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Tetui, Moses
Publikationer (10 of 23) Visa alla publikationer
Paina, L., Namazzi, G., Tetui, M., Mayora, C., Kananura, R. M., Kiwanuka, S. N., . . . Ekirapa-Kiracho, E. (2019). Applying the model of diffusion of innovations to understand facilitators for the implementation of maternal and neonatal health programmes in rural Uganda. Globalization and Health, 15, Article ID 38.
Öppna denna publikation i ny flik eller fönster >>Applying the model of diffusion of innovations to understand facilitators for the implementation of maternal and neonatal health programmes in rural Uganda
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2019 (Engelska)Ingår i: Globalization and Health, ISSN 1744-8603, E-ISSN 1744-8603, Vol. 15, artikel-id 38Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

In Uganda, more than 336 out of every 100,000 women die annually during childbirth. Pregnant women, particularly in rural areas, often lack the financial resources and means to access health facilities in a timely manner for quality antenatal, delivery, and post-natal services. For nearly the past decade, the Makerere University School of Public Health researchers, through various projects, have been spearheading innovative interventions, embedded in implementation research, to reduce barriers to access to care. In this paper, we describe two of projects that were initially conceived to tackle the financial barriers to access to care - through a voucher program in the community - on the demand side - and a series of health systems strengthening activities at the district and facility level - on the supply side. Over time, the projects diverged in the content of the intervention and the modality in which they were implemented, providing an opportunity for reflection on innovation and scaling up. In this short report, we used an adaptation of Greenhalgh's Model of Diffusion to reflect on these projects' approaches to implementing innovative interventions, with the ultimate goal of reducing maternal and neonatal mortality in rural Uganda. We found that the adapted model of diffusion of innovations facilitated the emergence of insights on barriers and facilitators to the implementation of health systems interventions. Health systems research projects would benefit from analyses beyond the implementation period, in order to better understand how adoption and diffusion happen, or not, over time, after the external catalyst departs.

Ort, förlag, år, upplaga, sidor
BioMed Central, 2019
Nyckelord
Uganda, Innovation, Maternal health, Health systems research, Vouchers, Diffusion
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
urn:nbn:se:umu:diva-161519 (URN)10.1186/s12992-019-0483-9 (DOI)000471604000001 ()31196193 (PubMedID)
Tillgänglig från: 2019-07-11 Skapad: 2019-07-11 Senast uppdaterad: 2019-07-11Bibliografiskt granskad
Sayinzoga, F., Tetui, M., van der Velden, K., van Dillen, J. & Bijlmakers, L. (2019). Understanding variation in health service coverage and maternal health outcomes among districts in Rwanda - A qualitative study of local health workers' perceptions. PLoS ONE, 14(10), Article ID e0223357.
Öppna denna publikation i ny flik eller fönster >>Understanding variation in health service coverage and maternal health outcomes among districts in Rwanda - A qualitative study of local health workers' perceptions
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2019 (Engelska)Ingår i: PLoS ONE, E-ISSN 1932-6203, Vol. 14, nr 10, artikel-id e0223357Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVE: To obtain the perspectives of health professionals and community health workers on factors that determine health service coverage and maternal health outcomes so as to understand variations between districts.

METHODS: 16 Focus group discussions involving four different groups of participants were conducted in May 2015 in four purposively selected districts, complemented by three key informant interviews in one of the districts.

RESULTS: The solidarity support for poor people and the interconnectedness between local leaders and heads of health facilities were identified as enablers of health service utilization. Geographical factors, in particular location close to borders with mobile populations and migrants, and large populations with sparsely distributed health infrastructure, exacerbated by hilly topography and muddy roads were identified as barriers. Shortages of skilled health providers at the level of district hospitals were cited as contributing to poor maternal health outcomes.

CONCLUSION: There is a need to take into account disparities between districts when allocating staff and financial resources in order to achieve universal coverage for high-quality maternal health services and better outcomes. Local innovations such as the use of SMS and WhatsApp text messages by health workers and financial protection schemes for poor patients improve solidarity and are worth to be scaled up.

