Exploring the Factors Influencing the Performance of District Health Management Teams in Sierra Leone

Background: Decentralized district health system is the cornerstone of a country’s health sectors. The aim of the present study was to investigate the factors that influence the performance of the district health management team (DHMT) in Sierra Leone. The study was guided by a conceptual framework that is adapted from the World Health Organization leadership and management strengthening framework. Methods: The study used a qualitative method design and targeted both the District Medical Officers (DMO) and their subordinates in four DHMTs (Bo, Kailahun, Kenema and Kono). An interview guide was used to explore the perspectives of both the DMOs and their subordinates (n=27) on the perceived factors that influence the performance of the DHMTs. A thematic analysis, using the WHO framework was carried out in the analysis of the data. Results: The perceived factors that influence the performance of DHMTs are notably the inadequate and late disbursement of funds to the district. This affects the implementation of planned activities. Further, the lack of adequate and capable staff within the DHMTs was highlighted. Other concerns were the poor coordination between national and district level in health program implementation; and the poor working conditions such as poor office spaces, unreliable power supplies and internet connectivity. Conclusions: Addressing the human resource gap within DHMT, ensuring a better flow of funds to the district, and improved coordination in health program implementation between national and district are promising measures that will optimize the performance of the DHMTs in Sierra Leone. Keywords: health system, health system strengthening, health system performance, district health system, district health management, decentralization, devolution DOI: 10.7176/JHMN/76-03 Publication date:June 30th 202

Decentralized Health System Leadership: Are District Health Management Teams in Good Hands? Perspectives of 4 districts in Sierra Leone

Background: Evidence is abound that good leadership and management practices can improve the performance of health system Conversely, poor leadership practices from health leaders have detrimental effects on the performance of the health system. Decentralized district health system is the cornerstone of a country’s health sectors. This is the more the reason the post Ebola health system strengthening in Sierra Leone had a component on staff leadership development for personnel at both central and district levels. In this study, the leadership styles of the District Medical Officers (DMOs) are examined to assess their influence on the performance of DHMTs in Sierra Leone. Methods: The was a cross-sectional quantitative study that targeted the heads of units within the District Health Management Teams of Bo, Kailahun, Kenema, and Kono. A self-administered questionnaire using Likert Scale was provided to the subordinates (n=23) to rate the leadership and management practices of their DMOs. SPSS version 25 was used to analyze the data. Results: The leadership and management practices of the DMOs are rated as democratic by the majority of the subordinates. However, the subordinates also reported that their DMOs are domineering and are also encouraging favouritism within the teams. The study did not find any statistically significant difference among the four districts on the influence of leadership of the DMO and DHMT performance (p >.05). Conclusions: The leadership style of the health managers can influence the performance of the DHMT. In this study, the leadership style of the DHMTs is largely perceived to be democratic by their subordinates. The good leadership skills of the DMOs in the surveyed districts might be responsible for the relative effectiveness and efficiency of the operations of their DHMTs. However, the majority of the subordinates in all the districts testified that their DMOs are domineering and also encourage favouritism. These practices are considered autocratic and divisive. These are areas for the MoHS leadership to actually examine and address for optimal DHMT performance. Keywords: healthcare, leadership styles, management and leadership theories, health system, health system strengthening, health system performance, district health system, district health management, decentralization, and devolution DOI: 10.7176/JHMN/76-02 Publication date:June 30th 202

Predictive Relationship Between Health System Attributes and Access to Essential Maternal and Child Health Services: Evidence from a SARA Survey

The robustness and responsiveness of a country’s health system predict access to a range of health services, including maternal and child health (MCH) services. The purpose of this cross-sectional study was to examine the influence of 5 health system characteristics on access to MCH services in Sierra Leone. The study was a secondary analysis of the Sierra Leone 2017 Service Availability and Readiness Assessment (SARA) dataset, which comprised 100% (1, 284) of the country’s health facilities. Data analysis included bivariate and multivariate logistic regressions. In the bivariate analysis, all the independent variables showed statistically significant association with access to MCH services and achieved a p-value < .001. In the multivariate analysis; however, only 3 predictors explained 38% of the variance (R² = .380, F (5, 1263) = 154.667, p <.001). The type of health provider significantly predicted access to MCH services (β =.549, p <.001), as did the availability of essential medicines (β= .255, p <.001) and the availability of basic equipment (β= .258, p <.001). According to the study findings, the availability of the right mix of health providers, essential medicines, and basic equipment significantly influenced access to MCH services, regardless of the level and type of health facility. The findings of this study might contribute in helping the authorities of the Sierra Leone health sector to identify critical health system considerations for increased access to MCH services and improved maternal and child health outcomes. Keywords: health system, health services, maternal health, child health, healthcare access DOI: 10.7176/JHMN/76-06 Publication date:June 30th 202

Postcard: Visiting Rock City, Ottawa County, Kansas

This black and white photographic postcard features three different photos at the rock park in Ottawa County, Kansas. The image on the left is in a round frame and depicts a group of six people in front of the rocks with one person on top. The image on the right consists of a man and a woman in a carriage buddy with a single horse. The rocks are in the background and it is in a rectangle frame. The bottom image depicts three people sitting on top of the rocks. The image is framed in the shape of Kansas. Printed illustrations of flowers frames the pictures. Printed text is on the right side of the card.https://scholars.fhsu.edu/tj_postcards/1303/thumbnail.jp

Segmentation, separation and pose estimation of prostate brachytherapy seeds in CT images.

