Health Service Delivery System Research Articles

Improving health systems performance in low- and middle-income countries: a system dynamics model of the pay-for-performance initiative in Afghanistan.

System dynamics methods were used to explore effective implementation pathways for improving health systems performance through pay-for-performance (P4P) schemes. A causal loop diagram was developed to delineate primary causal relationships for service delivery within primary health facilities. A quantitative stock-and-flow model was developed next. The stock-and-flow model was then used to simulate the impact of various P4P implementation scenarios on quality and volume of services. Data from the Afghanistan national facility survey in 2012 was used to calibrate the model. The models show that P4P bonuses could increase health workers’ motivation leading to higher levels of quality and volume of services. Gaming could reduce or even reverse this desired effect, leading to levels of quality and volume of services that are below baseline levels. Implementation issues, such as delays in the disbursement of P4P bonuses and low levels of P4P bonuses, also reduce the desired effect of P4P on quality and volume, but they do not cause the outputs to fall below baseline levels. Optimal effect of P4P on quality and volume of services is obtained when P4P bonuses are distributed per the health workers’ contributions to the services that triggered the payments. Other distribution algorithms such as equal allocation or allocations proportionate to salaries resulted in quality and volume levels that were substantially lower, sometimes below baseline. The system dynamics models served to inform, with quantitative results, the theory of change underlying P4P intervention. Specific implementation strategies, such as prompt disbursement of adequate levels of performance bonus distributed per health workers’ contribution to service, increase the likelihood of P4P success. Poorly designed P4P schemes, such as those without an optimal algorithm for distributing performance bonuses and adequate safeguards for gaming, can have a negative overall impact on health service delivery systems.

Future Organization of Oral Health Services Delivery: From 2012 to 2042.

The United States is currently experiencing a vortex of change in both general health and oral health care delivery, the ultimate outcome of which is still not well understood. The specific focus of this article is to examine the future organization of the oral health services delivery system (OHSDS) in the U.S., with special attention given to the role of large group dental practices (LGDPs) in that future. The article describes the various types of LGDPs and their ability to change the economic characteristics of the OHSDS. Large geographically distributed corporate group dental practices (LGDCGDPs) are the type that may expand their market share to the extent that they could change the economic characteristics of the OHSDS. A wide range of scenarios is used to project the expansion of LGDCGDPs into the future. The scenarios modeled are not intended as predictions but rather to present a range of possible OHSDS market structures that may emerge over the next 30 years. The implications of each scenario for the economic competition within the OHSDS are described. Possible implications of these trends for dental education are also discussed. This article was written as part of the project "Advancing Dental Education in the 21st Century."

Does involvement of local NGOs enhance public service delivery? Cautionary evidence from a malaria-prevention program in India.

Partnerships between government and non-state actors that aim to enhance the quality or efficiency of service delivery are increasingly common in today's development policy landscape. We investigate the impacts of such an approach using data from an experimental supportive intervention to India's malaria control program that leveraged local non-state capacity in order to promote mosquito net usage and recommended fever care-seeking patterns. The supportive activities were conducted simultaneously by 3 NGOs, contracted out by the Indian government, in 2 endemic districts in the state of Odisha. We find that program impact significantly varied by location. Examining 3 potential sources of this variation (differential population characteristics, differential health worker characteristics, and differential implementer characteristics), we provide evidence that both population and NGO characteristics significantly affected the success of the program. Specifically, the results suggest that the quality and effort of the local implementer played a key role in the differential effectiveness. We discuss these findings as they relate to the external validity of development policy evaluations and, specifically, for the ability of health and other service delivery systems to benefit from limited non-state capacity in underresourced areas.

Peer Education: Productive Engagement for Older African Americans in Recovery From Depression.

Older adults who have personal experience with the mental health service delivery system gain unique and potentially valuable insight from their treatment experiences. Research suggests that incorporating trained individuals in recovery from a mental illness (i.e., peer educators) into mental health service delivery roles results in substantial benefits for current mental health consumers, particularly for older adults and racial and ethnic minorities who may feel disenfranchised from the traditional mental health service delivery system. However, little research has examined the impact of participating in these activities on the peer educators themselves. This mixed methods study examines the experiences of 10 African American older adults in recovery from depression currently working as trained peer educators. Peer educators reported feeling more positive, feeling their lives had significantly improved, and feeling better in general due to their peer educator roles. This qualitative investigation highlights four unique themes that can explain the benefit of serving in this capacity (i.e., Community Engagement, Life Long Learning and Education, Mental Health Recovery and Productive Aging). This study suggests that serving has a peer educator has a number of beneficial outcomes for African American older adults in recovery from depression.

