Health Management Team Research Articles

Effectiveness of training hospital management teams in tier three hospitals in Kiambu County and utilization of routine health information

Health information is essential for health decision-making at all levels of the health pyramid. This study investigated the effect of training HMTs in tier three hospitals in Kiambu County and utilization of routine health information. The study design was interventional, employing a quasi-experimental research design that guided the study in the 12 tier-three hospitals. There was an intervention cluster and a control cluster, each with six hospitals. The study adopted a census technique, and all 240 HMT members were included. The study used both qualitative and qualitative data collection techniques. Data was analysed using Fisher’s exact test for the bi-variate analysis, logistics regression to ascertain the statistical relationships, Mann-Whitney U-test to test the difference in means at baseline and end-line, Difference in Difference technique was used to establish the average treatment effect of the intervention. The study used thematic content analysis to analyse qualitative data. The County Health Management Teams and the Sub County Health Management Teams participated in the Key Informant interviews. The results revealed a significant association between the training and the odds of good utilization (A.O. R=9.01, p=0.0001). Those who received training are 9 times more likely to utilize RHI. The study concludes that, designing HIS should be based on the users’ desired needs and that the intervention was highly effective in promoting the use of the RHI among HMTs. The study recommends that Kiambu County Department of Health should provide strategies for sustaining effective utilization RHI and should provide guidelines to ensure all HMTs are trained to enable them manage hospitals better. The study recommends that; further research be conducted in the lower-level health facilities to generate recommendations appropriate for the different levels of health care systems, similar studies should be replicated in other countries to compare results and enable the drawing of triangulated policy recommendations and a follow-up study be done to determine whether the increase in utilization translates into improved health outcomes or efficiencies within the health system.

Effectiveness of socio-economic-demographic factors on utilization of routine health information among hospital management teams in tier-three hospitals in in Kiambu County, Kenya

This study investigated the effectiveness of socio-economic-demographic factors on utilization of routine health information among HMTs in tier-three hospitals in Kiambu County. The study design was interventional, employing a quasi-experimental research design that guided the study in the 12 tier-three hospitals. There was an intervention cluster and a control cluster, each with six hospitals. The study adopted a census technique, and all 240 HMT members were included. The study used both qualitative and qualitative data collection techniques. Data was analysed using Fisher’s exact test for the bi-variate analysis, logistics regression to ascertain the statistical relationships, Mann-Whitney U-test to test the difference in means at baseline and end-line, Difference in Difference technique was used to establish the average treatment effect of the intervention. The study used thematic content analysis to analyse qualitative data. The County Health Management Teams and the Sub County Health Management Teams participated in the Key Informant interviews. The results indicate that there was no statistically significant difference regarding the socio-economic-demographic factors before and after the intervention, (Mann-Whitney U-test results (U = 28333, p = 0.7851). The study concludes that, designing HIS should be based on the users’ desired needs and that the intervention was highly effective in promoting the use of the RHI among HMTs. The study recommends that Kiambu County Department of Health should provide strategies for sustaining effective utilization RHI and should provide guidelines to ensure all HMTs are trained to enable them manage hospitals better. The study recommends that; further research be conducted in the lower-level health facilities to generate recommendations appropriate for the different levels of health care systems, similar studies should be replicated in other countries to compare results and enable the drawing of triangulated policy recommendations and a follow-up study be done to determine whether the increase in utilization translates into improved health outcomes or efficiencies within the health system.

Challenges in Lab-to-Clinic Translation of 5th/6th Generation Intelligent Nanomaterial-enabled Biosensors

Abstract Conventional diagnostic platforms often lack point-of-care, simple, economical, prompt and personalized detection features, whereas nanomaterial-supported intelligent biosensors belonging to the 5th/6th generation are vital vectors in medical diagnostics. The tunable and enhanced physicochemical properties of nanomaterials such as surface area, surface chemistry, band gap, and flexibility, nano-biosensors exhibit high sensitivity, specificity, and prompt and accurate detection. Despite substantial research and an exponentially growing market, projected to reach $46.4 billion by 2028, biosensors face considerable challenges in clinical implementation. This article underlines the manifold translational challenges, such as regulatory barriers, safety and toxicity concerns related to nanomaterials, technical and manufacturing issues, hesitancy in adopting new tools, and economic constraints. Besides discussing the perspectives of material scientists, medical doctors, data scientists, and public health professionals, this article presents a comprehensive overview of the current state and prospects of integrating next-generation nanomaterial-based artificial intelligence-supported biosensors into clinical practice. It emphasizes the need to address these barriers, which can enhance early disease detection, improve patient outcomes, and reduce the overall burden on healthcare systems. Their applications can be extended to one health management team with dedicated collaborations to achieve sustainable development goals.

