Capacity Of Healthcare Workers Research Articles

Factors influencing integrated disease surveillance and response system in selected districts in the Eastern Region of Ghana.

Ghana adopted the Integrated Disease Surveillance and Response (IDSR) system, which is an integration of the various programs in the surveillance system and can contain disease outbreaks and pandemics. Implementation of the IDSR is influenced by several factors which can affect its functionality and ability to contain disease outbreaks. This study assessed the factors influencing the IDSR system in selected districts in the Eastern Region of Ghana. A cross-sectional study was conducted between February-March, 2022 in Fanteakwa North, Abuakwa South and New Juaben South districts in the Eastern Region of Ghana among health care workers who are involved in IDRS activities. Both primary and secondary data were collected and analyzed using descriptive statistics and regression analysis at 0.05 significant level with 95% confidence interval. Three hundred and forty-seven (347) health care workers participated in the study with 56.2% (195/347) indicating that rumor registers were available at the health facilities. Most of the respondents (64.8%, 225/347) had means of transport for disease surveillance activities while majority (61.9%, 215/347) had case-based forms for case investigation. About half (51.9%, 180/347) of the participants revealed that they did not receive any feedback from the next higher level in the past year. Availability of transport for IDSR activities was almost 3.4 times more likely to contribute positively to IDSR system compared to facilities without transport (AOR = 3.36; 95% CI = 1.44-7.83; p = 0.005). Respondents who have the capacity to apply case definition are 2 times more likely to contribute to an effective IDSR system compared to health workers who cannot apply case definition (AOR = 1.94; 95% CI = 1.17-3.21; p = 0.013). Respondents who did not receive feedback from the next higher level were 52% less likely to have an effective IDSR system compared to respondents who received feedback from the next higher level (AOR = 0.48; 95% CI = 0.23-1.00; p = 0.05). Effective operation of IDSR is affected by the application of case definition and means of transport at health facilities. In addition, the capacity of health care workers to provide feedback can influence the smooth operation of the IDSR in the studied area in Ghana.

Health professionals' knowledge on dengue and health facility preparedness for case detection: A cross-sectional study in Dar es Salaam, Tanzania.

Dengue presents a growing public health concern in the Dar es Salaam region of Tanzania, marked by the recurring incidence of outbreaks. Unfortunately, there is little information available on the region's preparedness in terms of health care workers' knowledge on dengue as well as the availability of reagents and equipment essential for diagnosing and monitoring of dengue infections. To elucidate this, 78 health facilities were visited in Temeke district and structured questionnaires were distributed to 324 health care workers. The aim was to evaluate health care workers' knowledge on dengue and to assess the availability of reagents and equipment essential for diagnosing and monitoring of dengue infections. Content validity of the questionnaire was achieved through extensive literature review and it exhibited high reliability (Cronbach Alpha coefficient = 0.813). Cumulative scores for responses on knowledge questions by health care workers were computed. Characteristics such as level of education, place of work and gender were tested for association with these scores using chi-square tests and logistics regression. Almost all health care workers (99.7%) were aware of dengue disease. However, less than half (46.9%) had knowledge scores of or over 40%. Clinicians had approximately four times higher knowledge scores than other cadres (AOR, 3.637; p-value≤ 0.0001), and those who worked in private facilities had twice the knowledge score than those working in government institutions (AOR, 2.071; p-value = 0.007). Only 8.6%, 35.6% and 14.7% of respondents reported the availability of dengue rapid tests, medical guidelines and refresher training respectively, showing a lack of health facilities readiness for the detection of dengue infections. Based on findings from this study, we recommend government authorities to build capacity of health care workers, to improve their understanding of dengue. We also urge the government and stakeholders to work together to ensure availability of diagnostic tests and other tools needed for diagnosis and surveillance of dengue.

India's Multi-Sectoral Response to Oxygen Surge Demand during COVID-19 Pandemic: A Scoping Review.

