The diaconal role of the roman catholic church within the diocese of Lindi Southern Tanzania : an assessment of its transformational development

Thesis (DTh)--Stellenbosch University, 2012.ENGLISH ABSTRACT: This research study addresses the assessment of the role of the Roman Catholic Church in addressing poverty within the Diocese of Lindi in Southern Tanzania. The study is interested in assessing whether the Roman Catholic Church in the Diocese of Lindi is fulfilling its mandated role of diakonia – the ministry of service, philanthropy (initiatives for communal good focusing on excellence of human life), and Christian love to ones neighbor and its role, commitment and application within the Diocese. In addition, this research will focus on the assessment of the fulfillment of the diocese‟s diaconal role of empowering the rural poor to “develop their capacity and skills so that they become competent decision makers with their confidence to act on their choices” (Roy and Hartigan 2008:67). In this study, efforts are made to study poverty from the reality experienced by the poor in the Diocese of Lindi. The component themes in this research study are: - The research design of this study and the literature review; relative to Diakonia; Catholic Social Teaching of the Roman Catholic Church; and Bryant Myers‟ framework for Transformational Development. - The experience of poverty, diakonia, Catholic social teaching and transformational development by the respondents, with specific reference to the selected parishes in the Diocese of Lindi. - A reflection of the reality of poverty from what emerged in literature with empirical qualitative research that is conducted among the poor. - This research study suggests a model of Diakonia, which is contextual, relevant and liberating. Focusing on the Scriptures, the social teachings of the Church, the literature and listening to the poor during interview process, this research proposes that the Diocese of Lindi implement a model consistence with Diakonia that takes the following seriously: 1. The role of the church is mandated to carry out as it ministers to the poor in deed and word, guided by Christian love, to enable the poor to lead a better life (Pieterse 2001:111). Also, an African worldview1, which focuses on communal and systemic approaches to life and its problems. 2. The Roman Catholic Church deals with social, economic and political issues (Zalot and Guevin 2008:46). Socio-economic and political dimensions of life, with the recognition that poverty is structural and if the problems of the poor are to be dealt with effectively, the socio-economic and political structures are also to be addressed and transformed. 3. The reflection of concern for seeking positive change in the whole of human life, socially and spiritually (Myers 1999:3, 14). The poor, as living human documents, should not only be read and interpreted, but also taken seriously and regarded as central to the process of community development. The poor are to play the central role in the transformation of society. They are to be involved in the “functional priesthood of all believers” (Stevenson-Moessner 2005:21). The local churches of the Diocese must take seriously the socio-economic and political structures that perpetuate poverty and other injustices in society. The proposed model of Diakonia described herein is offered as a contribution in the direction of community development.AFRIKAANSE OPSOMMING: Hierdie studie fokus op die evaluering van die rol van die Rooms-Katolieke Kerk in die aanspreek van armoede binne die Bisdom van Lindi in suidelike Tanzanië. Die studie is geïnteresseerd in die assessering van die rol van die Rooms-Katolieke Kerk in die bisdom van Lindi rakende haar mandaat om diakonia te vervul – die bediening van die naastediens, filantropie (inisiatiewe gefokus op die gemeenskaplike welheid ten opsigte van die uitnemendheid van die menslike lewe), en Christelike liefde in toewyding aan die naaste en die toepassing daarvan bine die Bisdom. Daarbenewens sal hierdie navorsing fokus op die assessering van die vervulling van die bisdom se diakonale rol ten opsigte van die bemagtiging van die landelike armes deur die ontwikkelling van hul kapasiteit en vaardighede sodat hulle bevoegde besluitnemers kan word wat met selfvertoue hul keuses uitoefen” (Roy en Hartigan 2008:67). In hierdie studie, word pogings aangewend om warlike armoede soos ervaar deur die armes in die bisdom van Lindi te bestudeer. Die volgende toepaslike temas word in die navorsing behandel: - Die navorsingsontwerp van hierdie studie en die literatuuroorsig, relatief tot die Diakonia, Katolieke maatskaplike leerstellinge van die Rooms-Katolieke Kerk, en Bryant Myers se raamwerk vir Transformasionele Ontwikkeling. - Die ervaring van armoede, diakonia, Katolieke sosiale onderrig en transformasionele ontwikkeling deur die respondent, met spesiale verwysing na die geselekteerde gemeentes in die bisdom van Lindi. - 'n weerspieëling van die realiteit van armoede in die literatuur; te same met empiriese kwalitatiewe navorsing soos waargeneem onder die armes. - Hierdie navorsing studie dui op'n model van Diakonaat, wat kontekstueel, relevant en bevrydend is. Terwyl daar gefokus word op die Skrif, die sosiale leer van die Kerk, die literatuur en luister na die armes tydens die onderhoudsproses, wil hierdie navorsing voorstel dat die Bisdom van Lindi uitvoering gee aan 'n model in ooreenstemming met die Diakonaat deur die volgende ernsting te neem: 1. Die rol wat die kerk het as 'n mandaat om die armes in woord en daad te bedien aangedryf deur Christelike liefde,sodat die armes in staat gestel word om 'n beter lewe te lei (Pieterse 2001:111). Ook 'n Afrika-wêreldbeskouing, wat fokus op 'n kommunale en sistemiese benadering tot die lewe en sy probleme. 2. Die Rooms-Katolieke Kerk se werkswyse van die hantering van sosiale, ekonomiese en politieke kwessies (Zalot en Guevin 2008:46). Sosio-ekonomiese en politieke dimensies van die lewe, met die erkenning dat armoede struktureel is en om die problem van die armes doeltreffend te behandel moet die sosio-ekonomiese en politieke strukture ook aangespreek en getransformeer word. 3. Die weerspieëling van besorgdheid oor die nastreef van 'n positiewe verandering in die geheel van menslike lewe - sosiaal en geestelik (Myers 1999:3, 14). Die arme, as die lewende menslike dokumente, moet net nie gelees en geïnterpreter word nie, maar moet ook ernstig opgeneem word en beskou word as sentraal tot die proses van gemeenskapsontwikkeling. Die armes moet die sentrale rol speel in die transformasie van die samelewing. Hulle moet betrokke wees in die “funksionele priesterskap van alle gelowiges” (Stevenson-Moessner 2005:21). Die plaaslike gemeentes van die Bisdom moet ernstig op te neem die sosio-ekonomiese en politieke strukture wat die armoede en die ander onreg in die samelewing laat voortbestaan. Die voorgestelde model van die Diakonia soos in die tesis beskryf, word as 'n bydrae aangebied met die ontwikkeling van die gemeeskap as uitkoms

