Scaling up the integration of tuberculosis screening into reproductive health services

The Population Council’s APHIA II Operations Research and Kenya’s Ministry of Health implemented a pilot project in five facilities across Nairobi Province in 2010 with the aim of improving access to care and treatment for tuberculosis (TB) for women during postnatal care (PNC) services. As tuberculosis persists in Kenya, integration of screening and referrals within postnatal care services will increase case detection and treatment for those infected. Integration of TB screening is likely to be scaled up throughout PNC and maternal and child health services in Kenya. Strong linkages between health services, training, and supervision, and simple provider tools will optimize delivery of integrated TB services

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addresses political, economic and ecological development problems. ZEF closely cooperates with national and international partners in research and development organizations. For information, see: www.zef.de. ZEF – Discussion Papers on Development Policy are intended to stimulate discussion among researchers, practitioners and policy makers on current and emerging development issues. Each paper has been exposed to an internal discussion within the Center for Development Research (ZEF) and an external review. The papers mostly reflect work in progress. The Editorial Committee of the ZEF – DISCUSSION PAPERS ON DEVELOPMENT POLICY include Joachim von Braun (Chair), Solvey Gerke, and Manfred Denich. Tobias Wünscher is Managin

Operationalizing and scaling up HIV/RH referrals in Kenya: The way forward

This policy brief describes the APHIA II Operations Research Project through which the Population Council and Kenya’s Ministry of Health (MOH) developed and tested an approach to systematically link HIV-positive family planning (FP) clients to treatment and care services. Key activities included provider training and testing of a referral package which showed how, where, when, and who is to make and receive referrals. This referral package consisted of a directory listing all facilities in the vicinity available for services including HIV counseling and testing, FP, STIs, tuberculosis, and well-child checks; and referral forms directing clients to appropriate receiving clinics. The results of the study showed that the referral framework was feasible, acceptable and effective in all the participating health facilities. Successful replication and scale-up activities of an effective referral system can only be realized if key conditions such as leadership from MOH, a functional partnership, and a revitalized pipeline of commodities and supplies are in place

Total Quality Management Practices in Selected Private Hospitals

ABSTARCT The study assesses the existence of total quality management systems in selected private hospitals in Nairobi, Kenya. The critical factors for TQM implementation were also examined including the performance measurement for the effectiveness of these quality systems. This was a case study research design and convenience sampling was done for the top level managers, whereas stratified random sampling was done for the middle level functional managers. Data for identifying the critical factors influencing total quality management in the hospitals and its implementation was collected using semi-structured and structured questionnaires. Quantitative data analysis was done using principle component analysis. Factor analysis was done using analysis of moment structures. The results and findings of the study will be vital for the improvement of service provision in hospitals in developing countries

Index-based livestock insurance as an innovative tool against drought loss: Good practices and impact analysis from northern Kenya

Index-based livestock insurance (IBLI) is a donor-funded programme aimed at designing, developing and implementing market-mediated, index-based insurance products to protect livestock keepers, particularly in the drought-prone arid and semi-arid lands (ASALs), from drought-related asset losses. The IBLI index is based on satellite data, which measure the quality of the pastureland every 10–16 days. These data are inputs to a statistical model of livestock mortality developed using historical data from the region. When evolving range conditions predict livestock mortality in excess of a critical threshold (say 15%) over a predetermined area, the insurance pays contract-holding pastoralists for their losses, allowing them to manage their individual risk. The programme operates under the International Livestock Research Institute (ILRI) and is delivered by several private sector insurance providers, with financial support from the United Kingdom Department for International Development (DFID), Australia’s Department of Foreign Affairs and Trade and the European Union

Community perceptions of childbearing and use of safer conception strategies among HIV‐discordant couples in Kisumu, Kenya

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138196/1/jia29972.pd

From community to assemblage? : ICT provides a site for inclusion and exclusion in the global south

The role of information and communication technology (ICT) in development has been discussed from two distinctly different perspectives: some view it as a means for opening new alleys for the facilitation of development and democracy, while others assess it as counterproductive. Furthermore, it has been emphasised that people in cities and rural areas utilise ICT in different ways, as do people with wealth and education compared to poor people. In Africa, Kenya has declared itself an ICT hub. The state has emphasised ICT in promoting services, much less freedom of expression. This article discusses ICT and development via the filter of assemblage, a key concept developed by Deleuze and Guattari (2004/1980. A Thousand Plateaus: Capitalism and Schizophrenia. London: Continuum.). They emphasised fluidity as well as micro- and macro-level dichotomies. When communities based on sharing and consistent social order meet new technology, the change goes deeper than that of improved services. The basic difference might be the fact that a community is constructed on cultural ties developed over time, which strengthens immobility and stability, while an assemblage is characterised by mobility and fluidity. Thus, a system of values, hierarchies, and inherited traditions is challenged, mixed with ‘new’ problems brought about by individualised behaviour.Peer reviewe

