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Implementing large-scale workforce change: learning from 55 pilot sites of allied health workforce redesign in Queensland, Australia

Mié, 11/12/2013 - 00:00
Abstract Background

Increasingly, health workforces are undergoing high-level ‘re-engineering’ to help them better meet the needs of the population, workforce and service delivery. Queensland Health implemented a large scale 5-year workforce redesign program across more than 13 health-care disciplines. This study synthesized the findings from this program to identify and codify mechanisms associated with successful workforce redesign to help inform other large workforce projects.

Methods

This study used Inductive Logic Reasoning (ILR), a process that uses logic models as the primary functional tool to develop theories of change, which are subsequently validated through proposition testing. Initial theories of change were developed from a systematic review of the literature and synthesized using a logic model. These theories of change were then developed into propositions and subsequently tested empirically against documentary, interview, and survey data from 55 projects in the workforce redesign program.

Results

Three overarching principles were identified that optimized successful workforce redesign: (1) drivers for change need to be close to practice; (2) contexts need to be supportive both at the local levels and legislatively; and (3) mechanisms should include appropriate engagement, resources to facilitate change management, governance, and support structures. Attendance to these factors was uniformly associated with success of individual projects.

Conclusions

ILR is a transparent and reproducible method for developing and testing theories of workforce change. Despite the heterogeneity of projects, professions, and approaches used, a consistent set of overarching principles underpinned success of workforce change interventions. These concepts have been operationalized into a workforce change checklist.

Categorías: Investigaciones

The value of survival analyses for evidence-based rural medical workforce planning

Mié, 11/12/2013 - 00:00
Abstract Background

Globally, abundant opportunities exist for policymakers to improve the accessibility of rural and remote populations to primary health care through improving workforce retention. This paper aims to identify and quantify the most important factors associated with rural and remote Australian family physician turnover, and to demonstrate how evidence generated by survival analysis of health workforce data can inform rural workforce policy making.

Methods

A secondary analysis of longitudinal data collected by the New South Wales (NSW) Rural Doctors Network for all family physicians working in rural or remote NSW between January 1st 2003 and December 31st 2012 was performed. The Prentice, Williams and Peterson statistical model for survival analysis was used to identify and quantify risk factors for rural NSW family physician turnover.

Results

Multivariate modelling revealed a higher (2.65-fold) risk of family physician turnover in small, remote locations compared to that in small closely settled locations. Family physicians who graduated from countries other than Australia, United Kingdom, United States of America, New Zealand, Ireland, and Canada also had a higher (1.45-fold) risk of turnover compared to Australian trained family physicians. This was after adjusting for the effects of conditional registration. Procedural skills and public hospital admitting rights were associated with a lower risk of turnover. These risks translate to a predicted median survival of 11 years for Australian-trained family physician non-proceduralists with hospital admitting rights working in small coastal closely settled locations compared to 3 years for family physicians in remote locations.

Conclusions

This study provides rigorous empirical evidence of the strong association between population size and geographical location and the retention of family physicians in rural and remote NSW. This has important policy ramifications since retention grants for rural and remote family physicians in Australia are currently based on a geographical ‘remoteness’ classification rather than population size. In addition, this study demonstrates how survival analysis assists health workforce planning, such as through generating evidence to assist in benchmarking ‘reasonable’ lengths of practice in different geographic settings that might guide service obligation requirements.

Categorías: Investigaciones

Applying the workload indicators of staffing need (WISN) method in Namibia: challenges and implications for human resources for health policy

Mar, 10/12/2013 - 00:00
Abstract Introduction

As part of ongoing efforts to restructure the health sector and improve health care quality, the Ministry of Health and Social Services (MoHSS) in Namibia sought to update staffing norms for health facilities. To establish an evidence base for the new norms, the MoHSS supported the first-ever national application of the Workload Indicators of Staffing Need (WISN) method, a human resource management tool developed by the World Health Organization.