Oxygen support became one of the rate-limiting steps for medical care during COVID-19 pandemic in India. The primary aim of this study was to appraise the manufacturing, supply, and distribution of medical oxygen during the pandemic. The secondary objectives were to highlight the coordination of various stakeholders to mitigate the oxygen surge and to present a critical analysis of India's response to the emergent situation. Using an analytic approach, we have delineated India's response to mitigate the medical oxygen surge during the distressing second peak between March-May 2021. In the pre-COVID-19 era, of the total 6900 MT of oxygen produced in India, only 1000 MT was available for medical usage, which was increased up to 19940 MT through the strengthening of in-house oxygen manufacturing, low-cost innovations, and enhanced storage facilities. High-burden states were identified, and transport was facilitated through departments of railways, defence and civil aviation. Real-time scrutiny of the oxygen supply was provided. Essential customs duties on importing oxygen and vital equipment were exempted, along with other swift decisions. National Oxygen Stewardship Program' was initiated to build the capacity of health care workers in oxygen therapy and rational use of surplus oxygen. The pandemic overwhelmed the health system. But a coordinated multi-stakeholder approach facilitated the fight against oxygen surge. However, a comprehensive pandemic response will need more than just oxygen. This resourceful utilization offers a silver lining and facilitates the improvement of health systems and health outcomes in the long term.

Enhancing Tuberculosis Case-Finding: A Case of Quality Improvement Initiative in Tanzania.

Background: Tanzania is 1 of the 30 high TB burden countries and 1 of the 13 countries in which 75% of people with TB are unaccounted for and that is prioritized for the Global Fund Catalytic investment and Strategic Initiative support. Tanzania decided to strengthen its National TB Programme to find these people with TB who are unaccounted for by identifying evidence-driven innovations to deliver high-quality services and to improve the efficiency of TB case-finding. A quality improvement (QI) initiative was implemented by the National Tuberculosis and Leprosy Programme to enhance TB case-finding. The initiative involved identifying gaps in the quality of services, introducing new tools, improving the work capacity of health care workers through training and mentorship sessions, strengthening laboratory and referral services, and implementing mandatory TB screening of all patients attending health facilities. We aimed to assess the effectiveness of QI initiative to enhance TB case-findings at the health facility level. Method: A cross-sectional design, and intervention and control facilities randomly selected for an evaluation of the QI initiative were used. Twenty facilities from the Dodoma region across all health care system levels (dispensaries, health centres, and hospitals) were involved in this evaluation. The facilities were randomly divided into either the intervention or control groups at a 1:1 ratio (10 intervention and 10 control facilities). Data routinely collected from program registers from January 2016 to June 2017 were used. Result: The evaluation registered a 52% increase in TB case notification in Q1 of 2017 compared with in Q1 of 2016 and, similarly, a 52% increase in Q2 of 2017 compared with in Q2 of 2016, with 9 out of 10 intervention sites reporting increases in their quarterly TB case notifications. There were no positive changes in the ‘control facilities’ where routine services were provided, with half of the facilities showing a decrease in TB case notification from baseline. Conclusion: This QI initiative has the potential to support a long-term comprehensive approach to ending TB and to improve the quality of the foundations of the health care system. This initiative sets a reliable pace for health facilities to efficiently respond to and manage TB case-finding interventions put into action. Tanzania’s experience with implementing QI interventions could serve as a model for improving TB case notifications in other settings.

Perceptions of Adolescents and Health Workers Towards Adolescents' TB Diagnosis in Central Uganda: A Cross-Sectional Qualitative Study.

PurposePrompt diagnosis of TB among adolescents may reduce transmission and improve individual outcomes. However, TB diagnosis in adolescents is challenging. This study sought to understand challenges to adolescent TB diagnosis.MethodsWe conducted qualitative focus group discussions (FGDs) to explore adolescents’ and health workers’ perspectives on challenges to TB diagnosis among adolescents seeking care at four secondary health care facilities in Uganda. Eight FGDs were conducted: four with 32 adolescents consulting for medical care and four with 34 health workers involved in TB care.ResultsAdolescents were aware of TB and associated risk factors and believed behaviours like smoking and alcohol use are risk factors for TB. They reported school schedules limit them from seeking TB care and have to miss school or wait for holidays to seek TB diagnosis. They noted school nurses do not take much interest in diagnosing TB and do not refer them to hospitals for further evaluation when they present with TB symptoms. Furthermore, adolescents reported cross-cutting issues like loss of trust in public health systems, encountering unfriendly, judgmental and uncooperative health workers. Health workers mentioned the school environment exposes adolescents to TB as the dormitories they sleep in are overcrowded. They indicated that it was difficult to make a diagnosis of TB in adolescents as the adolescents do not disclose health information. They reported fellow health workers perceive adolescents as being at low risk of TB as they believe most often adolescents are HIV negative and thus have reduced risk of TB.ConclusionAdolescents present unique challenges that need to be addressed if TB diagnosis is to improve. These challenges could be handled by interventions that lead to minimal disruptions on school schedules, provision of adolescent-friendly services and intervention to build capacity of health care workers in the provision of adolescent-friendly services.

