African Health Initiative

Publications

A Mobile Phone-Based, Community Health Worker Program for Referral, Follow-up, and Service Outreach in Rural Zambia: Outcomes and Overview

Schnuttner L, Sindano N, Theis M. et al. Telemedicine and e-Health; DOI:10.1089/tmj.2013.0240

As part of a primary care improvement project, a pilot community health worker (CHW) program was developed using a mobile phone-based application to expand health services in rural Zambia. In the field, using a mobile phone to send data and receive follow-up requests, CHWs conducted household health surveillance visits, referred individuals to the clinic and followed up clinic patients. Mobile health (m-health) has the potential to improve service outreach, guide activities and facilitate data collection in Zambia. Components of this pilot project may aid clinical care in rural settings and have potential for epidemiologic and health system applications.

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Universal combination antiretroviral regimens to prevent mother-to-child HIV transmission in rural Zambia: a two-round cross-sectional study

Chi BH, Musonda P, Lembalemba MK, et al. Bulletin of the World Health Organization 2014

Combination antiretroviral regimens were offered to pregnant and breastfeeding, HIV-infected women at four rural health facilities in the Kafue District of Zambia. Twenty-four month HIV-free survival among children born to HIV-infected mothers was determined before and after prevention of mother-to-child HIV transmission (PMTCT) program implementation using community surveys. The PMTCT program was associated with an increased HIV-free survival in children born to HIV-infected mothers. Increased investment at the pilot sites probably also contributed to the observed improvements in health by increasing both the supply of and demand for PMTCT services.

 

Application of balanced scorecard in the evaluation of a complex health system intervention: 12 months post intervention findings from the BHOMA intervention: A cluster randomised trial in Zambia

Mutale W, Stringer J, Chintu, N, et al. PLoS ONE 2014;9(4):e93977.

In many low income countries, the delivery of quality health services is hampered by health system-wide barriers which are often interlinked, however empirical evidence on how to assess the level and scope of these barriers is scarce. A balanced scorecard is a tool for wider analysis of domains that are deemed important in achieving overall vision of the health system. Presented here are the quantitative results of the 12 months follow-up study applying the balanced scorecard approach in the BHOMA intervention with the aim of demonstrating the utility of the balanced scorecard in evaluationg multiple building blocks in a trial setting.

 

Protocol-driven primary care and community linkages to improve population health in rural Zambia: the Better Health Outcomes through Mentoring and Assessment (BHOMA) project

Stringer JSA, Chisembele-Taylor A, Chibwesha CJ, et al. BMC Health Services Research 2013;13(Suppl 2):S7.

Zambia's under-resourced public health system will not be able to deliver on its health-related Millennium Development Goals without a substantial acceleration in mortality reduction. Reducing mortality will depend not only upon increasing access to health care but also upon improving the quality of care that is delivered. Our project proposes to improve the quality of clinical care and to improve utilization of that care, through a targeted quality improvement (QI) intervention delivered at the facility and community level. The patient-provider interaction is an important interface where the community and the health system meet.

 

Measuring health system strengthening: application of the balanced scorecard approach to rank the baseline performance of three rural districts in Zambia

Mutale W, Godfrey-Fausset P, Mwanamwenge MT, et al. PLoS ONE 2013;8(3):e58650.

There is growing interest in health system performance and recently WHO launched a report on health systems strengthening emphasizing the need for close monitoring using system-wide approaches. One recent method for monitoring performance of interventions is the balanced scorecard system. The balanced scorecard, adopted from the private business approach, is made up of domains and indicators derived from the strategic vision of an organization aimed at measuring its performance. The idea is that a scorecard provides information on areas of strategic importance to guide future planning, but also serves as a snapshot of how well an organization or system is performing. This paper applies the concept of balanced scorecard to describe the baseline status of three intervention districts in Zambia.

 

Measuring health workers' motivation in rural health facilities: baseline results from three study districts in Zambia

Mutale W, Ayles H, Bond V, Mwanamwenge MT, Balabanova D. Human Resources for Health 2013,11:8.

Health worker motivation can potentially affect the provision of health services. Low morale among the workforce can undermine the quality of service provision and drive workers away from the profession. While the presence of high-quality, motivated staff is a key aspect of health system performance, it is also one of the most difficult factors to measure. We assessed health worker motivation as part of the baseline assessment for a health system strengthening intervention in three rural districts in Zambia. The intervention [Better Health Outcomes through Mentoring and Assessment (BHOMA)] aims to increase health worker motivation through training, mentoring and support. Results showed variation in motivation score by sex, type of health worker, training and time in post.