Application

The WISN method calculates the number of health workers per cadre, based on health facility workload. It provides two indicators to assess staffing: (1) the gap/excess between current and required number of staff, and (2) the WISN ratio, a measure of workload pressure. Namibian WISN calculations focused on four cadres (doctors, nurses, pharmacists, pharmacy assistants) and all four levels of public facilities (clinics, health centers, district hospitals, intermediate hospitals). WISN steps included establishing a task force; conducting a regional pilot; holding a national validation workshop; field verifying data; collecting, uploading, processing, and analyzing data; and providing feedback to policy-makers.

Challenges

The task force faced two challenges requiring time and effort to solve: WISN software-related challenges and unavailability of some data at the national level.

Findings

WISN findings highlighted health worker shortages and inequities in their distribution. Overall, staff shortages are most profound for doctors and pharmacists. Although the country has an appropriate number of nurses, the nurse workforce is skewed towards hospitals, which are adequately or slightly overstaffed relative to nurses’ workloads. Health centers and, in particular, clinics both have gaps between current and required number of nurses. Inequities in nursing staff also exist between and within regions. Finally, the requirement for nurses varies greatly between less and more busy clinics (range = 1 to 7) and health centers (range = 2 to 57).

Policy implications

The utility of the WISN health workforce findings has prompted the MoHSS to seek approval for use of WISN in human resources for health policy decisions and practices. The MoHSS will focus on revising staffing norms; improving staffing equity across regions and facility types; ensuring an appropriate skill mix at each level; and estimating workforce requirements for new cadres.

Categorías: Investigaciones

A cycle of brain gain, waste and drain - a qualitative study of non-EU migrant doctors in Ireland

Lun, 09/12/2013 - 00:00
Abstract Background

Ireland is heavily reliant on non-EU migrant health workers to staff its health system. Shortages of locally trained health workers and policies which facilitate health worker migration have contributed to this trend. This paper provides insight into the experiences of non-EU migrant doctors in the Irish health workforce.

Method

In-depth interviews were conducted with 37 non-EU migrant doctors in Ireland in 2011/2012.

Results

Respondents believed they had been recruited to fill junior hospital doctor ‘service’ posts. These posts are unpopular with locally trained doctors due to the limited career progression they provide. Respondents felt that their hopes for career progression and postgraduate training in Ireland had gone unrealised and that they were becoming de-skilled. As a result, most respondents were actively considering onward migration from Ireland.

Discussion & conclusions

Failure to align the expectations of non-EU migrant doctors with the requirements of the health system has resulted in considerable frustration and a cycle of brain gain, waste and drain. The underlying reasons for high mobility into and out of the Irish medical workforce must be addressed if this cycle is to be broken. The heavy reliance on non-EU migrant doctors to staff the medical workforce has distracted from the underlying workforce challenges facing the Irish medical workforce.

Categorías: Investigaciones

Strengthening research capacity through the medical education partnership initiative: the Mozambique experience

Jue, 05/12/2013 - 00:00
Abstract Background

Since Mozambique’s independence, the major emphasis of its higher educational institutions has been on didactic education. Because of fiscal and human resource constraints, basic and applied research activities have been relatively modest in scope, and priorities have often been set primarily by external collaborators. These factors have compromised the scope and the relevance of locally conducted research and have limited the impact of Mozambique’s universities as major catalysts for national development.

Case description

We developed a multi-institutional partnership to undertake a comprehensive analysis of the research environment at Mozambique’s major public universities to identify factors that have served as barriers to the development of a robust research enterprise. Based on this analysis, we developed a multifaceted plan to reduce the impact of these barriers and to enhance research capacity within Mozambique.

Interventions

On the basis of our needs assessment, we have implemented a number of major initiatives within participating institutions to facilitate basic and applied research activities. These have included specialized training programmes, a reorganization of the research administration infrastructure, the development of multiple collaborative research projects that have emphasized local research priorities and a substantial investment in bioinformatics. We have established a research support centre that provides grant development and management services to Mozambique’s public universities and have developed an independent Institutional Review Board for the review of research involving human research subjects. Multiple research projects involving both communicable and non-communicable diseases have been developed and substantial external research support has been obtained to undertake these projects. A sizable investment in biomedical informatics has enhanced both connectivity and access to digital reference material. Active engagement with relevant entities within the Government of Mozambique has aligned institutional development with national priorities.

