Implementation of the partograph in India's JSY cash transfer programme for facility births: a mixed methods study in Madhya Pradesh province

Objectives To study implementation of partograph use to monitor labour in facilities providing the JSY (Janani Suraksha Yojana) cash transfer programme for facility births in India by determining (1) adherence to partograph use, (2) staff abilities at partograph use and (3) staff responsiveness to the policy on partograph use. Design A mixed methods study using Carroll's framework for implementation fidelity. Methods include (1) obstetric case record review, (2) a vignette-based survey among nurse midwives and (3) interviews with staff. Setting Routine use of the partograph is recommended to monitor progress of labour in most low-and middle-income countries (LMICs), including India, although currently available evidence in this regard is insufficient. This study was conducted in the context of the highly successful JSY programme in three districts of Madhya Pradesh province. Participants 73 different level JSY programme facilities participated in the record review, 233 nurse midwives at these facilities participated in the vignette survey and a total of 11 doctors and midwives participated in the interviews. Results The partograph was used in 6% of the 1466 records reviewed. The staff obtained a median score of 1.08 (maximum of 10) at competence in plotting a partograph. Three themes emerged from the qualitative data: (1) partographs are used rarely and retrospectively; (2) training does not support correct use of the partograph; and (3) partographs can be useful but are not feasible. Conclusions Implementation fidelity of partograph use in the JSY programme is low. Successful implementation of the partograph can result in improved quality of care in the JSY programme only if potential moderators to its adherence, such as training, supervision, staff ‘buy in’ and practice environment are addressed so that staff find a conducive practice environment in which to use the partograph and women find it beneficial to present early in labour

Behaviors as Predictors of Reinforcement: Investigating Parent’s Psychological Antecedent and Parental Engagement Mechanisms in Distance Learning

Due to COVID-19, remote learning gave way to implementing modular and online setup of acquiring education. Several studies resulted in the efficacy of parent\u27s commitment to the achievement of their children academically. The research seeks to determine the relationship between parental engagement and their psychological antecedent with the use of a 4-point Likert Scale intervened by parent’s demographic profile in terms of gender, age, type of modular learning, number of children enrolled in S.Y. 2020 to 2021, and educational background. Validation of the questionnaire was calculated using Cronbach\u27s alpha coefficient formula through the SPSS software. The computed alpha coefficient was 0.96, which is acceptable reliability. Additionally, with 301 parents, researchers evaluated the gathered data through Pearson Correlation and Regression analysis. The results implied that between the parent\u27s psychological antecedent and engagement in their children\u27s remote learning, parent\u27s psychological behavior influences change in their commitment and determination to guide and teach their children amidst the COVID-19 pandemic. It has also been acknowledged through regression analysis that parental engagement mechanisms are best predicted by the demographic\u27s profile of parents, specifically concerning gender and their children’s remote learning modalities and their psychological antecedent amidst the pandemic. Hence, future researchers must employ longitudinal studies to determine parent\u27s display of behavior during and after the remote learning environment for further investigation

Feminization of the health workforce in China: exploring gendered composition from 2002 to 2020

Background: Feminization of health workforce has been globally documented, but it has not been investigated in China. This study aims to analyze changes in the gendered composition of health workforce and explore the trend in different types of health workforce, health organizations and majors within China’s health system. Methods: The data were collected from China Health Statistical Yearbook from 2002 to 2020. We focused on health professionals including doctors, nurses, and pharmacists in health organizations. Trend analysis was employed to examine the change in the ratio of female health workforce over 18 years. The estimated average annual percent change (AAPC) was estimated, and the reciprocals of variances for the female ratios were used as weights. Results: In China, health professionals increased from 4.7 million in 2002 to 10.68 million in 2020. Health professionals per 1000 population increased from 3.41 in 2002 to 7.57 in 2020. The ratio of female health professionals significantly increased from 63.85% in 2002 to 72.4% in 2020 (AAPC = 1.04%, 95% CI 0.96–1.11%, P < 0.001). Female doctors and pharmacists increased 4.7 and 7.9 percentage points from 2002 to 2020. Female health workers at township health centers, village clinics, centers for disease control and prevention had higher annual increase rate (AAPC = 1.67%, 2.25% and 1.33%, respectively) than those at hospital (0.70%) and community health center (0.5%). Female doctors in traditional Chinese medicine, dentistry and public health had higher annual increase rate (AAPC = 1.82%, 1.53% and 1.91%, respectively) than female clinical doctor (0.64%). Conclusions: More women are participating in the healthcare sector in China. However, socially lower-ranked positions have been feminizing faster, which could be due to the inherent and structural gender norms restricting women’s career. More collective and comprehensive system-level actions will be needed to foster a gender-equitable environment for health workforce at all levels

