Trust and motivation in the health sector : a systematic review

Supporting improved performance of health workers is vital in health system strengthening. There are several factors that have been identified as playing key roles in influencing health worker performance. Motivation of HWs is one of the areas for improving delivery of health care services, yet it is under investigated. Moreover, the mechanisms underlying the interactions between motivation and other variables such as workplace trust relations are largely unknown. This dissertation is organised into three parts. Part A is the review protocol which outlines the background and the review methodology. A qualitative systematic review approach is adopted and literature search of the five chosen databases is conducted using keywords and phrases derived from the review question. Defined inclusion and exclusion criteria are used to identify and select suitable articles. An appropriate tool is then used to appraise selected articles which are then subjected to thematic analysis. Part B is a literature review of existing empirical and theoretical work on health worker motivation. It provides the background to the systematic review in Part C. It defines the word motivation as used in the health sector, and then explores empirical work on health worker motivation using an appropriate conceptual framework. The literature review further summarises and concludes on the possible link between trust and motivation in the health sector

The leadership trinity: examining the interplay between healthcare organisational context, collective leadership and leadership effectiveness in the health sector - a multiple case study of district hospitals in the Western Cape Province, South Africa

To address the current leadership challenges within the South African health system, it is important to understand what influences the nature and practice of leadership within healthcare organisations. This thesis presents research about the interlinkages between context, leadership practices and staff satisfaction and morale – as indicators of leadership effectiveness - in district hospitals. The study represents one of the few detailed empirical inquiries into these issues in South Africa and adds to the still limited body of relevant empirical evidence in low- and middle-income countries. The research specifically drew on organisational and leadership theory to shape its strategies of data collection and analysis. It was conducted in two case study, district-level, hospitals. Multiple sources of data were collected, including document reviews, non-participant observations, and in-depth qualitative interviews. Data from staff satisfaction surveys carried out separately from this study were also considered. The in-depth interviews involved the three broad cadres of clinical, nursing, and administrative staff working within the hospitals, including those with and without formal managerial roles. Thematic analysis was applied in analysing experience in each case study hospital and also in cross-case analysis. This analysis involved iterative inductive, deductive, and abductive processes. The thesis generates insights about the leadership practices experienced in the case study hospitals that may both engender (positive practices) or undermine (negative practices) staff satisfaction and morale. Positive leadership practices also nurtured the collective leadership that itself enhanced teamworking and influenced the hospital context to spread collective leadership more widely. These leadership practices were, in turn, influenced by contextual elements internal and external to the hospital, some of which themselves had possible consequences for staff satisfaction and morale. Critical features of hospital external context included hospitals' histories and backgrounds, as well as the wider bureaucratic context of rigidity in which they are situated. Key features of hospital internal context influencing collective leadership were, meanwhile, internal power structures and processes, professional identity, and cross-professional relationships. This analysis of the interactions between hospital context, collective leadership and staff satisfaction and morale illuminates the complex dynamics of hospitals. This Leadership Trinity offers insights of relevance to health system reform in South Africa, and more specifically, to implementation of current National Health Insurance proposals

Correction to: A Systematic Review of Methodological Variation in Healthcare Provider Perspective Tuberculosis Costing Papers Conducted in Low- and Middle-Income Settings, Using An Intervention-Standardised Unit Cost Typology.

In the original version of this article, Fig. 3 was published in an incorrect format. The correct figure is published with this correction

The global pendulum swing towards community health workers in low- and middle-income countries: A scoping review of trends, geographical distribution and programmatic orientations, 2005 to 2014

BACKGROUND: There has been a substantial increase in publications and interest in community health workers (CHWs) in low- and middle-income countries (LMIC) over the last years. This paper examines the growth, geographical distribution and programmatic orientations of the indexed literature on CHWs in LMIC over a 10-year period. METHODS: A scoping review of publications on CHWs from 2005 to 2014 was conducted. Using an inclusive list of terms, we searched seven databases (including MEDLINE, CINAHL, Cochrane) for all English-language publications on CHWs in LMIC. Two authors independently screened titles/abstracts, downloading full-text publications meeting inclusion criteria. These were coded in an Excel spreadsheet by year, type of publication (e.g. review, empirical), country, region, programmatic orientation (e.g. maternal-child health, HIV/AIDS, comprehensive) and CHW roles (e.g. prevention, treatment) and further analysed in Stata14. Drawing principally on the subset of review articles, specific roles within programme areas were identified and grouped. FINDINGS: Six hundred seventy-eight publications from 46 countries on CHWs were inventoried over the 10-year period. There was a sevenfold increase in annual number of publications from 23 in 2005 to 156 in 2014. Half the publications were reporting on initiatives in Africa, a third from Asia and 11 % from the Americas (mostly Brazil). The largest single focus and driver of the growth in publications was on CHW roles in meeting the Millennium Development Goals of maternal, child and neonatal survival (35 % of total), followed by HIV/AIDS (16 %), reproductive health (6 %), non-communicable diseases (4 %) and mental health (4 %). Only 17 % of the publications approached CHW roles in an integrated fashion. There were also distinct regional (and sometimes country) profiles, reflecting different histories and programme traditions. CONCLUSIONS: The growth in literature on CHWs provides empirical evidence of ever-increasing expectations for addressing health burdens through community-based action. This literature has a strong disease- or programme-specific orientation, raising important questions for the design and sustainable delivery of integrated national programmes.Scopu