Epidemiology of asthma in adults living in the Silesian voivodeship according to secondary epidemiological data

Asthma is a serious public health challenge because of the increasing number of people with a new diagnosis and consequently the increasing costs of medical treatment (direct and indirect). The aim of this study is to analyze available epidemiological data with respect to their spatial and temporal variability in the Silesian voivodeship. In addition, the costs incurred by the National Health Fund (Narodowy Fundusz Zdrowia - NFZ) in treating asthmaic patients are analyzed. The epidemiological descriptive study concerns adult inhabitants of the Silesian voivodeship with asthma diagnosed under the health service delivery system, financed by NFZ, as well as diagnossis and/or hospitalization registed in the routine register run by the NFZ in Katowice. Crude and standardized incidence and prevalence rates are calculated and their changes are evaluated. Spatial variability in districts is evaluated as well and costs incurred by NFZ are revealed. In the years 2006-2010 the standardized rate of asthma remained at a high level of 392.3-469.6/100 000 inhabitants. Greater values were related to women than to men, as well as to inhabitants of districts located in the central and southern parts of the Silesian voivodeship. A slight decrease in the values of crude prevalence rates, from 52/100 000 inhabitants to 42/100 000, is reported. The annual cost of new cases treatment is 17 million PLN while the annual cost of all hospitalizations is at the level of 10 million PLN. Variability of incidence and prevalence due to asthma in the Silesian voivodeship is observed. An attempt at explaining this diversity requires in-depth research. A slight decrease in the values of both rates over time indicates less significant reduction in expenditure devoted to hospital treatment of asthmatic patients. Med Pr 2017;68(4):479-489.

Extending access to essential services against constraints: the three-tier health service delivery system in rural China (1949\u20131980)

BackgroundChina has made remarkable progress in scaling up essential services during the last six decades, making health care increasingly available in rural areas. This was partly achieved through the building of a three-tier health system in the 1950s, established as a linked network with health service facilities at county, township and village level, to extend services to the whole population.MethodsWe developed a Theory of Change to chart the policy context, contents and mechanisms that may have facilitated the establishment of the three-tier health service delivery system in rural China. We systematically synthesized the best available evidence on how China achieved universal access to essential services in resource-scarce rural settings, with a particular emphasis on the experiences learned before the 1980s, when the country suffered a particularly acute lack of resources.ResultsThe search identified only three peered-reviewed articles that fit our criteria for scientific rigor. We therefore drew extensively on government policy documents, and triangulated them with other publications and key informant interviews. We found that China’s three-tier health service delivery system was established in response to acute health challenges, including high fertility and mortality rates. Health system resources were extremely low in view of the needs and insufficient to extend access to even basic care. With strong political commitment to rural health and a “health-for-all” policy vision underlying implementation, a three-tier health service delivery model connecting villages, townships and counties was quickly established. We identified several factors that contributed to the success of the three-tier system in China: a realistic health human resource development strategy, use of mass campaigns as a vehicle to increase demand, an innovative financing mechanisms, public-private partnership models in the early stages of scale up, and an integrated approach to service delivery. An implementation process involving gradual adaptation and incorporation of the lessons learnt was also essential.ConclusionsChina’s 60 year experience in establishing a de-professionalized, community-based, health service delivery model that is economically feasible, institutionally and culturally appropriate mechanism can be useful to other low- and middle-income countries (LMICs) seeking to extend essential services. Lessons can be drawn from both reform content and from its implementation pathway, identifying the political, institutional and contextual factors shaping the three-tier delivery model over time.

Assessment of Provision of Women Friendly Care and Associated Factors among Postnatal Mothers at Three Public Hospitals of Jimma Zone, Oromia Region, Ethiopia, 2016

