Participatory monitoring and evaluation approaches that influence decision-making: lessons from a maternal and newborn study in Eastern Uganda

BACKGROUND: The use of participatory monitoring and evaluation (M&E) approaches is important for guiding local decision-making, promoting the implementation of effective interventions and addressing emerging issues in the course of implementation. In this article, we explore how participatory M&E approaches helped to identify key design and implementation issues and how they influenced stakeholders’ decision-making in eastern Uganda. METHOD: The data for this paper is drawn from a retrospective reflection of various M&E approaches used in a maternal and newborn health project that was implemented in three districts in eastern Uganda. The methods included qualitative and quantitative M&E techniques such as key informant interviews, formal surveys and supportive supervision, as well as participatory approaches, notably participatory impact pathway analysis. RESULTS: At the design stage, the M&E approaches were useful for identifying key local problems and feasible local solutions and informing the activities that were subsequently implemented. During the implementation phase, the M&E approaches provided evidence that informed decision-making and helped identify emerging issues, such as weak implementation by some village health teams, health facility constraints such as poor use of standard guidelines, lack of placenta disposal pits, inadequate fuel for the ambulance at some facilities, and poor care for low birth weight infants. Sharing this information with key stakeholders prompted them to take appropriate actions. For example, the sub-county leadership constructed placenta disposal pits, the district health officer provided fuel for ambulances, and health workers received refresher training and mentorship on how to care for newborns. CONCLUSION: Diverse sources of information and perspectives can help researchers and decision-makers understand and adapt evidence to contexts for more effective interventions. Supporting districts to have crosscutting, routine information generating and sharing platforms that bring together stakeholders from different sectors is therefore crucial for the successful implementation of complex development interventions

Regulatory mechanisms for absenteeism in the health sector: a systematic review of strategies and their implementation

Angela N Kisakye,1 Raymond Tweheyo,1 Freddie Ssengooba,1 George W Pariyo,2 Elizeus Rutebemberwa,1 Suzanne N Kiwanuka1 1Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda; 2Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Background: A systematic review was undertaken to identify regulatory mechanisms aimed at mitigating health care worker absenteeism, to describe where and how they have been implemented as well as their possible effects. The goal was to propose potential policy options for managing the problem of absenteeism among human resources for health in low- and middle-income countries. Mechanisms described in this review are at the local workplace and broader national policy level. Methods: A comprehensive online search was conducted on EMBASE, CINAHL, PubMed, Google Scholar, Google, and Social Science Citation Index using MEDLINE search terms. Retrieved studies were uploaded onto reference manager and screened by two independent reviewers. Only publications in English were included. Data were extracted and synthesized according to the objectives of the review. Results: Twenty six of the 4,975 published articles retrieved were included. All were from high-income countries and covered all cadres of health workers. The regulatory mechanisms and possible effects include 1) organizational-level mechanisms being reported as effective in curbing absenteeism in low- and middle-income countries (LMICs); 2) prohibition of private sector activities in LMICs offering benefits but presenting a challenge for the government to monitor the health workforce; 3) contractual changes from temporary to fixed posts having been associated with no reduction in absenteeism and not being appropriate for LMICs; 4) multifaceted work interventions being implemented in most settings; 5) the possibility of using financial and incentive regulatory mechanisms in LMICs; 6) health intervention mechanisms reducing absenteeism when integrated with exercise programs; and 7) attendance by legislation during emergencies being criticized for violating human rights in the United States and not being effective in curbing absenteeism. Conclusion: Most countries have applied multiple strategies to mitigate health care worker absenteeism. The success of these interventions is heavily influenced by the context within which they are applied. Keywords: absenteeism, health workers, regulatory mechanisms, systematic revie

Clients and Providers’ Perceptions on the Quality and Provision of Contraceptive Services to Youths at Community Level in Rural Uganda: A Qualitative Study

Background: Contraceptive uptake among youths aged 15-24 years in Uganda remains low at 11%, despite a conducive policy environment and various contraceptive delivery models in the country. We explored the perceptions of youths on the quality of contraceptive services available and the providers’ perceptions towards delivering contraceptive services to young people at community level. Methods: Qualitative data were drawn from open-ended questions in a survey of 323 sexually active youths aged 15-24 years old. In addition, we conducted four focus group discussions with 48 youths, and eight (8) in-depth interviews with community-level contraceptive providers. We used latent content analysis technique to analyse the data. Results: A number of gaps in relation to the quality of available contraceptive services were cited by the youths. These included; inconsistencies in the supply of contraceptives, limited contraceptive options, absence of counselling from drug shop operators and perceived technical incompetency among some contraceptive providers. The youths also reported good client relations among Community Based Distributors of contraceptives (CBDs) and drug shop operators. In general, providers did not know that family planning policies existed, although the public healthcare providers and CBDs of contraceptives followed the family planning provision checklists. The providers also had misconceptions about contraceptive use among youths and negative attitudes towards the provision of contraceptives to the young ones and unmarried youths. Conclusion: To improve on the quality of contraceptive services provided to youths at community level, the inconsistencies in the availability of contraceptives and the negative attitudes by service providers towards dispensing contraceptives especially to the unmarried youths should be addressed. The availability of contraceptive choices too should not be compromised and dispensing contraceptives should be accompanied by adequate information