How Does the Context Shape the Technical Support from the Provincial Health Administration to District Health Management Teams in the Democratic Republic of Congo? A Realist Evaluation.

Since 2014, the health sector in the Democratic Republic of the Congo has been undergoing reforms aimed at strengthening the Provincial Health Administration (PHA) to better support health district development through technical support to district health management teams (DHMTs). However, there is limited understanding of how, for whom, and under what conditions this support works. Using a realist evaluation approach, this study aimed to test an initial program theory of technical support to DHMTs by PHA staff in Kasai Central Province. Data were collected from document reviews, interviews, questionnaires, and routine health information systems. After thematically analysing the implementation, context, actors, mechanisms, and outcomes, we applied retroductive reasoning to connect these elements using the Intervention-Context-Actors-Mechanisms-Outcomes configurations (ICAMOcs) heuristic. We identified nine ICAMOcs showing how resource constraints and political and organisational challenges hindered the effective delivery of technical support. These challenges triggered disabling mechanisms, such as low motivation, self-efficacy, a sense of accountability, psychological safety, reflexivity, the perceived relevance of support, the perceived credibility of PHA staff, and perceived autonomy, resulting in mixed outcomes. The performance-based financing scheme helped mitigate some issues by providing resources and boosting extrinsic motivation, but concerns persist about its sustainability due to reliance on external funding. These findings highlight the need for strong political commitment and coordinated efforts to address these challenges.

Examining Factors Influencing the Use of Health Management Information Systems Data for Health Facility Planning in Kigoma Ujiji Municipal and Kigoma District Councils, Tanzania

Background: Tanzania has adopted an open-source Health Management Information System (HMIS) to help understand health patterns, make informed decisions, and take action to improve the quality of health services through effective planning. However, generating and utilizing health data in most facilities presents significant challenges. This study examined factors influencing the use of HMIS data for health facility planning in Kigoma Ujiji Municipal and Kigoma District Councils. Methods: This cross-sectional explanatory study was conducted using a qualitative approach in two districts of the Kigoma region—Kigoma and Ujiji district councils. Participants included members of the Council Health Management Teams and staff from six healthcare facilities. The study employed the PRISM framework to explore how technical, organizational, and behavioral factors influence the use of data in health facility planning. Data was collected through in-depth interviews and focus group discussions. Thematic analysis, supported by NVivo software, was applied to manage and analyze the data. Results: A total of 32 participants were involved in this study. Most reported that health facilities had standard indicators, data collection forms, and established data analysis and reporting procedures, with clear HMIS roles and responsibilities. However, challenges such as poor data quality, insufficient IT resources, inadequate staff training, limited financial support, and unsupportive organizational culture were reported to affect the effective use of data in planning. Conclusions: Poor data quality, inadequate training, inadequate HMIS staff, and poor information culture, motivation, attitudes, and values limited data use. This study calls for health system interventions to address staffing, training, information culture, data quality, and individual attitudes and behaviors to improve the use of data in health facility planning and decision-making.

Using community-based participatory approaches to improve access to mass drug administration for trachoma elimination in a pastoral conflict area of Kenya.

