Global Health: Science and Practice最新文献

{"title":"Process Evaluation of Teaching Critical Thinking About Health Using the Informed Health Choices Intervention in Uganda: A Mixed Methods Study.","authors":"Ronald Ssenyonga, Simon Lewin, Esther Nakyejwe, Faith Chelagat, Michael Mugisha, Matt Oxman, Allen Nsangi, Daniel Semakula, Sarah E Rosenbaum, Jenny Moberg, Andrew D Oxman, Heather Munthe-Kaas, Christine Holst, Margaret Kaseje, Laetitia Nyirazinyoye, Nelson Sewankambo","doi":"10.9745/GHSP-D-23-00484","DOIUrl":"10.9745/GHSP-D-23-00484","url":null,"abstract":"<p><strong>Introduction: </strong>We designed the Informed Health Choices (IHC) secondary school intervention and evaluated whether it improves students' ability to assess the trustworthiness of claims about treatment effects in Uganda. We conducted a process evaluation alongside a randomized trial to identify factors that may affect the implementation, fidelity, and scaling up of the intervention in Uganda. We also explored the potential adverse and beneficial effects of the intervention.</p><p><strong>Methods: </strong>We used mixed methods to collect, triangulate, and report data from a variety of sources. We observed at least 1 lesson in all 40 intervention schools. One teacher from each of these schools completed a teacher training evaluation form and lesson evaluation questionnaires after each lesson. We purposively selected 10 schools where we conducted a total of 10 focus group discussions with students and 1 with parents. We also conducted key informant interviews with policymakers (N=9), teachers (N=10), head teachers (N=4), and parents (N=3). We used a framework analysis approach to analyze the data.</p><p><strong>Findings: </strong>All participants in the process evaluation felt that the IHC intervention was needed, important, and timely. Students were motivated to attend class and learn the content because it spoke to their daily life experiences and their own challenges to decide what to do or believe when faced with health claims. The training workshop gave teachers the confidence to teach the lessons. The participating students demonstrated a clear understanding of the content and use of what was learned. The content improved both students' and teachers' appreciation of the critical thinking, communication, and problem-solving competencies in the lower secondary school curriculum.</p><p><strong>Conclusion: </strong>The findings of this process evaluation are consistent with the findings of the trial, which showed that the intervention improved the students' critical thinking skills. The IHC resources enabled teachers to teach this competency.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":"12 6","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Health Information System Interventions on Maternal and Child Health Service Utilizations in Ethiopia: A Quasi-Experimental Study.","authors":"Abebaw Gebeyehu Worku, Wubshet Denboba Midekssa, Hibret Alemu Tilahun, Hiwot Tadesse Belay, Zeleke Abebaw, Afrah Mohammedsanni, Naod Wendrad, Mesoud Mohammed, Shemsedin Omer Mohammed, Amanuel Biru, Benti Ejeta Futassa","doi":"10.9745/GHSP-D-24-00145","DOIUrl":"10.9745/GHSP-D-24-00145","url":null,"abstract":"<p><strong>Background: </strong>Health information systems (HIS) are vital in supporting all aspects of managing health systems, financing, policymaking, and service delivery. A package of priority HIS interventions was piloted in selected woredas across all regions in Ethiopia. This study examined the impact of HIS interventions on maternal and child health (MCH) service utilization.</p><p><strong>Methods: </strong>A 2-arm quasi-experimental study was implemented in intervention and control woredas. Baseline and endline household and health facility surveys were conducted for both arms in 2020 and 2022, respectively. At baseline, 3,016 mothers and 167 health facilities were surveyed. At endline, 3,076 mothers and 160 health facilities were surveyed. The study used modified Performance of Routine Information System Management tools for the facility survey and a structured questionnaire for the household survey. Difference-in-difference (DID) analysis using mixed effect modeling was employed to measure changes and to account for clustering and control for likely confounders.</p><p><strong>Results: </strong>Intervention sites showed greater improvements in 75% of key HIS performance indicators. The changes in 90% of the MCH service utilization indicators were higher in the intervention sites. Significant (DID: <i>P</i><.05) changes were observed in indicators including quality of antenatal care, skilled birth attendance, delivery at a health facility, family planning met need and unmet need, measles and second dose of rotavirus vaccination, and Vitamin A supplementation. BCG vaccination showed significantly higher improvement in the control sites. Other key indicators did not show significant changes.