Health Committee Members Research Articles

Post-Pandemic Analysis on the Factors Affecting Academic Performance of Tourism and Hospitality Management Students During COVID-19 Pandemic: Basis of an Enhanced Learning Continuity Plan

World Health Organization (WHO) Director-General and Committee members declared in 2023 that COVID-19 will no longer constitute a public health emergency (PHEIC). During the pandemic surge in global business, the educational system worldwide, including hospitality education, has been greatly affected by the pandemic crisis. The influence of COVID-19 causes worldwide school closures that have far-reaching implications for students’ short- and long-term growth because of the disruption of teacher and student networks, leading to poor performance. Thus, the study aims to analyze the factors that affect the academic performance of Tourism and Hospitality Management students of Far Eastern University Manila, Philippines, enrolled in the academic year 2020-2021 during the COVID-19 surge. The study used a descriptive survey design using a self-administered survey instrument with 342 respondents. The findings of the study showed that different factors in technology and learning management system (LMS), student’s environment, study area, delivery of academic subjects offered by the teachers, and the assessment used by the school during the distance learning have impacted the academic performance of students as evidence in the decline of Quality Point Average (QPA) on both programs from the Institute of Tourism and Hospitality Management despite that distance learning is designed to be convenient and easy. The factors influencing academic performance, such as technology and study environment, primarily play a significant and considerable role in how students learn and cope with the distant learning mode. The result of the study will serve as a guide in enhancing the University’s continuity plan for flexible learning options, given the factors that need reinforcement to the scholarly performance of the students. The study can be a benchmarking tool among Higher Education Institutions (HEIs) in the Philippines as a basis to further strengthen their learning strategies relative to flexible teaching and learning modalities, refining the scholarly learning assessment tools as well as sustaining the schools’ continuity framework and achieving the academic goals and aspiration for the success of students and graduates of the HEIs whether in the new normal or the future global crisis.

Health Resource Gaps in Primary Health Care Facilities: Community Members’ Perspectives in the Era of Universal Health Coverage in Lawra Municipality, Ghana

Background. Health resources are key determinants of healthcare coverage. Community members who utilise healthcare have significant insights into the availability of health resources in providing healthcare. Aim. This study sought to explore community (health committee) members’ perspectives on health resource gaps in lower-level health facilities in the municipality. Methods. The qualitative descriptive study explored the perspectives of community members who served on the health committee. Thirty-four community health committee members at community-based health planning and services (CHPS) compounds, maternity-unit CHPS, and health centres were studied. Results. The study found three high-level categories of resource gaps deemed relevant to community members—infrastructural gaps, equipment gaps, and safety-quality gaps. Conclusion and Recommendation. There are perceived gaps in health resources from the community members’ perspective. It is recommended that the Lawra Municipal Health Directorate and other health directorates with similar health resource challenges take steps to fill health resource gaps to ensure universal health coverage.

Health Managers’ Utilization of Evidence to Inform Annual Health Sector Planning and Budgeting Process in Bungoma County, Kenya

Evidence-based planning and budgeting within the health sector are essential in strengthening the health system building blocks. Decentralization has presented opportunities for collecting local and reliable data to facilitate evidence-based planning and budgeting. Despite the increasing availability of routine health information at all levels of the health system, its effective utilization among health managers in lower and middle-income countries remains inadequate. This study, therefore, aimed to assess the health managers’ utilization of evidence to inform the annual planning and budgeting process. The study utilized a descriptive cross-sectional design, incorporating quantitative and qualitative research methods. Quantitative data were collected from 170 health managers, while qualitative data were gathered from three county department of health executives and 83 community health committee members across eight functional community health units. Statistical Package for the Social Sciences (SPSS v. 29.0) was employed for analyzing the quantitative data, while thematic analysis was used for the qualitative data. Only 42.4% of health managers received training in planning, budgeting, and annual performance reviews (APRs). Among the 45.9% who conduct APRs, only 47.4% use the findings to inform the process. A significant association was found between training and conducting of APRs, χ2 (1, N = 170) = 21.73, p < .001, and between training and the utilization of APR findings in decision-making, χ2 (1, N = 78) = 14.72, p < .001. Although 75% of health managers acknowledged the availability of health information, 71% disagreed that they have skills in data use for planning and budgeting and 54% disagreed regarding the reliability of the available data. The health managers who were trained in health sector planning, budgeting, and APRs were more likely to use findings to inform the process. To improve evidence-based planning and budgeting, the county health department should allocate additional funding towards conducting APRs as a critical first step in guiding the identification of priorities. Additionally, there is a need to implement capacity-building initiatives targeting health managers across all tiers of the county health system, focusing on data management and its effective utilization in planning and budgeting.