International audienceIn this paper, we address the development of an automatic approach for the computation of pose information (position + orientation) of prostate brachytherapy loose seeds from 3D CT images. From an initial detection of a set of seed candidates in CT images using a threshold and connected component method, the orientation of each individual seed is estimated by using the principal components analysis (PCA) method. The main originality of this approach is the ability to classify the detected objects based on a priori intensity and volume information and to separate groups of closely spaced seeds using three competing clustering methods: the standard and a modified k-means method and a Gaussian mixture model with an Expectation-Maximization algorithm. Experiments were carried out on a series of CT images of two phantoms and patients. The fourteen patients correspond to a total of 1063 implanted seeds. Detections are compared to manual segmentation and to related work in terms of detection performance and calculation time. This automatic method has proved to be accurate and fast including the ability to separate groups of seeds in a reliable way and to determine the orientation of each seed. Such a method is mandatory to be able to compute precisely the real dose delivered to the patient post-operatively instead of assuming the alignment of seeds along the theoretical insertion direction of the brachytherapy needles

Automatic calculation of chamfer mask coefficients for large masks and anisotropic images

Chamfer disctances are widely used in image analysis, and many ways have been investigated to compute optimal chamfer mask coefficients. Unfortunately, these methods are not systematized: they have to be conducted manually for every mask size or image anisotropy. Since image acquisistion (e.g. medical imaging) can lead to anisotropic discrete grids with unpredictable anisotropy value, automated calculation of chamfer mask coefficients becomes mandatory for efficient distance map computation. This report presentes a systematized calculation of these coefficients based on the automatic construction of chamfer masks of any size associated with a triangulation that allows to derive analytically the relative error with respect to the Euclidean distance, in any 3-D anisotropic lattice and that also allows to compute norm constraints

Comments on "On Approximating Euclidean Metrics by Weighted t-Cost Distances in Arbitrary Dimension"

Mukherjee (Pattern Recognition Letters, vol. 32, pp. 824-831, 2011) recently introduced a class of distance functions called weighted t-cost distances that generalize m-neighbor, octagonal, and t-cost distances. He proved that weighted t-cost distances form a family of metrics and derived an approximation for the Euclidean norm in $\mathbb{Z}^n$. In this note we compare this approximation to two previously proposed Euclidean norm approximations and demonstrate that the empirical average errors given by Mukherjee are significantly optimistic in $\mathbb{R}^n$. We also propose a simple normalization scheme that improves the accuracy of his approximation substantially with respect to both average and maximum relative errors.Comment: 7 pages, 1 figure, 3 tables. arXiv admin note: substantial text overlap with arXiv:1008.487

On optimal chamfer masks and coefficients

This report describes the calculation of local errors in Chamfer masks both in two- and in three-dimensional anisotropic spaces. For these errors, closed forms are given that can be related to the Chamfer mask geometry. Thanks to these calculation, it can be obsrved that the usual Chamfer masks (i.e. 3x3x3 or 5x5x5) have an inhomogeneously distributed error. Moreover, it allows us to design dedicated Chamfer masks by controlling either the complexity of the computation of the distance map (or equivalently the number of vectors in the mask), or the error of the mask in \mathbbZ^2 or in \mathbbZ^3. Last, since Chamfer distances are usually computed with integer weights (and approximate the Euclidean distance up to a multiplicative factor), we demonstrate that the knowledge of the local errors allows a very efficient computation of these weights

Systematized calculation of optimal coefficients of 3-D chamfer norms

International audienceChamfer distances are widely used in image analysis, and many ways have been investigated to compute optimal chamfer mask coefficients. Unfortunately, these methods are not systematized: they have to be conducted manually for every mask size or image anisotropy. Since image acquisition (e.g. medical imaging) can lead to anisotropic discrete grids with unpredictable anisotropy value, automated calculation of chamfer mask coefficients becomes mandatory for efficient distance map computation. This article presents a systematized calculation of these coefficients based on the automatic construction of chamfer masks of any size associated with a triangulation that allows to derive analytically the relative error with respect to the Euclidean distance, in any 3-D anisotropic lattice

3D/4D ultrasound registration of bone

This paper presents a method to reduce the invasiveness of Computer Assisted Orthopaedic Surgery (CAOS) using ultrasound. In this goal, we need to develop a method for 3D/4D ultrasound registration. The premilinary results of this study suggest that the development of a robust and ``realtime'' 3D/4D ultrasound registration is feasible