Research Article (Human Resources for Health) Postoperative outcome of caesarean sections and other major emergency obstetric surgery by clinical officers and medical officers in Malawi

Background: Clinical officers perform much of major emergency surgery in Malawi, in the absence of medical officers. The aim of this study was to validate the advantages and disadvantages of delegation of major obstetric surgery to  non-doctors.Methods: During a three month period, data from 2131 consecutive obstetric  surgeries in 38 district hospitals in Malawi were collected prospectively. The interventions included caesarean sections alone and those that were combined with other interventions such as subtotal and total hysterectomy repair of uterine rupture and tubal ligation. All these surgeries were conducted either by clinical officers or by medical officers.Results: During the study period, clinical officers performed 90% of all straight caesarean sections, 70% of those combined with subtotal hysterectomy, 60% of those combined with total hysterectomy and 89% of those combined with repair of uterine rupture. A comparable profile of patients was operated on by clinical officers and medical officers, respectively. Postoperative outcomes were almost identical in the two groups in terms of maternal general condition – both immediately and 24 hours postoperatively – and regarding occurrence of pyrexia, wound infection, wound dehiscence, need for re-operation, neonatal outcome or maternal death.Conclusions: Clinical officers perform the bulk of emergency obstetric operations at district hospitals in Malawi. The postoperative outcomes of their procedures are comparable to those of medical officers. Clinical officers constitute a crucial component of the health care team in Malawi for saving maternal and neonatal lives given the scarcity of physicians