Conclusions

Although multiple challenges remain, over the past 3 years significant progress has been made towards establishing conditions within which a broad range of basic, translational and clinical and public health research can be undertaken. Ongoing development of this research enterprise will enhance capacity to address critical locally relevant research questions and will leverage resources to accelerate the development of Mozambique’s national universities.

Categorías: Investigaciones

Turn-over rate of academic faculty at the College of Health Sciences, Addis Ababa University: a 20-year analysis (1991 to 2011)

Dom, 01/12/2013 - 00:00
Abstract Background

Faculty turn-over affects both workers and organizations. Turnover of faculty and researchers is increasing alarmingly and costing the universities and the country at large. Fast turnover of health professionals from the health system and from academic institutions has recently received substantial attention from both academia and health sector managers. This paper calculates the faculty turnover rate at the College of Health Sciences of Addis Ababa University during the period of September 1991 to August 2011.

Methods

The study was conducted at the College of Health Sciences, Addis Ababa University. Retrospective analysis of employee records was done. All records of the faculty that were working in the College during the 20-year period, starting from September 1991 to August 2011 were retrospectively reviewed. Data were collected from the employee records accessed from the College’s human resources database and supplemented by payroll sheets and different reports. A structured checklist was used to extract the required data from the database. The crude turnover rate for academic faculty was calculated.

Results

Within the 20-year period of September 1991 to August 2011, a total of 120 faculty members left. The overall turn-over rate was 92.8 %. The rate in the most recent five years (172 %) is 8.5 times higher than the rate for the first five years (20 %). The average retention period before the termination of an employment contract was 4.9 years. The top five departments where employment contracts were relatively higher include: Nursing 15 (15.6 %), Internal Medicine 12 (12.5%), Public Health 10 (10.4%), Pediatrics 9 (9.4%) and Surgery 9 (9.4%). About two thirds (66.6%) of the faculty who were leaving were at the ranks of assistant professorship and above.

Conclusion

This study revealed that outflow of faculty has been continuously increasing in the period reviewed. This implies that the College had been losing highly skilled professionals with considerably higher costs in monetary terms. In this regard, an urgent response is required to retain or significantly decrease the outflow of faculty. Different motivation and retention mechanisms should be identified and implemented. Various modalities of faculty development programs should also be initiated.

Categorías: Investigaciones

Right time, right place: improving access to health service through effective retention and distribution of health workers

Lun, 25/11/2013 - 00:00
Abstract

This editorial introduces the 'Right time, Right place: improving access to health service through effective retention and distribution of health workers’ thematic series. This series draws from studies in a range of countries and provides new insights into what can be done to improve access to health through more effective human resources policies, planning and management. The primary focus is on health workforce distribution and retention.

Categorías: Investigaciones

National program for family planning and primary health care Pakistan: a SWOT analysis

Vie, 22/11/2013 - 00:00
Abstract Background

The National Program for Family Planning and Primary Healthcare was launched in 1994. It is one of the largest community based programs in the world, providing primary healthcare services to about 80 million people, most of which is rural poor. The program has been instrumental in improving health related indicators of maternal and child health in the last two decades.

Methods

SWOT analysis was used by making recourse to the structure and dynamics of the program as well as searching the literature.

SWOT analysis

Strengths of the program include: comprehensive design of planning, implementation and supervision mechanisms aided by an MIS, selection and recruitments processes and evidence created through improving health impact indicators. Weaknesses identified are slow progress, poor integration of the program with health services at local levels including MIS, and de-motivational factors such as job insecurity and non-payment of salaries in time. Opportunities include further widening the coverage of services, its potential contribution to health system research, and its use in areas other than health like women empowerment and poverty alleviation. Threats the program may face are: political interference, lack of funds, social threats and implications for professional malpractices.

Conclusion

Strengthening of the program will necessitate a strong political commitment, sustained funding and a just remuneration to this bare foot doctor of Pakistan, the Lady Health Worker.

Categorías: Investigaciones

Widening disparity in the geographic distribution of pediatricians in Japan

Vie, 22/11/2013 - 00:00
Abstract Background

The shortage of physicians in Japan is a serious concern, particularly in specialties like pediatrics. The purpose of this study was to investigate recent changes in the geographic distribution of pediatricians and the factors underlying this change.