Temporal and Spatial Cluster Analysis of 2019 Novel Coronavirus Pneumonia in Chongqing, 2020.1∼2020.2.

In order to explore the spatial and temporal distribution characteristics of COVID-19 in Chongqing from January 22 to February 25, 2010, and provide a series of suggestions for scientific prevention and control of epidemic situation, we will mainly analyze the epidemic situation data of Chongqing Municipal Health Committee members and improve the descriptive analysis. Regional distribution and spatiotemporal scans were analyzed for COVID-19 outbreaks using ArcGIS10.2 and SaTScan9. 5 software. After the analysis, a total of 576 novel coronavirus pneumonia patients were confirmed in Chongqing. The incidence trend increased rapidly from January 22 to January 31, then decreased gradually, and there were no new cases until February 25. The purely spatial scanning results were consistent with spatiotemporal scanning, and a first-level accumulation area was detected by spatiotemporal scanning in the east and northeast of Chongqing from January 22 to February 10. From January 22 to February 25, 2020,COVID-19 occurred in the eastern and northeast regions of Chongqing. It is recommended to strengthen the detection of cluster areas to prevent another outbreak of COVID-19 risk.

Conceptualization, detection, and management of psychological distress and mental health conditions among people with tuberculosis in Zambia: a qualitative study with stakeholders’ and TB health workers

BackgroundIn recent years, there has been increased recognition of the need to integrate mental health services into routine tuberculosis (TB) care. For successful integration, policymakers need to first understand the practices of TB health workers in the management of mental health conditions, including depression, anxiety, and psychological distress, and use this to decide how best mental health services could be delivered in tandem with TB services. In this qualitative study we aimed to understand how TB health workers and other stakeholders viewed mental health conditions linked to TB and how they screened and treated these in their patients.MethodsThe study draws on qualitative data collected in 2018 as part of the Tuberculosis Reduction through Expanded Antiretroviral Treatment and Screening for active TB trial (TREATS), conducted in eight urban communities in Zambia. Data were collected through 17 focus group discussions with local health committee members (n = 96) and TB stakeholders (n = 57) present in the communities. Further in-depth interviews were held with key TB health workers (n = 9). Thematic analysis was conducted.ResultsTB stakeholders and health workers had an inadequate understanding of mental health and commonly described mental health conditions among TB patients by using stigmatizing terminology and overtones, for example “madness”, which often implied a characterological flaw rather an actual illness. Psychological distress was also described as “overthinking”, which participants attributed to psychosocial stressors, and was not perceived as a condition that would benefit from mental health intervention. There were no standard screening and treatment options for mental health conditions in TB patients and most TB health workers had no mental health training. TB Stakeholders and health workers understood the negative implications of mental health conditions on TB treatment adherence and overall wellbeing for TB patients.ConclusionsTB stakeholders and health workers in Zambia have a complex conceptualisation of mental health and illness, that does not support the mental health needs of TB patients. The integration of mental health training in TB services could be beneficial and shift negative attitudes about mental health. Further, TB patients should be screened for mental health conditions and offered treatment.Trial registration number NCT03739736-Registered on the 14th of November 2018- Retrospectively registered-https://clinicaltrials.gov/ct2/results?cond=&term=NCT03739736&cntry=&state=&city=&dist

Resilient Safety Culture and Safety Performance: Examining the Effect in Malaysian Paramedic Training Institute through Importance-Performance Map Analysis (IPMA)

An increasing number of studies have shown that safety culture factors have a substantial influence on safety performance in a variety of industrial sectors. These factors’ impact on safety performance are unclear, especially at public service and statutory authorities. On the other hand, the understanding of indicators for safety performance in every working sector in Malaysia is continuing to progress. Hence, this study’s contribution is to explore the influence of safety culture factors (i.e., management commitment and supervision in safety, safety system) and safety competence on safety performance in government paramedic training institutes. Importance-performance map analysis (IPMA) is a technique used in Smart PLS to determine the significance and performance of each of these factors. The study was conducted via an online survey and involved 258 safety and health committee members in the Ministry of Health paramedic training institute. As a matter of relevance, the IPMA’s empirical data study revealed that management commitment and supervision in safety were the predominant factors in determining safety performance. Meanwhile, for performance, the findings showed that worker involvement, safety system, and safety competence perform well in determining safety performance.

