Cadres Of Health Workers Research Articles

Pos UKK Cumi dan Pos UKK Kerapuh Sebagai Upaya Meningkatkan Kesehatan Keluarga di Wilayah Tambakwedi Kecamatan Kenjeran, Surabaya

UKK Kerapuh and UKK Cumi not develop because of the low participation of fishing communities in the region in the implementation of the program Tambak Wedi UKK . Volunteers or health workers who are not active, people do not understand about the benefits and management of UKK .Health education activities have not been carried out routinely by cadres of health workers. Poor work habits, among others squat and bend over too long, working without protective , complaints Hypertension disease, respiratory illness, back pain, skin diseases on the fishermen.The Matter UKK group health was hypertension, disorders of the respiratory tract (cough), family members of fishermen 10% are anemic.The approach offered to resolve the issue is to carry out workshops, training and mentoring, in improving the skills of cadre pos UKK and the fishing communities of Tambakwedi region, help improve management capabilities UKK .Output Increased knowledge and skills of partners in managing the UKK, healthy eating family management skills, Training Module Health and Safety, Management Pos UKK, Scientific; Proceending; and Poster. Keywords: fishing communities, UKK .

From known to the unknown: investigating an unusual outbreak of viral exanthema in a secondary school in Abeokuta, Nigeria, 2015.

Investigating an outbreak of disease requires mastery of a set of skills and collaboration among different cadres of health workers. Although you want to focus on a specific disease, you need to keep your mind open to possibilities. This case study is based on investigation of an outbreak of rashes suspected to be measles but which proved to be otherwise. It reinforces the knowledge of the steps in outbreak investigation which should have been covered in classroom lecture or background reading. This case study is best suited for basic level of training in field epidemiology and can be completed within 2-3 hours.

Determinants of appropriate knowledge on human immunodeficiency virus postexposure prophylaxis among professional health-care workers in Sokoto, Nigeria.

Introduction:The prevention of human immunodeficiency virus (HIV/AIDS) among health-care workers (HCWs) has remained a major topical issue worldwide. Accidental transmission of HIV infection to HCWs during occupational exposure is a real threat today. The study aimed to assess the knowledge, attitude, and practice of postexposure prophylaxis (PEP) among HCWs in a tertiary health institution in Sokoto, Northwestern Nigeria.Methodology:The study was carried out at Usmanu Danfodiyo University Teaching Hospital, Sokoto, through a cross-sectional descriptive study design; a total of 156 participants were recruited using a stratified sampling technique. Data were collected using a semi-structured, self-administered questionnaire and analyzed using SPSS computer software after obtaining ethical clearance from the Health Ethics and Research Committee of the teaching hospital.Results:A total of 87.2% (136) of the respondents had heard of PEP and 71.8% (112) thought that HIV/AIDs could be prevented through PEP. A total of 71.2% (111) had good knowledge about PEP, whereas 86.8% (118) had a positive attitude toward PEP.Conclusion:Although the study demonstrated high knowledge and positive attitude toward PEP, the observance of safety measures against needlestick injuries that could result in HIV infections was abysmally low. There is the need to create more awareness and strengthen the use of PEP protocol by all cadres of health workers as this will go a long way in minimizing blood-borne infections.

Task-shifting impact of introducing a pilot community health worker cadre into Zambia's public sector health workforce.

BackgroundThe Zambia Ministry of Health (MOH) recruited and trained a new cadre of Community Health Assistants (CHAs) as part of its National Community Health Strategy. The inaugural class of 307 CHAs completed one year of training in July 2012 and deployed to their communities.MethodsThe impact of the CHA program on the volume and type of health services provided at health posts and their respective referral health centers was measured with a non-randomized difference-in-differences design. Monthly health service provision data was collected for 12 months before and after CHA deployment at 8 health posts along with 8 referral health centers. The analysis controlled for seasonality, changes in non-CHA staffing, and periodic regional child health campaigns, and used facility-level fixed effects.ResultsDeploying two CHAs to a health post did not lead to a statistically-discernible increase in services at the intervention facilities. Health services provided at referral health centers increased by 697.9 services per month (95% CI: 131.4 to 1,264.3, p = .016), and combined services (at health posts and referral health centers) increased by 848.6 services per month (95% CI: 178.2 to 1,519.1, p = .013).ConclusionIn this pilot, the addition of CHAs in rural areas increased health service provision at referral health facilities and at facilities overall, shifting the burden of basic health services away from more highly trained health workers. Shifting tasks to lesser-trained, less-expensive cadres like the CHAs, policymakers can rapidly improve access to care with constrained budgets. Evaluations measuring the direct impact of lower level cadres without accounting for task-shifting may underestimate their contribution to the health workforce.