</p><p><strong>Conclusions: </strong>In many of the MCH service utilization indicators, the changes in the intervention sites were significantly higher compared to the control sites, but it was not universal. Scale-up of performance monitoring teams is crucial because it is one of the key pathways that links HIS performance with MCH service utilization. Outcome indicators that showed no or lower improvement require in-depth investigation.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":"12 6","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Integrated Community Case Management Institutionalization Processes Within National Health Systems in Malawi, Mali, and Rwanda: A Qualitative Study.","authors":"Alyssa L Davis, Erica Felker-Kantor, Jehan Ahmed, Zachariah Jezman, Beh Kamate, John Munthali, Noella Umulisa, Oumar Yattara","doi":"10.9745/GHSP-D-23-00509","DOIUrl":"10.9745/GHSP-D-23-00509","url":null,"abstract":"<p><strong>Introduction: </strong>Since 2012, the World Health Organization (WHO) and UNICEF have recommended integrated Community Case Management (iCCM) of childhood illnesses as an intervention delivered by community health workers (CHWs) in areas with limited access to health facilities to increase access to lifesaving interventions for children younger than 5 years with malaria, pneumonia, or diarrhea. In recent years, the importance of institutionalizing iCCM and community health more broadly within national health systems has become increasingly recognized.</p><p><strong>Methods: </strong>This qualitative study sought to identify and describe processes of iCCM institutionalization from the perspectives of health system actors. A total of 51 semistructured interviews were conducted with purposefully selected key informants in 3 countries: Malawi, Mali, and Rwanda. Thematic analysis of coded interview data was conducted, and country documentation was reviewed to provide contextual background for qualitative interpretation. The study was informed by a newly developed iCCM Institutionalization Framework, which conceptualizes the process of institutionalization through a maturity model of phases (i.e., awareness, experimentation, expansion, consolidation, and maturity) with 4 drivers: core values, leadership, resources, and policy.</p><p><strong>Results: </strong>According to key informant narrative descriptions, processes of iCCM institutionalization reflected a progression of maturity phases, which were iterative rather than linear in progression. All 4 drivers of institutionalization as conceptualized within the iCCM Institutionalization Framework were described by key informants as contributing to the advancement of iCCM institutionalization within their countries. Key informants emphasized the need to continually strengthen or reinforce iCCM institutionalization for it to be sustained within the context of wider health system dynamics.</p><p><strong>Conclusion: </strong>Overall, key informants viewed government ownership and integration within national systems to define the status of iCCM institutionalization. Further development of the iCCM Institutionalization Framework and other practical sensemaking models could assist health system actors in advancing institutionalization of iCCM and other health interventions.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simulation-Based Education of Health Workers in Low- and Middle-Income Countries: A Systematic Review.","authors":"Samuel J A Robinson, Angus M A Ritchie, Maurizio Pacilli, Debra Nestel, Elizabeth McLeod, Ramesh Mark Nataraja","doi":"10.9745/GHSP-D-24-00187","DOIUrl":"10.9745/GHSP-D-24-00187","url":null,"abstract":"<p><strong>Introduction: </strong>Simulation-based education (SBE) is increasingly used to improve clinician competency and patient care and has been identified as a priority by the World Health Organization for low- and middle-income countries (LMICs). The primary aim of this review was to investigate the global distribution and effectiveness of SBE for health workers in LMICs. The secondary aim was to determine the learning focus, simulation modalities, and additional evaluation conducted in included studies.</p><p><strong>Methods: </strong>A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta Analysis guidelines, searching Ovid (Medline, Embase, and Emcare) and the Cochrane Library from January 1, 2002, to March 14, 2022. Primary research studies reporting evaluation at Level 4 of The Kirkpatrick model were included. Studies on simulation-based assessment and validation were excluded. Quality and risk-of-bias assessments were conducted using appropriate tools. Narrative synthesis and descriptive statistics were used to present the results.