Use of a Mobile App for the Process Evaluation of an Intervention in Health Care: Development and Usability Study.

BackgroundProcess evaluation measures the context in which an outcome was or was not achieved through the ongoing monitoring of operations. Mobile apps are a potentially less burdensome tool for collecting these metrics in real time from participants. Research-driven apps are not always developed while paying attention to their usability for target users. Usability testing uncovers gaps in researchers’, developers’, and users’ mental models of what an efficient, effective, and satisfying product looks like and facilitates design improvement. Models may vary by user demographics.ObjectiveThis study describes the development of a mobile app for collecting process evaluation metrics in an intervention study with health care workers that uses feedback at multiple stages to refine the app design, quantify usage based on workers' overall adoption of the app and the app's specific function, and compare the demographic and job characteristics of end users.MethodsAn app was developed to evaluate the Center for Promotion of Health in the New England Workplace Healthy Workplace Participatory Program, which trains teams to develop solutions for workforce health obstacles. Labor-management health and safety committee members, program champions, and managers were invited to use the app. An accompanying website was available for team facilitators. The app’s 4 functions were meeting creation, postmeeting surveys, project time logs, and chat messages. Google Analytics recorded screen time. Two stages of pilot tests assessed functionality and usability across different device software, hardware, and platforms. In stage 1, student testers assessed the first functional prototype by performing task scenarios expected from end users. Feedback was used to fix issues and inform further development. In stage 2, the app was offered to all study participants; volunteers completed task scenarios and provided feedback at deployment. End user data for 18 months after deployment were summarized and compared by user characteristics.ResultsIn stage 1, functionality problems were documented and fixed. The System Usability Scale scores from 7 student testers corresponded to good usability (mobile app=72.9; website=72.5), whereas 15 end users rated usability as ok (mobile app=64.7; website=62.5). Predominant usability themes from student testers were flexibility and efficiency and visibility of system status; end users prioritized flexibility and efficiency and recognition rather than recall. Both student testers and end users suggested useful features that would have resulted in the large-scale restructuring of the back end; these were considered for their benefits versus cost. In stage 2, the median total use time over 18 months was 10.9 minutes (IQR 23.8) and 14.5 visits (IQR 12.5). There were no observable patterns in use by demographic characteristics.ConclusionsOccupational health researchers developing a mobile app should budget for early and iterative testing to find and fix problems or usability issues, which can increase eventual product use and prevent potential gaps in data.

Exploring community support on safe motherhood: A case of Lilongwe District, Malawi

BackgroundMalawi is grappling with a high maternal mortality of 439 per 100 000 live births. It is estimated that 80% of maternal deaths can be prevented by actively engaging the community in the country. However, community support on safe motherhood remains unknown.AimThis study, therefore, explored community support rendered to mothers and babies during antenatal, intrapartum and postpartum periods.SettingThis study was conducted in the Lilongwe District, Malawi.MethodsThis was a qualitative study that collected data from 30 village health committee members through Focus Group Discussions (FGDs). Data were analysed using thematic analysis.ResultsThis study found that community support on safe motherhood rendered to women varied. The following five themes emerged from FGDs data on community support on safe motherhood: antenatal support, intrapartum support, postpartum support, bylaws reinforced by chiefs in the community and safe motherhood support groups. Community members encourage pregnant women to attend antenatal care, escorted pregnant women to the hospital for delivery and assisted women to care for a child and go for postpartum checkups. Community bylaws were considered as a necessary tool for encouraging women to attend antenatal care, deliver at the health facility and attend postpartum checkups.ConclusionThis study suggests that community members play a crucial role in providing support to women and newborns during antenatal, intrapartum and postpartum periods.

Letter to the Editor: Landsbergis et al (2019) Titled "Work Exposures and Musculoskeletal Disorders Among Railroad Maintenance-of-Way Workers".

Letter to the Editor: Landsbergis et al (2019) Titled "Work Exposures and Musculoskeletal Disorders Among Railroad Maintenance-of-Way Workers".

The role of community participation in primary health care: practices of South African health committees.

