings, and no systematic analysis within specific approaches to provide evidence with clear generalizability. Future research should prioritize comparative intervention trials to establish clear global standards for performance and quality improvement initiatives. Such standards will be critical to creating and sustaining a well-functioning health workforce and for global initiatives such as universal health coverage

    Combatting dependency and promoting child protection in Rwanda

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    Continuing dependence on aid that waxes and wanes with time and that comes largely from external sources can lead to feelings of powerlessness. It can furthermore undermine family- and community-based initiatives to protect children

    Humanitarian health programming and monitoring in inaccessible conflict settings: a literature review

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    Abstract Increasing global conflicts and risk to humanitarian aid workers have necessitated innovative approaches to deliver humanitarian assistance. Remotely managed operations aim to continue the provision of services where grave risk to expatriate staff and restrictions by authorities inhibit access. This review of peer-reviewed and gray literature identified these remote approaches and collated lessons learned and best practices for humanitarian health programming and monitoring in inaccessible conflict settings. Analysis identified key principles, including the importance of capacity building and frequent communication, comprehensively assessing and addressing the risks to national staff, increasing monitoring and evaluation efforts despite difficult conditions, and planning for the possibility of a transition to remote programming and having an exit strategy to prevent falling into the remote operations trap. Evidence on how to effectively carry out remote operations is limited; rigorous documentation and evaluation of remotely managed humanitarian operations are required to further build the evidence base
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