Methods

We investigated the numerical changes in the pediatrician workforce (2002 to 2007) per 100,000 of the population under the age of 15 years in 369 secondary medical areas throughout Japan, using attributive variables such as population size, social and economic status, and pediatric service delivery. We performed principal component analysis and multiple regression analysis.

Results

We obtained two principal components: one that reflected the degree of urbanization and another that reflected the volume of pediatric service delivery. Only the first component score was positively correlated with an increased pediatrician workforce per 100,000 of the population under the age of 15 years. We classified the secondary medical areas into four groups using component scores. The increase in pediatrician workforce during this period was primarily absorbed into the two groups with higher levels of urbanization, whereas the two rural groups exhibited little increase. Pediatricians aged 50 to 59 years increased in all four groups, whereas pediatricians aged 30 to 39 years decreased in the two rural groups and increased in the two urban groups.

Conclusions

The trends of the pediatrician workforce increase generally kept pace with urbanization, but were not associated with the original pediatrician workforce supply. The geographic distribution of pediatricians showed rapid concentration in urban areas. This trend was particularly pronounced among female pediatricians and those aged 30 to 39 years. Given that aging pediatricians in rural areas are not being replaced by younger doctors, these areas will likely face new crises when senior physicians retire.

Categorías: Investigaciones

For more than love or money: attitudes of student and in-service health workers towards rural service in India

Jue, 21/11/2013 - 00:00
Abstract Background

While international literature on rural retention is expanding, there is a lack of research on relevant strategies from pluralistic healthcare environments such as India, where alternate medicine is an integral component of primary care. In such contexts, there is a constant tug of war in national policy on “Which health worker is needed in rural areas?” and “Who can, realistically, be got there?” In this article, we try to inform this debate by juxtaposing perspectives of three cadres involved in primary care in India—allopathic, ayurvedic and nursing—on rural service. We also identify key incentives for improved rural retention of these cadres.

Methods

We present qualitative evidence from two states, Uttarakhand and Andhra Pradesh. Eighty-eight in-depth interviews with students and in-service personnel were conducted between January and July 2010. Generic thematic analysis techniques were employed, and the data were organized in a framework that clustered factors linked to rural service as organizational (salary, infrastructure, career) and contextual (housing, children’s development, safety).

Results

Similar to other studies, we found that both pecuniary and non-pecuniary factors (salary, working conditions, children’s education, living conditions and safety) affect career preferences of health workers. For the allopathic cadre, rural primary care jobs commanded little respect; respondents from this cadre aimed to specialize and preferred private sector jobs. Offering preferential admission to specialist courses in exchange for a rural stint appears to be a powerful incentive for this cadre. In contrast, respondents from the Ayurvedic and nursing cadres favored public sector jobs even if this meant rural postings. For these two cadres, better salary, working and rural living conditions can increase recruitment.

Conclusions

Rural retention strategies in India have predominantly concentrated on the allopathic cadre. Our study suggests incentivizing rural service for the nursing and Ayurvedic cadres is less challenging in comparison to the allopathic cadre. Hence, there is merit in strengthening rural incentive strategies for these two cadres also. In our study, we have developed a detailed framework of rural retention factors and used this for delineating India-specific recommendations. This framework can be adapted to other similar contexts to facilitate international cross-cadre comparisons.

Categorías: Investigaciones

Associations between employee and manager gender: impacts on gender-specific risk of acute occupational injury in metal manufacturing

Vie, 08/11/2013 - 00:00
Abstract Background

Prior research has shown increased risk of injury for female employees compared to male employees after controlling for job and tasks, but have not explored whether this increased risk might be moderated by manager gender. The gender of one’s manager could in theory affect injury rates among male and female employees through their managers’ response to an employee’s psychosocial stress or through how employees differentially report injuries. Other explanations for the gender disparity in injury experience, such as ergonomic factors or differential training, are unlikely to be impacted by supervisor gender. This study seeks to explore whether an employee’s manager’s gender modifies the effect of employee gender with regards to risk of acute injury.