Community participation is an essential component in a primary health care (PHC) and a human rights approach to health. In South Africa, community participation in PHC is organised through health committees linked to all clinics. This paper analyses health committees' roles, their degree of influence in decision-making and factors impacting their participation. Data were collected through a mixed-methods study consisting of a cross-sectional survey, focus groups, interviews and observations. The findings from the survey were analysed using simple descriptive statistics. The qualitative data were analysed using thematic content analysis. Data on health committees' roles were analysed according to a conceptual framework adapted from the Arnstein ladder of participation to measure the degree of participation. The study found that 55 per cent of clinics in Cape Town were linked to a health committee. The existing health committees faced sustainability and functionality challenges and primarily practised a form of limited participation. Their decision-making influence was curtailed, and they mainly functioned as a voluntary workforce assisting clinics with health promotion talks and day-to-day operational tasks. Several factors impacted health committee participation, including lack of clarity on health committees' roles, health committee members' skills, attitudes of facility managers and ward councillors, limited resources and support and lack of recognition. To create meaningful participation, health committee roles should be defined in accordance with a PHC and human rights framework. Their primary role should be to function as health governance structures at facility level, but they should also have access to influence policy development. Consideration should be given to their potential involvement in addressing social determinants of health. Effective participation requires an enabling environment, including support, financial resources and training.

Community and health provider perspectives on the quality of family planning and contraceptive services in Kabwe District, Zambia

Quality family planning and contraceptive (FP/C) services result in positive outcomes such as client satisfaction and sustained use of contraceptives. While most assessments of quality in FP/C services are based on measurable reproductive health outcomes, there is limited consideration of the perspectives and experiences of health providers and community members. This study aimed to address this knowledge gap, by exploring health providers’ and community perspectives on the elements of quality FP/C services in Kabwe district, Zambia. Fourteen focus group discussions and 10 in-depth interviews were conducted in October–December 2016, involving community members, key community stakeholders such as religious and political leaders, health committee members and frontline and managerial healthcare providers. Data were analysed using a thematic approach. According to study participants, quality FP/C services would include provision by skilled personnel with positive attitudes towards clients, availability of preferred methods and affordable products. Additional factors included appropriate infrastructure, especially counselling services spaces and adequate consultation time. Participants stressed the need for reduced waiting time and opportunity for self-expression. The efficiency and effectiveness of service delivery factors, such as information dissemination and community engagement, were also considered important elements of quality FP/C. This study underscores the value of considering both community and health provider perspectives in efforts to improve the quality of FP/C services, with the overall aim of increasing client satisfaction and sustained utilisation. However, service delivery processes must also be addressed in addition to providing for community participation, if quality is to be achieved in FP/C services.

A qualitative exploration of barriers to health-facility-based delivery in Bomachoge-Borabu and Kaloleni, Kenya.

To explore barriers to utilization of health-facility-based delivery in Kenya, use of which is associated with reduced maternal mortality. In April 2017, a qualitative study utilizing key informant interviews (KIIs) and focus group discussions (FGDs) was carried out in Bomachoge-Borabu and Kaloleni, Kenya. Twenty-four KIIs were performed including health service providers, community health workers, religious leaders, local government representatives, Ministry of Health representatives, and representatives of women's organizations. Sixteen FGDs were held separately with adolescent females, adult females, adult males, and Community Health Committee members. Data were transcribed, coded, and categorized thematically to illustrate supply-side and demand-side barriers to use of health-facility-based delivery services. Supply-side barriers included staff shortages, inadequate supplies and space, poor interpersonal relations, few trained staff, long distance to services, poor transport infrastructure, and limited service hours. Demand-side barriers included financial constraints, limited spousal support, observance of birthing traditions, limited knowledge on importance of health-facility-based delivery, and fear of health-facility procedures. Diverse barriers continue to influence use of health-facility-based delivery services in Kenya. Practical, integrated interventions are urgently needed to reduce barriers noted, to further reduce the maternal mortality rate.

Deliver on Your Own: Disrespectful Maternity Care in rural Kenya.