In Baringo County, Kenya, trachoma remains endemic despite repeated mass drug administration (MDA) efforts, with coverage in one of the wards consistently falling short of world health organization (WHO) targets. The disease is endemic in 12 out of the 47 counties in Kenya. Baringo county is a pastoral conflict, hard to reach area where eight rounds of mass drug administration (MDA) for trachoma have been implemented. In Loyamorok ward, treatment coverage has been below 68% against the WHO recommended threshold of 80%. Community engagements that promote participatory approaches are key to MDA success. In this study, we describe community-based participatory approaches qualitatively developed and implemented during the intervention phase of a study that involved a pre-intervention, intervention and post intervention phases and aimed to address barriers of community participation and access to trachoma MDA. Interviews and focus group discussions were used to identify barriers to community participation in MDA, that included power and gender dynamics, rampant insecurity, community myths and misconceptions, migration in search of water and pastures, vastness and terrain and ineffective teams which resulted to unsupervised swallowing of drugs during MDA campaigns. Stakeholders in trachoma were identified through meetings with national, county and sub-county health management teams. The stakeholders, community members and the research team used the identified barriers to formulate MDA strategies including effective stakeholder engagement, enhanced social mobilization, community awareness creation on trachoma, effective planning and execution of MDA and implementation monitoring of the MDA campaign, all aimed at increasing MDA coverage. Overall MDA coverage in the area increased from 67.6% in 2021 to 87% in 2023 thus meeting the WHO threshold of 80%. The use of community-based, participatory approaches in the development and implementation of data driven strategies has the potential to positively influence MDA coverage for trachoma, and other neglected tropical diseases.

Finding a way in and making it stick: an exploration of chiropractor experiences working in team-oriented elite sport practice settings

Interprofessional healthcare teams have become the benchmark for optimising athlete health and performance in high-stakes sports. Despite a history of utility as provider partners, chiropractors are currently a relatively underutilised...

A model of prevention of mother-to-child transmission and health management team for improving adverse outcomes of pregnancy syphilis in Ningxia, China

Regional variations exist in the implementation of Syphilis Mother-to-Child Transmission Prevention (PMTCT). Thus, it is crucial to assess the effectiveness of this model in the Ningxia region and explore the supplementary role of Health Management Teams (HMT). This study established the PMTCT + HMT model and examined its impact on adverse outcomes in pregnant women with syphilis infection. The majority of participants were urban residents, married, had a minimum high school education, and held public positions; 36.7% and 26.7% were from minority ethnic groups. The PMTCT + HMT model enhanced participants’ knowledge, rates of voluntary counseling, and testing. The incidence of adverse pregnancy outcomes (miscarriages, preterm births, stillbirths) significantly decreased, and adverse neonatal outcomes (low birth weight, neonatal mortality, congenital syphilis) were notably reduced. Simultaneously, we identified factors associated with adverse outcomes, including non-residency, unmarried status, lower educational attainment, minority ethnicity, primary syphilis, and positive titers. Thus, HMT may be an effective intervention to enhance the effect of PMTCT for syphilis. The unique population structure in Ningxia is closely linked to adverse outcomes, highlighting the significance of providing equitable treatment for vulnerable populations.

The covid-19 pandemic and its effect on maternal health indicators in Latin American countries

Introduction: Maternal mortality constitutes one of the most important indicators of public health, and also reflects the response capacity of health systems to the healths needs of one of the most vulnerable groups, such a pregnant women. Objective: Conduct a bibliographic review of the maternal mortality indicators used by health management teams, before and during the COVID-19 pandemic in Latin American countries. Methodology: A bibliographic review was carried out by searching for scientific articles related to the topic. In addition, information was collected from epidemiological bulletins updated as of the review date. The PEO question was used (Population: pregnant women. Exposure: before and during the COVID-19 pandemic Result: maternal mortality in the context before and during the pandemic): What are the maternal mortality indicators before and during the COVID-19 pandemic? The search sources were PubMed, Scielo and Google Scholar. The key words were: "Maternal mortality" "Morbidity and mortality indicators" "COVID-19". Articles published from January 1, 2021 to May 30, 2023 were selected. Results: Of the 5670 articles found, 5654 articles were discarded because they did not meet our criteria for keyword combinations in the title or abstract. Of the 16 articles selected, 12 had research results. Of the total number of articles, there were 4 prospective articles and 8 retrospecitve articles, 4 were considered for conceptual theoretical aspects that are related to the objective of the study. Conclusion: an increase in the maternal mortality ratio was evident in the pre-pandemic period and during the pandemic compared to the figures from previous years, this was associated with the presence of comorbidities and maternal risk factors as well as the limited supply of health services, lack of intra-and extramural organization.