Internal contracting of health services in Cambodia: drivers for change and lessons learned after a decade of external contracting

** From PubMed via Jisc Publications Router. ** History: received 05-05-2017; accepted 30-04-2018.Since the late 1990s, contracting has been employed in Cambodia in an attempt to accelerate rural health system recovery and improve health service delivery. Special Operating Agencies (SOA), a form of 'internal contracting', was introduced into selected districts by the Cambodia Ministry of Health in 2009. This study investigates how the SOA model was implemented and identifies effects on service delivery, challenges in operation and lessons learned. The study was carried out in four districts, using mixed__methods. Key informant interviews were conducted with representatives of donors and the Ministry of Health. In-depth interviews were carried out with managers of SOA and health facilities and health workers from referral hospitals and health centres. Data from the Annual Health Statistic Report 2009-2012 on utilisation of antenatal care, delivery and immunisation were analysed. There are several challenges with implementation: limited capacity and funding for monitoring the SOA, questionable reliability of the monitoring data, and some facilities face challenges in achieving the targets set in their contracts. There are some positive effects on staff behaviour which include improved punctuality, being on call for 24__h service, and perceived better quality of care, promoted through adherence to work regulations stipulated in the contracts and provision of incentives. However, flexibility in enforcing these regulations__in SOA has led to more dual practice, compared to previous contracting schemes. There are reported increases in utilization of services by the general population and the poor although the quantitative findings question the extent to which these increases are attributable to the contracting model. Capacity in planning and monitoring contracts at different levels in the health system is required. Service delivery will be undermined if effective performance management is not established nor continuously applied. Improvements in the implementation of SOA include: better monitoring by the central and provincial levels; developing incentive schemes that tackle the issues of dual practice; and securing trustworthy baseline data for performance indicators.sch_iih18pub5389pub37

Being a midwife is being prepared to help women in very difficult conditions”: midwives’ experiences of working in the rural and fragile settings of Ituri Province, Democratic Republic of Congo

Introduction: Maternal and neonatal health is a core focus area in fragile and conflict-affected states and midwives are key actors. But there is currently very little evidence on midwives’ experiences, the challenges that they face and coping strategies they employ in the challenging and fragile rural areas of Ituri region in the North-Eastern Democratic Republic of Congo. This understanding is critical to developing strategies to attract, retain and support midwives to provide vital services to women and their families. This study aims to explore midwives’ work experiences and challenges through time from initial professional choice to future career aspiration in rural Ituri Province, North-eastern DRC. Methods: A qualitative approach using life history interviews with 26 midwives and 6 ex-midwives, and 3 focus group discussions with 22 midwives in 3 health districts of Ituri Province (Bunia, Aru and Adja) was conducted in 2017. Purposive sampling was used to recruit research participants. The transcripts were digitally recorded, and thematically analyzed using NVivo. A lifeline framework was deployed in the analytical process. Results: Problem solving, child aspirations and role models were the main reasons for both midwives and ex-midwives to join midwifery. Midwives followed a range of midwifery training courses resulting in different levels and training experiences of midwives. Midwives face many work challenges: serious shortage of qualified health workers; poor working conditions due to lack of equipment, supplies and professional support; and no salary from the government. This situation is worsened by insecurity caused by militia operating in some rural health districts. Midwives in those settings have developed coping strategies such as generating income and food from farm work, lobbying local organizations for supplies and training traditional birth attendants to work in facilities. Despite these conditions, most midwives want to continue working as midwives or follow further midwifery studies. Family related reasons were the main reasons for most ex-midwives to leave the profession

How can intersectoral collaboration and action help improve the education, recruitment, and retention of the health and care workforce? A scoping review

Inadequate numbers, maldistribution, attrition, and inadequate skill‐mix are widespread health and care workforce (HCWF) challenges. Intersectoral—inclusive of different government sectors, non‐state actors, and the private sector—collaboration and action are foundational to the development of a responsive and sustainable HCWF. This review presents evidence on how to work across sectors to educate, recruit, and retain a sustainable HCWF, highlighting examples of the benefits and challenges of intersectoral collaboration. We carried out a scoping review of scientific and grey literature with inclusion criteria around intersectoral governance and mechanisms for the HCWF. A framework analysis to identify and collate factors linked to the education, recruitment, and retention of the HCWF was carried out. Fifty‐six documents were included. We identified a wide array of recommendations for intersectoral activity to support the education, recruitment, and retention of the HCWF. For HCWF education: formalise intersectoral decision‐making bodies; align HCWF education with population health needs; expand training capacity; engage and regulate private sector training; seek international training opportunities and support; and innovate in training by leveraging digital technologies. For HCWF recruitment: ensure there is intersectoral clarity and cooperation; ensure bilateral agreements are ethical; carry out data‐informed recruitment; and learn from COVID‐19 about mobilising the domestic workforce. For HCWF retention: innovate around available staff, especially where staff are scarce; improve working and employment conditions; and engage the private sector. Political will and commensurate investment must underscore any intersectoral collaboration for the HCWF