Measuring inequalities in the distribution of the Fiji Health Workforce

BackgroundDespite the centrality of health personnel to the health of the population, the planning, production and management of human resources for health remains underdeveloped in many low- and middle-income countries (LMICs). In addition to the general shortage of health workers, there are significant inequalities in the distribution of health workers within LMICs. This is especially true for countries like Fiji, which face major challenges in distributing its health workforce across many inhabited islands.MethodsIn this study, we describe and measure health worker distributional inequalities in Fiji, using data from the 2007 Population Census, and Ministry of Health records of crude death rates and health workforce personnel. We adopt methods from the economics literature including the Lorenz Curve/Gini Coefficient and Theil Index to measure the extent and drivers of inequality in the distribution of health workers at the sub-national level in Fiji for three categories of health workers: doctors, nurses, and all health workers (doctors, nurses, dentists and health support staff). Population size and crude death rates are used as proxies for health care needs.ResultsThere are greater inequalities in the densities of health workers at the provincial level, compared to the divisional level in Fiji – six of the 15 provinces fall short of the recommended threshold of 2.3 health workers per 1,000 people. The estimated decile ratios, Gini co-efficient and Thiel index point to inequalities at the provincial level in Fiji, mainly with respect to the distribution of doctors; however these inequalities are relatively small.ConclusionWhile populations with lower mortality tend to have a slightly greater share of health workers, the overall distribution of health workers on the basis of need is more equitable in Fiji than for many other LMICs. The overall shortage of health workers could be addressed by creating new cadres of health workers; employing increasing numbers of foreign doctors, including specialists; and increasing funding for health worker training, as already demonstrated by the Fiji government. Close monitoring of the equitable distribution of additional health workers in the future is critical.

An exploration of facilitators and challenges in the scale-up of a national, public sector community health worker cadre in Zambia: a qualitative study

BackgroundIn 2010 a public sector cadre of community health workers called Community Health Assistants (CHAs) was created in Zambia through the National Community Health Worker Strategy to expand access to health services. This cadre continues to be scaled up to meet the growing demands of Zambia’s rural population. We summarize factors that have facilitated the scale-up of the CHA program into a nationwide CHW cadre and the challenges of introducing and institutionalizing the cadre within the Zambian health system.MethodsSemi-structured, individual interviews were held across 5 districts with 16 CHAs and 6 CHA supervisors, and 10 focus group discussions were held with 93 community members. Audio recordings of interviews and focus group discussions were transcribed and thematically coded using Dedoose web-based software.ResultsThe study showed that the CHAs play a critical role in providing a wide range of services at the community level, as described by supervisors and community members. Some challenges still remain, that may inhibit the CHAs ability to provide health services effectively. In particular, the respondents highlighted infrequent supervision, lack of medical and non-medical supplies for outreach services, and challenges with the mobile data reporting system.ConclusionsThe study shows that in order to optimize the impact of CHAs or other community health workers, key health-system support structures need to be functioning effectively, such as supervision, community surveillance systems, supplies, and reporting. The Ministry of Health with support from partners are currently addressing these challenges through nationwide supervisor and community data trainings, as well as advocating for adding primary health care as a specific focus area in the new National Health Strategy Plan 2017–2021. This study contributes to the evidence base on the introduction of formalized community health worker cadres in developing countries.

