Service Delivery Environment Research Articles

“Do I feel safe here?” Organisational climate and mental health peer worker experience

BackgroundIn Australia, lived experience peer support workforces are expanding making it one of the fastest growing emerging disciplines in transdisciplinary mental health settings. This article provides insight for organisations on the contextual realities peer workers face, increases understanding of peer support services to improve service delivery environments and contributes to mental health systems reform. This study aimed to qualitatively explore peer support workers experience integrating into and working within transdisciplinary mental health service teams.MethodSemi-structured interviews were undertaken with 18 peer support workers currently working in mental health services in Australia. The research was a qualitative descriptive study design. All data collected were analysed utilising thematic analysis.ResultsPeer workers found their experience in the workplace was influenced by their colleagues and the organisation’s understanding of the peer role. Factors relating to organisational culture and climate were a central theme throughout discussions noting that a negative climate was perceived as harmful to peer workers. Themes established through results include (1) the role of leadership, (2) attitudes and behaviours of colleagues, (3) provision of psychologically safe environments, (4) the organisations messaging and use of language and (5) organisational structures and policy.ConclusionThis study contributes to evidence for the impact of organisational culture on integrating and supporting peer support workers in mental health service delivery. This study provides insights into peer worker experiences integrating into transdisciplinary teams, confirming findings established in previous studies, highlighting a lack of movement or change in workplace culture to support peer worker integration into mental healthcare settings.

Data-driven program adaptation and continuous improvement: A case study of the Adolescents 360 (A360) project in Ethiopia, Nigeria, and Tanzania

Interventions benefit from ongoing continuous quality improvement during implementation to refine and strengthen them in response to changing contexts and emerging opportunities. This article reflects on the experience from the Adolescents 360 (A360) project in implementing user-centered, adaptive programming across Tanzania, Ethiopia, and Nigeria from 2018 to 2020. During this implementation period, A360 progressed through three distinct phases: an ‘optimization’ of project interventions in pursuit of efficiency and preparation for scale; a re-focusing on user-centered programming to go beyond efficiency and pursue greater impact; and a rapid course correction in response to the emerging COVID-19 pandemic. A360’s approach to data-informed adaptation evolved throughout these phases. From a hyper focus on cost-efficiency during optimization to a more expansive use of mixed methods data for adaptation during its second phase and finally iteration in response to an extremely restrictive service delivery environment during the COVID-19 pandemic. In this article we reflect on how these periods of adaptation and course correction contributed to the evolution of the project’s interventions and provided significant lessons which the project has taken into its new investment phase. Balance is key – utilizing a range of mixed methods data instead of a singular focus on cost-efficiency, streamlining interventions while not compromising long-term impact, and retaining a user-focus even while considering sustainability.

Empowering and supporting frontline providers in the paediatric-adolescent HIV response: results from participatory priority-setting and group discussions in twenty-four sites in twelve high HIV-burden African countries

ABSTRACT Children and adolescents living with HIV in Africa experience poor outcomes across the HIV cascade of care. Paediatric and adolescent-friendly services are crucial to their well-being, and recent years have seen a call for urgent service improvements. While frontline health workers are responsible for these services, less attention has been given to their contextual realities, and what constitutes an enabling service delivery environment. We engaged participatory priority-setting and group discussions across twenty-four sites in twelve high HIV-burden African countries in November 2022 with 801 frontline paediatric-adolescent providers. Data were analysed using thematic analysis and priority mapping. We constructed a socio-ecological model for supportive and empowering service delivery environments for frontline paediatric-adolescent HIV services. Individual-level themes related to well-being, self-care and mental health. Interpersonal themes included supportive supervision/mentorship, teamwork and acknowledgement. At the organisational level, resources, physical infrastructure and confidential spaces were included. The community level included feeling appreciated and positive stakeholder relationships. The structural level included funding, discriminatory SRHR policies and guidelines. Results provide insight into priorities, challenges and needs of frontline providers in the paediatric-adolescent HIV response. Improving the well-being of HIV-affected children and adolescents requires greater investment and attention to creating more caring, supportive environments for their frontline providers.