Impact of agripreneurial orientations on resilience and performance of dairy agripreneurs in Murang’a County, Kenya: the mediating effect agribusiness support services

The performance of rural smallholder dairy agrienterprises in Kenya is very critical as it contributes to welfare improvement of rural people especially the youth and women. Despite this acknowledgement, the farm productivity of rural dairy agripreneurs is persistently low. Entrepreneurial orientations and utilization of agribusiness support services have been viewed as a catalyst for improvement of agrienterprises performance. This study sought to determine impact of agripreneurial orientations on resilience and performance of dairy agripreneurs in Murang’a County, Kenya. The specific objectives were to determine; dairy agripreneurs’ preferences for production, animal health and marketing support services, factors influencing the usage of Agribusiness Support Services (ASS), effect of agripreneurial orientation mediated by ASS and effect of ASS on performance of smallholder dairy agripreneurs in Murang’a County. A multistage sampling method was used to select a sample of 682 dairy agripreneurs. Through a Cross-sectional survey, data were collected using a standardized questionnaire, discrete choice experiment (DCE) and analysed through a number of novel econometric approaches. Dairy agripreneurs had higher preference for group marketing, curative services and artificial insemination support services. However, dairy agripreneurs have less preference for business plan training service. In relation to willingness to pay (WTP), dairy agripreneurs were more willing to pay for group marketing (KES 8797.91/month), artificial insemination (KES 2816.01/month) and curative services (KES 2577.62/month), but were not willing to forgo KES 2411.29 per month for business plan training service. Secondly, the findings revealed that education level of household head, number of adults in the household, experience in dairy farming, land size, livestock type, number of cows owned, milk yield, price of milk, access to contract, type of road and level of buyer trust were the major factors that affect the likelihood of utilising agribusiness support services among dairy farmers. Thirdly, the findings indicate that there is positive and significant relationship between future orientation (β = 0.395, t=12.699, p=0.01), risk-taking orientation (β = 0.088, t=2.743, p=0.01) and market orientation (β = 0.136, t=3.609, p=0.01) on agripreneurial resilience. However, it was found that social orientation had a negative relationship with agripreneurial resilience (β = -0.166, t=3.966, p=0.01), while ASS had no mediating effect on the relationship between agripreneurial orientation and agripreneurial resilience. Finally, the results show that utilization of combination of ASS significantly increased milk productivity and income per year for smallholder dairy agripreneurs. The study recommended increased linkage on access of ASS and entrepreneusrhip capacity building programmes to smallholder dairy farmers

Effect of paddy sourcing methods on the volume of rice milled by rice millers in Mwea, Kirinyaga county, Kenya

Rice millers access paddy through private traders, cooperatives, individual farmers, and village agents. These methods determine the capacity utilization of the mills, costs incurred, and profitability of the rice milling business. This article aimed at determining the effect of paddy sourcing methods on the volume of rice milled by small and medium-scale rice millers in Kenya. Specifically, the study sought to determine the sourcing methods used, combinations of sourcing methods, and effects of these combinations on the volume of rice milled. A multistage sampling technique resulted to a total of 160 millers comprised of 90 and 70 small and medium-scale rice millers respectively. A multinomial endogenous switching regression (MESR) was used to determine the resultant effects of paddy sourcing methods on volume of rice milled. Results: The results show that sourcing paddy directly from individual farmers, individual farmers bringing paddy to the miller, buying from traders and sourcing through agents are the four paddy-sourcing methods used by rice millers. Factors that influence utilization of a combination of sourcing methods are age of the miller, ownership of the miller, unit price of paddy, distance from the mills, ownership of the mills, degree of competition, contract agreements, access to information and finance. The highest volume of paddy sourced was achieved using a combination of three paddy sourcing methods: buying from traders, direct sourcing from individual farmers and individual farmers bringing paddy to the miller (B1D1I1A0). This combination increases volumes sourced by 114.1 %. This underscores the sole vitality of a myriad of factors in determining the choice of utilization of a combination of paddy sourcing methods. This study can influence decisions and rice milling related policy formulation towards a sustainable paddy sourcing mechanisms and consistent rice milling business

Machinery Adoption and Its Effect on Maize Productivity among Smallholder Farmers in Western Kenya: Evidence from the Chisel Harrow Tillage Practice

A major component of contemporary agriculture is machinery. Nonetheless, in Kenya and other African nations, the rate of adoption of agricultural machinery remains quite low. Understanding the fundamental causes and their impacts on agricultural output is crucial. Using data collected from a household survey of 1,499 farmers in Western Kenya, this study employed the endogenous switching regression model to examine the use of chisel harrows and their effects on maize production. Results show that the adoption of the chisel harrow was positively impacted by factors such as farm size, credit accessibility, gender, extension contact, and education attainment, while factors such as age and market proximity had a negative impact. The yield per hectare was higher for adopters than for non-adopters. According to the counterfactual analysis results, those who utilized chisel harrow tools were able to achieve a higher yield (1512 kg/ha) than they would have if they had not used the equipment (1099 kg/ha). The average maize yield per hectare increased by 413 kg and 217 kg for adopters and non-adopters, respectively, when chisel harrows were used. It is concluded that while training and field demonstrations may also be held to increase farmers’ understanding of the benefits of the chisel harrow, encouraging farmers to adopt the tool has the potential to improve low production in the surveyed regions