Setting up a pragmatic clinical trial in a low-resource setting: A qualitative assessment of GoLBeT, a trial of podoconiosis management in Northern Ethiopia.

BackgroundClinical trials are often perceived as being expensive, difficult and beyond the capacity of healthcare workers in low-resource settings. However, in order to improve healthcare coverage, the World Health Organization (WHO) World Health Report 2013 stated that all countries need to become generators as well as recipients of data. This study is a methodological examination of the steps and processes involved in setting up the Gojjam Lymphoedema Best Practice Trial (GoLBeT; ISRCTN67805210), a highly pragmatic clinical trial conducted in northern Ethiopia. Challenges to the trial and strategies used to deal with them were explored, together with the reasons for delays.Methodology and principal findingsQualitative research methods were used to analyse emails and reports from the period between trial inception and recruitment. This analysis was complemented by interviews with key informants from the trial operational team. The Global Health Research Process Map was used as a framework against which to compare the steps involved in setting up the trial. A mini-group discussion was conducted with the trial operational team after study completion for reflection and further recommendations.This study showed that the key areas of difficulty in setting up and planning this trial were: the study design, that is, deciding on the study endpoint, where and how best to measure it, and assuring statistical power; recruitment and appropriate training of staff; planning for data quality; and gaining regulatory approvals. Collaboration, for example with statisticians, the trial steering committee, the study monitors, and members of the local community was essential to successfully setting up the trial.Conclusions and significanceLessons learnt from this trial might guide others planning pragmatic trials in settings where research is not common, allowing them to anticipate possible challenges and address them through trial design, planning and operational delivery. We also hope that this example might encourage similar pragmatic studies to be undertaken. Such studies are rarely undertaken or locally led, but are an accessible and efficient way to drive improved outcomes in public health.

Identification, management and care of refugee patients at a metropolitan public health service: a healthcare worker perspective.

Objective To describe the perceptions of healthcare workers employed at a metropolitan public health service, with respect to how they identify, manage and care for refugee patients. Methods This study surveyed healthcare workers using a cross-sectional, mixed methods descriptive design, which partially replicates a previous Australian study. A total of 215 responses to a brief online survey were received (n=48 medical, n=100 nursing and midwifery, n=50 allied health, n=4 other). Results Nurses and allied health respondents were more likely to record working with refugees rarely or never (P=0.00). Most respondents (70.3%) identified no negative effects from working with refugees, and perceived this patient group enhanced (71.3%) their work. Insufficient identification, interpreter availability, education, healthcare worker capacity and providing culturally specific treatment were all identified as potential service barriers. Allied health respondents were more likely to report low confidence about working with refugees in general (P=0.04). Respondents with more than 10 years' experience with refugees (P=0.02), and those with good self-perceived awareness of community services (P=0.01), were more confident in their ability to manage social issues. Conclusions This study suggests that contextual factors influence the perceptions of healthcare workers who provide care to refugee patients; however, communication, health literacy and healthcare worker capacity were consistently raised as key issues when working with refugees. What is known about the topic? Refugee and asylum seeker patients may present with complex health needs to any part of the Australian health system. The majority of previous research has occurred in primary care settings. What does this paper add? This study adds an acute and subacute perspective to the evidence base, and also includes medical respondents for the first time. Compared to previous research, respondents of this study saw refugee patients more frequently in their practice, and also reported fewer negative effects from working with them. Most demographic characteristics had no significant effect on worker-reported confidence in this study; however, greater experience of working with refugees and good self-perceived awareness of community services were both identified as positive influences. What are the implications for practitioners? Practitioners should prioritise remedying barriers that are consistently identified as affecting the service provided to refugee patients (communication, health literacy and healthcare worker capacity) as part of their quality and service improvement efforts.