E-learning use and teaching and learning performance in Tanzanian universities

The use of E-learning as a new educational technology is currently a top priority in many universities in developing-countries. The main purpose of this research is to determine how e-learning affects the teaching and learning (T&L) performance in Tanzanian universities. Employing a questionnaire tool, a quantitative approach was used to collect the data. A total of 390 out of 400 respondents including lectures and students were taken into account, with a 97.5% response rate. Data in SPSS version 21 were analyzed using partial least squares structural equation modeling (PLS-SEM) technique and confirmatory factor analysis (CFA). According to the findings of this study, only one of the nine hypotheses tested have a non-significant effect on T&L performance, as indicated by p-values >0.01. Further, there is no statistically significant effect of perceived usefulness in using e-learning in T&L performance by lowering cost/expenses. Furthermore, other variables assessed including performance expectancy, ease of use, and perceived usefulness have significance effect on T&L performance by increased quality of instructional material delivery, convenience in teaching and learning facilities. The findings of this study inform policymakers on how to reformulate information and communication technology (ICT) policy to clearly spell out the adoption of e-learning for providing facilities in universities. The policy should, in particular, have a clear vision of implementing an appealing, conducive teaching and learning service delivery environment, as well as achieving appropriate and high T&L performance. By influencing the cost/expenses in T&L, quality of instructional material, and the convenience of T&L service delivery as the indicators of performance, this paper contributes to improve understanding of the factors of e-learning (including performance expectancy, perceived usefulness, and ease of use) on teaching and learning performance of the Tanzanian universities. These factors, which have a substantial influence on T&L performance in Tanzanian universities through affecting its indicators, were not thoroughly addressed in earlier relevant studies.

How interventions to maintain services during the COVID-19 pandemic strengthened systems for delivery of maternal and child health services: a case-study of Wakiso District, Uganda

ABSTRACT Background Health systems are resilient if they absorb, adapt, and transform in response to shocks. Although absorptive and adaptive capacities have been demonstrated during the COVID-19 response, little has been documented about their transformability and strengthened service delivery systems. We aimed to describe improvements in maternal and child health service delivery as a result of investments during the COVID-19 response. Methods This was a descriptive case study conducted in Wakiso District in central Uganda. It included 21 nurses and midwives as key informants and 32 mothers in three focus group discussions. Data were collected using an interview guide following the Systems Engineering Initiative for Patient Safety theoretical framework for service delivery. Results Maternal and child health service delivery during the pandemic involved service provision without changes, service delivery with temporary changes and outcomes, and service delivery that resulted into sustained changes and outcomes. Temporary changes included patient schedule adjustments, community service delivery and negative outcomes such as increased workload and stigma against health workers. Sustained changes that strengthened service delivery included new infrastructure and supplies such as ambulances and equipment, new roles involving infection prevention and control, increased role of community health workers and outcomes such as improved workplace safety and teamwork. Conclusions In spite of the negative impact the COVID-19 pandemic had on health systems, it created the impetus to invest in system improvements. Investments such as new facility infrastructure and emergency medical services were leveraged to improve maternal and child health services delivery. The inter-departmental collaboration during the response to the COVID-19 pandemic resulted into an improved intra-hospital environment for other service delivery. However, there is a need to evaluate lessons beyond health facilities and whether these learnings are deliberately integrated into service delivery. Future responses should also address the psychological and physical impacts suffered by health workers to maintain service delivery.

"I Have to Do It in Secrecy": Provider Perspectives on HIV Service Delivery and Quality of Care for Key Populations in Zambia.

Key populations (KPs) experience suboptimal outcomes along the HIV care and prevention continua, but there is limited study of the challenges service providers encounter delivering HIV services to KPs, particularly in settings like Zambia, where provision of these services remains legally ambiguous. Seventy-seven providers completed in-depth interviews exploring constraints to HIV service delivery for KPs and recommendations for improving access and care quality. Thematic analysis identified salient challenges and opportunities to service delivery and quality of care for KPs, spanning interpersonal, institutional, and structural domains. Limited provider training in KP-specific needs was perceived to influence KP disclosure patterns in clinical settings, impeding service quality. The criminalization of KP sexual and drug use behaviors, coupled with perceived institutional and legal ambiguities to providing HIV services to KPs, cultivated unwelcoming service delivery environments for KPs. Findings elucidate opportunities for improving HIV service delivery/quality, from decentralized care to expanded legal protections for KPs and service providers.

