Performance measurement of district level hospitals in low income countries: participatory development of an instrument to assess inputs, processes, and outputs for evidence-based management and quality improvement

Thesis (Dr.P.H.)--Boston UniversityBACKGROUND: The potential of hospital performance measurement (HPM) to contribute to improved quality of care and patient outcomes is underrepresented in the health system strengthening literature and no standardized HPM instrument exists for hospitals in developing countries. The problem centered Participatory Action Research (PAR) approach is particularly suited to addressing complex organizational problems in low resource settings and is gaining acceptance as an applied research method in healthcare settings. METHODS: This quasi-experimental study using the PAR approach was carried out in 4 hospitals in Cameroon. Quantitative (415 surveys) and qualitative (129 interviews and 77 observations) methods examined how participating in the design of a HPM instrument influences health personnel's knowledge, attitude, interest, and intention to continue use of performance measurement for quality improvement. Changes in scores for the above outcomes from before and after implementation of the performance indicators were compared to scores from a non-participating control hospital at the same time points. RESULTS: Personnel designed and pilot tested performance measurement indicators in all hospital services. Hospitals that actively participated in instrument design showed a statistically significant increase in HPM knowledge and attitude, and were more likely to report intention to continue using HPM as compared to the non-participating hospital. Hospital personnel participating in the design process were more aware of the workload barriers to implementing HPM but nonetheless were more motivated to continue the HPM effort. In addition, the PAR approach fostered ownership, increased skills, raised awareness of performance gaps, and led to a contextually appropriate tool. CONCLUSIONS: The results of this study demonstrate the feasibility of designing and implementing an HPM instrument in a low-resource health care system and highlight the positive benefits of the PAR approach. Further research is needed to determine the effect of regular HPM on quality of care and its sustainability over time in resource constrained settings

Research report: "Using what you have to get what you want": Vulnerability to HIV and prevention needs of female post‐secondary students engaged in transactional sex in Kumasi, Ghana

This study was implemented by Boston University in collaboration with the Kwame Nkrumah University of Science and Technology with support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 2010. The content and views expressed here are the authors’ and do not necessarily reflect the opinion or policy of USAID or the U.S. Government.This report presents findings from a qualitative study examining vulnerability to HIV of female post‐secondary students engaged in transactional sex in Kumasi, Ghana and their prevention needs. The study was conducted by Boston University’s Center for Global and Health and Development (CGHD) and the Kwame Nkrumah University of Science and Technology (KNUST) as part of Project SEARCH funded by the United States Agency for International Development Ghana. Participants were recruited from five post‐secondary institutions in the greater Kumasi area. Our objective is to provide academic institutions, the Ghana AIDS Commission (GAC), the National AIDS Control Program, donors, and other stakeholders with rich data to inform research and programmatic efforts in Kumasi specifically, as well as academic institutions in general. We set out to document what forms of transactional sex female students are engaging in, who their partners are, and what motivates them to participate. We asked students about the individual and structural vulnerabilities for HIV reported by female post‐secondary students involved in transactional sex and what their prevention needs are. We also interviewed a small sample of faculty, residence hall matrons, and hotel staff to get their perspective on the behavior of female students practicing transactional sex that might put them at risk for HIV. The findings of this study can be used as well to inform the design of future studies of young women engaging in transactional sex in Ghana. With such limited understanding of HIV transmission among young female post‐secondary students engaged in transactional sex, research is needed to determine how this group contributes to the overall HIV epidemic. The Ghana AIDS Commission has recognized the need for further research among communities engaged in less well‐defined risky sex practices in the National Strategic Plan for Most‐at – Risk Populations (MARP) 2011‐2015.4 This study attempts to fill in gaps in the research regarding transactional sex, taking into account the complexities and nuances of the practice, in addition to examining the needs of female students for targeted HIV prevention programs.Support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 201

Program brief: "Using what you have to get what you want: HIV vulnerability and prevention needs of female post‐secondary students engaged in transactional sex in Kumasi, Ghana

This study was implemented by Boston University in collaboration with the Kwame Nkrumah University of Science and Technology with support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 2010. The content and views expressed here are the authors’ and do not necessarily reflect the opinion or policy of USAID or the U.S. Government.HIV prevalence among young Ghanaian men and women aged 15–24 years old is estimated at 1.7%.1 HIV prevalence in the specific population of female post-secondary students is unknown. The Ghana AIDS Commission (GAC) recognizes the need for further research in communities participating in less well-defined risky sex practices. This study was conducted by Boston University’s Center for Global Health and Development and the Kwame Nkrumah University of Science and Technology with funding from the United States Agency for International Development/Ghana. The objective was to provide academic institutions, the GAC, the National AIDS Control Program, donors, and other stakeholders with data to inform research and programmatic efforts in Kumasi, specifically, as well as academic institutions, in general. Study participants were recruited from five post-secondary institutions in the greater Kumasi area. Data were collected on students’ perceptions of transactional sex (TS) on campus, individual and structural HIV vulnerabilities, and prevention needs through in-depth interviews with seven female post-secondary students involved in TS and focus groups with twenty-nine female and male students. Key informant interviews were also conducted with faculty, residence hall matrons, and hotel staff. Non-commercial transactional sex is defined here as engaging in sex for the purposeof obtaining material goods, financial support, or grades.Support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 201

A University-Church-Community Look at Community Health Using Community-Based-Participatory Research

The purpose of this sequential explanatory mixed-method approach using quantitative methods followed by qualitative inquiry was to assess a Southern California community’s perception of its health and of barriers to improving health. The qualitative aspects of this mixed-method CBPR project by a church-university-community partnership further describe member perceptions of their community and contributors/barriers to community health. Four focus group interviews were conducted over eight months at two elementary schools with the mothers of school children (N = 21) in the 2017–2018 and 2018–2019 school years, including one Spanish-only group. Four themes emerged, describing the contributors and barriers to community health and well-being: lack of connection, poor communication, fear/anxiety, and lack of access to affordable healthcare. The findings highlight how small anchor institutions, those whose primary mission is not health (church, school, trailer park, local businesses, etc.), can be facilitators of health and address these disruptions of connectivity, communication, and care present within the healthcare system itself, and its disappointed community recipients of “care”. The church as a community of care, in collaboration with educational institutions, is suited to invite community participation, affirm humanness, build trust, and offer increased access to care in the neighborhoods surrounding its location