Background: Women friendly care is an approach to care giving with the goal of creating an enabling environment at all level to improve women’s access to safe motherhood and reproductive health services. Objectives: to assess the provision of women friendly care and associated factors among postnatal mothers at three public hospitals of Jimma zone Methods: A facility based cross-sectional quantitative study design was conducted on 264 respondents. Systematic random sampling technique was used for selecting study subjects. Pre-tested structured questionnaires were used to collect data from April-May 2016.The data was entered, cleaned and analyzed by using SPSS version 21. Binary and Multivariable logistic regressions were used for data analysis. Results: A total of 264 Jimma University specialized, Shenen Gibe and Limmu Genet Hospital respondents participated in the study with the response rate of 99.24%. More than half of respondents’, 147 (56.1%) main means of transport to health facility was walk/on foot, and 128 (48.9%) of them needed 30 minutes to reach there. From the total respondents, 186 (71%) had received the provision of women friendly care at ANC, Delivery and Postnatal wards. Variables found to be statistically associated to provision of women friendly care at p<0.05 were: Main means of transport (public transport) (AOR=3.99, 95 CI [1.98, 8.05], Left alone in labor (AOR=0.41, 95 CI [0.19, 0.87], and were you treated badly (AOR=0.054, 95 CI [0.023, 0.13]. Conclusion and Recommendations: The provision of women friendly care at study area among respondents was 71% and the factors statistically associated to it were:-main means of transport left alone in labor and treated badly. Each health facilities’ administrative body being in collaboration with regional health bureau and regional government must facilitate the health service delivery system to be as accessible as possible for pregnant, delivering and postnatal mothers.

Direct medical costs of type 2 diabetes in China: a multicentre, prospective cohort study

BackgroundWe aimed to investigate the direct medical costs of type 2 diabetes and factors affecting such costs in China. MethodsIn this multicentre, prospective cohort study, we recruited outpatients and inpatients with type 2 diabetes from 16 tertiary hospitals in 14 major cities of China. We followed-up patients for 6 months and collected patient data (including outpatient visits, hospital admissions, treatments, hypoglycaemia, and self-monitoring of glucose) and direct medical costs monthly. Log-transformed direct medical costs were fitted by multiple linear regression to indicator variables for demographics, metabolic control, treatments, complications, and comorbidities. Ethics approval was granted by local committees of the 306th Hospital of People's Liberation Army, and all participants provided written informed consent. FindingsBetween March 1, 2015, and Nov 15, 2015, we enrolled 1070 outpatients and 684 inpatients (mean 57·9 years, SD 11·4). Mean 6 month total direct medical costs per patient were US$1612·3 (SD 1735·6, median $1207·4, IQR 562·5–2105·9; US$1·0=CNY 6·2 as of March, 2015) overall, $995·1 (1434·8; $704·8, 345·0–1196·6) for outpatients, and $2660·3 (1714·4; $2244·3, 1702·3–3089·4) for inpatients. Outpatient costs were $833·2 (909·3; $641·2, 345·6–1056·9) overall, $843·6 (940·4; $683·8, 336·7–1111·6) for outpatients, and $815·6 (854·5; $566·3, 364·1–981·3) for inpatients. 567 (41%) of 1384 participants who completed the study (54 [6%] of 871 outpatients and 513 [100%] of 513 inpatients) had 634 hospital admissions (62 for outpatients and 59 readmissions for inpatients) during the 6 month study period. Mean hospital stay expenses were $1700·7 (SD 1405·1, median $1438·0, IQR 1097·5–1946·0) overall, $2127·1 (3149·5, $1335·9, 665·5–2285·1) for outpatients, and $1654·4 (1052·1, $1442·8, 1104·8–1939·5) for inpatients. For 6 month total direct medical costs, the proportions of out-of-pocket payments were 41·5% ($405·4) overall, 45·4% ($394·9) for outpatients, and 34·9% ($963·6) for inpatients. For outpatient medical costs, these proportions were 52·0% ($605·7) overall, 46·2% ($339·5) for outpatients, and 61·8% ($518·4) for inpatients. For hospital stay expenses, these proportions were 25·7% ($437·2) overall, 37·1% ($788·6) for outpatients, and 24·1% ($399·2) for inpatients. For inpatients, out-of-pocket payment accounted for 22·8% ($366·8) of mean hospital stay expense due to diabetes. Medical costs incurred at each centre differed substantially. Mean 6 month costs per person were lowest at centre 11 (Wuhan, $891·5 [SD 1133·0]) and highest at centre 14 (Shenyang, $2475·9 [1534·0]) for total direct costs, lowest at centre 11 (Wuhan, $258·7 [157·0]) and highest at centre 1 (Beijing, $1582·2 [1939·2]) for outpatient costs, and lowest at centre 13 (Wulumuqi, $813·8 [397·3]) and highest in centre 9 (Chengdu, $2907·1 [3890·0]) for hospital stay expenses. Per-person out-of-pocket payment also varied widely across centres, being lowest at centre 11 (Wuhan, $72·3 [SD 114·8]) and highest at centre 15 (Changsha, $1357·9 [1219·6]) for 6 month total costs, lowest at centre 10 (Tianjin, $134·0 [134·3]) and highest at centre 15 (Changsha, $906·0 [853·9]) for outpatient costs, and lowest at centre 14 (Shenyang city, $0·93 [7·11]) and highest at centre 9 (Chengdu, $1944·4 [3807·8]) for mean hospital stay expenses. Duration of diabetes, treatment with lipid-lowering agents, HbA1c, diabetic kidney disease, diabetic neuropathy, and cardiovascular disease were each associated with a 20–40% increase in cost. Diabetes treatments were associated with a cost increase of 1·5–4·0 times. Compared with centre 11, the increases in cost associated with diabetes treatment were 24·0% at centre 13,102·5%at centre 14, and 80·7% at centre 16. InterpretationDiabetes treatment, particularly for glucose control and diabetes complications, substantially increases direct medical costs of type 2 diabetes. As different health policies and regional health inequalities have important effects on direct medical costs, health-care reform needs to optimise resource allocation in health service delivery systems and provide more equitable health care. FundingWu Jieping Medical Foundation.