Gearing health systems for universal health coverage.

Universal health coverage requires adequate and sustainable resourcing, which includes human capital, finance and infrastructure for its realization and sustainability. Well-functioning health systems enable health service delivery and therefore need to be either adequately or optimally geared-prepared and equipped-for service delivery to advance universal health coverage. Adequately geared health systems have sufficient capacity and capability per resourcing levels whereas optimally geared health systems achieve the best possible capacity and capability per resourcing levels. Adequately or optimally geared health systems help to mitigate health system constraints, challenges and inefficiencies. Effective, efficient, equitable, robust, resilient and responsive health systems are elements for implementing and realizing universal health coverage and are embedded and aligned to a global people-centric health strategy. These elements build, enhance and sustain health systems to advance universal health coverage. Effective and efficient health systems encompass continuous improvement and high performance for providing quality healthcare. Robust and resilient health systems provide a supportive and enabling environment for health service delivery. Responsive and equitable health systems prioritize people and access to healthcare. Efforts should be made to design, construct, re-define, refine and optimize health systems that are effective, efficient, equitable, robust, resilient and responsive to deliver decent quality healthcare for all.

Academic performance of engineering students: A predictive validity study of first‐year GPA and final‐year CGPA

AbstractStudents' academic achievement is regarded as the scholastic standing of students at the end of a given study period that is expressed in terms of grades. This study focused on students' first‐year GPA as a predictor of final‐year CGPA and the relationship between demographic attributes of the students to academic achievement. An ex‐post factor research approach was adopted, and Pearson's correlation and Regression Analysis were fitted with the data using Minitab software. The results of the study highlighted that first‐year GPA had a strong positive relationship with final‐year CGPA which is an indication that first‐year GPA greatly influences final‐year CGPA meanwhile, demographic characteristics have no significant correlation with students' final‐year CGPA. Finally, the correlations drawn from this study indicated that first‐year GPA had a strong positive relationship with final‐year CGPA. Therefore, the students should be properly guided, University administrators, Faculty members, policy‐makers and other stakeholders should effectively develop a monitoring blueprint for students' academic progress as poor performance has severe consequences on students, teachers should inculcate effective learning culture among students, while government and its supervisory agencies should provide adequate teaching and learning resources, create enabling learning environment for effective service delivery that focuses on improving students' performance in Engineering.

The enabling environment for citywide water service provision: Insights from six successful cities

Equitable access to safe drinking water remains a key challenge in many urban areas of low- and middle-income countries. This study aimed to characterize the enabling environment for inclusive urban water service delivery, and specifically to elucidate the institutional arrangements, policies, regulations, service delivery approaches, financing models, and surrounding contextual factors that influence progress. We identified six cities across Africa, Asia, and South America that offered historical examples of success in inclusive piped water provision, resulting in high levels of access and service quality, including within low-income areas. Using a modified form of the social-ecological systems framework to structure our investigation, we conducted a comparative case study analysis to learn from these cities. Our analysis focused on a review of existing case-specific literature, supplemented by interviews with 1–3 key informants per case to update or fill gaps in the literature. A variety of characteristics supported safe and inclusive services, with contextually appropriate strategies depending on existing institutional arrangements, infrastructure, and the surrounding social, economic, political, and environmental context. Our study cities illustrated three types of progress–utility-driven, regulator-supported, and municipality-driven–each characterized by specific features and drivers of success. We also identified 12 characteristics making up the enabling environment across all three types. These characteristics highlighted two broad themes. First, a well-functioning water service provider was often a prerequisite for inclusive, pro-poor service provision. Elements such as clear performance indicators, customer feedback mechanisms, and strategies to sustainably finance operating costs contributed to cities’ success. Second, inclusive water services often required explicit pro-poor policies and strategies, such as the removal of land tenure requirements for piped connections and community mobilization for participatory decision-making. Although the importance of specific characteristics will vary depending on context, our analysis offers a common foundation to guide progress toward universal access to safe water.

