Institutional pluralism, two publics theory and performance reporting practices in Zambia’s health sector

Purpose: The purpose of this paper is to investigate accounting and performance reporting practices embraced in the midst of a pluralistic institutional environment of an emerging economy (EE), Zambia. The research is necessitated due to the increased presence and influence of donor institutions whose information needs may not conform to the needs of local citizens in many EEs. Design/methodology/approach: The study draws on institutional pluralism and Ekeh’s post-colonial theory of “two publics” to depict pluralistic environments that are typical of EEs. Primary data were collected through semi-structured interviews with 33 respondents drawn from the main stakeholder groups involved in health service delivery including legislators, policy makers, regulators, healthcare professionals and health service managers. Data analysis took the form of thematic analysis which involved identifying, analysing and constructing patterns and themes implicit within the data that were deemed to address the study’s research questions. Findings: Findings indicate that Zambia’s institutional environment within the health sector is highly fragmented and pluralistic as reflected by the multiplicity of both internal and external stakeholders. These stakeholder groups equally require different reporting mechanisms to fulfil their information expectations. Social implications: The multiple reporting practices evident within the health sector entail that the effectiveness of health programmes may be compromised due to the fragmentation in goals between government and international donor institutions. Rather than pooling resources and skills for maximum impact, these practices have the effect of dispersing performance efforts with the consequence of compromising their impact. Fragmented reporting equally complicates the work of policy makers in terms of monitoring the progress and impact of such programmes. Originality/value: Beyond Goddard et al. (2016), the study depicts the usefulness of Ekeh’s theory in understanding how organisations and institutions operating in pluralistic institutional environments may be better managed. In view of contradictory expectations of accounting and performance reporting requirements between the civic and primordial publics, the study indicates that different practices, mechanisms and structures have to be embraced in order to maintain institutional harmony and relevance to different communities within the health sector

Adolescent Sexual and Reproductive Health:Report on an Assessment and Review of Training Materials

Young people in Tanzania face a range of serious reproductive health risks – from early unwanted pregnancy and unsafe abortion to sexually transmitted infections, including HIV/AIDS. These reproductive health problems do not only have an immediate impact on the lives and well being of young people, but also contribute to long-term pattern of high fertility, poverty, dependency and poor socio-economic development. In recognition of the extent of adolescent health problems, the Government of Tanzania has initiated an effort to address young people’s needs for reproductive health information, counseling and services. To guide improved adolescent sexual and reproductive health programming, the Reproductive and Child Health Section (RCHS) of the Ministry of Health, with technical assistance from Family Care International (FCI) and financial assistance from the United Nations Population Fund (UNFPA), launched an effort to assess and review training curricula and related resource materials that are available in Ta nzania and internationally. Specific objectives of the Assessment were: To provide an overview of adolescent sexual and reproductive health (ASRH) training curricula that is available in Tanzania and at the international level. To identify priorities for curriculum development in Tanzania. To recommend training materials that could be used as models for developing national training curricula for various target audiences. Through interviews with key ASRH stakeholders in Tanzania and literature reviews, a \ud range of training materials were identified and reviewed. Materials were analyzed by target user and audience as well as by content and depth of coverage. The Assessment and Review served to illuminate critical ASRH issues that need to be addressed through training programmes for those working with youth. In addition, the Assessment highlighted key gaps in available curricula. Based on the Assessment findings, priorities for curriculum development include. An in-service training curriculum for orienting health service providers. The Assessment revealed that there are few materials for orienting service providers to youth friendly service delivery. Therefore, a standardized curriculum is needed to guide in-service training of facility-based health staff, as well as school-based health workers, outreach workers, lay counselors and other community-based providers in adolescent sexual and reproductive health counseling and service delivery. A comprehensive peer education training manual. Many organizations working with peer educators have developed training curricula, and there is considerable variety in the content and quality of these resources. To ensure the content and quality of peer education programmes for youth, it is recommended that a comprehensive peer education manual be developed, which could be used for training various types of peer educators and youth counselors (i.e. those working with in-school adolescents, those working with out-of-school adolescents, etc). Curricula and teaching aids for primary and secondary schools. Although the Ministry of Education and Culture has begun developing syllabi to guide implementation of the Family Life Education Programme in primary and secondary schools, teachers need more detailed curricula, reference materials and teaching aids to successfully carry out this important education programme. In developing the above curricula, it is recommended that special emphasis be placed on designing training resources comprised of separate training modules – modules that can be used either separately or together, depending on the specific training needs of various audiences. For example, the curriculum for service providers should include separate modules on adolescent sexual and reproductive health, information and counseling, and service provision to young people. While all tree modules would be used in training service providers, select modules could be used to train lay counselors and outreach workers. Similarly, the comprehensive training manual for peer educators should include separate modules on topics, such as adolescent sexual and reproductive health, facilitation and peer education skills, and working with different target audiences – in school adolescents, out-of-school youth, and parents and other adults – to ensure that peer education programmes could use the specific modules that are appropriate to their outreach efforts.The Assessment revealed that a large number of training curricula and related materials exist to support adolescent sexual and reproductive health initiatives in Tanzania. Although none of these resources is precisely suited to meet the above-mentioned gaps,many of the existing materials contain excellent content, which should be used as the basis for developing standardized national curricula