The impact of training non-physician clinicians in Malawi on maternal and perinatal mortality : a cluster randomised controlled evaluation of the enhancing training and appropriate technologies for mothers and babies in Africa (ETATMBA) project

Background: Maternal mortality in much of sub-Saharan Africa is very high whereas there has been a steady decline in over the past 60 years in Europe. Perinatal mortality is 12 times higher than maternal mortality accounting for about 7 million neonatal deaths; many of these in sub-Saharan countries. Many of these deaths are preventable. Countries, like Malawi, do not have the resources nor highly trained medical specialists using complex technologies within their healthcare system. Much of the burden falls on healthcare staff other than doctors including non-physician clinicians (NPCs) such as clinical officers, midwives and community health-workers. The aim of this trial is to evaluate a project which is training NPCs as advanced leaders by providing them with skills and knowledge in advanced neonatal and obstetric care. Training that will hopefully be cascaded to their colleagues (other NPCs, midwives, nurses). Methods/design: This is a cluster randomised controlled trial with the unit of randomisation being the 14 districts of central and northern Malawi (one large district was divided into two giving an overall total of 15). Eight districts will be randomly allocated the intervention. Within these eight districts 50 NPCs will be selected and will be enrolled on the training programme (the intervention). Primary outcome will be maternal and perinatal (defined as until discharge from health facility) mortality. Data will be harvested from all facilities in both intervention and control districts for the lifetime of the project (3–4 years) and comparisons made. In addition a process evaluation using both quantitative and qualitative (e.g. interviews) will be undertaken to evaluate the intervention implementation. Discussion: Education and training of NPCs is a key to improving healthcare for mothers and babies in countries like Malawi. Some of the challenges faced are discussed as are the potential limitations. It is hoped that the findings from this trial will lead to a sustainable improvement in healthcare and workforce development and training. Trial registration: ISRCTN6329415

Postoperative outcome of caesarean sections and other major emergency obstetric surgery by clinical officers and medical officers in Malawi

<p>Abstract</p> <p>Background</p> <p>Clinical officers perform much of major emergency surgery in Malawi, in the absence of medical officers. The aim of this study was to validate the advantages and disadvantages of delegation of major obstetric surgery to non-doctors.</p> <p>Methods</p> <p>During a three month period, data from 2131 consecutive obstetric surgeries in 38 district hospitals in Malawi were collected prospectively. The interventions included caesarean sections alone and those that were combined with other interventions such as subtotal and total hysterectomy repair of uterine rupture and tubal ligation. All these surgeries were conducted either by clinical officers or by medical officers.</p> <p>Results</p> <p>During the study period, clinical officers performed 90% of all straight caesarean sections, 70% of those combined with subtotal hysterectomy, 60% of those combined with total hysterectomy and 89% of those combined with repair of uterine rupture. A comparable profile of patients was operated on by clinical officers and medical officers, respectively. Postoperative outcomes were almost identical in the two groups in terms of maternal general condition – both immediately and 24 hours postoperatively – and regarding occurrence of pyrexia, wound infection, wound dehiscence, need for re-operation, neonatal outcome or maternal death.</p> <p>Conclusion</p> <p>Clinical officers perform the bulk of emergency obstetric operations at district hospitals in Malawi. The postoperative outcomes of their procedures are comparable to those of medical officers. Clinical officers constitute a crucial component of the health care team in Malawi for saving maternal and neonatal lives given the scarcity of physicians.</p