Exploring informed consent in HIV clinical trials: A case study in Uganda

Introduction: In settings with low literacy levels ensuring that participants are fully-informed before they consent to participate in clinical trials is a challenge. We explored the experiences and concerns of key actors in the informed consent process in two HIV clinical trials. Method: Semi-structured interviews were conducted with 46 respondents including trial participants, research study team and research ethics committee members about their experiences during the informed consent process. Three focus group discussions were conducted with 14 Community Advisory Board (CAB) members and 17 trial participants. Data were analysed to identify key themes. Findings: The consent process was highlighted as an important procedure by all the key actors however each group had a particular area of emphasis. Signing a consent form was given importance by research team and ethics committee members, because it provided documented evidence of a participant’s willingness to join a clinical trial. Participants did not welcome the presence of a witness for a non-literate participant because understanding study information was not closely related to an ability to read and write. Conclusion: This study’s findings indicated that obtaining a volunteer’s signature or thumbprint on a consent form did not necessarily mean that the participant was fully-informed about the information relevant to their taking part nor that they understood all the information shared with them. Informed consent requires sufficient time in the research process to have staff trained well enough before research begins. Ensuring and gaining informed consent should be understood and treated as a relation-centred, dynamic supportive process throughout the duration of a research study

Overview of migration, poverty and health dynamics in Nairobi City's slum settlements

The Urbanization, Poverty, and Health Dynamics research program was designed to generate and provide the evidence base that would help governments, development partners, and other stakeholders understand how the urban slum context affects health outcomes in order to stimulate policy and action for uplifting the wellbeing of slum residents. The program was nested into the Nairobi Urban Health and Demographic Surveillance System, a uniquely rich longitudinal research platform, set up in Korogocho and Viwandani slum settlements in Nairobi city, Kenya. Findings provide rich insights on the context in which slum dwellers live and how poverty and migration status interacts with health issues over the life course. Contrary to popular opinions and beliefs that see slums as homogenous residential entities, the findings paint a picture of a highly dynamic and heterogeneous setting. While slum populations are highly mobile, about half of the population comprises relatively well doing long-term dwellers who have lived in slum settlements for over 10 years. The poor health outcomes that slum residents exhibit at all stages of the life course are rooted in three key characteristics of slum settlements: poor environmental conditions and infrastructure; limited access to services due to lack of income to pay for treatment and preventive services; and reliance on poor quality and mostly informal and unregulated health services that are not well suited to meeting the unique realities and health needs of slum dwellers. Consequently, policies and programs aimed at improving the wellbeing of slum dwellers should address comprehensively the underlying structural, economic, behavioral, and service-oriented barriers to good health and productive lives among slum residents

Supporting children and adolescents who have experienced sexual abuse to access services: community health workers’ experiences in Kenya

Child sexual abuse (CSA) is a global health problem with significant health consequences. The World Health Organization recommends immediate and long-term treatment for all survivors. However, in low- and middle-income countries, less than 10 % of sexually abused children seek health services. Community health workers (CHWs) can potentially increase uptake of services, but, the risks and benefits of services provided by CHWs are poorly understood. Methods: Through in-depth interviews, we examined the experiences of CHWs providing services to children in Kenya. Sixteen CHWs were purposively selected from two locations. Data were audio-recorded, transcribed verbatim and analysed thematically. Findings: Nearly all the CHWs reported assisting children who had experienced sexual abuse. Children were brought to their attention by caregivers, neighbours, teachers, local authorities or the police. CHWs roles included providing information and advice, assisting the child to report to the police, access healthcare or find shelter. Multiple challenges were reported including lack of support from formal institutions; community norms; safety concerns; inadequate resources and interference from family, perpetrators and local authorities. Lack of protocols and training on how to handle children was evident. Conclusions: CHWs are a crucial community-level resource for CSA survivors and their caregivers. However, community norms, lack of guidelines and training may compromise the quality of services provided. There is a significant gap in literature on service models for CHWs delivering CSA services. Data are lacking on what services CHWs can effectively offer, how they should be delivered and what factors may influence delivery, acceptance and uptake of services