</p><p><strong>Results: </strong>A total of 97 studies were included. Of these, 54 were in sub-Saharan Africa (56%). Forty-seven studies focused on neonatology (48%), 29 on obstetrics (30%), and 16 on acute care (16%). Forty-nine used mannequins (51%), 46 used scenario-based simulation (47%), and 21 used synthetic part-task trainers (22%), with some studies using more than 1 modality. Sixty studies focused on educational programs (62%), while 37 used SBE as an adjunct to broader interventions and quality improvement initiatives (38%). Most studies that assessed for statistical significance demonstrated at least partial improvement in Level 4 outcomes (75%, n=81).</p><p><strong>Conclusion: </strong>SBE has been widely applied to improve outcomes in a variety of contexts across LMICs. Modalities of simulation are typically low-technology versions. However, there is a lack of standardized reporting of educational activities, particularly relating to essential features of SBE. Further research is required to determine which approaches are effective in specific contexts.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accelerating Progress in Women's Sexual and Reproductive Health and Rights Decision-Making: Trends in 32 Low- and Middle-Income Countries and Future Perspectives.","authors":"Mengjia Liang, Lindsay Katz, Emilie Filmer-Wilson, Priscilla Idele","doi":"10.9745/GHSP-D-24-00228","DOIUrl":"10.9745/GHSP-D-24-00228","url":null,"abstract":"<p><strong>Introduction: </strong>In 1994, the International Conference on Population and Development (ICPD) Programme of Action established the empowerment and autonomy of women as fundamental to achieving sustainable economic and social progress. Three decades later, significant strides have been made in enhancing sexual and reproductive health and rights (SRHR). However, deep-rooted gender inequality continues to impede substantial progress for many. We assess the advancements made under the Sustainable Development Goals, specifically through indicator 5.6.1, which measures women's SRHR decision-making.</p><p><strong>Methods: </strong>Using data from 76 Demographic and Health Surveys and 1 Multiple Indicator Cluster Survey in 32 low- and middle-income countries from 2006 to 2022, the study analyzed trends in women's SRHR decision-making and its subcomponents of autonomy on reproductive health care, contraceptive use, and sexual relations-among married or in-union women aged 15-49 years currently using contraception. The analysis also examined trends in decision-making disparities related to household wealth quintiles, women's education levels, and area of residence, using disaggregated population-weighted percentages.</p><p><strong>Results: </strong>Analysis revealed a generally positive trend in women's SRHR decision-making, with gains observed in Eastern and Southern Africa and notable declines in West and Central Africa. Subindicator disparities showed variations in autonomy across health care, contraception, and the ability to refuse sex. An inequality analysis highlighted that while some countries saw a narrowing wealth gap in decision-making, others faced growing disparities. Educational and urban-rural divides also shifted, reflecting a complex landscape of progress and challenges in improving women's SRHR decision-making.</p><p><strong>Conclusion: </strong>The analysis underscores a patchwork of progress in women's SRHR decision-making while also exposing deep disparities. These data suggest a critical need for interventions tailored to cultural and socioeconomic contexts, particularly in countries and subnational areas lagging behind. Forward-thinking strategies must prioritize enhancing women's reproductive agency, ensuring interventions are informed by community-tailored priorities and global human rights standards.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":"12 6","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maturity Assessment of the Health Information System Using Stages of Continuous Improvement Methodology: Results From Serbia.","authors":"Steve Ollis, Milan Kovačević, Bosiljka Djikanovic, Nikola Radoman, Isidora Smigic, Mamadou Alimou Barry","doi":"10.9745/GHSP-D-24-00083","DOIUrl":"10.9745/GHSP-D-24-00083","url":null,"abstract":"<p><strong>Introduction: </strong>Since the health information system (HIS) in public health care services in Serbia was introduced in 2009, it has gradually expanded. However, it is unclear how well the HIS components have developed and the whole system's stage of maturity.