A qualitative and quantitative performance evaluation of Swaziland’s Rural Health Motivator program

Background: Community health workers (CHWs) are increasingly used to increase access to primary healthcare, and considered to be a key health worker cadre to achieve the UNAIDS 90-90-90 target. Despite the recent policy interest in effectively designing, implementing, and evaluating new CHW programs, there is limited evidence on how long-standing CHW programs are performing. Using the CHW Performance Logic model as an evaluation framework, this study aims to assess the performance of Swaziland’s long-standing national CHW program, called the rural health motivator (RHM) program. Methods: This study was carried out in the Manzini and Lubombo regions of Swaziland. We conducted a survey of 2,000 households selected through two-stage cluster random sampling and a survey among a stratified simple random sample of 306 RHMs. Additionally, semi-structured qualitative interviews were conducted with 25 RHMs. Results: While RHMs are instructed to visit every household assigned to them at least once a month, only 15.7% (95% CI: 11.4 – 20.4%) of RHMs self-reported to be meeting this target. Less than half (46.3%; 95% CI: 43.4 – 49.6%) of household survey respondents, who reported to have ever been visited by a RHM, rated their overall satisfaction with RHM services as eight or more points on a 10-point scale (ranging from “very dissatisfied” to “very satisfied”). A theme arising from the qualitative interviews was that community members only rarely seek care from RHMs, with care-seeking tending to be constrained to emergency situations. Conclusions: The RHM program does not meet some of its key performance objectives. Two opportunities to improve RHM performance identified by the evaluation were increasing RHM's stipend and improving the supply of equipment and material resources needed by RHMs to carry out their tasks.

A New Cadre of Health Worker: Meeting Health Organization Capacity Needs in East and Southern Africa and the United States via a leadership Development Fellowship program

A New Cadre of Health Worker: Meeting Health Organization Capacity Needs in East and Southern Africa and the United States via a leadership Development Fellowship program

Unpredictability dictates quality of maternal and newborn care provision in rural Tanzania-A qualitative study of health workers\u2019 perspectives

BackgroundHealth workers are the key to realising the potential of improved quality of care for mothers and newborns in the weak health systems of Sub Saharan Africa. Their perspectives are fundamental to understand the effectiveness of existing improvement programs and to identify ways to strengthen future initiatives. The objective of this study was therefore to examine health worker perspectives of the conditions for maternal and newborn care provision and their perceptions of what constitutes good quality of care in rural Tanzanian health facilities.MethodsIn February 2014, we conducted 17 in-depth interviews with different cadres of health workers providing maternal and newborn care in 14 rural health facilities in Tandahimba district, south-eastern Tanzania. These facilities included one district hospital, three health centres and ten dispensaries. Interviews were conducted in Swahili, transcribed verbatim and translated into English. A grounded theory approach was used to guide the analysis, the output of which was one core category, four main categories and several sub-categories.Results‘It is like rain’ was identified as the core category, delineating unpredictability as the common denominator for all aspects of maternal and newborn care provision. It implies that conditions such as mothers’ access to and utilisation of health care are unreliable; that availability of resources is uncertain and that health workers have to help and try to balance the situation. Quality of care was perceived to vary as a consequence of these conditions. Health workers stressed the importance of predictability, of ‘things going as intended’, as a sign of good quality care.ConclusionsUnpredictability emerged as a fundamental condition for maternal and newborn care provision, an important determinant and characteristic of quality in this study. We believe that this finding is also relevant for other areas of care in the same setting and may be an important defining factor of a weak health system. Increasing predictability within health services, and focusing on the experience of health workers within these, should be prioritised in order to achieve better quality of care for mothers and newborns.

Impact of a critical health workforce shortage on child health in Zimbabwe: a country case study on progress in child survival, 2000-2013.

Despite notable progress reducing global under-five mortality rates, insufficient progress in most sub-Saharan African nations has prevented the achievement of Millennium Development Goal four (MDG#4) to reduce under-five mortality by two-thirds between 1990 and 2015. Country-level assessments of factors underlying why some African countries have not been able to achieve MDG#4 have not been published. Zimbabwe was included in a four-country study examining barriers and facilitators of under-five survival between 2000 and 2013 due to its comparatively slow progress towards MDG#4. A review of national health policy and strategy documents and analysis of qualitative data identified Zimbabwe’s critical shortage of health workers and diminished opportunities for professional training and education as an overarching challenge. Moreover, this insufficient health workforce severely limited the availability, quality, and utilization of life-saving health services for pregnant women and children during the study period. The impact of these challenges was most evident in Zimbabwe’s persistently high neonatal mortality rate, and was likely compounded by policy gaps failing to authorize midwives to deliver life-saving interventions and to ensure health staff make home post-natal care visits soon after birth. Similarly, the lack of a national policy authorizing lower-level cadres of health workers to provide community-based treatment of pneumonia contributed to low coverage of this effective intervention and high child mortality. Zimbabwe has recently begun to address these challenges through comprehensive policies and strategies targeting improved recruitment and retention of experienced senior providers and by shifting responsibility of basic maternal, neonatal and child health services to lower-level cadres and community health workers that require less training, are geographically broadly distributed, and are more cost-effective, however the impact of these interventions could not be assessed within the scope and timeframe of the current study.