Peer support services in the behavioral healthcare workforce: State of the field.

This article examines how the history and philosophy of peer support services has shaped current mental health and substance use service delivery systems. The growth of peer-run and recovery community organizations in the changing health care environment are discussed, including issues related to workforce development, funding, relevant policies, and opportunities for expansion. These initiatives are designed to increase access to recovery-promoting services. We conducted an environmental scan and analysis of peer support services within the behavioral health care field in the United States, with particular attention to initiatives of the Substance Abuse and Mental Health Services Administration. Published manuscripts, policy statements, and reports were reviewed. There is abundant and growing literature illustrating how peer support services have become an integral component of behavioral health care systems in many states. Peer support services have the potential to increase access to recovery-oriented services for people with mental and substance use disorders served by the public behavioral health care system. Numerous initiatives in various states are being undertaken to build this workforce. Workforce and financing challenges exist, yet opportunities, including among others those made possible by the Affordable Care Act, will continue to strengthen the peer support workforce within behavioral health service delivery systems. (PsycINFO Database Record

A Learning Behavioral Health Care System: Opportunities to Enhance Research.

Sweeping changes in health care financing combined with the increased use of technology across health care systems are making it possible to address long-standing challenges to the behavioral health services delivery system. This Open Forum outlines opportunities and challenges facing health services researchers in this rapidly changing landscape. Inspired by a 2012 report by the Institute of Medicine, the authors discuss innovative research endeavors, promising study designs, and challenges involved in integrating high-impact behavioral health services research within a learning behavioral health care framework. The Open Forum concludes with a discussion of the critical next steps in this process: building consensus around common metrics for high-quality care, relevant outcomes, and contextual factors; connecting researchers to community and clinical settings; creating a data commons to pool information across sites; and designing and evaluating evidence-based decision support tools to drive improved care and outcomes.

Interprofessional Working: Perceptions of Healthcare Professionals in Nepalese Hospitals

Interprofessional working (IPW) is an essential part of the health service delivery system. Effective delivery of health services relies on the contribution of healthcare professionals (HCPs) from all groups. The aim of the study is to examine how HCPs collaborate and to assess their perceptions of IPW on healthcare delivery. This study follows a qualitative research approach. It was conducted in three hospitals in Nepal using semi-structured interview schedule. Purposive sampling method was used to select the hospitals and the participants. All together thirty-eight HCPs participated in the research. This study suggests that IPW is an integral part of HCPs’ life and they viewed it as a booster to support them to deliver the optimal and desired health outcomes. HCPs perceived that organisational support and involvement of service users are important for the successful delivery IPW. Verbal means of communication are mostly used during IPW. Nursing and allied health professionals (AHPs) are more critical to the medical professionals because they feel domination and professional isolation from the medical professionals. This study recognises factors that support IPW and also identifies various barriers to IPW in Nepalese hospitals.

