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- PublicationA systematic review and narrative synthesis of the experiences of caring for older people living with dementia in sub-Saharan AfricaThe broad review question will be: What are the experiences of caring for older people with dementia in sub-Saharan Africa (SSA)?
- PublicationAssessing the demand for community health workers’ social support: a qualitative perspective of mothers in rural Rwanda(Amref Health Africa, 2018-07-25)Introduction: better utilization of community health workers (CHWs) is considered a key strategy that can improve access to health care services in low resource settings. Community acceptance of the supports that CHWs provide is important to enable CHWs deliver their services and for these services to have long-term benefits. The objective of this study was to examine mothers’ perceptions and demand for CHWs services in two rural districts in Rwanda. Methods: this was a qualitative study and data were collected using 6 focus group interviews. The groups comprised a total of 64 mothers aged 19-42 years who had delivered within the last year preceding the study. Thematic analysis of the group interviews resulted in three major themes related to social support a) informational b) emotional and c) tangible support. Results: informational support (advice on nutrition, antenatal care, delivery care) was by far the most valued support by mothers. Mothers expressed a need for more emotional support from CHWs (for example counselling partners about pregnancy and childbirth) and tangible support (helping mothers to solve practical problems). Conclusion: mothers attach great value to CHWs services but gaps in types of services provided were noted. The findings point to the multiple roles that CHWs may have to play to meet the demands of community members. More studies on the interactions of CHWs with mothers, in particular longitudinal studies are needed to improve the understanding and planning of CHWs interventions.
- PublicationDoes the sun hold the key to improving the lives and well-being of a growing older population in rural Africa?Globally the number of older people is rising. In Africa the number of people over 60 years is expected to increase from just under 50 million to nearly 200 million by 2050 1. Generally the number of older persons is growing faster in urban areas than in rural areas 1 however, a large share of the elderly reside in rural areas, where support and services are more difficult to find 2. Many older people across sub-Saharan Africa (SSA) live in chronic and profound poverty. Increasingly, older people also live alone or are disconnected from their families who may have moved into the cities or even abroad 3. Despite the changing demographics of Africa, the older population has largely remained invisible in international development initiatives and related health policy discourses. As a result, SSA is lagging in investment and development of infrastructure and support programs to meet the needs of their ageing citizens. Preparing for an ageing population is vital to achieving the goals of poverty eradication, good health, gender equality, economic growth and decent work, reduction of inequalities and creation of sustainable cities as set out in Agenda 2030 for sustainable development 4.
- PublicationWhat Encourages Community Health Workers (CHWs) to Use Mobile Technologies for Health Interventions? Emerging Lessons from Rural Rwanda(Wiley, 2018-01)This paper explores the determinants of the utilisation of mobile phone technologies for public health (mHealth) through a June 2014 fieldwork among community health workers (CHWs) in rural Rwanda. Using a socio-technical approach, user, program and technical characteristics were tested and deemed influential in determining use. It focused on 72 CHWs in two districts in Southern Rwanda who were using the mHealth tool, RapidSMS. While not purporting to be a comprehensive evaluation of Rwanda¿s RapidSMS project, it makes three contributions to our understanding of mHealth: First, a combination of user centric approach and the socio-technical systems theory affords this study the ability to identify the multiplicity of factors most likely to impact CHWs use of RapidSMS. Second, the study identifies possible factors contributing to the relative success of RapidSMS in rural Rwanda and third, it identifies gaps that ought to be addressed in future mHealth research. This study reports the findings of those factors that were deemed most interesting, novel, counterintuitive- and least well established in the literature. Technical characteristics (reminders and alerts) were by far the strongest predicting factors of use. The user characteristic, age, had no apparent influence on utilization while supports though training and supervision (program characteristics) revealed mixed findings. These findings illustrate the uniqueness of each context and reiterate the need to consider social and technical factors when implementing mHealth projects.
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- PublicationThe Impact of Supportive Supervision on the Implementation of HRM processes; A Mixed-Methods study in TanzaniaBackground: Supportive supervision is a key determinant of service quality and provider performance, and is particularly pertinent to low-resources settings where supervisors are pivotal to the performance of health workers. To strengthen the human resource management (HRM) function at district and health facility level we implemented the Support, Train and Empower Managers (STEM) project to increase the capacity of managers to support and supervise their staff in Tanzania. Methods: This study used a mixed-methods design, utilising data from health facilities to assess changes in practice and employing focus group discussions to explore perceptions of supervisors 12 months following implementation of STEM in three regions of Tanzania. The present study focused on the perceptions of supervisors on the implementation of supportive HRM processes and how these influenced the supervision practice. Results: The most notable behavioural change attributed to STEM was the introduction of systemic record keeping systems, including staff files and job descriptions. The systems led to an improved work environment and improved communication between health providers and supervisors. In-turn this eased the supervision process and saved on time spent supervising staff. Introduction of registers to monitor staff movement into and out of the facility reduced unexplained absences while availability of clear job descriptions led to more efficient use of HR. Conclusion: Supportive supervision can promote implementation of HRM policies leading to an enabling environment for management to support staff, thereby improving staff morale and retention. Lessons learned from STEM can be incorporated in rolling out such an intervention in other settings and can also enhance our knowledge about developing supportive supervision interventions.
- Publication“To stop #FGM it is important to involve the owners of the tradition aka men”: An Exploratory Analysis of Social Media Discussions on Female Genital MutilationFemale genital mutilation (FGM) remains a significant public health challenge and affects the lives of a million girls and women. Advocacy by men and their involvement in fighting the practice may influence the intention to have it performed; however, men often lack the opportunities and support to voice their stand. Increasingly, social media platforms are becoming effective and culturally relevant communication channels to engage ‘hard-to-reach’ populations on sensitive topics. This study explored the views on the involvement of men in discussions about FGM on Twitter. Data were obtained from Twitter-based activity for February 5th and 6th 2017 to coincide with the International Day of Zero Tolerance for FGM using the search terms ‘FGM and Men’. Thematic data analysis was conducted using a data- driven inductive approach and resulted in four main themes a) Prevailing attitudes of FGM b) Support for FGM c) FGM is an issue for men and d) Strategies to effect change. Our study suggests that men can play a role in the continuation of FGM but can also rally the abandonment of the practice. However, men were considered disengaged from the issue as most consider FGM a woman’s issue. The need to empower men through health literacy was deemed particularly influential in creating awareness and ultimately change. Young men may, in certain contexts, be important agents of change and male musicians or sportsmen may particularly be influential in effecting change. Our findings demonstrate that increased use and involvement of ‘hard to reach’ populations with social media can offer a window into real-time ongoing discussions of sensitive topics like FGM. Exploring the use of social media platforms and the content of the discussions among these populations can offer valuable insights of their perspectives on where change is needed in terms of designing effective interventions.