Training Midwives and Other Cadre of Health Workers Using a Solar-Charged Device in Ethiopia.

Dear Editor, Ensuring the wellbeing of pregnant women and providing them with appropriate care and support for a good outcome has been acknowledged as one of the most important public health priorities of the health sector.[1,2] Even though a wide range of potential risk factors can result in maternal deaths, it has been identified that provision of skilled care during and after the birth of the child can save the lives of thousands of women and newborn child.[1,2] However, considering the shortage of primary care physicians or obstetricians in the rural settings, midwives and nursing staff have been identified as potential candidates for the delivery of essential care during childbirths.[1] At the same time, these midwives have been assigned the task of offering antenatal care, creating awareness among members of the community regarding the services offered in health facilities, motivate women for institutional delivery, and referring women to higher centers for management of high‑ risk women.[1,3]

The inescapable question of fairness in Pay-for-performance bonus distribution: a qualitative study of health workers' experiences in Tanzania.

BackgroundDuring the last decade there has been a growing concern about the lack of results in the health sectors of many low income countries. Progress has been particularly slow in maternal- and child health. Prompted by the need to accelerate progress towards these health outcomes, pay-for- performance (P4P) schemes have been initiated in a number of countries. This paper explores the perceptions and experiences of health workers with P4P bonus distribution in the health system context of rural Tanzania.MethodsThis qualitative study was based on the P4P pilot in Pwani Region of Tanzania. The study took place in 11 health care facilities in Rufiji District. The study informants and participants were different cadres of health workers assigned to different outpatient and inpatient departments at the health facilities, and local administrators of the P4P bonus distribution. Thirty two in-depth interviews (IDIs) with administrators and health care workers, and six focus group discussions (FGDs with Reproductive and Child Health (RCH) staff, non-RCH staff and non-medical staff were conducted. Collected data was analyzed through qualitative content analysis.ResultsThe study found that the bonus distribution modality employed in the P4P programme was experienced as fundamentally unjust. The bonuses were calculated according to the centrality of the health worker position in meeting targeted indicators, drawn from the reproductive and child health (RCH) section. Both RCH staff and non-RCH perceived the P4P bonus as unfair. Non-RCH objected to getting less bonus than RCH staff, and RCH staff running the targeted RCH services, objected to not getting more P4P bonus. Non-RCH staff and health administrators suggested a flat-rate across board as the fairest way of distributing P4P bonuses. The perceived unfairness affected work motivation, undermined teamwork across departments and created tensions in the social relations at health facilities.ConclusionOur results suggest that the experience of unfairness in the way bonuses are distributed and administered at the health facility level undermines the legitimacy of the P4P scheme. More importantly, long term tensions and conflicts at the workplace may impact negatively on the quality of care which P4P was intended to improve. We argue that fairness is a critical factor to the success of a P4P scheme and that particular attention should be paid to aspects of workplace justice in the design of P4P bonus structures.

Regulatory mechanisms for absenteeism in the health sector: a systematic review of strategies and their implementation.