Effects of revised diagnostic recommendations on malaria treatment practices across age groups in Kenya

OBJECTIVE. The recent change of treatment policy for uncomplicated malaria from sulfadoxine-pyrime-thamine to artemether-lumefantrine (AL) in Kenya was accompanied by revised malaria diagnosis recommendations promoting presumptive antimalarial treatment in young children and parasitological diagnosis in patients 5 years and older. We evaluated the impact of these age-specific recommendations on routine malaria treatment practices 4-6 months after AL treatment was implemented. METHODS. Cross-sectional, cluster sample survey using quality-of-care assessment methods in all government facilities in four Kenyan districts. Analysis was restricted to the 64 facilities with malaria diagnostics and AL available on the survey day. Main outcome measures were antimalarial treatment practices for febrile patients stratified by age, use of malaria diagnostic tests, and test result. RESULTS. Treatment practices for 706 febrile patients (401 young children and 305 patients =5 years) were evaluated. 43.0% of patients =5 years and 25.9% of children underwent parasitological malaria testing (87% by microscopy). AL was prescribed for 79.7% of patients =5 years with positive test results, for 9.7% with negative results and for 10.9% without a test. 84.6% of children with positive tests, 19.2% with negative tests, and 21.6% without tests were treated with AL. At least one antimalarial drug was prescribed for 75.0% of children and for 61.3% of patients =5 years with a negative test result. CONCLUSIONS. Despite different recommendations for patients below and above 5 years of age, malaria diagnosis and treatment practices were similar in the two age groups. Parasitological diagnosis was under-used in older children and adults, and young children were still tested. Use of AL was low overall and alternative antimalarials were commonly prescribed; but AL prescribing largely followed the results of malaria tests. Malaria diagnosis recommendations differing between age groups appear complex to implement; further strengthening of diagnosis and treatment practices under AL policy is required.The Wellcome Trust; the Kenya Medical Research Institute; Novartis Pharm

Translation of artemether–lumefantrine treatment policy into paediatric clinical practice: an early experience from Kenya

OBJECTIVE: To describe the quality of outpatient paediatric malaria case-management approximately 4-6 months after artemether-lumefantrine (AL) replaced sulfadoxine-pyrimethamine (SP) as the nationally recommended first-line therapy in Kenya. METHODS: Cross-sectional survey at all government facilities in four Kenyan districts. Main outcome measures were health facility and health worker readiness to implement AL policy; quality of antimalarial prescribing, counselling and drug dispensing in comparison with national guidelines; and factors influencing AL prescribing for treatment of uncomplicated malaria in under-fives. RESULTS: We evaluated 193 facilities, 227 health workers and 1533 sick-child consultations. Health facility and health worker readiness was variable: 89% of facilities stocked AL, 55% of health workers had access to guidelines, 46% received in-service training on AL and only 1% of facilities had AL wall charts. Of 940 children who needed AL treatment, AL was prescribed for 26%, amodiaquine for 39%, SP for 4%, various other antimalarials for 8% and 23% of children left the facility without any antimalarial prescribed. When AL was prescribed, 92% of children were prescribed correct weight-specific dose. AL dispensing and counselling tasks were variably performed. Higher health worker's cadre, in-service training including AL use, positive malaria test, main complaint of fever and high temperature were associated with better prescribing. CONCLUSIONS: Changes in clinical practices at the point of care might take longer than anticipated. Delivery of successful interventions and their scaling up to increase coverage are important during this process; however, this should be accompanied by rigorous research evaluations, corrective actions on existing interventions and testing cost-effectiveness of novel interventions capable of improving and maintaining health worker performance and health systems to deliver artemisinin-based combination therapy in Africa

Mobility of primary health care workers in China

© 2009 Meng et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Predictors of defaulting from completion of child immunization in south Ethiopia, May 2008 – A case control study

<p>Abstract</p> <p>Background</p> <p>Epidemiological investigations of recent outbreaks of vaccine preventable diseases have indicated that incomplete immunization was the major reason for the outbreaks. In Ethiopia, full immunization rate is low and reasons for defaulting from immunization are not studied well. The objective of the study was to identify the predictors of defaulting from completion of child immunization among children between ages 9–23 months in Wonago district, South Ethiopia.</p> <p>Methods</p> <p>Unmatched case control study was conducted in eight Kebeles (lowest administrative unit) of Wonago district in south Ethiopia. Census was done to identify all cases and controls. A total of 266 samples (133 cases and 133 controls) were selected by simple random sampling technique. Cases were children in the age group of 9 to 23 months who did not complete the recommended immunization schedule. Pre-tested structured questionnaire were used for data collection. Data was analyzed using SPSS 15.0 statistical software.</p> <p>Results</p> <p>Four hundred eighteen (41.7%) of the children were fully vaccinated and four hundred twelve (41.2%) of the children were partially vaccinated. The BCG: measles defaulter rate was 76.2%. Knowledge of the mothers about child immunization, monthly family income, postponing child immunization and perceived health institution support were the best predictors of defaulting from completion of child immunization.</p> <p>Conclusion</p> <p>Mothers should be educated about the benefits of vaccination and the timely administration of vaccines.</p