Setting Core Competencies of Health Workers Towards Quality Primary Care: Proceedings of a National Consultative Workshop

The National Academy of Science and Technology (NAST), in cooperation with the Philippine Primary Care Studies (PPCS), organized the Stakeholders’ Meeting on Training Objectives for Primary Care in the Philippines on February 1, 2018, at Hotel Jen, Pasay City. The stakeholder’s meeting arrived at a consensus on the objectives of primary care workshops, training the existing cadre of doctors, nurses, midwives, and BHWs in the country. Competencies built upon these training objectives will strengthen the capacity of health care workers to render patient-centered primary care services. The expected output was not intended to replace the objectives of existing professional training curricula. Instead, the consensus obtained through this meeting works to establish the framework from which future primary care training workshops can be built upon.

Hope and trust in times of Zika: the views of caregivers and healthcare workers at the forefront of the epidemic in Brazil.

This article investigates how hope and trust played out for two groups at the forefront of the Zika epidemic: caregivers of children with congenital Zika syndrome and healthcare workers. We conducted 76 in-depth interviews with members of both groups to examine hope and trust in clinical settings, as well as trust in public institutions, in the health system and in the government of Brazil. During and after the Zika epidemic, hope and trust were important to manage uncertainty and risk, given the lack of scientific evidence about the neurological consequences of Zika virus infection. The capacity of healthcare workers and caregivers to trust and to co-create hope seems to have allowed relationships to develop that cushioned social impacts, reinforced adherence to therapeutics and enabled information flow. Hope facilitated parents to trust healthcare workers and interventions. Hope and trust appeared to be central in the establishment of support networks for caregivers. At the same time, mistrust in the government and state institutions may have allowed rumours and alternative explanations about Zika to spread. It may also have strengthened activism in mother’s associations, which seemed to have both positive and negative implications for healthcare service delivery. The findings also point to distrust in international health actors and global health agenda, which can impact community engagement in future outbreak responses in Brazil and other countries in Latin America.

Bridging the Gap of Diabetes Education—The IDF School of Diabetes

Background: In 2017, 425 million people were affected worldwide by diabetes. The rapid global growth of the disease shows that there is an urgent need to upgrade the capacity of healthcare workers to educate, manage and treat people with diabetes. Thus, the International Diabetes Federation (IDF) launched the IDF School of Diabetes in Nov. 2016. Aim: The online IDF School of Diabetes aims to meet the global demand in diabetes education by offering up-to-date and evidenced-based diabetes education available globally. Methods: IDF conducted a needs assessment, based on a survey amongst the Diabetes Education Network for Health Professionals (D-NET) 10,000 members from 172 countries. In response a set of courses were produced, combining knowledge from world-leading specialists and renowned experts. The curricula are designed to deliver international standards of diabetes care, management and prevention, targeted at Diabetes Educators, PCPs and GPs and Specialists. Furthermore, short courses on Prevention, Diabetic Retinopathy and CVD are offered for free. The IDF School is accredited by the European Accreditation Council for Continuing Medical Education and thus, can grant CMEs to course participants. Results: The latest statistics, collected in January 2018, indicated that over 3500 members are using the IDF School of Diabetes. In general, Healthcare Professionals registered on the platform than Non-Healthcare Professionals. The geographical reach of the platform extends to 170 countries, with middle-income countries taking up the majority of these registrations. Discussion: The IDF School offers an opportunity for all people involved in diabetes care to access unique and convenient education that is vital in tackling the global health crisis of diabetes. To date, the platform has received widespread interest for the open access content and paid online courses. This encouraging data provides a firm basis to continue development of further content that will help in the prevention, care, and management of diabetes. Disclosure S. Pathan: None. A. Ohlrogge: None. B. Malanda: None. E. Sung: None. L. Piemonte: None.

Readiness of Sub-Saharan Africa Healthcare Systems for the New Pandemic, Diabetes: A Systematic Review.