BackgroundA systematic review was undertaken to identify regulatory mechanisms aimed at mitigating health care worker absenteeism, to describe where and how they have been implemented as well as their possible effects. The goal was to propose potential policy options for managing the problem of absenteeism among human resources for health in low- and middle-income countries. Mechanisms described in this review are at the local workplace and broader national policy level.MethodsA comprehensive online search was conducted on EMBASE, CINAHL, PubMed, Google Scholar, Google, and Social Science Citation Index using MEDLINE search terms. Retrieved studies were uploaded onto reference manager and screened by two independent reviewers. Only publications in English were included. Data were extracted and synthesized according to the objectives of the review.ResultsTwenty six of the 4,975 published articles retrieved were included. All were from high-income countries and covered all cadres of health workers. The regulatory mechanisms and possible effects include 1) organizational-level mechanisms being reported as effective in curbing absenteeism in low- and middle-income countries (LMICs); 2) prohibition of private sector activities in LMICs offering benefits but presenting a challenge for the government to monitor the health workforce; 3) contractual changes from temporary to fixed posts having been associated with no reduction in absenteeism and not being appropriate for LMICs; 4) multifaceted work interventions being implemented in most settings; 5) the possibility of using financial and incentive regulatory mechanisms in LMICs; 6) health intervention mechanisms reducing absenteeism when integrated with exercise programs; and 7) attendance by legislation during emergencies being criticized for violating human rights in the United States and not being effective in curbing absenteeism.ConclusionMost countries have applied multiple strategies to mitigate health care worker absenteeism. The success of these interventions is heavily influenced by the context within which they are applied.

Performance-based incentives may be appropriate to address challenges to delivery of prevention of vertical transmission of HIV services in rural Mozambique: a qualitative investigation.

BackgroundPerformance-based incentives (PBIs) have garnered global attention as a promising strategy to improve healthcare delivery to vulnerable populations. However, literature gaps in the context in which an intervention is implemented and how the PBIs were developed exist. Therefore, we (1) characterized the barriers and promoters to prevention of vertical transmission of HIV (PVT) service delivery in rural Mozambique, where the vertical transmission rate is 12 %, and (2) assessed the appropriateness for a PBI’s intervention and application to PVT.MethodsWe conducted 24 semi-structured interviews with nurses, volunteers, community health workers, and traditional birth attendants about the barriers and promoters they experienced delivering PVT services. We then explored emergent themes in subsequent focus group discussions (n = 7, total participants N = 92) and elicited participant perspectives on PBIs. The ecological motivation-opportunity-ability framework guided our iterative data collection and thematic analysis processes.ResultsThe interviews revealed that while all health worker cadres were motivated intrinsically and by social recognition, they were dissatisfied with low and late remuneration. Facility-based staff were challenged by factors across the rest of the ecological levels, primarily in the opportunity domain, including the following: poor referral and record systems (work mandate), high workload, stock-outs, poor infrastructure (facility environment), and delays in obtaining patient results and donor payment discrepancies (administrative). Community-based cadres’ opportunity challenges included lack of supplies, distance (work environment), lack of incorporation into the health system (administration), and ability challenges of incorrect knowledge (health worker). PBIs based on social recognition and that enable action on intrinsic motivation through training, supervision, and collaboration were thought to have the most potential for targeting improvements in record and referral systems and better integrating community-based health workers into the health system. Concerns about the implementation of incentives included neglect of non-incentivized tasks and distorted motivation among colleagues.ConclusionsWe found that highly motivated health workers encountered severe opportunity challenges in their PVT mandate. PBIs have the potential to address key barriers that facility- and community-based health workers encounter when delivering PVT services, specifically by building upon existing intrinsic motivation and leveraging highly valued social recognition. We recommend a controlled intervention to monitor incentives’ effects on worker motivation and non-incentivized tasks to generate insights about the feasibility of PBIs to improve the delivery of PVT services.Electronic supplementary materialThe online version of this article (doi:10.1186/s12960-016-0157-0) contains supplementary material, which is available to authorized users.

Faktor Dominan Lansia Aktif Mengikuti Kegiatan Posyandu di Dusun Ngentak

<p>Posyandu elderly aims to monitor the elderly condition in particular area because the body condition and aging process. But not all were able to actively follow the elderly Posyandu activities by various factors. The purpose of this study was to identify the factors related to the activity of the elderly following the Posyandu activities. This study was quantitative, using cross sectional design. From 155 respondents, 75 samples was obtained by purpossive sampling technique. Data were analyzed using chi-square test and logistic regression. Chi-square test result in this study indicate the variables that have a relationship with liveliness elderly family support variable (p=0.001), service cadres (p=0.000) and service of health workers (p=0.000). While that does not have a relationship with the activity of the elderly is a variable job (p=0.570) as well as distance and access (p=1.000). The result showed that cadre services was most dominant relationship with the liveliness of the elderly. In conclusion, the factors that have a relationship with the activity of the elderly following the Posyandu activities are support families, services and service cadres of health workers. This study sugest, cadres should be more active to disseminate information concerning the elderly and increase the number of cadres Posyandu.</p>

Job preferences among clinical officers in public sector facilities in rural Kenya: a discrete choice experiment.

