Health systems research

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    Enhanced health systems to improve uptake of early infant diagnosis among post-partum women in primary health care in Malawi (EEHS study)
    (Kamuzu University of Health Sciences, 2022-06-06) Kapesa, Leticia
    Type of the study: This is an embedded mixed-method, with a before and after design. Consultative workshop with stakeholders will inform an intervention, that will be evaluated for its effectiveness and acceptability, combining quantitative and qualitative data collection and analysis.Problem statement: In many African countries, low utilisation of health services after birth contributes to significant gaps in HIV testing for HIV-exposed infants (HEIs). Several integrated initiatives to improve early infant diagnosis (EID) have emerged. However, implementation of evidence-based practices may not always be achieved. In our formative assessment of implementation of EID services in Blantyre in 2019, various factors contributed to low uptake of EID services, including inability to identify HEIs and limited testing capacity of the point-of-care machine. Strengthening the health system, is likey to address factors that influence retention in health care and improve uptake of EID services. Overall objective: This study aims to evaluate the effectiveness and acceptability of an enhanced health system strategy (EEHS) among post-partum women and health care workers in primary health care in Blantyre, Malawi.Specific objectives: The study will have the following specific objectives: 1) To refine EEHS intervention with stakeholders in Blantyre District. 2) To assess the change in proportion of HEIs enrolled in HIV care clinics at birth, and tested at 6 weeks before and after introducing EEHs strategy. 3) To evaluate how well the EEHS package intervention will be delivered as intended. 4) To evaluate the acceptability of the EEHs strategy among health care workers (HCWs) and women with HEIs. Methodology: We will conduct the study in two primary health facilities in Blantyre District, Zingwangwa and Madziabango argeting women with HEIs and (HCWs) who provide EID services. Sampling will be done purposively for the interviews with HCWs, conveniently for women with HEIs and HCWs' observations. The eligibility criteria for HCWs will include: training or orientation in EEHs intervention and involvement in its implementation. For women with HEIs at birth and at 6 weeks of age, they can not have maternal complications, or sick children, and must be at least 18 years old All HEIs will have their data extracted by taking photographs without identifiers that will be backed up by entering data into tablets to validate routinely collected data because we anticipate data quality issues that was also observed during the formative study. Structured observations will be conducted to assess if HCWs are implementing the EEHs intervention as intended. Semistructured interviews will be conducted with HCWs and women with HEIs to assess the acceptability of the intervention. Quantitative data will be analysed and managed using the Pearson chisquare test and we will use R software to compare the proportions of enrolment and HIV testing before and after the EEHs intervention. N-Vivo will be used to manage qualitative data. A locked cabinet at the Malawi Liverpool Welcome programme(MLW) offices, will store the hard copies of study data, and electronic data will be stored on password-protected computers. Participants will be asked to give written informed consent by signing or using a thumbprint if illiterate. Ethics approval will be obtained from the College of Medicine(CoM) Research and Ethics Committee (COMREC) and Liverpool School of Tropical Medicine (LSTM). The study will not assess the cost-effectiveness of the intervention. However, this study will provide practical guidance on stakeholders engagement to guide the understanding of the system and context to develop appropriate interventions,The results cannot be generalized to all EID facilities in Malawi, which calls for further research. Expected findings and dissemination: The study will co-design a context appropriate intervention that will be assessed for its effectiveness and acceptability. The study findings will be made available to the LSTMREC, COMREC and to both study sites The results will be presented at conferences and published through mamanuscripts.
