Access to HIV healthcare services by farm workers in sub-Saharan Africa (SSA): A systematic review protocol

Sub-Saharan Africa (SSA) region harbours the highest burden of HIV infections in the world. Agricultural work has been reported as one of the occupations with a high prevalence of HIV. Farm workers generally have poor access to health services, which prevents them from receiving proper HIV prevention and care. Furthermore, poor policies and policy implementation, and lack of workplace programmes increases farm workers’ vulnerability to HIV infection. Thus, the aim of this study is to conduct a systematic review to assess HIV prevention and treatment services and national policies governing access to healthcare services by farm workers in SSA

Non-booking for antenatal care and risks for vertical HIV transmission among women in Chitungwiza, Zimbabwe: a cross-sectional study

Background: The success of prevention of mother to child transmission of HIV (PMTCT) programs dependents on pregnant women accessing antenatal care (ANC) services. Failure to access ANC throughout the course of pregnancy presents a missed opportunity to fully utilize PMTCT services and a high risk for vertical HIV transmission. Whilst not booking for ANC was about 6% in Zimbabwe, according to the 2015 Zimbabwe Demographic and Health Survey, it is important to determine the local burden of pregnant women both un-booked for ANC and living with HIV. in Chitungwiza city, to inform local response. This study aimed at determining the proportion of women un-booked for antenatal care and among them, the proportion of women who were with HIV and to identify risk factors associated with not-booking for ANC in Chitungwiza city in Zimbabwe

Understanding key drivers of performance in the provision of maternal health services in eastern cape, South Africa: a systems analysis using group model building

Background The Eastern Cape Province reports among the poorest health service indicators in South Africa with some of its districts standing out as worst performing as regards maternal health indicators. To understand key drivers and outcomes of this underperformance and to explore whether a participatory analysis could deepen action-oriented understanding among stakeholders, a study was conducted in one of the chronically poorly performing districts. Methods The study used a systems analysis approach to understand the drivers and outcomes affecting maternal health in the district in order to identify key leverage points for addressing the situation. The approach included semi-structured interviews with a total of 24 individuals consisting health system managers at various levels, health facility staff and patients. This was followed by a participatory group model building exercise with 23 key stakeholders to analyze system factors and their interrelationships affecting maternal health in the district using rich pictures and interrelationship diagraphs (IRDs) and finally the development of causal loop diagrams (CLDs). Results The stakeholders were able to unpack the complex ways in which factors were interrelated in contributing to poor maternal health performance and identified the feedback loops which resulted in the situation being intractable, suggesting strategies for sustainable improvement. Quality of leadership was shown to have a pervasive influence on overall system performance by linking to numerous factors and feedback loops, including staff motivation and capacity building. Staff motivation was linked to quality of care in turn influencing patient attendance and feeding back into staff motivation through its impact on workload. Without attention to workload, patient waiting times and satisfaction, the impact of improved leadership and staff support on staff competence and attitudes would be diminished. Conclusion Understanding the complex interrelationships of factors in the health system is key to identifying workable solutions especially in the context of chronic health systems challenges. Systems modelling using group model building methods can be an efficient means of supporting stakeholders to recognize valuable resources within the context of a dysfunctional system to strengthen systems performance

Health service resilience in Yobe state, Nigeria in the context of the Boko Haram insurgency: a systems dynamics analysis using group model building