A special section: Recruiting and retaining couples from underrepresented backgrounds in intervention research.

This special section represents a collection of papers on recruitment and retention of couples from underrepresented backgrounds in couple intervention research. Research shows that couples from underrepresented backgrounds tend to be missing from intervention research. This gap is concerning; conclusions about the effectiveness of these interventions are not being drawn from diverse and representative samples and it may be that scholars are inadvertently creating inappropriate and inaccessible services for these couples. Recruiting and retaining these couples require specialized efforts and attention. In this summary paper, we describe (a) the origins of this special section, (b) the existing research on recruitment and retention in couple intervention research, (c) an overview of the papers in this special section, and (d) future recommendations and directions for this aspect of methodology in couple research. This collection of papers elevates the need to involve community members from the beginning, reduce barriers to access, and create recruitment materials and a service delivery environment that is specific for the target population.

Experiences and learnings of pharmacists, students, and clinical assistants working collaboratively in a COVID-19 vaccination clinic: a qualitative study

BackgroundThe involvement of pharmacists and pharmacy clinical assistants (CAs) in hospital clinics has demonstrated benefits for improving medication safety and care delivery. Internationally, pharmacy staff played a crucial role in the safe storage, provision and administration of vaccines, as well as reinforcement of pharmacovigilance efforts during the COVID-19 pandemic. In Australia, healthcare providers collaborated to rapidly facilitate a phased COVID-19 vaccination program. The perspectives of the pharmacy team, including pharmacy students, involved in implementing novel health services are underexplored in the literature. ObjectiveTo describe the key learnings in how a team of pharmacists, CAs and pharmacy students contributed to the COVID-19 vaccine service, and to explore their preparedness and experiences working at a vaccination clinic within a quaternary hospital. MethodThis study involved semi-structured interviews with pharmacy students, CAs and pharmacists. All pharmacy staff who worked in the clinic were invited to participate in the study and a snowball strategy was used to maximise recruitment. The interviews were audio-recorded, transcribed, and analysed using inductive thematic techniques to identify major themes. ResultsA total of 11 participants were interviewed including: four pharmacists, four CAs and three undergraduate students. Using thematic analysis, five main themes were identified: (1) Potential for student value and experiential learning; (2) Adaptive procedures and work practices in a rapidly changing environment; (3) Clear leadership, with role clarity, role expansion and interchangeability; (4) Supportive learning environment and (5) Stakeholder drivers for service delivery and to optimise societal benefit. These five themes often interacted with each other, highlighting the complexities of implementing and operating the service. ConclusionsThe vaccine clinic service provided a novel and valuable opportunity for students, CAs, and pharmacists to work collaboratively, extending their scope of practice to contribute to better national health outcomes. Participants expressed their support for future initiatives involving pharmacy students and healthcare staff collaborating in hospital settings.

Internet of Things and organizational performance in the Tanzanian banks

PurposeThe adoption of the Internet of Things (IoT) as a new technology is gaining traction in many business organizations in developing countries. The purpose of this study is to assess the effect of IoT on the organizational performance of Tanzanian banks.Design/methodology/approachFor data collection, this study used a quantitative approach with a questionnaire. A total of 342 respondents were considered, with an 82.16% response rate. AMOS software was used to analyze data using structural equation modeling (SEM) as the primary technique.FindingsThe results revealed that the majority of the hypotheses tested in this study have a significant effect on organizational performance, as indicated by their p-value of 0.05. However, there is no statistically significant effect of performance expectancy on organizational performance by lowering IoT operation costs. Furthermore, the availability of IoT has no discernible effect on organizational performance by improving service quality.Practical implicationsThe findings of this study inform policymakers to reformulate information and communication technologies policy to clearly spell out the adoption and implementation of the IoT as a new technological innovation for providing services not only in the banking sector but also in other service delivery organizations. In particular, the policy should have a clear vision of implementing an appealing, conducive and positive, meaningful service delivery environment, as well as achieving appropriate, successful, effective and sustainable organizational performanceOriginality/valueAs a result, this paper contributes to a better understanding of the factors (including performance expectancy, effort expectancy and accessibility) of IoT on organizational performance by influencing operational costs, service delivery speed and service quality. These factors were not adequately addressed in previous related studies, and they have a significant influence on organizational performance levels in Tanzanian banks.