Development of Telemedicine System

The tendency of computer technologies implementation to all areas of life is obvious and indisputable. Informatization of such area as medicine, gives huge advantage to health care service. For example, use of telemedicine technologies will allow making professional medical care to the removed patient. The telemedicine is distance medical care of patients by means of computers, the Internet and other communication technologies. Nowadays, telemedicine is developed subarea of health services delivery and medical education system. It is the reliable and available instrument for the improvement of healthcare systems. In the remote regions of Russia forming of medical services is rather difficult, but last years, Russian organizations show interest in implementation of telemedical services. Telemedicine promotes cooperation between the medical organizations, allows organizing effective system of medical personnel training. Priority tasks of telemedicine development are following: standardization of the applied medical, computer and telecommunication technologies, development of information resources. Approach “telemedicine” is rather new, especially for Russia, so the problem of healthcare services improvement is a priority task of our society and one of the main aspects in policy of the Russian Federation. In this paper, we raise the issue of algorithms development for carrying out the medical consultations in telemedicine system

Improving Maternal Health in Rwanda: The Role of Community-Based Interventions: A Systematic Review (2005-2015)

Introduction: Rwanda has achieved Millennium Development Goal target (5A). To improve maternal health, the Government of Rwanda, in the context of its vision 2020 and related health sector reforms and policies, has been investing in the essential health interventions for reducing maternal mortality. We initiated this study aimed at exploring the role of community–based interventions. Materials and Methods: This paper presents evidence on improvements in maternal health in Rwanda. We performed a systematic literature search in PubMed, limited to articles published between 2005 and 2015. Our literature search yielded 63 potentially relevant papers. This paper is a systematic review of 12 relevant peerreviewed articles. Results: The maternal mortality ratio in Rwanda has been reduced by 78% from 1,300/100,000 live births to 567/100,000 live births (2005) and 290/100,000 live births (2015), with fewer women dying from preventable causes of maternal death. The key maternal health indicators increased by two to four folds between 2005 and 2015, with the most significant changes registered in rural areas. Each village in Rwanda has a community health worker (CHW), ‘a female known as mobilizer for maternal Health’ who is responsible for community–based interventions during and after pregnancy. In 2011, a short message (SMS)-based system was set up to improve maternal and child health (MCH) using RapidSMS, a free and open–source framework, providing great opportunities for community health workers to contribute to implementing essential maternal health interventions, through communication. To achieve Millennium Development Goal 5A target, Rwanda has moved from ‘home birth’ to ‘facility–based childbirth’ policy, supported by innovative health sector reforms for the last two decades. Community health workers played a critical role in linking up communities to the health facilities and in providing relevant support for health promotion, maternal health service delivery and referral system, family planning as well as data collection for health system management.

A Study of the Current State of the Mental Health Service Delivery System Using the Focused-Group Interview

A Study of the Current State of the Mental Health Service Delivery System Using the Focused-Group Interview

Raising the Priority of Lifestyle-Related Noncommunicable Diseases in Physical Therapy Curricula.

Given their enormous socioeconomic burdens, lifestyle-related noncommunicable diseases (heart disease, cancer, chronic lung disease, hypertension, stroke, type 2 diabetes mellitus, and obesity) have become priorities for the World Health Organization and health service delivery systems. Health care systems have been criticized for relative inattention to the gap between knowledge and practice, as it relates to preventing and managing noncommunicable diseases. Physical therapy is a profession that can contribute effectively to patients'/clients' lifestyle behavior changes at the upstream end of prevention and management. Efforts by entry-to-practice physical therapist education programs to align curricula with epidemiological trends toward best health care practices are varied. One explanation may be the lack of a frame of reference for reducing the knowledge translation gap. The purpose of this article is to provide a current perspective on epidemiological indicators and societal priorities to inform physical therapy curriculum content. Such content needs to include health examination/evaluation tools and health behavior change interventions that are consistent with contemporary values, directions, and practices of physical therapy. These considerations provide a frame of reference for curriculum change. Based on 5 years of experience and dialogue among curriculum stakeholders, an example of how epidemiologically informed and evidence-based best health care practices may be systematically integrated into physical therapy curricula to maximize patient/client health and conventional physical therapy outcomes is provided. This novel approach can serve as an example to other entry-to-practice physical therapist education programs of how to align their curricula with societal health priorities, specifically, noncommunicable diseases. The intentions are to stimulate dialogue about effectively integrating health-based competencies into entry-level education and advancing best practice, as opposed to simply evidence-based practice, across professions and health services and to establish accreditable, health promotion practice standards for physical therapy.