BackgroundUnder the Free Maternity Policy (FMP), Kenya has witnessed an increase in health facility deliveries rather than home deliveries with Traditional Birth Attendants (TBA) resulting in improved maternal and neonatal outcomes. Despite these gains, maternal and infant mortality and morbidity rates in Kenya remain unacceptably high indicating that more needs to be done.AimUsing data from the Access to Quality Care through Extending and Strengthening Health Systems (AQCESS) project’s qualitative gender assessment, this paper examines women’s experience of disrespectful care during pregnancy, labour, and delivery. The goal is to promote an improved understanding of the actual care conditions to inform the development of interventions that can lift the standard of care, increase maternity facility use, and improve health outcomes for both women and newborns.MethodologyWe conducted sixteen focus group discussions (FGDs), two each for adolescent females, adult females, adult males, and community health committee members. As well, twenty-four key Informants interviews (KII) were also conducted including religious leaders, and persons from local government representatives, Ministry of Health (MOH), and local women’s organizations. Data were captured through audio recordings and reflective field notes.Research siteKisii and Kilifi Counties in Kenya.FindingsFindings show nursing and medical care during labour and delivery were at times disrespectful, humiliating, uncompassionate, neglectful, or abusive. In both counties, male health workers were preferred by women giving birth, as they were perceived as more friendly and sensitive. Adolescent females were more likely to report abuse during maternity care while women with disabled children reported being stigmatized. Structural barriers related to transportation and available resources at facilities associated with disrespectful care were identified.ConclusionsA focus on quality and compassionate care as well as more facility resources will lead to increased, successful, and sustainable use of facility care. Interpreting these results within a systems perspective, Kenya needs to implement, enforce, and monitor quality of care guidelines for pregnancy and delivery including respectful maternity care of pregnant women. To ensure these procedures are enforced, measurable benchmarks for maternity care need to be established, and hospitals need to be regularly monitored to ensure these benchmarks are achieved.

Analysis of the free caesarean section initiative at the Nabil Choucair Health Center

Abstract Introduction The initiative for free caesareans was officially launched in December 2004. Our study, with The overall objective of contributing to an evaluation of the impact of this initiative on the operation of the Nabil Choucair Health Center (NCHC) will strengthen its implementation. Methods This is an analytical, cross-sectional, quantitative and qualitative study conducted from September 1 to October 31, 2017 at NCHC. It focused on four target populations: providers, beneficiaries, members of health and co-management committees, and those responsible for maternity and the laboratory. Data entry and analysis were performed with the Excel software and EPI Info version 3.3.2. Results The survey involved a total of 135 beneficiaries, 55 providers, 11 co-management committee members, 2 health committee members, the manager, the laboratory manager, and the chief medical officer of the community. maternity. The average age of the beneficiaries was 29.31 years. The media represented the main source of information with 52%. Despite the free cost of drug expenditure was 40039 FCFA. The average waiting time was 5 hours. The most frequently mentioned problems were: delay in repayment, influx, debt of the structure, abuse of benefits, breakage of reagents and / or drugs. At NCHC 33% of deliveries are by caesarean section. The rate of caesarean section in population has increased from 4% to 8% with free delivery. Conclusions It seems appropriate to make recommendations for the referral of providers on free caesarean section, for the management of cesarean section, for reorganization of services and for the improvement of the quality of reception. Key messages Caesarean. Universal health coverage.

Adapting the 2015 Mother-Baby Friendly Birth Facility Guidelines for Semi-nomadic Pastoralist Communities in Laikipia and Samburu Counties of Kenya.

Purpose To adapt the 2015 International Federation of Gynecologists and Obstetricians (FIGO), International Confederation of Midwives (ICM), White Ribbon Alliance (WRA), International Pediatric Association (IPA), and WHO auspiced Guidelines on Mother-Baby Friendly Facilities to a particular sub-population; seminomadic pastoralist communities of Laikipia and Samburu Counties, Kenya. We anticipate an increased utilization of childbirth services by improving their acceptability. Description We drafted a Pastoralist Friendly Birthing Facility Checklist based on the FIGO/ICM/WRA/IPA/WHO guidelines and previous research in this context. We employed mixed methods to finalise the adaptation: a workshop with 27 local stakeholders; interviews with ten health planners and skilled birth attendants (SBAs); and ten focus group discussions (FGDs) with health committee members, community health workers, mothers and traditional birth attendants (TBAs). A facility audit of dispensaries across five group ranches was also undertaken. Assessment The final Checklist was divided into: characteristics of care and the environment; care during labour and birth; post-partum care; and community staff relationships. It was endorsed by the Ministries of Health in the relevant counties, and by women, SBAs and TBAs. No facility currently satisfies all the criteria specified in the Checklist. Conclusion The FIGO/ICM/WRA/IPA/WHO Guidelines were successfully adapted and can be used to ensure health facilities meet the needs of pastoralist women.