Background Effective health systems are needed to care for the coming surge of diabetics in sub-Saharan Africa (SSA). Objective We conducted a systematic review of literature to determine the capacity of SSA health systems to manage diabetes. Methodology We used three different databases (Embase, Scopus, and PubMed) to search for studies, published from 2004 to 2017, on diabetes care in SSA. Results Fifty-five articles met the inclusion criteria, covering the different aspects related to diabetes care such as availability of drugs and diagnostic tools, the capacity of healthcare workers, and the integration of diabetes care into HIV and TB platforms. Conclusion Although chronic care health systems in SSA have developed significantly in the last decade, the capacity for managing diabetes remains in its infancy. We identified pilot projects to enhance these capacities. The scale-up of these pilot interventions and the integration of diabetes care into existing robust chronic disease platforms may be a feasible approach to begin to tackle the upcoming pandemic in diabetes. Nonetheless, much more work needs to be done to address the health system-wide deficiencies in diabetes care. More research is also needed to determine how to integrate diabetes care into the healthcare system in SSA.

Domestic violence: a cross-sectional study among pregnant women in different regions of Sri Lanka

ObjectivesThe aims of this study were to assess the regional differences in domestic violence among pregnant women in the capital district and in the tea plantation sector of Sri Lanka,...

Providing information about the consequences of female genital mutilation to healthcare providers caring for women and girls living with female genital mutilation: A systematic review

The persistence of female genital mutilation (FGM) in some countries, despite an overall decline in the prevalence of the practice, calls for improvement in the capacity of healthcare workers and institutions to provide optimal care for this population. To determine the impact of providing information on FGM and its consequences to healthcare providers on their attitudes toward FGM, and quality of care and patient satisfaction. The following major databases were searched from inception to August 2015: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, SCOPUS, Web of Science, and ClinicalTrials.gov, without language restrictions. Controlled studies were included based on use of objective measures. Two team members independently screened and collected data. Relative risks and proportions were calculated and evidence assessed using the GRADE (Grade of Recommendation, Assessment, Development and Evaluation) approach. One study was identified. Based on this study there was no evidence to suggest change in healthcare provider outcomes after the intervention. Despite a comprehensive search, only one study of low methodological quality was included. This precludes a definitive conclusion regarding the impact of providing information on FGM to healthcare providers. More research is needed. CRD42015024570.

Challenges Facing Implementation Of Referral System For Quality Health Care Services In Kiambu County, Kenya

The right to the highest attainable standard of health is a fundamental human right and, central to this right within a hierarchical health system, is the existence of a well-functioning referral system that allows for continuity of care across the different tiers of care. A referral system enables management of client health needs comprehensively with resources locally unavailable. This study sought to establish challenges facing implementation of the referral system for quality health care services in Kiambu County, Kenya. Specifically, investigated the influence of infrastructure, capacity of health care workers, health information systems and financial resources on implementation of health care referral system. A crosssectional research design was done targeting health care workers in public health care facilities Tier 2 and Tier 3 in Kiambu County and two hundred and seventy one respondents took part in the study. A statistical analysis was done using SPSS 20 and Excel 2013. Both questionnaires and interview guide were employed as data collection tools which attained quantitative and qualitative data. Inferential statistics was used to conduct regression analysis. From the findings of the study it was established there existed a relationship between independent and dependent variables as revealed by infrastructure with coefficient 4.457; capacity of health care workers with coefficient 4.105; health information systems with coefficient 4.405; and financial resources with coefficient.4.013. The p value was <0.001. The study concluded that infrastructure, health information systems, capacity of health care workers, and financial resources are challenges in implementation of health care referral system in Kiambu County and should be strengthened. The study recommended that Kiambu County Health care facilities should improve infrastructure; implement a standard referral system monitoring toolkit and curriculum to train health workers on the referral policies and guidelines; develop standard referral forms/registers and provide adequate funds for implementation monitoring and evaluation.

Preparing Health Care Workers for a Cholera Epidemic, Dominican Republic, 2010

Preparing Health Care Workers for a Cholera Epidemic, Dominican Republic, 2010

Need for global partnership in cancer care: perceptions of cancer care researchers attending the 2010 australia and Asia pacific clinical oncology research development workshop.