Use of Massively Parallel Pyrosequencing to Evaluate the Diversity of and Selection on Plasmodium falciparum csp T-Cell Epitopes in Lilongwe, Malawi

The development of an effective malaria vaccine has been hampered by the genetic diversity of commonly used target antigens. This diversity has led to concerns about allele-specific immunity limiting the effectiveness of vaccines. Despite extensive genetic diversity of circumsporozoite protein (CS), the most successful malaria vaccine is RTS/S, a monovalent CS vaccine. By use of massively parallel pyrosequencing, we evaluated the diversity of CS haplotypes across the T-cell epitopes in parasites from Lilongwe, Malawi. We identified 57 unique parasite haplotypes from 100 participants. By use of ecological and molecular indexes of diversity, we saw no difference in the diversity of CS haplotypes between adults and children. We saw evidence of weak variant-specific selection within this region of CS, suggesting naturally acquired immunity does induce variant-specific selection on CS. Therefore, the impact of CS vaccines on variant frequencies with widespread implementation of vaccination requires further study

District Health Managers' Perceptions of Supervision in Malawi and Tanzania.

Mid-level cadres are being used to address human resource shortages in many African contexts, but insufficient and ineffective human resource management is compromising their performance. Supervision plays a key role in performance and motivation, but is frequently characterised by periodic inspection and control, rather than support and feedback to improve performance. This paper explores the perceptions of district health management teams in Tanzania and Malawi on their role as supervisors and on the challenges to effective supervision at the district level. This qualitative study took place as part of a broader project, "Health Systems Strengthening for Equity: The Power and Potential of Mid-Level Providers". Semi-structured interviews were conducted with 20 district health management team personnel in Malawi and 37 council health team members in Tanzania. The interviews covered a range of human resource management issues, including supervision and performance assessment, staff job descriptions and roles, motivation and working conditions. Participants displayed varying attitudes to the nature and purpose of the supervision process. Much of the discourse in Malawi centred on inspection and control, while interviewees in Tanzania were more likely to articulate a paradigm characterised by support and improvement. In both countries, facility level performance metrics dominated. The lack of competency-based indicators or clear standards to assess individual health worker performance were considered problematic. Shortages of staff, at both district and facility level, were described as a major impediment to carrying out regular supervisory visits. Other challenges included conflicting and multiple responsibilities of district health team staff and financial constraints. Supervision is a central component of effective human resource management. Policy level attention is crucial to ensure a systematic, structured process that is based on common understandings of the role and purpose of supervision. This is particularly important in a context where the majority of staff are mid-level cadres for whom regulation and guidelines may not be as formalised or well-developed as for traditional cadres, such as registered nurses and medical doctors. Supervision needs to be adequately resourced and supported in order to improve performance and retention at the district level

The Critical Role of Supervision in Retaining Staff in Obstetric Services: A Three Country Study

Millennium Development Goal (MDG) 5 commits us to reducing maternal mortality rates by three quarters and MDG 4 commits us to reducing child mortality by two-thirds between 1990 and 2015. In order to reach these goals, greater access to basic emergency obstetric care (EmOC) as well as comprehensive EmOC which includes safe Caesarean section, is needed.. The limited capacity of health systems to meet demand for obstetric services has led several countries to utilize mid-level cadres as a substitute to more extensively trained and more internationally mobile healthcare workers. Although this does provide greater capacity for service delivery, concern about the performance and motivation of these workers is emerging. We propose that poor leadership characterized by inadequate and unstructured supervision underlies much of the dissatisfaction and turnover that has been shown to exist amongst these mid-level healthcare workers and indeed health workers more generally. To investigate this, we conducted a large-scale survey of 1,561 mid-level cadre healthcare workers (health workers trained for shorter periods to perform specific tasks e.g. clinical officers) delivering obstetric care in Malawi, Tanzania, and Mozambique. Participants indicated the primary supervision method used in their facility and we assessed their job satisfaction and intentions to leave their current workplace. In all three countries we found robust evidence indicating that a formal supervision process predicted high levels of job satisfaction and low intentions to leave. We find no evidence that facility level factors modify the link between supervisory methods and key outcomes. We interpret this evidence as strongly supporting the need to strengthen leadership and implement a framework and mechanism for systematic supportive supervision. This will promote better job satisfaction and improve the retention and performance of obstetric care workers, something which has the potential to improve maternal and neonatal outcomes in the countdown to 2015