Types of Methods of Occupational Physician's Actions in the Health Committee

In this study, we aimed to categorize the actions of occupational physicians in health committees leading to solutions of occupational health problems. We conducted two focus group discussions among experienced occupational physicians. The discussions addressed the following question: what had they and others said and done that had led to the development of solutions to occupational health problems. We used a qualitative content analysis approach developed by Berelson, and created a draft of the categories of actions. Subsequently, an online questionnaire survey was then used to evaluate the external validity of the draft. The questionnaire asked physicians whether they had experience of each item in the draft. They were also asked whether they had experienced any other items not included in the draft. If so, they were asked to provide a description of their experience. These descriptions were discussed by three researchers. Any suggested new items considered to fall under any of the original items in the draft were excluded, and any new items proposed by two or more participants were added as additional items. Finally, we corrected words and phrases and reviewed the items to ensure that they clearly conveyed the required meaning, and described actions leading to solutions to occupational health problems. The content analysis revealed six basic actions, and 32 items were categorized in the draft. The six basic actions were "participate", "gather information", "make a place that allows communication with key people and health committee members", "make arrangements", "speak at a health committee", and "pay attention". In total, 67 physicians responded to the questionnaire survey. At least 40% of participants answered that they had experience of the draft items. All items in the draft had also been experienced by groups of occupational physicians other than those involved in the focus groups. Three additional items proposed by two or more participants were added. "Pay attention" was deleted following the final review. We categorized the actions of occupational physicians in health committees into five basic actions, and 32 items. Being aware of types of actions used in groups may encourage occupational physicians to be more involved in workplace health committees and contribute to the promotion of occupational health activities in the workplace.

Universal Health Coverage in Marginalized Populations: A Qualitative Evaluation of a Health Reform Implementation in Rural Ecuador.

In 2008, Ecuador underwent a major health reform with the aim of universal coverage. Little is known about the implementation of the reform and its perceived effects in rural parts of the country. The aim of this study was to explore the perceived effects of the 2008 health reform implementation, on rural primary health care services and financial access of the rural poor. A qualitative study using focus group discussions was conducted in a rural region in Ecuador, involving health staff, local health committee members, village leaders, and community health workers. Qualitative content analysis focusing on the manifest content was applied. Three categories emerged from the texts: (1) the prereform situation, which was described as difficult in terms of financial access and quality of care; (2) the reform process, which was perceived as top-down and lacking in communication by the involved actors; lack of interest among the population was reported; (3) the effects of the reform, which were mainly perceived as positive. However, testimonies about understaffing, drug shortages, and access problems for those living furthest away from the health units show that the reform has not fully achieved its intended effects. New problems are a challenging health information system and people without genuine care needs overusing the health services. The results indicate that the Ecuadorean reform has improved rural primary health care services. Still, the reform faces challenges that need continued attention to secure its current achievements and advance the health system further.

Gendered norms of responsibility: reflections on accountability politics in maternal health care in Malawi

BackgroundThis paper aims to provide insights into the role of traditional authorities in two maternal health programmes in Northern Malawi. Among strategies to improve maternal health, these authorities issue by-laws: local rules to increase the uptake of antenatal and delivery care. The study uses a framework of gendered institutions to critically assess the by-law content, process and effects and to understand how responsibilities and accountabilities are constructed, negotiated and reversed.MethodsFindings are based on a qualitative study in five health centre catchment areas in Northern Malawi. Data were collected using meeting observations and document search, 36 semi-structured individual interviews and 19 focus group discussions with female maternal health service users, male community members, health workers, traditional leaders, local officials and health committee members. A gender and power sensitive thematic analysis was performed focusing on the formulation, interpretation and implementation process of the by-laws as well as its effects on women and men.ResultsIn the study district, traditional leaders introduced three by-laws that oblige pregnant women to attend antenatal care; bring their husbands along and; and to give birth in a health centre. If women fail to comply with these rules, they risk being fined or denied access to maternal health services. The findings show that responsibilities and accountabilities are negotiated and that by-laws are not uniformly applied. Whereas local officials support the by-laws, lower level health cadres’ and some community members contest them, in particular, the principles of individual responsibility and universality.ConclusionsThe study adds new evidence on the understudied phenomenon of by-laws. From a gender perspective, the by-laws are problematic as they individualise the responsibility for maternal health care and discriminate against women in the definition and application of sanctions. Through the by-laws, supported by national policies and international institutions, women bear the full responsibility for failures in maternal health care, suggesting a form of ‘reversed accountability’ of women towards global maternal health goals. This can negatively impact on women’s reproductive health rights and obstruct ambitions to achieve gender inequality and health equity. Contextualised gender and power analysis in health policymaking and programming as well as in accountability reforms could help to identify these challenges and potential unintended effects.