Exploring Multimorbidity Through the Use of Deterministic and Probabilistic Record Linkage of Data in Five Health Facilities in Nairobi

IntroductionData collected by Health Demographic Surveillance Systems (HDSSs) at the community level can support very powerful research questions if it was linked to records at health facilities. In particular, understanding multimorbidity and building predictive models for key health outcomes requires linked data collected both in the community and health facilities. Additionally, the linked data can assist health management teams at the national, county, and local levels in making evidence-based choices. Problemthe inability to link population level data with records at health facilities affects the ability to use data to solve key health research questions. lack of common identifiers affects the possibility of integrating clinic records with population-based data. MethodologyWe intend to link data from five health facilities in Nairobi County serving the population in the Nairobi Urban Health Demographic Surveillance System (NUHDSS) where longitudinal data was collected between 2001 and 2018. The longitudinal data is from a database of about 260,000 individuals. This will result in a merged dataset and will also provide an opportunity to assess the accuracy of the deterministic and probabilistic record linkage algorithm compared with other methods. Note: We will have results by the time the conference is happening as groundwork has been put. ConclusionThe growing burden of multimorbidity on the African continent requires creative and effective strategies of addressing the problem through utilization of existing longitudinal data. By merging clinic records with population-based data, this initiative will promote the use of data evidence informed decision making for interventions to address multimorbidity.

Power and positionality in the practice of health system responsiveness at sub-national level: insights from the Kenyan coast

BackgroundHealth system responsiveness to public priorities and needs is a broad, multi-faceted and complex health system goal thought to be important in promoting inclusivity and reducing system inequity in participation. Power dynamics underlie the complexity of responsiveness but are rarely considered. This paper presents an analysis of various manifestations of power within the responsiveness practices of Health Facility Committees (HFCs) and Sub-county Health Management Teams (SCHMTs) operating at the subnational level in Kenya. Kenyan policy documents identify responsiveness as an important policy goal.MethodsOur analysis draws on qualitative data (35 interviews with health managers and local politicians, four focus group discussions with HFC members, observations of SCHMT meetings, and document review) from a study conducted at the Kenyan Coast. We applied a combination of two power frameworks to interpret our findings: Gaventa’s power cube and Long’s actor interface analysis.ResultsWe observed a weakly responsive health system in which system-wide and equity in responsiveness were frequently undermined by varied forms and practices of power. The public were commonly dominated in their interactions with other health system actors: invisible and hidden power interacted to limit their sharing of feedback; while the visible power of organisational hierarchy constrained HFCs’ and SCHMTs’ capacity both to support public feedback mechanisms and to respond to concerns raised. These power practices were underpinned by positional power relationships, personal characteristics, and world views. Nonetheless, HFCs, SCHMTs and the public creatively exercised some power to influence responsiveness, for example through collaborations with political actors. However, most resulting responses were unsustainable, and sometimes undermined equity as politicians sought unfair advantage for their constituents.ConclusionOur findings illuminate the structures and mechanisms that contribute to weak health system responsiveness even in contexts where it is prioritised in policy documents. Supporting inclusion and participation of the public in feedback mechanisms can strengthen receipt of public feedback; however, measures to enhance public agency to participate are also needed. In addition, an organisational environment and culture that empowers health managers to respond to public inputs is required.

Decentralisation of the Health System Derailed by Organisational Inertia in Machinga, Malawi.

Managing the transition of a health system (HS) from a centralised to a decentralised model has been touted as a panacea to the complex challenges in developing countries like Malawi. However, recent studies have demonstrated that decentralisation of the HS has had mixed effects in service provision with more dominant negative outcomes than positive results. The aim of this study was to develop a substantive grounded theory (GT) that elaborates on how activities of central decision-makers and local healthcare mangers shape the process of shifting the HS to a decentralised model in Machinga, Malawi. The study was qualitative in nature and employed the Straussian version of GT. Some participants were interviewed twice, and a total of 36 semi-structured interviews were conducted with 25 purposively selected participants using an interview guide. The interviews were conducted at the headquarters of the Ministry of Health (MoH) and other ministries and agencies, and in Machinga District. Data were analysed using open, axial, and selective coding processes of the GT methodology; and the conditional matrix and paradigm model were used as data analysis tools. The findings of this study revealed seven different activities, forming two opposing and interactional sub-processes of enabling and impeding patterns that derailed the decentralisation drive. The study generated a GT labelled "decentralisation of the HS derailed by organisational inertia," which elaborates that decentralisation of the HS produced mixed results with more predominant negative outcomes than positive effects due to resistance at the upper organisational echelons and members of the District Health Management Team (DHMT). This article concludes that organisational inertia at the personal and strategic levels of leadership entrusted with decentralising the HS in Malawi, contributed immensely to the derailment of shifting the HS from the centralised to the decentralised model of health service provision.