</p><p><strong>Method: </strong>In June-September 2021, a maturity assessment of the Serbian HIS was conducted for the first time using the HIS Stages of Continuous Improvement (SOCI) toolkit. The toolkit measures HIS status across 5 HIS domains: leadership and governance, management and workforce, information and communication technology (ICT), standards and interoperability, and data quality and use. The domains were further divided into 13 components and 39 subcomponents whose maturity stage was assessed on a 5-point Likert scale, indicating the level of development: (1) emerging/ad hoc; (2) repeatable; (3) defined; (4) managed; and (5) optimized. The toolkit was applied in a working group of 32 professionals and experts who were engaged in developing the new national eHealth strategy and action plan.</p><p><strong>Results: </strong>The overall maturity score of the Serbian HIS was 1.6, which indicates a low level. The highest baseline score (2) was given to the standards and interoperability domain, and the lowest (1.1) was given to ICT infrastructure. The remaining 3 domains (leadership and governance, Management and Workforce, and Data Quality and Use) were similarly rated (1.7, 1.7, and 1.6, respectively).</p><p><strong>Conclusion: </strong>A baseline assessment of the maturity level of Serbian HIS indicates that the majority of components are between the emerging/ad hoc stage and repeatable, which represent isolated, ad hoc efforts, with some basic processes in place and existing and accessible policies. This exercise provided an opportunity to address identified weaknesses in the upcoming national eHealth strategy.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11521554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Documenting the Provision of Emergency Contraceptive Pills Through Youth-Serving Delivery Channels: Exploratory Mixed Methods Research on Malawi's Emergency Contraception Strategy.","authors":"Holly M Burke, Philip Mkandawire, Mary Mulombe Phiri, Fannie Kachale, Kristen Little, Caroline Bakasa, Luwiza Puleni, Eden Demise, Paola Letona, Gwyneth Austin, Moses Kumwenda","doi":"10.9745/GHSP-D-24-00076","DOIUrl":"10.9745/GHSP-D-24-00076","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency contraceptive pills (ECPs) are effective and can be used safely at any age repeatedly within the same cycle. They are often favored by youth yet are underutilized. Private facilities can increase ECP access but present barriers including cost. Identifying effective public-sector ECP distribution models can help ensure equitable access. The Malawi Ministry of Health developed a strategy to improve ECP access in 2020. We documented ECP provision through select public, youth-serving channels recommended by the strategy: general and youth-specific outreach, paid and unpaid community health workers (CHWs), and youth clubs.</p><p><strong>Methods: </strong>We conducted this mixed methods study from November 2022-March 2023 in 2 rural districts (Mchinji and Phalombe) implementing the strategy. We conducted qualitative interviews with 10 national stakeholders, 46 providers, and 24 clients aged 15-24 years about ECP service delivery. Additionally, 25 providers collected quantitative tally data about clients seeking ECPs. We analyzed qualitative data using grounded theory and quantitative data descriptively.</p><p><strong>Results: </strong>Stakeholders and providers reported ECP uptake increased in geographies where the strategy was implemented, especially among youth. Providers documented 3,988 client visits for ECPs over 3 months. Of these visits, 26% were from male clients, 36% were from clients aged younger than 20 years, and 64% received ECPs for the first time. Across channels, youth club leaders and unpaid CHWs reported the most client visits per provider and served the youngest clients. However, no ECPs were dispensed during 29% of visits due to stock-outs. While many providers were supportive of youth accessing ECPs, most held unfavorable attitudes toward repeat use.</p><p><strong>Conclusion: </strong>ECP access should be expanded through provision in the studied channels, especially youth clubs and CHWs. However, to meet demand, the supply chain must be strengthened. We recommend addressing providers' attitudes about repeat use to ensure informed method choice.