Capacity building and performance in local health systems

In countries such as India, local health systems struggle to utilise their resources optimally and to deliver quality health services in an effective manner. While the reasons for these are many, poor health management capacity has been postulated to contribute to this problem. Understanding how public health organisations can move towards change through capacity building interventions is crucial to strengthening health systems. By studying a capacity building intervention of health managers in Tumkur district of southern India using realist evaluation approach, we advance the understanding of how these interventions could contribute to organisational change. We find that capacity building programmes need to go much beyond transfer of knowledge and skills in order to effect organisational change and identify several individual and institutional factors and various alignments within decentralising local health systems that are crucial to achieving change. We conclude that human resources management strategies in Karnataka ought to invest in altering workplace conditions and organisational culture through restructuring the current health bureaucracy so that committed health managers could better utilise change opportunities presented by capacity building programmes.(SP - Sciences de la santé publique) -- UCL, 201

Advancing the application of systems thinking in health : a realist evaluation of a capacity building programme for district managers in Tumkur, India

District health systems are constantly evolving in response to national policies, the local socio-political environment, and internal dynamics within healthcare institutions. A realist evaluation can help to make sense of these complex changes. The study compares outcomes of cases which received a capacity-building intervention for health managers, and explores how individual, institutional, and contextual factors interact and contribute to observed outcomes. Performance of health staff is determined by a variety of factors related to motivation, organisational dynamics and culture, and environmental factors including socio-economic and political forces. The paper describes the complexity of capacity-building interventions at the district level

Increasing risks for emerging infectious diseases within a rapidly changing High Asia

The cold and arid mountains and plateaus of High Asia, inhabited by a relatively sparse human population, a high density of livestock, and wildlife such as the iconic snow leopard Panthera uncia, are usually considered low risk for disease outbreaks. However, based on current knowledge about drivers of disease emergence, we show that High Asia is rapidly developing conditions that favor increased emergence of infectious diseases and zoonoses. This is because of the existing prevalence of potentially serious pathogens in the system; intensifying environmental degradation; rapid changes in local ecological, socio-ecological, and socio-economic factors; and global risk intensifiers such as climate change and globalization. To better understand and manage the risks posed by diseases to humans, livestock, and wildlife, there is an urgent need for establishing a disease surveillance system and improving human and animal health care. Public health must be integrated with conservation programs, more ecologically sustainable development efforts and long-term disease surveillance

How does capacity building of health managers work? A realist evaluation study protocol

Introduction There has been a lot of attention on the role of human resource management interventions to improve delivery of health services in low- and middle-income countries. However, studies on this subject are few due to limited research on implementation of programmes and methodological difficulties in conducting experimental studies on human resource interventions. The authors present the protocol of an evaluation of a district-level capacity-building intervention to identify the determinants of performance of health workers in managerial positions and to understand how changes (if any) are brought about. Methods and analysis The aim of this study is to understand how capacity building works. The authors will use realist evaluation to evaluate an intervention in Karnataka, India. The intervention is a capacity-building programme that seeks to improve management capacities of health managers at district and subdistrict levels through periodic classroom-based teaching and mentoring support at the workplace. The authors conducted interviews and reviewed literature on capacity building in health to draw out the programme theory of the intervention. Based on this, the authors formulated hypothetical pathways connecting the expected outcomes of the intervention (planning and supervision) to the inputs (contact classes and mentoring). The authors prepared a questionnaire to assess elements of the programme theory—organisational culture, self-efficacy and supervision. The authors shall conduct a survey among health managers as well as collect qualitative data through interviews with participants and non-participants selected purposively based on their planning and supervision performance. The authors will construct explanations in the form of context–mechanism–outcome configurations from the results. This will be iterative and the authors will use a realist evaluation framework to refine the explanatory theories that are based on the findings to explain and validate an improved theory on ‘what works for whom and under what conditions’. Discussion The scope for applying realist evaluation to study human resource management interventions in health are discussed

Implementation Strategies for Maternal Near-Miss Case Reviews in LICs and LMICs: A scoping review protocol

Background: Maternal mortality remains a persistent public health concern despite significant strides in reduction over the past few decades, with a global maternal mortality ratio (MMR) of 223 deaths per 100,000 live births in 2020, indicating a 34.3% decline over 20 years, with Low income countries (LICs) and Lower Middle-Income Countries (LMICs) bearing the major burden. Effective implementation of facility-based near-miss case reviews (NMCR), endorsed by the World Health Organization (WHO), faces challenges hindering progress, making exploring implementation strategies through a scoping review essential. This scoping review aims to identify and characterize implementation strategies employed in Low and Lower Middle-Income Countries to facilitate the implementation of facility-based NMCR. Methods: The scoping review will follow Arksey and O’Malley’s methodological framework, involving five stages: identifying the research question, selecting relevant studies, selecting data, charting, and summarizing the results. Electronic databases like PubMed, Embase, Web of Science, EBSCOhost - CINAHL Ultimate, and Ovid MEDLINE will be searched, supplemented by citation tracking. Rayyan will be used to screen and remove duplicates, with data charting conducted using Google Sheets. Two independent reviewers will conduct blinded screening, eligibility assessment, and inclusion phases. Reviewers will conduct Systematic data extraction independently using piloted forms, with discrepancies resolved through team discussion and consensus. Results: The review will identify and characterize implementation strategies employed to facilitate the implementation of facility-based near-miss case reviews in LICs and LMICs. Conclusions:The findings of this review will contribute to the understanding of implementing strategies for facility-based NMCR in LICs and LMICs. The review can help in designing interventions / programs to reduce maternal mortality and knowledge products

Validation of ToucHb, a non-invasive haemoglobin estimation: Effective for normal ranges, needs improvement for anaemia detection.