Healthcare workers’ views on decentralized primary health care management in Lesotho: a qualitative study

BackgroundLesotho experienced high rates of maternal (566/100,000 live births) and under-five mortality (72.9/1000 live births). A 2013 national assessment found centralized healthcare management in Ministry of Health led to fragmented, ineffective district health team management. Launched in 2014 through collaboration between the Ministry of Health and Partners In Health, Lesotho’s Primary Health Care Reform (LPHCR) aimed to improve service quality and quantity by decentralizing healthcare management to the district level. We conducted a qualitative study to explore health workers’ perceptions regarding the effectiveness of LPHCR in enhancing the primary health care system.MethodsWe conducted 21 semi-structured key informant interviews (KII) with healthcare workers and Ministry of Health officials purposively sampled from various levels of Lesotho’s health system, including the central Ministry of Health, district health management teams, health centers, and community health worker programs in four pilot districts of the LPHCR initiative. The World Health Organization’s health systems building blocks framework was used to guide data collection and analysis. Interviews assessed health care workers’ perspectives on the impact of the LPHCR initiative on the six-health system building blocks: service delivery, health information systems, access to essential medicines, health workforce, financing, and leadership/governance. Data were analyzed using directed content analysis.ResultsParticipants described benefits of decentralization, including improved efficiency in service delivery, enhanced accountability and responsiveness, increased community participation, improved data availability, and better resource allocation. Participants highlighted how the reform resulted in more efficient procurement and distribution processes and increased recognition and status in part due to the empowerment of district health management teams. However, participants also identified limited decentralization of financial decision-making and encountered barriers to successful implementation, such as staff shortages, inadequate management of the village health worker program, and a lack of clear communication regarding autonomy in utilizing and mobilizing donor funds.ConclusionOur study findings indicate that the implementation of decentralized primary health care management in Lesotho was associated a positive impact on health system building blocks related to primary health care. However, it is crucial to address the implementation challenges identified by healthcare workers to optimize the benefits of decentralized healthcare management.

From PERFORM to PERFORM2Scale: lessons from scaling-up a health management strengthening intervention to support Universal Health Coverage in three African countries.

Strengthening management and leadership competencies among district and local health managers has emerged as a common approach for health systems strengthening and to achieve Universal Health Coverage (UHC). While the literature is rich with localized examples of initiatives that aim to strengthen the capacity of district or local health managers, particularly in sub-Saharan Africa, considerably less attention is paid to the science of 'how' to scale-up these initiatives. The aim of this paper is thus to examine the 'process' of scaling-up a management strengthening intervention (MSI) and identify new knowledge and key lessons learned that can be used to inform the scale-up process of other complex health interventions, in support of UHC. Qualitative methods were used to identify lessons learned from scaling-up the MSI in Ghana, Malawi and Uganda. We conducted 14 interviews with district health management team (DHMT) members, three scale-up assessments with 20 scale-up stakeholders, and three reflection discussions with 11 research team members. We also kept records of activities throughout MSI and scale-up implementation. Data were recorded, transcribed and analysed against the Theory of Change to identify both scale-up outcomes and the factors affecting these outcomes. The MSI was ultimately scaled-up across 27 districts. Repeated MSI cycles over time were found to foster greater feelings of autonomy among DHMTs to address longstanding local problems, a more innovative use of existing resources without relying on additional funding and improved teamwork. The use of 'resource teams' and the emergence of MSI 'champions' were instrumental in supporting scale-up efforts. Challenges to the sustainability of the MSI include limited government buy-in and lack of sustained financial investment.

Process Mapping Midwifery Students' Clinical Placement in Sierra Leone: Identifying Facilitators and Barriers.