Methods

A cohort of employees and managers were identified using human resources and injury management data between January 1, 2002 and December 31, 2007 for six facilities of a large US aluminum manufacturing company. Cox proportional hazards models were employed to examine the interaction between employee gender and whether the employee had female only manager(s), male only manager(s), or both male and female managers on injury risk. Manager gender category was included as a time varying covariate and reassessed for each employee at the midpoint of each year.

Results

The percentage of departments with both female and male managers increased dramatically during the study period due to corporate efforts to increase female representation in management. After adjustment for fixed effects at the facility level and shared frailty by department, manager gender category does not appear to moderate the effect of employee gender (p = 0.717). Manager category was not a significant predictor (p = 0.093) of time to first acute injury. Similarly, having at least one female manager did not modify the hazard of injury for female employees compared to males (p = 0.899) and was not a significant predictor of time to first acute injury (p = 0.601).

Conclusions

Prior findings suggest that female manufacturing employees are at higher risk for acute injury compared to males; this analysis suggests that this relationship is not affected by the gender of the employee’s manager(s).

Categorías: Investigaciones

Interprofessional teamwork in the trauma setting: a scoping review

Mar, 05/11/2013 - 00:00
Abstract

Approximately 70 to 80% of healthcare errors are due to poor team communication and understanding. High-risk environments such as the trauma setting (which covers a broad spectrum of departments in acute services) are where the majority of these errors occur. Despite the emphasis on interprofessional collaborative practice and patient safety, interprofessional teamworking in the trauma setting has received little attention. This paper presents the findings of a scoping review designed to identify the extent and nature of this literature in this setting. The MEDLINE (via OVID, using keywords and MeSH in OVID), and PubMed (via NCBI using MeSH), and CINAHL databases were searched from January 2000 to April 2013 for results of interprofessional teamworking in the trauma setting. A hand search was conducted by reviewing the reference lists of relevant articles. In total, 24 published articles were identified for inclusion in the review. Studies could be categorized into three main areas, and within each area were a number of themes: 1) descriptions of the organization of trauma teams (themes included interaction between team members, and leadership); 2) descriptions of team composition and structure (themes included maintaining team stability and core team members); and 3) evaluation of team work interventions (themes included activities in practice and activities in the classroom setting).

Descriptive studies highlighted the fluid nature of team processes, the shared mental models, and the need for teamwork and communication. Evaluative studies placed a greater emphasis on specialized roles and individual tasks and activities. This reflects a multiprofessional as opposed to an interprofessional model of teamwork. Some of the characteristics of high-performing interprofessional teams described in this review are also evident in effective teams in the community rehabilitation and intermediate care setting. These characteristics may well be pertinent to other settings, and so provide a useful foundation for future investigations.

Categorías: Investigaciones

ADad 11: Needs and Service Provisions for Anxiety Disorders Among Adolescents in a Rural Community Population in India

Vie, 01/11/2013 - 01:00
Abstract Objective

Despite the need to have adolescent-centric policies and mental health services, India is yet far from having one. The authors aimed at generating opinions on the need to have adolescent focused policies and clinical services using the data on Anxiety Disorders they collected from the community.

Methods

This qualitative study used Focus Group Discussions (FGD) to generate opinions on the various needs to enhance better mental health services and policies for adolescents in India. A Modified Delphi technique was used with experts in mental health to prioritize these needs. Experts gave their plans on how to approach the needs during the in-depth interviews.

Results

The mental health professionals viewed scaled-up mental health services to include adolescent mental health services; improve the consumer opinion about public sector health providers; strengthening the government hospitals; capacity building among the health sector and non-health sector; research in service delivery models and policy changes as the needs. The parents felt the need to address the stigma associated with their children’s mental illness, minimize the barriers in approaching mental health services and involve non-medical agencies in mental health care. These needs were prioritized and solutions to these problems were discussed.

Conclusions

India-centric and adolescent specific mental health policies and services need to be developed as well as integrated into the existing health system in India.