To understand the diversity of issues and the breadth of growing clinical care, professional education, and clinical research needs of developing countries, not typically represented in Western or European surveys of cancer care and research. A cross-sectional survey was conducted of the attendees at the 2010 Australia and Asia Pacific Clinical Oncology Research Development workshop (Queensland, Australia) about the most important health care questions facing the participant's home countries, especially concerning cancer. Early-career oncologists and advanced oncology trainees from a region of the world containing significant low- and middle-income countries reported that cancer is an emerging health priority as a result of aging of the population, the impact of diet and lifestyle, and environmental pollution. There was concern about the capacity of health care workers and treatment facilities to provide cancer care and access to the latest cancer therapies and technologies. Although improving health care delivery was seen as a critical local agenda priority, focusing on improved cancer research activities in this select population was seen as the best way that others outside the country could improve outcomes for all. The burden of cancer will increase dramatically over the next 20 years, particularly in countries with developing and middle-income economies. Cancer research globally faces significant barriers, many of which are magnified in the developing country setting. Overcoming these barriers will require partnerships sensitive and responsive to both local and global needs.

Critical health infrastructure for refugee resettlement in rural Australia: Case study of four rural towns

To explore the reported impact of regional resettlement of refugees on rural health services, and identify critical health infrastructure for refugee resettlement. Comparative case study, using interviews and situational analysis. Four rural communities in New South Wales, which had been the focus of regional resettlement of refugees since 1999. Refugees, general practitioners, practice managers and volunteer support workers in each town (n = 24). The capacity of health care workers to provide comprehensive care is threatened by low numbers of practitioners, and high levels of turnover of health care staff, which results in attrition of specialised knowledge among health care workers treating refugees. Critical health infrastructure includes general practices with interest and surge capacity, subsidised dental services, mental health support services; clinical support services for rural practitioners; care coordination in the early settlement period; and a supported volunteer network. The need for intensive medical support is greatest in the early resettlement period for 'catch-up' primary health care. The difficulties experienced by rural Australia in securing equitable access to health services are amplified for refugees. While there are economic arguments about resettlement of refugees in regional Australia, the fragility of health services in regional Australia should also be factored into considerations about which towns are best suited to regional resettlement.

Investigating attitudes towards caring for people with HIV/AIDS among hospital care workers in Ibadan, Nigeria: the role of self-efficacy

Fear of HIV infection and its consequences may affect the willingness and capacity of health care workers to provide good quality care for people with HIV/AIDS (PWHAs). The study was founded on the proposition that self-efficacy may mediate the attitudinal disposition of health care workers related to provision of care to PWHAs. Two hundred and ten physicians (n = 103) and nurses (n = 107) sampled from the University College Hospital, Ibadan, Nigeria, responded (48% response rate) to a questionnaire which addressed self-efficacy relating to HIV/AIDS, knowledge about HIV/AIDS and treatment of and attitudes towards HIV/AIDS patients. Attitude questions included items on fear of HIV infection, futility in providing care for HIV patients, distress in caring for the patient who is likely to die and willingness to care for PWHAs. The major finding was a significant association between reported high selfefficacy and less fear of acquiring HIV, less futility in providing care for PWHAs and increased willingness to provide such care. More years of education was associated with higher willingness to care, less fear associated with care as well as lower perceived futility related to the care of PWHAs. Female gender was significantly related to the perception of futility related to the care of PWHAs. There was no significant relationship between self-efficacy and knowledge about HIV/AIDS. The findings have significant implications for hospital care for PWHAs and suggest that self-efficacy, rather than knowledge about HIV/AIDS may be important in mediating attitudes towards PWHAs and also in developing intervention programmes aimed at helping health care providers to reframe their attitudes.

Working with public sector clinics to provide adolescent-friendly services in South Africa

Health care facilities can play an important role for adolescents in preventing health problems, in promoting sexual and reproductive health and in shaping positive behaviours. Extensive research has established that South African public health facilities are failing to provide adolescent-friendly health services. The National Adolescent-Friendly Clinic Initiative (NAFCI) is an accreditation programme designed to improve the quality of adolescent health services at the primary care level and strengthen the public sector's ability to respond to adolescent health needs. The key objectives of the programme are to make health services more accessible and acceptable to adolescents, establish national standards and criteria for adolescent health care in clinics throughout the country, and build the capacity of health care workers to provide quality services. One of the indicators for success of NAFCI will be increased utilisation of public sector clinics by adolescents. NAFCI is an integral component of the largest, most innovative, public health programme ever launched in South Africa, LoveLife. Achieving NAM accreditation involves clinic self-appraisals, quality improvements, external assessments and award of achievement stars. NAFCI is currently being piloted in ten government clinics in South Africa.