BackgroundClinical officers (COs), a mid-level cadre of health worker, are the backbone of healthcare provision in rural Kenya. However, the vacancy rate for COs in rural primary healthcare facilities is high. Little is known about factors motivating COs’ preferences for rural postings.MethodsA discrete choice experiment (DCE) questionnaire was used with 57 COs at public health facilities in nine districts of Nyanza Province, Kenya. The questionnaire was developed on the basis of formative qualitative interviews with COs (n = 5) and examined how five selected job attributes influenced COs’ preferences for working in rural areas. Conditional logit models were employed to examine the relative importance of different job attributes.ResultsAnalysis of the qualitative data revealed five important job attributes influencing COs’ preferences: quality of the facility, educational opportunities, housing, monthly salary and promotion. Analysis of the DCE indicated that a 1-year guaranteed study leave after 3 years of service would have the greatest impact on retention, followed by good quality health facility infrastructure and equipment and a 30% salary increase. Sub-group analysis shows that younger COs demonstrated a significantly stronger preference for study leave than older COs. Female COs placed significantly higher value on promotion than male COs.ConclusionsAlthough both financial incentives and non-financial incentives were effective in motivating COs to stay in post, the study leave intervention was shown to have the strongest impact on COs’ retention in our study. Further research is required to examine appropriate interventions at each career stage that might boost COs’ professional identity and status but without leading to larger deficits in the availability of generalist COs.

Health worker migration from South Africa: causes, consequences and policy responses.

BackgroundThis paper arises from a four-country study that sought to better understand the drivers of skilled health worker migration, its consequences, and the strategies countries have employed to mitigate negative impacts. The four countries—Jamaica, India, the Philippines, and South Africa—have historically been “sources” of skilled health workers (SHWs) migrating to other countries. This paper presents the findings from South Africa.MethodsThe study began with a scoping review of the literature on health worker migration from South Africa, followed by empirical data collected from skilled health workers and stakeholders. Surveys were conducted with physicians, nurses, pharmacists, and dentists. Interviews were conducted with key informants representing educators, regulators, national and local governments, private and public sector health facilities, recruitment agencies, and professional associations and councils. Survey data were analyzed using descriptive statistics and regression models. Interview data were analyzed thematically.ResultsThere has been an overall decrease in out-migration of skilled health workers from South Africa since the early 2000s largely attributed to a reduced need for foreign-trained skilled health workers in destination countries, limitations on recruitment, and tighter migration rules. Low levels of worker satisfaction persist, although the Occupation Specific Dispensation (OSD) policy (2007), which increased wages for health workers, has been described as critical in retaining South African nurses. Return migration was reportedly a common occurrence. The consequences attributed to SHW migration are mixed, but shortages appear to have declined. Most promising initiatives are those designed to reinforce the South African health system and undertaken within South Africa itself.ConclusionsIn the near past, South Africa’s health worker shortages as a result of emigration were viewed as significant and harmful. Currently, domestic policies to improve health care and the health workforce including innovations such as new skilled health worker cadres and OSD policies appear to have served to decrease SHW shortages to some extent. Decreased global demand for health workers and indications that South African SHWs primarily use migratory routes for professional development suggest that health worker shortages as a result of permanent migration no longer pertains to South Africa.