Categorías: Investigaciones

Preservice laboratory education strengthening enhances sustainable laboratory workforce in Ethiopia

Lun, 28/10/2013 - 01:00
Abstract Background

There is a severe healthcare workforce shortage in sub Saharan Africa, which threatens achieving the Millennium Development Goals and attaining an AIDS-free generation. The strength of a healthcare system depends on the skills, competencies, values and availability of its workforce. A well-trained and competent laboratory technologist ensures accurate and reliable results for use in prevention, diagnosis, care and treatment of diseases.

Methods

An assessment of existing preservice education of five medical laboratory schools, followed by remedial intervention and monitoring was conducted. The remedial interventions included 1) standardizing curriculum and implementation; 2) training faculty staff on pedagogical methods and quality management systems; 3) providing teaching materials; and 4) procuring equipment for teaching laboratories to provide practical skills to complement didactic education.

Results

A total of 2,230 undergraduate students from the five universities benefitted from the standardized curriculum. University of Gondar accounted for 252 of 2,230 (11.3%) of the students, Addis Ababa University for 663 (29.7%), Jimma University for 649 (29.1%), Haramaya University for 429 (19.2%) and Hawassa University for 237 (10.6%) of the students. Together the universities graduated 388 and 312 laboratory technologists in 2010/2011 and 2011/2012 academic year, respectively. Practical hands-on training and experience with well-equipped laboratories enhanced and ensured skilled, confident and competent laboratory technologists upon graduation.

Conclusions

Strengthening preservice laboratory education is feasible in resource-limited settings, and emphasizing its merits (ample local capacity, country ownership and sustainability) provides a valuable source of competent laboratory technologists to relieve an overstretched healthcare system.

Categorías: Investigaciones

Measuring governance at health facility level: developing and validation of simple governance tool in Zambia

Vie, 09/08/2013 - 01:00
Abstract Background

Governance has been cited as a key determinant of economic growth, social advancement and overall development. Achievement of millennium development goals is partly dependant on governance practices. In 2007, Health Systems 20/20 conducted an Internet-based survey on the practice of good governance. The survey posed a set of good practices related to health governance and asked respondents to indicate whether their experience confirmed or disconfirmed those practices. We applied the 17 governance statements in rural health facilities of Zambia. The aim was to establish whether the statements were reliable and valid for assessing governance practices at primary care level.

Methods

Both quantitative and qualitative methods were used. We first applied the governance statements developed by the health system 20/20 and then conducted focus group discussion and In-depth interviews to explore some elements of governance including accountability and community participation. The target respondents were the health facility management team and community members. The sample size include 42 health facilities. Data was analyzed using SPSS version 17 and Nvivo version 9.

Results

The 95% one-sided confidence interval for Cronbach’s alpha was between 0.69 and 0.74 for the 16 items.

The mean score for most of the items was above 3. Factor analysis yielded five principle components: Transparency, community participation, Intelligence & vision, Accountability and Regulation & oversight. Most of the items (6) clustered around the transparency latent factor. Chongwe district performed poorly in overall mean governance score and across the five domains of governance. The overall scores in Chongwe ranged between 51 and 94% with the mean of 80%. Kafue and Luangwa districts had similar overall mean governance scores (88%). Community participation was generally low. Generally, it was noted that community members lacked capacity to hold health workers accountable for drugs and medical supplies.

Conclusions

The study successfully validated and applied the new tool for evaluating health system governance at health facility level. The results have shown that it is feasible to measure governance practices at health facility level and that the adapted tool is fairly reliable with the 95% one-sided confidence interval for Cronbach’s alpha laying between 0.69 and 0.74 for the 16 items. Caution should be taken when interpreting overall scores as they tended to mask domain specific variations.

Categorías: Investigaciones

Safety Culture: A Catalyst for Sustainable Development

Mar, 06/08/2013 - 01:00
Abstract

The present paper investigates the potential benefits of a strong safety culture (SC). Specifically, we build on the organizational support theory to explore the direct and indirect effects of SC on firm performance. Partial least squares method is used to analyze the data collected from a survey among 251 Canadian plants. The results show that SC is associated with several performance indicators all linked to sustainable development (i.e., environmental, financial, and safety performance). Importantly, our findings also suggest that the relationships between SC and environmental/safety performance are mediated by the actual level of implemented environmental/safety practices within plants. We conclude the paper by highlighting the study’s limitations and contributions as well as theoretical and managerial implications.