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11521556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antenatal Care Interventions to Increase Contraceptive Use Following Birth in Low- and Middle-Income Countries: Systematic Review and Narrative Synthesis.","authors":"Ona L McCarthy, Nasser Fardousi, Vandana Tripathi, Renae Stafford, Karen Levin, Farhad Khan, Maxine Pepper, Oona M R Campbell","doi":"10.9745/GHSP-D-24-00059","DOIUrl":"10.9745/GHSP-D-24-00059","url":null,"abstract":"<p><strong>Introduction: </strong>Health risks associated with short interpregnancy intervals, coupled with women's desires to avoid pregnancy following childbirth, underscore the need for effective postpartum family planning programs. The antenatal period provides an opportunity to intervene; however, evidence is limited on the effectiveness of interventions aimed at reaching women in the antenatal period to increase voluntary postpartum family planning in low- and middle-income countries (LMICs). This systematic review aimed to identify and describe interventions in LMICs that attempted to increase postpartum contraceptive use via contacts with pregnant women in the antenatal period.</p><p><strong>Methods: </strong>Studies published from January 2012 to July 2022 were considered if they were conducted in LMICs, evaluated an intervention delivered during the antenatal period, were designed to affect postpartum contraceptive use, were experimental or quasi-experimental, and were published in French or English. The main outcome of interest was postpartum contraceptive use within 1 year after birth, defined as the use of any method of contraception at the time of data collection. We searched EMBASE, Global Health, and Medline and manually searched the reference lists from studies included in the full-text screening.</p><p><strong>Results: </strong>We double-screened 771 records and included 34 reports on 31 unique interventions in the review. Twenty-three studies were published from 2018 on, with 21 studies conducted in sub-Saharan Africa. Approximately half of the study designs (n=16) were randomized controlled trials, and half (n=15) were quasi-experimental. Interventions were heterogeneous. Among the 24 studies that reported on the main outcome of interest, 18 reported a positive intervention effect, with intervention recipients having greater contraceptive use in the first year postpartum.</p><p><strong>Conclusion: </strong>While the studies in this systematic review were heterogeneous, the findings suggest that interventions that included a multifaceted package of initiatives appeared to be most likely to have a positive effect.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11521549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delays in Cardiovascular Emergency Responses in Africa: Health System Failures or Cultural Challenges?","authors":"Kofi Tekyi Asamoah, Alfred Doku, Florence Akumiah, Eugene Ampofo, Fiifi Duodu, Francis Agyekum, Mohammed Hafez, Joseph Akamah, Nicholas Ossei-Gerning, James Baligeh Walter Russell, Charles Agyemang","doi":"10.9745/GHSP-D-24-00092","DOIUrl":"10.9745/GHSP-D-24-00092","url":null,"abstract":"","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11521546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Lessons From Working With Local Partners to Expand Private-Sector Health Care Networks in Burundi and Mali.","authors":"Lydia Gahimbare, Nina Shalita, Erin Files Dumas, Mariela Rodríguez, Pierre Moon","doi":"10.9745/GHSP-D-24-00109","DOIUrl":"10.9745/GHSP-D-24-00109","url":null,"abstract":"<p><p>The private health care sector is an important source of service delivery in low- and middle-income countries (LMICs). Yet, the private sector remains fragmented, making it difficult for health system actors to support and ensure the availability of quality health care services. In global health programs, social franchising is one model used to engage and organize the private health care sector. Two social franchise networks, ProFam in West Africa and Tunza in East and Central Africa, provide health care through branded networks of facilities. However, these social franchise networks include a limited number of private health care facilities, and in fragile contexts, like Burundi and Mali, they have faced challenges in integrating with national health systems. The MOMENTUM Private Healthcare Delivery (MPHD) project in Burundi and Mali sought to expand the number of health facilities it engaged beyond the existing ProFam and Tunza networks. The expansion aimed to help improve service quality in more private facilities while advancing localization and reducing fragmentation for improved stewardship by health system actors. MPHD achieved this expansion by removing barriers for private health facilities to join inclusive, nonbranded networks and engaging local partners to build and maintain these networks. We share lessons learned regarding the growing role of local organizations as actors within mixed health systems and provide insights on strengthening stewardship of the increasingly heterogeneous private health care delivery sector in LMICs, particularly in fragile settings.</p>","PeriodicalId":12692,"journal":{"name":"Global Health: Science and Practice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11521560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}