Non-invasive methods for haemoglobin estimation hold enormous potential for early detection and treatment of anaemia, especially in limited resource settings. We sought to validate the diagnostic accuracy of ToucHb, a non-invasive haemoglobin estimation device available in the Indian market. We prospectively evaluated the diagnostic performance of the ToucHb device using the Automated complete blood count (CBC) method as the gold standard. Persons referred for haemoglobin estimation to the central laboratory of the government medical college hospital in Mysore, southern India were included in the study. Out Of 140 people approached, 127 gave consent; 65% (n = 82) were female with median age of 37 (IQR 28-45). ToucHB reported median haemoglobin value of 14 g/dL compared to 13.3 g/dL for CBC. Within 1 g/dL and 2 g/dL of CBC, 55.2% (70/127) and 74% (94/127) of ToucHb haemoglobin observations fell, respectively. The Bland-Altman plot showed a mean difference of 3 g/dL in haemoglobin between ToucHb and CBC among those with anaemia. The ToucHb device showed 22.2% sensitivity and 94.5% specificity for anaemia detection. In rural resource-limited settings, point of care non-invasive devices such as ToucHb can improve access and acceptance for anaemia screening. However, ToucHb has showed low sensitivity for anaemia detection and low accuracy at lower haemoglobin values. The utility of the instrument is especially limited in detecting anaemia, while it can estimate haemoglobin accurately among those with haemoglobin is in the normal range. Based on these findings, ToucHb and devices that work on the core technology deployed in ToucHb may be better suited to monitor known haemoglobin level rather than in anaemia screening or detection in primary/ secondary care and community settings

Crying baby gets the milk?:The governmentality of grievance redressal for patient rights violations in Karnataka, India

BACKGROUND: Patient rights aim to protect the dignity of healthcare-seeking individuals. Realisation of these rights is predicated on effective grievance redressal for the victims of patient rights violations. METHODS: We used a critical case (that yields the most information) of patient rights violations reported in Karnataka state (South India) to explore the power dynamics involved in resolving grievances raised by healthcare-seeking individuals. Using interviews, media reports and other documents pertaining to the case, we explored the 'governmentality' of grievance redressal for patient rights violations, that is, the interaction of micropractices and techniques of power employed by actors to govern the processes and outcomes. We also examined whether existing governmentality ensured procedural and substantive justice to care-seeking individuals. RESULTS: Collective action was necessary by the aggrieved women in terms of protests, media engagement, petitions and follow-up to ensure that the State accepted a complaint against a medical professional. Each institution, and especially the medical professional council, exercised its power by problematising the grievance in its own way which was distinct from the problematisation of the grievance by the collective. The State bureaucracy enacted its power by creating a maze of organisational units and by fragmenting the grievance redressal across various bureaucratic units. CONCLUSION: There is a need for measures guaranteeing accountability, transparency, promptness, fairness, credibility and trustworthiness in the patient grievance redressal system. Governmentality as a framework enabled to study how subjects (care-seeking individuals) are rendered governable and resist dominant forces in the grievance redressal system for patient rights violations

Practices and outcomes of responsive caregiving on child neurodevelopment and mental health across diverse global populations: a scoping review protocol.

Responsive caregiving (RC) leads to positive outcomes in children, including secure attachment with caregivers, emotional regulation, positive social interactions and cognitive development. Through our scoping review, we aim to summarise the practices and outcomes of RC in diverse caregiver and child populations from 0 to 8 years. We will use the Arksey and O'Malley framework and the Joanna Briggs Institute methodology for scoping reviews. We shall present our findings as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping review. Only peer-reviewed, English-language articles from 1982 to 2022 will be included from PubMed, Web of Science, APA PsychInfo, APA PsycArticles, SocINDEX and Google Scholar databases. Reference lists of included articles will also be screened. The search strategy will be developed for each database, and search results will be imported into Rayyan. Screening will be done in two phases: (1) titles and abstracts will be screened by two authors and conflicts will be resolved by mutual discussion between both or by consulting with a senior author; and (2) full-texts of shortlisted studies from the first phase will then be screened using the same inclusion/exclusion criteria. A data extraction form will be developed to collate relevant information from the final list of included articles. This form will be pilot tested on the first 10 papers and iteratively refined prior to data extraction from the remaining articles. Results will be presented in figures, tables and a narrative summary. No ethics approval needed as the review shall only use already published data. We shall publish the review in an open-access, peer-reviewed journal and disseminate through newsletters, social media pages, and presentations to relevant audiences.This work is supported by the DBT/Wellcome Trust India Alliance Team Science Grant [Grant No. IA/TSG/20/1/600023] (Awarded to GRB as lead Principal investigator). Prashanth N Srinivas was supported by the DBT/Wellcome Trust India Alliance CRC Grant [Grant IA/CRC/20/1/600007] awarded to him. The funders had no role in study design, methods, decision to publish, or preparation of the manuscript