Background: Improving midwifery education is critical to improving maternal and infant health outcomes in Sierra Leone. A significant priority within midwifery education is to strengthen the clinical teaching and students' hands-on experience in the clinical setting. Objectives: To identify facilitators and challenges within midwifery students' clinical placements and to highlight areas to strengthen the clinical midwifery education system as well as the role of preceptors. Methods: We conducted a participatory process mapping with two schools of midwifery in Sierra Leone to detail steps taken by practicing midwives and midwifery faculty when students are placed in clinical settings for midwifery rotations. Findings: There were 42 participants from the Bo and Makeni regions of Sierra Leone. Participants included midwifery faculty from the Schools of Midwifery in Makeni and Bo, clinical midwives from two regional government hospitals, clinical midwives from two affiliated community health centers, and midwives from the District Health Management Teams. Three recurring themes emerged in the process. First, there was always some element of preparing or teaching the student. Second, there were administrative tasks to coordinate between the schools, clinical sites, and students, before, during, and after clinical placements. And third, there were elements of communication and collaboration between schools and clinical sites/preceptors that could be improved through shared understanding and standardization. Additional themes were inconsistencies across activities before, during, and after students' clinical placement and limited opportunities and confusion around systems of evaluating all components of the clinical placement experience. Conclusions: This study provides insight into the process of midwifery students' clinical placement and highlights facilitators to be standardized and some modifiable barriers to be addressed. As Sierra Leone and many other similar countries in sub-Saharan Africa attempt to strengthen students' clinical education through educating and developing preceptors, processing mapping can be a useful tool.

Health care prioritization process for the elderly in rural Tanzania under decentralized system: Prospects and challenges.

Beginning the early 1990s, many countries globally adopted the third-generation health sector reforms with a focus of strengthening the primary health care system through community participation. On the contrary, three decades later, primary health care systems in many Low- and Middle-Income countries (LMICs) including Tanzania have remained weak. Specifically, priority setting for the vulnerable groups including the elderly have been weak. We aimed to analyse the prospects and challenges of the priority setting process for the elderly health care services following the 1990s health sector reforms in Tanzania. We conducted an exploratory case study on priority setting process for the elderly healthcare services in Igunga and Nzega Tanzania. We carried out 24 Key Informant Interviews (KIIs) with the positions of District medical officers, social welfare, Medical Officers in-charge (MOI), planning officers and health system information focal person. Additionally, we carried out two focus group discussions (FGDs), one from each district with six participants from each group. Participants for the FGDs were MOI, health secretary, representative members of Health Facility Governing Committee (HFGC) and Council Health Management Team (CHMT). Data were analyzed using the qualitative content analysis. Two categories emerged from the analysis of the transcripts. These were the prospects and challenges in priority setting for the elderly population under the decentralized health sector in rural Tanzania. The prospects included; the capacity of the LGAs on priority setting; existence of strategies used by LGAs; availability of teamwork spirit and the existence of guidelines for priority setting at LGAs. The challenges included difficulties of elderly identification, insufficient resources to implement the planned activities at the LGAs, unintegrated digitalized government health information tools or programs at the LGAs, interference of LGAs by the Central Government and low interest of stakeholders on elderly health care. This study highlights the prospects and challenges facing priority setting for elderly care at the centralized health system in rural Tanzania. From the results the process is well organized but faces some challenges which if not addressed jeopardized and has potential to continue affecting the priority setting. Addressing the challenges highlighted requires joint efforts from both the elderly population in the community, healthcare providers and decision makers across all levels of the health system. This study serves as an eye-opener and calls for a bigger study to get a comprehensive picture of priority setting of the elderly health care in Tanzania.

Development of the self-efficacy scale in caregivers of Duchenne muscular dystrophy patients.

It is important to measure the self-efficacy knowledge of the caregiver of Duchenne muscular dystrophy (DMD) patients in order to overcome the problems that arise and carry out the care process in a healthy manner. This research was carried out to develop a self-efficacy scale in caregivers of individuals with DMD. The study was conducted with 99 volunteer DMD caregivers to evaluate the psychometric properties of the developed scale. Exploratory Factor Analysis (EFA) was performed with the SPSS 25 Package Program to determine the factors of the scale. Confirmatory Factor Analysis (CFA) analysis was performed with AMOS 23 to confirm the factors obtained by EFA. Cronbach's alpha coefficient was used for the internal consistency of the DMD-CSES. A valid and reliable scale was obtained to measure the self-efficacy of caregivers of DMD patients. Although some scales have been developed to evaluate the care burden of family members who care for patient-centered symptoms and functional changes in patients with DMD, there is no single scale that adequately describes the conditions and resources of caregivers on a global scale. The search for a definitive scale is expected to continue until a definitive treatment for the disease is found. Developing a valid and reliable scale to identify the self-efficacy, knowledge, skills and resources of caregivers with a common perspective of physicians and health management team centred on patients with DMD will be effective in practice.