Need for Standardized Measure of Modern Method Availability: Assessment of Indicators Using Health Facility Data from Three Country Contexts.

The concept of contraceptive method choice is complex and difficult to measure, usually requiring multiple metrics that represent the service environment, access, and acceptability. One of the most used measures for the family planning service delivery environment is method availability, or specifically, the contraceptive options that are available to clients at any given family planning service delivery point. Despite the importance of the measure, indicator definitions vary widely and are not standardized. We identified six versions of the method availability indicator and calculated each version using Service Provision Assessment data from three countries with varying family planning profiles, health service structures, and from different geographic areas: Bangladesh, the Democratic Republic of Congo, and Haiti. We compared method availability estimates by urban/rural location, facility type, and across country context. Our results showed a wide variability in method availability estimates depending on the indicator used. Generally, indicators requiring a particular mix of method types had lower estimates of method availability than indicators only requiring a minimum number of methods. Results are discussed and recommendations are made to standardize indicator language and guidance. We further recommend the standardization of an indicator with a minimum mix of method types to ensure that a variety of method preferences can be met.

What is the relationship between contraceptive services and knowledge of abortion availability and legality? Evidence from a national sample of women and facilities in Ethiopia.

In Ethiopia, abortions are legal for minors and for rape, incest, foetal impairment or maternal disability. Knowledge of abortion legality and availability is low, and little effort has been made to disseminate this information for fear of invoking anti-abortion sentiment; instead, systems rely on health providers as information gatekeepers. This study explores how exposure to and interaction with family planning service delivery environment, specifically (1) availability of contraceptive and facility-based abortion services within 5 km of one's residence and (2) contact with a health provider in the past 12 months, relate to women's knowledge of the legality of accessing abortion services and of where to access facility-based abortion services. We used data from a nationally representative sample of 8719 women in Ethiopia and a linked health facility survey of 799 health facilities. Our outcome of interest was a categorical variable indicating if a woman had (1) knowledge of at least one legal ground for abortion, (2) knowledge of where to access abortion services, (3) knowledge of both or (4) knowledge of neither. We conducted multilevel, multinomial logistic regressions, stratified by residence. Approximately 60% of women had no knowledge of either a legal ground for abortion or a place to access services. Women who visited a health provider or who were visited by a health worker in the past 12 months were significantly more likely to know about abortion legality and availability. There were no differences based on whether women lived within 5 km of a facility that offered contraception and abortion services. We find that health workers are likely valuable sources of information; however, progress to disseminate information may be slowed if it relies on uptake of services and limited outreach. Efforts to train providers on legality and availability are critical, as is additional research on knowledge dissemination pathways.

Implementing design thinking to drive innovation in technical design

ABSTRACT Design Thinking has been gaining attention over the past decade with more and more companies seeking to use it as a human-centered problem-solving approach that can create novel solutions and foster (radical) innovation. Following several success stories from business, management or even civic service delivery environment, where Design Thinking has produced highly impactful and popularized innovation, technically oriented companies have increasingly shown interest in using it to nurture their innovation and creative capabilities. In this article, a qualitative analysis of semi-structured interviews with experts applying and researching Design Thinking are presented in the context of technology-focused organizations. Several concrete insights are derived to reveal specific success factors, central characteristics, tools and methods, but also limitations and prerequisites for its effective application in such contexts. Finally, the study highlights potential adaptations of the approach to support its integration with the processes similar organizations apply in their routine practices.