Fragile and conflict affected states: report from the Consultation on Collaboration for Applied Health Research and Delivery

Fragile and Conflict Affected States present difficult contexts to achieve health system outcomes and are neglected in health systems research. This report presents key debates from the Consultation of the Collaboration for Applied Health Research and Delivery, Liverpool, June, 2014

Using a human resource management approach to support community health workers: experiences from five African countries

Background Like any other health worker, community health workers (CHWs) need to be supported to ensure that they are able to contribute effectively to health programmes. Management challenges, similar to those of managing any other health worker, relate to improving attraction, retention and performance. Methods Exploratory case studies of CHW programmes in the Democratic Republic of Congo, Ghana, Senegal, Uganda and Zimbabwe were conducted to provide an understanding of the practices for supporting and managing CHWs from a multi-actor perspective. Document reviews (n = 43), in-depth interviews with programme managers, supervisors and community members involved in managing CHWs (n = 31) and focus group discussions with CHWs (n = 13) were conducted across the five countries. Data were transcribed, translated and analysed using the framework approach. Results CHWs had many expectations of their role in healthcare, including serving the community, enhancing skills, receiving financial benefits and their role as a CHW fitting in with their other responsibilities. Many human resource management (HRM) practices are employed, but how well they are implemented, the degree to which they meet the expectations of the CHWs and their effects on human resource (HR) outcomes vary across contexts. Front-line supervisors, such as health centre nurses and senior CHWs, play a major role in the management of CHWs and are central to the implementation of HRM practices. On the other hand, community members and programme managers have little involvement with managing the CHWs. Conclusions This study highlighted that CHW expectations are not always met through HRM practices. This paper calls for a coordinated HRM approach to support CHWs, whereby HRM practices are designed to not only address expectations but also ensure that the CHW programme meets its goals. There is a need to work with all three groups of management actors (front-line supervisors, programme managers and community members) to ensure the use of an effective HRM approach. A larger multi-country study is needed to test an HRM approach that integrates context-appropriate strategies and coordinates relevant management actors. Ensuring that CHWs are adequately supported is vital if CHWs are to fulfil the critical role that they can play in improving the health of their communities

Improving the performance of community health workers in humanitarian emergencies: a realist evaluation protocol for the PIECES programme.

INTRODUCTION Understanding what enhances the motivation and performance of community health workers (CHWs) in humanitarian emergencies represents a key research gap within the field of human resources for health. This paper presents the research protocol for the Performance ImprovEment of CHWs in Emergency Settings (PIECES) research programme. Enhancing Learning and Research in Humanitarian Action (ELRHA) funded the development of this protocol as part of their Health in Humanitarian Crises (R2HC) call (No.19839). PIECES aims to understand what factors improve the performance of CHWs in level III humanitarian emergencies. METHODS AND ANALYSIS The suggested protocol uses a realist evaluation with multiple cases across the 3 country sites: Turkey, Iraq and Lebanon. Working with International Medical Corps (IMC), an initial programme theory was elicited through literature and document reviews, semistructured interviews and focus groups with IMC programme managers and CHWs. Based on this initial theory, this protocol proposes a combination of semistructured interviews, life histories and critical incident narratives, surveys and latent variable modelling of key constructs to explain how contextual factors work to trigger mechanisms for specific outcomes relating to IMC's 300+ CHWs' performance. Participants will also include programme staff, CHWs and programme beneficiaries. Realist approaches will be used to better understand 'what works, for whom and under what conditions' for improving CHW performance within humanitarian contexts. ETHICS AND DISSEMINATION Trinity College Dublin's Health Policy and Management/Centre for Global Health Research Ethics Committee gave ethical approval for the protocol development phase. For the full research project, additional ethical approval will be sought from: Université St. Joseph (Lebanon), the Ethics Committee of the Ministry of Health in Baghdad (Iraq) and the Middle East Technical University (Turkey). Dissemination activities will involve a mixture of research feedback, policy briefs, guidelines and recommendations, as well as open source academic articles