Innovative Management of Non-Communicable Disease in a Low-Income Country: Supporting Nurses and Midwives to Set Up and Manage a Nurse-Led Diabetes Clinic at Bo Government Hospital in Sierra Leone

Recognising the increasing prevalence of diabetes globally and the challenges faced by communities with limited resources, the Organisation of Sierra Leonean Healthcare Professionals Abroad (TOSHPA) proposed the establishment of a nurse/midwife-led clinic for patients with Type 2 and gestational diabetes to be established in Bo Government Hospital (BGH) Southern Sierra Leone. The nurse/midwife-led approach can prove to be an effective and sustainable solution and is done in collaboration with the Ministry of Health (MOH) and BGH Management Team in Sierra Leone. The project is funded by The Burdett Trust for Nursing, UK. BGH will allow second-motivated registered nurses and midwives who have a passion for community health to be trained/upskilled and capacitated to work in an extended role. The training will focus on patient assessment, investigations, diagnosis, treatment, health promotion, education, cultural competency, effective communication and active follow-up.

Community-Based Oncology Nursing: Current Status and Prospects – A Secondary Publication

Objective: Currently, it is difficult to determine whether a comprehensive and systematic community-based cancer care project is properly implemented. The purpose of this article is to present the current status and prospects of community-based oncology nursing by reviewing related literature. Methods: A new cancer care model was established through the analysis of existing models and a literature review of community-based cancer prevention, cancer screening, cancer survivor care, and cancer patient hospice care. Results: The Comprehensive Cancer Care Model (CCCM) was established. The CCCM organizes the stages of cancer treatment and the cancer journey on the horizontal axis. On the vertical axis, public health centers, oncology hospitals, cancer convalescent hospitals, primary care physicians, and prayer centers were involved. The levels of participation of human resources among institutions and the degree of interconnection between organizations was observed. Conclusion: It is expected that CCCM will be used for holistic, sustainable, and cost-effective cancer management. In community-based oncology nursing, the team of health promotion nurses in public health centers is in charge of population-based cancer prevention and early detection programs, while the visiting health management team of nurses is in charge of individual-based cancer survivor and hospice programs.

The role of provincial health administration in supporting district health management teams in the Democratic Republic of Congo: eliciting an initial programme theory of a realist evaluation

BackgroundIn 2006, the Ministry of Health in the Democratic Republic of Congo designed a strategy to strengthen the health system by developing health districts. This strategy included a reform of the provincial health administration to provide effective technical support to district health management teams in terms of leadership and management. The provincial health teams were set up in 2014, but few studies have been done on how, for whom, and under what circumstances their support to the districts works. We report on the development of an initial programme theory that is the first step of a realist evaluation seeking to address this knowledge gap.MethodsTo inform the initial programme theory, we collected data through a scoping review of primary studies on leadership or management capacity building of district health managers in sub-Saharan Africa, a review of policy documents and interviews with the programme designers. We then conducted a two-step data analysis: first, identification of intervention features, context, actors, mechanisms and outcomes through thematic content analysis, and second, formulation of intervention–context–actor–mechanism–outcome (ICAMO) configurations using a retroductive approach.ResultsWe identified six ICAMO configurations explaining how effective technical support (i.e. personalised, problem-solving centred and reflection-stimulating) may improve the competencies of the members of district health management teams by activating a series of mechanisms (including positive perceived relevance of the support, positive perceived credibility of provincial health administration staff, trust in provincial health administration staff, psychological safety, reflexivity, self-efficacy and perceived autonomy) under specific contextual conditions (including enabling learning environment, integration of vertical programmes, competent public health administration staff, optimal decision space, supportive work conditions, availability of resources and absence of negative political influences).ConclusionsWe identified initial ICAMO configurations that explain how provincial health administration technical support for district health management teams is expected to work, for whom and under what conditions. These ICAMO configurations will be tested in subsequent empirical studies.