Does intensified case finding increase tuberculosis case notification among children in resource-poor settings? A report from Nigeria

Objective/BackgroundTuberculosis (TB) is a major cause of morbidity and mortality in developing countries. Passive case detection in national TB programmes is associated with low case notification, especially in children. This study was undertaken to improve detection of childhood TB in resource-poor settings through intensified case-finding strategies. MethodsA community-based intervention was carried out in six states in Nigeria. The creation of TB awareness was undertaken, and work aids, guidelines, and diagnostic charts were produced, distributed, and used. Various cadres of health workers and ad hoc project staff were trained. Child contacts with TB patients were screened in their homes, and children presenting at various hospital units were screened for TB. Baseline and intervention data were collected for evaluation populations and control populations. ResultsDetection of childhood TB increased in the evaluation population during the intervention, with a mean quarterly increase of 4.0% [new smear positive (NSP), although the increasing trend was not statistically significant (χ2=1.8; p<.179)]. Additionally, there was a mean quarterly increase of 3% for all forms of TB, although the trend was not statistically significant (χ2=1.48; p<.224). Conversely, there was a decrease in case notification in the control population, with a mean decline of 3% (all forms). Compared to the baseline, there was an increase of 31% (all forms) and 22% (NSP) in the evaluation population. ConclusionIntensified case finding combined with capacity building, provision of work aids/guidelines, and TB health education can improve childhood-TB notification.

Integrated community case management in Malawi: an analysis of innovation and institutional characteristics for policy adoption.

In 2007, Malawi became an early adopter of integrated community case management for childhood illnesses (iCCM), a policy aimed at community-level treatment for malaria, diarrhoea and pneumonia for children below 5 years. Through a retrospective case study, this article explores critical issues in implementation that arose during policy formulation through the lens of the innovation (i.e. iCCM) and of the institutions involved in the policy process. Data analysis is founded on a documentary review and 21 in-depth stakeholder interviews across institutions in Malawi. Findings indicate that the characteristics of iCCM made it a suitable policy to address persistent challenges in child mortality, namely that ill children were not interacting with health workers on a timely basis and consequently were dying in their communities. Further, iCCM was compatible with the Malawian health system due to the ability to build on an existing community health worker cadre of health surveillance assistants (HSAs) and previous experiences with treatment provision at the community level. In terms of institutions, the Ministry of Health (MoH) demonstrated leadership in the overall policy process despite early challenges of co-ordination within the MoH. WHO, United Nations Children's Fund (UNICEF) and implementing organizations played a supportive role in their position as knowledge brokers. Greater challenges were faced in the organizational capacity of the MoH. Regulatory issues around HSA training as well as concerns around supervision and overburdening of HSAs were discussed, though not fully addressed during policy development. Similarly, the financial sustainability of iCCM, including the mechanisms for channelling funding flows, also remains an unresolved issue. This analysis highlights the role of implementation questions during policy development. Despite several outstanding concerns, the compatibility between iCCM as a policy alternative and the local context laid the foundation for Malawi's road to early adoption of iCCM.

Integrated community case management for childhood illnesses: explaining policy resistance in Kenya: Table 1.

There has been a re-emphasis recently on community health workers to provide child health care services including integrated community case management for childhood illness (iCCM). This research analysed iCCM policy development in Kenya and in particular the types of decision-making criteria used by Kenyan policy-makers in considering whether to advance iCCM policy. Data were collected through document reviews (n = 41) and semi-structured interviews (n = 19) with key stakeholders in iCCM policy including government officials, development partners, bilateral donors, and civil society organizations. Initial analysis was guided by the policy triangle with further analysis of factors affecting policy decision-making drawing upon a simple framework developed by Grindle and Thomas (Policy makers, policy choices and policy outcomes: the political economy of reform in developing countries. 1989; Policy Sci 22: :213-48.). Policy development for iCCM has been slow in Kenya, compared with other Sub-Saharan African countries. At the time of the study, the Government had just completed the Community Health Training Manual which incorporated iCCM as a module, but this was the only formal expression of iCCM in Kenya. We found technical considerations, notably concerns about community health workers dispensing antibiotics to be a key factor slowing iCCM policy development, but this also overlapped with bureaucratic considerations, such as how the development of community health worker cadres may affect clinicians, as well as initial concerns about how an integrated approach might affect vertically oriented programs. International actors through agreements such as the Millennium Development Goals helped to get child survival onto the national policy agenda and such actors were active promoters of iCCM policy change. However international funders had not committed funding to scale-up iCCM policy, and this probably constrained their influence over iCCM policy debate. Kenyan actors' concerns about iCCM underline the importance of adapting global policies to local conditions, and also generating local evidence to inform decision-making.