The Fourth Industrial Revolution (4IR) and its Effects on Public Service Delivery in South Africa

In recent decades, the Fourth Industrial Revolution (4IR) has added a new dimension to change and has been exponential in its development. It is important to understand its effects in various environments, particularly the opportunities and challenges it bringsto public sector functioning, where there needs to be a greater drive towards innovative service delivery. This article explores 4IR within the context of public sector service delivery, focusing on South Africa as a developmental nation. It examines technologicaladvancements of 4IR in line with some of the aims of local government, particularly in its mandate to be more responsive and effective in its service delivery. It also establishes how 4IR platforms are being adopted for effective citizen engagement, which is an essentialgoal of service delivery within the sphere of local government. It examines some of the gaps that need to be addressed around the essential practicalities required to integrate 4IR effectively and explores the readiness of the general public sector environment torespond to the demands of 4IR. Key factors regarding what is needed to create a more enabling environment for local government service delivery and its prevalent developmental constraints are also discussed.

Measuring health service providers’ attitudes towards the provision of youth-friendly sexual and reproductive health services: a psychometric study to develop and validate a scale in Jordan

ObjectivesThe aim of this study is to develop and validate a scale to measure provider attitudes towards provision of youth-friendly sexual and reproductive health (SRH) services in a conservative setting...

The lived experience of health sciences students’ participation in an interprofessional community-based stroke class

Background. Collaborative approaches in healthcare contexts may provide better care for patients. Interprofessional circuit-based group therapy could counter profession-specific tribalism. There is no evidence on interprofessional education (IPE) community-based interventions on student learning in the health professions. Objective. To explore undergraduate health sciences students’ experience of being involved in community-based interprofessional circuit-based group therapy. Methods. Semi-structured interviews were inductively analysed exploring undergraduate health sciences students’ experience of involvement in an IPE community-based stroke intervention. Results. A total of 12 final-year students participated, with representation from physiotherapy, occupational therapy and speech therapy. This IPE opportunity beneficially impacted students’ collaborative competencies in knowledge, attitudes, skills and behaviours. This community-based rotation immersed students in a service-delivery environment where patient management was co-ordinated by a multiprofessional rehabilitation team. The integrated stroke circuit group activity aimed to enhance further interconnectedness between student participants. Students who were exposed to this clinical activity reported an understanding of (i) patients’ unique contexts; (ii) role development and complementary overlap between health professions; and (iii) the value of joint interventions to both patients and rehabilitation teams in resource-constrained settings. Conclusion. These students have been primed in their practice-readiness as healthcare professionals for the 21st century who will promote quality care, and embrace collaborative professional practice and person-centredness.

A Review of Privatization of Waste Management Service in Oman

Waste management service is an important issue that needs great attention from the government. To improve the quality of waste services, many governments have turned to the privatization of municipal waste management services. This study investigates the linkage between privatization of waste management service and (a) effective service, (b) cost saving/efficiency, (c) timely service delivery, (d) quality service, (e) health and clean environment, (f) adopted new technology, (g) Bureaucracy? The target respondents of this research are household or the owner of the house in Oman or the users of waste service.

The Burden of Disease and Pathology at a Rapidly Expanding Tertiary Paediatric Surgical Unit in South Africa.

The precise burden of paediatric surgical care in South Africa is unknown. In the absence of epidemiological data, hospital-based study is a first step to gauge the burden and profile of paediatric surgical disease. We aim to describe the profile of pathology, pattern of referrals, and complications of paediatric surgical care at Chris Hani Baragwanath Academic Hospital (CHBAH). A 1-year retrospective record review for the period 3/1/2019 to 1/1/2020 was conducted by evaluation of the morbidity and mortality databases of the Department of Paediatric Surgery (DPS). Number of admissions, consultations, complications, and surgeries performed were analysed and classified. A total of 11,932 unique patient encounters occurred. Emergencies (79%, 1841/2329) accounted for the majority of admissions. Trauma accounted for 49% (896/1841) of emergency admissions. Elective surgery constituted 52% (1202/2316) and emergency surgery 48% (1114/2316) of all procedures performed. The emergency department (55%, 1271/2329), outpatients department (19%, 447/2329), and peripheral hospitals (16%, 378/2329) were the source of the majority of admissions. A complication rate of 9% (208/2316) was observed. The high-volume subspecialist environment at CHBAH presents the ideal environment for delivery of specialist paediatric surgical services and training. Injury prevention, optimal use of existing resources, and additional physical, human and financial resources are required to meet the existing and predicted future burden of paediatric surgical disease.