Background: Yobe State has faced severe disruption of its health service as a result of the Boko Haram insurgency. A systems dynamics analysis was conducted to identify key pathways of threat to provision and emerging pathways of response and adaptation. Methods: Structured interviews were conducted with 39 stakeholders from three local government areas selected to represent the diversity of conflict experience across the state: Damaturu, Fune and Nguru, and with four officers of the PRRINN-MNCH program providing technical assistance for primary care development in the state. A group model building session was convened with 11 senior stakeholders, which used participatory scripts to review thematic analysis of interviews and develop a preliminary systems model linking identified variables. Results: Population migration and transport restrictions have substantially impacted access to health provision. The human resource for health capability of the state has been severely diminished through the outward migration of (especially non-indigenous) health workers and the suspension of programmes providing external technical assistance. The political will of the Yobe State government to strengthen health provision - through lifting a moratorium on recruitment and providing incentives for retention and support of staff - has supported a recovery of health systems functioning. Policies of free-drug provision and decentralized drug supply appear to have been protective of the operation of the health system. Community resources and cohesion have been significant assets in combatting the impacts of the insurgency on service utilization and quality. Staff commitment and motivation - particularly amongst staff indigenous to the state - has protected health care quality and enabled flexibility of human resource deployment. Conclusions: A systems analysis using participatory group model building provided a mechanism to identify key pathways of threat and adaptation with regard to health service functioning. Generalizable systems characteristics supportive of resilience are suggested, and linked to wider discussion of the role of factors such as diversity, self-regulation and integration. 2015 Ager et al.sch_iih9pub4145pub

Post-doctoral research fellowship as a health policy and systems research capacity development intervention: a case of the CHESAI initiative

BACKGROUND: Building capacity in health policy and systems research (HPSR), especially in low- and middle-income countries, remains a challenge. Various approaches have been suggested and implemented by scholars and institutions using various forms of capacity building to address challenges regarding HPSR development. The Collaboration for Health Systems Analysis and Innovation (CHESAI) – a collaborative effort between the Universities of Cape Town and the Western Cape Schools of Public Health – has employed a non-research based post-doctoral research fellowship (PDRF) as a way of building African capacity in the field of HPSR by recruiting four post-docs. In this paper, we (the four post-docs) explore whether a PDRF is a useful approach for capacity building for the field of HPSR using our CHESAI PDRF experiences. METHODS: We used personal reflections of our written narratives providing detailed information regarding our engagement with CHESAI. The narratives were based on a question guide around our experiences through various activities and their impacts on our professional development. The data analysis process was highly iterative in nature, involving repeated meetings among the four post-docs to reflect, discuss and create themes that evolved from the discussions. RESULTS: The CHESAI PDRF provided multiple spaces for our engagement and capacity development in the field of HPSR. These spaces provided us with a wide range of learning experiences, including teaching and research, policy networking, skills for academic writing, engaging practitioners, co-production and community dialogue. Our reflections suggest that institutions providing PDRF such as this are valuable if they provide environments endowed with adequate resources, good leadership and spaces for innovation. Further, the PDRFs need to be grounded in a community of HPSR practice, and provide opportunities for the post-docs to gain an in-depth understanding of the broader theoretical and methodological underpinnings of the field. CONCLUSION: The study concludes that PDRF is a useful approach to capacity building in HPSR, but it needs be embedded in a community of practice for fellows to benefit. More academic institutions in Africa need to adopt innovative and flexible support for emerging leaders, researchers and practitioners to strengthen our health systemsIS

Assessing the effectiveness and efficiency of targeting methods in public works programmes in Malawi: the case of MASAF and CARE managed programmes in the central region of Malawi

Magister Artium - MAThis research was aimed at assessing the effectiveness and efficiency of community based targeting and self-targeting methods in the selection of beneficiaries in Safety nets programmes in Malawi. These methods have been chosen because they have been largely used for selecting beneficiaries in Safety net programmes. The focus was on assessing the effectiveness and efficiency of these methods where effectiveness refers to the ability of the methodology to reach out to the poorest while efficiency is a measure of the costs that are associated with the identification of these people. In order to objectively assessed the challenges associated with these methods, the study concentrated on Public Works Programmes, which targets relatively high number of people compared to the other programmes and have used both methods for identifying beneficiaries.South Afric

Analysis of the effectiveness of Non Governmental Organizations (NGOs) in HIV and AIDS Service Delivery