Prevalence of mental distress and associated factors among caregivers of patients with severe mental illness in the outpatient unit of Amanuel Hospital, Addis Ababa, Ethiopia, 2013: Cross-sectional study.

sBackgroundCaregivers like family members or other relatives are central and provide not only practical help and personal care but also give emotional support, and they are suffering from plenty of challengeable tasks. These, eventually, cast out family caregivers into multidimensional problems prominently for mental distress like depression, anxiety, sleep problem and somatic disorder which are followed by physiologic changes and impaired health habits that ultimately lead to illness and possibly to death. Numerous studies demonstrate that mental distress of caregivers are two times compared to general populations.Despite it was not uncommon to observe manifestations of caregivers’ mental distress, yet there was no study on this area. Therefore, this study was intended to assess the prevalence of mental distress and associated factors among the caregivers of persons with severe mental illness in the out patients unit of Amanuel Hospital, Ethiopia.MethodsInstitutional based cross sectional study was conducted from May 1 to 31, 2013 at Amanuel Hospital, Addis Ababa, Ethiopia. Systematic random sampling technique with “k” interval of 13 was employed to withdraw a total of 423 participants from study population. Five psychiatric nurses carried out interview by using standardized and validated Self Reported Questionnaire (SRQ 20). Descriptive statistics, binary and multivariate logistic regression analysis were conducted.ResultsThis study revealed that the overall prevalence of mental distress was found to be 221(56.7 %). The factors like missed social support, two or more times admission of patient, care giving for psychotic patient, being farmer and being female were found to be predictors for mental distress of caregivers with this [AOR 95 % CI = 9.523(5.002, 18.132)], 3.293(1.474, 3.3560), 2.007(1.109, 3.634), 2.245(1.129, 4.463) and 3.170(1.843, 5.454)] respectively.ConclusionsIn this respect the study observed that there was a higher level of mental distress experienced by caregivers of patients with severe mental illness in Amanuel Hospital, and social support are strongly associated with mental distress besides to other variables. Effectively planned interventions have to be targeted at alleviating mental distress and actions like on-going psycho-education and mutual support that could expand social support should be implemented in Amanuel hospital health service delivery system.

Nutritional Deficiencies: Major Public Health Problem in Nepal

Nutritional deficiency is a major public health challenge in Nepal. Nutritional deficiencies are occurring varying degree of manifestations and have tremendous impact not only on the health of vulnerable population but to the national economy too. Even though quite adequate government policies and guidelines have been prepared, over the years, basic nutrition promotion strategies haven’t been applied seriously at the community level. The major causes of nutritional deficiency in developing country like Nepal is poverty, lack of food security and nutrition education. Combating the deficiency seems a big challenge hence Government should develop more integrated and practical approaches to combat the deficiency. Nutrition promotion and support efforts should be ensured to reach specially to the needy, marginalized populations. Mere policy and strategy cannot yield foreseeable results. There is a strong need to improve the health service delivery systems which can ensure the desired change. This review study is an attempt to the draw attention of concerned authorities and public health researcher, to explore more information which can be helpful in revising the current approaches and in turn helps in achieving government’s desired goal: eradication of hunger and malnutrition from the country.

Development of healthcare system in Macao and its implications for China's mainland

This paper introduced the latest healthcare management and the service delivery system including health resources in Macao, highlighting the developed legal system, government financing policies for health sector, the well-developed medical service referral system, favorable development supports for private medical institutions, and remuneration incentive policies for health workers in Macao.These may serve as the useful implications and recommendations for health reform and development in mainland of China. Key words: Macao; Health management; Health service delivery system; Policy suggestions

English

Available literature shows that retention of human resources for health is underpinned by a number of factors in Motivation-Hygiene Theory key which include human resource development, financial incentives, and personal and professional support mechanisms. These are all linked to motivation and productivity. There is convergence of opinion that staff retentions required packaging different bundle of incentives depending on the staff cadres and location in the health service delivery system. This paper which was premised on literature review analyzes the main issues that impinge on retention of human resources for health in the region and Uganda in particular. It further delves into the options that the ministry of health and government of Uganda can consider to minimize staff migration from rural areas to greener pastures. The discourse in this paper ends with a conclusion against the backdrop of how these challenges can be addressed and the emphasis for pragmatic approaches as opposed to theoretical perception in addressing the challenges in human resources for health retention. &nbsp; Key words: Human resources for health, human resource retention.

Interprofessional Care and Role of Team Leaders

Interprofessional care is an essential part of the health service delivery system. It helps to achieve improved care and to deliver the optimal and desired health outcomes by working together, sharing and learning skills. Health care organisation is a collective sum of many leaders and followers. Successful delivery of interprofessional care relies on the contribution of interprofessional care team leaders and health care professionals from all groups. The role of the interprofessional care team leader is vital to ensuring continuity and consistency of care and to mobilise and motivate health care professionals for the effective delivery of health services. Medical professionals usually lead interprofessional care teams. Interprofessional care leaders require various skills and competencies for the successful delivery of interprofessional care.