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    Impact of the budget process on the performance of public health programs: A balanced scorecard assessment of Thyolo District Health Office in Malawi
    (Kamuzu University of Health Sciences, 2022-06-06) Chibowa, Henry Jr
    This is a retrospective descriptive case study. The problem Implementation of the Decentralisation Policy in Malawi has delegated a lot of responsibility and funds for public health programs to the District Health Office (DHO). To produce the performance the country has envisioned. there is need to develop ways to ensure districts effectively utilise these resources. There exist several management tools for managing organisational performance. Of these tools, the budget is the only management tool that can directly link an organisation’s funding utilisation with its performance. Studying the budgeting practices of organisations and how they affect performance thus provides valuable insights into how organisations can use this tool to optimise their performance. Indeed, studies in private for-profit companies have demonstrated relationships between the three budget processes of negotiation, approval, and implementation, with organisational performance. However, very few such studies have been done in the public sector, let alone in the public health sector in developing countries. As such, it is imperative to study how the budgeting practices affect the performance of public health programs. Study Objectives The main objective of the study is to assess the effect of the budget process on the performance of public health programs at Thyolo District Health Office. in the 2020/2021 financial year. The specific objectives are the following: • To assess the effect of budget negotiation on public health program performance at Thyolo District Health Office. in the 2020/2021 financial year. • To assess examine the effect of budget approval on public health program performance at Thyolo District Health Office in the 2020/2021 financial year. • To assess examine the effect of budget implementation on public health program performance at Thyolo District Health Office. in the 2020/2021 financial year. Methodology This is a retrospective descriptive case study. It will be carried out at Thyolo DHO. The study population comprises the 20 distinct public health programs that DHOs are currently mandated to manage in the decentralised era. Convenience sampling has been used to select 16 programs to be studied. These have been chosen because it is the reports of these programs that are readily available in the District Health Management Information System (DHIS2). Program performance data will be collected from the DHIS2 system using forms. Data on budget processes will be obtained through interviews with the respective District Program Coordinators using a structured questionnaire. The data will be analysed with SPSS. To make inferences, regression analysis with Pearson’s correlation coefficients will be used to determine the significance of the relationship between the budget processes (independent variables) and the performance of public health programs(dependent variable) at Thyolo DHO. Judgement of significance will be made at 95% level (p<0.5). Expected Findings It is expected that the study will demonstrate the nature of the relationship between budget processes and the performance of public health programs at Thyolo DHO. This knowledge will provide insight into what best practices DHOs can employ to use the available funds effectively. Dissemination The results will be disseminated to Thyolo DHO, the Ministry of Health, the Ministry of Local Government, the College of Medicine Research Ethics Committee (COMREC), and the wider scientific community. Dissemination will be through meetings, sharing of research report and publication of findings in a journal.
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    Primary Health care sevices for older people with progressive multimorbidity. Lessons from Malawi
    (2022-06-15) Kwaitana, Duncan
    The type of research study: This is a primary care health services research study. The study will employ a cross sectional mixed methods design. The problem: Older people living in Malawi are faced with challenges to effectively access and utilize primary healthcare services due to several factors that have not been adequately documented. Keeping primary healthcare services available and accessible to this patient population especially for those living with multiple serious illnesses is therefore vital in promoting quality of life thereby preventing unnecessary deaths. The Objectives: Broad Objective  To explore primary healthcare service delivery and utilization for the older patients with progressive multi-morbidity in Malawi. Specific Objectives 1. To analyze provision of primary healthcare services in the older population with progressive morbid conditions in LMIC including Malawi. 2. To assess experiences for the utilization of primary healthcare services by the older patients living with progressive multi-morbidity. 3. To characterize nature of progressive co-morbidities for the older patients receiving primary healthcare services. Methodology: A Systematic Review (SR) will be conducted first to help give an understanding of how primary healthcare services are provided to the older patients living with progressive multi-morbidity in Malawi including some Low and Middle Income Countries (LMIC). This will be followed by In-Depth interviews with prospective participants (older 15-Jun-2022 Date: 16 May 2022 version: 1.1 Page | 12 patients and caregiver dyads and healthcare workers) and completion of data collection tools using medical records. Data collection will be done at respective health facilities (study sites) including Mangochi District Hospital, Kamuzu Central Hospital and Mzimba District Hospital. Expected Findings and their dissemination: Using the Andersen-Newman framework for health services utilization, the study is expected to unearth series of factors i.e. predisposing, enabling and need factors that influence utilization of health services by the older patients living with multi-morbidity. Findings will be presented to the respective participating health facilities across the country. Additionally, both local and international scientific conferences will be targeted for dissemination including publication in peer reviewed journals. Copies of findings will be shared with College of Medicine Research and Ethics Committee (COMREC and College of Medicine Library for wider dissemination.