In den vergangenen drei Jahrzehnten gab es eine rasche Zunahme der Zahl der Nicht-Regierungs-Organisationen (NGOs) in allen Bereichen der Entwicklung. Diese Studie untersucht die Wirksamkeit von NGOs bei der Bereitstellung von antiretroviralen Therapie Dienstleistungen in Malawi. Er vergleicht die Qualität und Kosteneffizienz von NGOs, Regierungen und den for-Profit-Sektor. Daten über die ART-Programm Ergebnisse wurden von der HIV und AIDS-Einheit gesammelt, in dem Gesundheitsministerium. Mortality Ergebnisse zeigen, dass der Staatssektor die schlechteste Sterblichkeit von 17,7 Todesfälle pro 100 Personenjahre hat, der NGOs mit 15.2, gefolgt vom for-profit mit 12.2. Der öffentliche Sektor ist der Kostengünstige mit einem Kosten-Nutzen-Verhältnis von 199.74 US$pro Person und Jahr gelebt, gefolgt von NGOs (267.00 US$) und dem for-profit (370.98 US$). Die Studie kommt zu dem Schluss, dass die NGO-Sektor kritische Spieler in HIV-und AIDS-Service Delivery in Malawi ist.In the past three decades, there has been a rapid increase in the number of Non-Governmental Organisations (NGOs) operating in all areas of development. This study analyses the effectiveness of NGOs in providing antiretroviral therapy services in Malawi. It compares the quality and cost-effectiveness of NGOs, government and the for-profit sectors. Data on the ART programme outcomes was collected from the HIV and AIDS unit, in the Ministry of Health. Mortality outcomes show that the government sector has the worst mortality rate of 17.7 deaths per 100 person years followed by the NGOs with15.2 and the for-profit with12.2. The government sector is the most cost-effective with a cost-effectiveness ratio of 199.74US$ per person year lived, followed by NGOs (267.00US$) and the for-profit (370.98US$). The study concludes that the NGO sector is critical player in HIV and AIDS service delivery in Malawi

Systems dynamics analysis of health systems resilience: Case Studies from Cote d’Ivoire and Nigeria

Background: There is increasing interest in applying the concept of resilience to understand ways of promoting robust health service delivery in contexts of acute or chronic crisis. Identifying key sources of vulnerability and health systems structures and designs that promote resilient functioning can inform policy-making across a broad range of settings

A case study of health service provision in Yobe State, Nigeria in the context of the Boko Haram insurgency

Health Systems Resilience: A Systems Analysis is a ReBUILD affiliate research project applying a systems dynamics approach to understand, predict and identify mechanisms that influence the resilience of health systems in contexts of adversity. The project is implemented by the Mailman School of Public Health, Columbia University, in collaboration with the School of Public Health, University of Western Cape. Resilience is now a dominant concept underpinning development and humanitarian support in contexts vulnerable to crisis, including conflict. This paper is an analysis of the circumstances in the health sector in Yobe state in northern Nigeria, related, and in response to the Boko Haram insurgency beginning around 2011 and continuing to the present. The paper makes a number of Key Points: Yobe State has faced severe disruption of its health service as a result of the Boko Haram insurgency. -Population migration and transport restrictions have severely impacted access to health provision . -The human resource for health capability of the state has been severely diminished through the outward migration of (especially nonindigenous) health workers and the suspension of programmes providing external technical assistance -The political will of the Yobe State government to strengthen health provision - through lifting a moratorium on recruitment and providing incentives for retention and support of staff - has supported a recovery of health systems functioning -Policies of free-drug provision and decentralized drug supply appear to have been protective of the operation of the health system -Community resources and cohesion have been significant assets in combatting the impacts of the insurgency on service utilization and quality -Staff commitment and motivation - particularly amongst staff indigenous to the state - has protected health care quality and enabled flexibility of human resource deployment -Systems modelling provided a mechanism to enable stakeholders to articulate a vivid picture of the interplay of key factors seen to influence response to the crisis -The methodology adopted appears promising for consolidating insights from multiple stakeholders regarding factors supporting - or undermining - health systems resiliencesch_iihpub4216pu