Bacterial infections in Lilongwe, Malawi: aetiology and antibiotic resistance

<p>Abstract</p> <p>Background</p> <p>Life-threatening infections present major challenges for health systems in Malawi and the developing world because routine microbiologic culture and sensitivity testing are not performed due to lack of capacity. Use of empirical antimicrobial therapy without regular microbiologic surveillance is unable to provide adequate treatment in the face of emerging antimicrobial resistance. This study was conducted to determine antimicrobial susceptibility patterns in order to inform treatment choices and generate hospital-wide baseline data.</p> <p>Methods</p> <p>Culture and susceptibility testing was performed on various specimens from patients presenting with possible infectious diseases at Kamuzu Central Hospital, Lilongwe, Malawi.</p> <p>Results</p> <p>Between July 2006 and December 2007 3104 specimens from 2458 patients were evaluated, with 60.1% from the adult medical service. Common presentations were sepsis, meningitis, pneumonia and abscess. An etiologic agent was detected in 13% of patients. The most common organisms detected from blood cultures were <it>Staphylococcus aureus</it>, <it>Escherichia </it><it>coli</it>, Salmonella species and <it>Streptococcus pneumoniae</it>, whereas <it>Streptococcus pneumoniae </it>and <it>Cryptococcus neoformans </it>were most frequently detected from cerebrospinal fluid. <it>Haemophilus influenzae </it>was rarely isolated. Resistance to commonly used antibiotics was observed in up to 80% of the isolates while antibiotics that were not commonly in use maintained susceptibility.</p> <p>Conclusions</p> <p>There is widespread resistance to almost all of the antibiotics that are empirically used in Malawi. Antibiotics that have not been widely introduced in Malawi show better laboratory performance. Choices for empirical therapy in Malawi should be revised accordingly. A microbiologic surveillance system should be established and prudent use of antimicrobials promoted to improve patient care.</p

Antiretroviral pharmacokinetics in mothers and breastfeeding infants from 6 to 24 weeks post partum: results of the BAN Study

An intensive, prospective, open-label pharmacokinetic (PK) study in a subset of HIV-infected mothers and their uninfected infants enrolled in the Breastfeeding, Antiretroviral, and Nutrition study was performed to describe drug exposure and antiviral response

Factors influencing job preferences of health workers providing obstetric care : results from discrete choice experiments in Malawi, Mozambique and Tanzania

BACKGROUND: Task shifting from established health professionals to mid-level providers (MLPs) (professionals who undergo shorter training in specific procedures) is one key strategy for reducing maternal and neonatal deaths. This has resulted in a growth in cadre types providing obstetric care in low and middle-income countries. Little is known about the relative importance of the different factors in determining motivation and retention amongst these cadres. METHODS: This paper presents findings from large sample (1972 respondents) discrete choice experiments to examine the employment preferences of obstetric care workers across three east African countries. RESULTS: The strongest predictors of job choice were access to continuing professional development and the presence of functioning human resources management (transparent, accountable and consistent systems for staff support, supervision and appraisal). Consistent with similar works we find pay and allowances significantly positively related to utility, but financial rewards are not as fundamental a factor underlying employment preferences as many may have previously believed. Location (urban vs rural) had the smallest average effect on utility for job choice in all three countries. CONCLUSIONS: These findings are important in the context where efforts to address the human resources crisis have focused primarily on increasing salaries and incentives, as well as providing allowances to work in rural areas