Categorías: Investigaciones

The interface between the national tuberculosis control programme and district hospitals in Cameroon: missed opportunities for strengthening the local health system –a multiple case study

Vie, 22/03/2013 - 01:00
Abstract Background

Tuberculosis remains a major public health problem in sub-Saharan Africa. District hospitals (DHs) play a central role in district-based health systems, and their relation with vertical programmes is very important. Studies on the impact of vertical programmes on DHs are rare. This study aims to fill this gap. Its purpose is to analyse the interaction between the National Tuberculosis Control Programme (NTCP) and DHs in Cameroon, especially its effects on the human resources, routine health information system (HIS) and technical capacity at the hospital level.

Methods

We used a multiple case study methodology. From the Adamaoua Region, we selected two DHs, one public and one faith-based. We collected qualitative and quantitative data through document reviews, semi-structured interviews with district and regional staff, and observations in the two DHs.

Results

The NTCP trained and supervised staff, designed and provided tuberculosis data collection and reporting tools, and provided anti-tuberculosis drugs, reagents and microscopes to DHs. However, these interventions were limited to the hospital units designated as Tuberculosis Diagnostic and Treatment Centres and to staff dedicated to tuberculosis control activities. The NTCP installed a parallel HIS that bypassed the District Health Services. The DH that performs well in terms of general hospital care and that is well managed was successful in tuberculosis control. Based on the available resources, the two hospitals adapt the organisation of tuberculosis control to their settings. The management teams in charge of the District Health Services are not involved in tuberculosis control. In our study, we identified several opportunities to strengthen the local health system that have been missed by the NTCP and the health system managers.

Conclusion

Well-managed DHs perform better in terms of tuberculosis control than DHs that are not well managed. The analysis of the effects of the NTCP on the human resources, HIS and technical capacity of DHs indicates that the NTCP supports, rather than strengthens, the local health system. Moreover, there is potential for this support to be enhanced. Positive synergies between the NTCP and district health systems can be achieved if opportunities to strengthen the district health system are seized. The question remains, however, of why managers do not take advantage of the opportunities to strengthen the health system.

Categorías: Investigaciones

The Alabama Coalition for a Healthier Black Belt: A Proof of Concept Project

Vie, 01/02/2013 - 00:00
Abstract

The Alabama Coalition for a Healthier Black was a demonstration of concept project. This paper is a descriptive and qualitative overview of this 2.5 year project. Limited key project results are reported here. Located in the rural Black Belt region of Alabama this coalition had several key aims: to develop a collaboration between primary care and mental health care through co-location of services; use of video-conferencing capability to provide mental health services more efficiently; enhanced training in rural healthcare; and development of stigma reduction campaigns along with other coalition partner specific initiatives. Co-location and telepsychiatry implementation produced the major challenges and resulting adaptations to original aims. Despite many challenges these new service patterns were put into place and appear to be sustainable.

Categorías: Investigaciones

Livelihoods and Disasters

Mar, 01/01/2013 - 00:00
Categorías: Investigaciones

The Implementation of the Guidelines for Environmental Labels and Declarations in Agri-Food SMEs

Mar, 01/01/2013 - 00:00
Abstract

In order to test the implementation of the guidelines for environmental labels and declarations in agri-food SMEs, a firm which operates in the pasta chain was chosen as it was considered representative of the Sicilian economic system. After a brief description of the sector and the pilot firm, the path followed by the firm towards the choice of a voluntary environmental labelling system which suited its peculiarities will be reported. Following the iterative procedural steps and making use of decision support instruments, the organisation has given to its distributors and consumers the necessary information for a conscious choice of eco-compatible products and the relevant information connected with the phases of the productive process, the product itself and the performance in terms of environmental impact. The experience resulting from the application of the guidelines proposed to the pilot firm has shown how it is possible to choose the voluntary communication system, closer to the business reality, by starting from the analysis of the company activities and of the expectations of the management, the stakeholders and their environmental awareness.

Categorías: Investigaciones

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