The health system accountability impact of prison health committees in Zambia

BackgroundFrom 2013, the Zambian Corrections Service (ZCS) worked with partners to strengthen prison health systems and services. One component of that work led to the establishment of facility-based Prison Health Committees (PrHCs) comprising of both inmates and officers. We present findings from a nested evaluation of the impact of eight PrHCs 18 months after programme initiation.MethodsIn-depth-interviews were conducted with 11 government ministry and Zambia Corrections Service officials and 6 facility managers. Sixteen focus group discussions were convened separately with PrHC members (21 females and 51 males) and non-members (23 females and 46 males) in 8 facilities. Memos were generated from participant observation in workshops and meetings preceding and after implementation. We sought evidence of PrHC impact, refined with reference to Joshi’s three domains of impact for social accountability interventions – state (represented by facility-based prison officials), society (represented here by inmates), and state-society relations (represented by inmate-prison official relations). Further analysis considered how project outcomes influenced structural dimensions of power, ability and justice relating to accountability.ResultsData pointed to a compelling series of short- and mid-term outcomes, with positive impact on access to, and provision of, health services across most facilities. Inmates (members and non-members) reported being empowered via a combination of improved health literacy and committee members’ newly-given authority to seek official redress for complaints and concerns. Inmates and officers described committees as improving inmate-officer relations by providing a forum for information exchange and shared decision making. Contributing factors included more consistent inmate-officer communications through committee meetings, which in turn enhanced trust and co-production of solutions to health problems. Nonetheless, long-term sustainability of accountability impacts may be undermined by permanently skewed power relations, high rates of inmate (and thus committee member) turnover, variable commitment from some officers in-charge, and the anticipated need for more oversight and resources to maintain members’ skills and morale.ConclusionOur study shows that PrHCs do have potential to facilitate improved social accountability in both state and societal domains and at their intersection, for an extremely vulnerable population. However, sustained and meaningful change will depend on a longer-term strategy that integrates structural reform and is delivered through meaningful cross-sectoral partnership.

Factors influencing vaccine acceptance and hesitancy in three informal settlements in Lusaka, Zambia

IntroductionHeterogeneous coverage threatens to compromise the effectiveness of immunization programs in Zambia. Demand-creation initiatives are needed to address this; however, there is incomplete understanding of why vaccine coverage is suboptimal. We investigated overarching perceptions on vaccine acceptability, hesitancy, and accessibility at three informal settlements in Lusaka, Zambia. MethodsNested within a cholera vaccination uptake study, we sought to understand overarching perceptions on vaccines’ hesitancy in three informal settlements in Lusaka, Zambia. We conducted 48 focus group discussions with a convenience sample of laypersons, lay healthcare workers, neighbourhood health committee members and vaccinators. ResultsBoth laypersons and community-based health actors reported high vaccine acceptance though several sources of hesitancy were reported. Traditional remedies, alcohol use and religious beliefs emerged as drivers of vaccine hesitancy, likely reinforced by a background of distrust towards western medicine. Also mentioned were previous adverse events, fear of injections and low perceived need for immunization. Limited understanding of how vaccines work and overlapping local terms for vaccine and other medical concepts created confusion and inaccurate views and expectations. Some reported refusing injections to avoid pain and perceived risk of infection. Discussants emphasised the importance of education and preferred mobile immunization campaigns, with weekend to reach those with poor access and delivered by a combination of professional and volunteer workers. ConclusionsVaccine hesitancy in Zambia is underpinned by many factors including personal experiences with vaccinations, alternative belief models, limited knowledge, deep misunderstanding about how vaccines work, and barriers to access. To overcome these, community-driven models that incorporate factual communication by professionals and operate outside of traditional hours, may help. Better research to understand community preferences for vaccine uptake could inform interventions to improve immunization coverage in Zambia.