Ort, förlag, år, upplaga, sidor
Public Library of Science (PLOS), 2019
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
urn:nbn:se:umu:diva-167391 (URN)10.1371/journal.pone.0223357 (DOI)31589635 (PubMedID)
Tillgänglig från: 2020-01-17 Skapad: 2020-01-17 Senast uppdaterad: 2020-01-23Bibliografiskt granskad
Tetui, M., Zulu, J. M., Hurtig, A.-K., Ekirapa-Kiracho, E., Kiwanuka, S. N. & Coe, A.-B. (2018). Elements for harnessing participatory action research to strengthen health managers’ capacity: a critical interpretative synthesis. Health Research Policy and Systems, 16, Article ID 33.
Öppna denna publikation i ny flik eller fönster >>Elements for harnessing participatory action research to strengthen health managers’ capacity: a critical interpretative synthesis
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2018 (Engelska)Ingår i: Health Research Policy and Systems, ISSN 1478-4505, E-ISSN 1478-4505, Vol. 16, artikel-id 33Artikel, forskningsöversikt (Refereegranskat) Published
Abstract [en]

Background: Health managers play a key role in ensuring that health services are responsive to the needs of the population. Participatory action research (PAR) is one of the approaches that have been used to strengthen managers’ capacity. However, collated knowledge on elements for harnessing PAR to strengthen managers’ capacity is missing. This paper bridges this gap by reviewing existing literature on the subject matter.

Methods: A critical interpretive synthesis method was used to interrogate eight selected articles. These articles reported the use of PAR to strengthen health managers’ capacity. The critical interpretive synthesis method’s approach to analysis guided the synthesis. Here, the authors interpretively made connections and linkages between different elements identified in the literature. Finally, the Atun et al. (Heal Pol Plann, 25:104–111, 2010) framework on integration was used to model the elements synthesised in the literature into five main domains.

Results: Five elements with intricate bi-directional interactions were identified in the literature reviewed. These included a shared purpose, skilled facilitation and psychological safety, activity integration into organisational procedures, organisational support, and external supportive monitoring. A shared purpose of the managers’ capacity strengthening initiative created commitment and motivation to learn. This purpose was built upon a set of facilitation skills that included promoting participation, self-efficacy and reflection, thereby creating a safe psychological space within which the managers interacted and learnt from each other and their actions. Additionally, an integrated intervention strengthened local capacity and harnessed organisational support for learning. Finally, supportive monitoring from external partners, such as researchers, ensured quality, building of local capacity and professional safety networks essential for continued learning.

Conclusions: The five elements identified in this synthesis provide a basis upon which the use of PAR can be harnessed, not only to strengthen health managers’ capacity, but also to foster other health systems strengthening initiatives involving implementation research. In addition, the findings demonstrated the intricate and complex relations between the elements, which further affirms the need for a systems thinking approach to tackling health systems challenges.

Ort, förlag, år, upplaga, sidor
BioMed Central, 2018
Nyckelord
Participatory Action Research, factors, harnessing, health managers' capacity, systems thinking, implementation research
Nationell ämneskategori
Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
urn:nbn:se:umu:diva-146830 (URN)10.1186/s12961-018-0306-0 (DOI)29673346 (PubMedID)
Tillgänglig från: 2018-04-19 Skapad: 2018-04-19 Senast uppdaterad: 2018-06-09Bibliografiskt granskad
Tetui, M. (2018). Participatory approaches to strengthening district health managers' capacity: Ugandan and global experiences. (Doctoral dissertation). Umeå: Umeå universitet
Öppna denna publikation i ny flik eller fönster >>Participatory approaches to strengthening district health managers' capacity: Ugandan and global experiences
2018 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Introduction:

Residents of low in-come countries have persistently suffered poor health outcomes, modest progress made over time notwithstanding. Weak health systems are one of the key reasons for the less than optimum progress. These health systems are constrained by inadequately equipped managers who play a main role in curbing this progress. Strengthening the capacity of health managers capacity is one of the known ways to improve the performance of health systems. This study examined strategies for strengthening the capacity of health managers at the sub-national level, with a special focus on the Participatory Action Research (PAR) approach.

Methods:

I used an emergent qualitative design which included both primary data collection and a literature review. Primary data collection techniques included individual interviews, Focus Group Discussions (FGDs), participant observations, and a review of project documents and meeting minutes, while searching for peer-reviewed databases was used for the literature review. Several analytical tools were adopted to answer the objectives, including the grounded theory, content and thematic analysis approaches. The Critical Interpretive Synthesis (CIS) method was used to analyze the literature reviewed.

Findings:

Stakeholders’ perceived the approaches to strengthening health managers’ capacity as an overarching process comprised of three interconnected subprocesses namely: the professionalizing of health managers, the use of engaging approaches to learning, and the availability of a supportive work environment. PAR as an engaging approach to learning was experienced by stakeholders as a nuanced awakening approach. On the one hand, stakeholders felt engaged, valued, responsible, awakened and a sense of ownership. On the other hand, they felt conflicted, stressed and uncertain. The PAR approach enhanced health managers’ capacity to collaborate with others, be creative, attain goals, and review progress. Expanded spaces for interaction, the encouragement of flexibility, the empowerment of local managers and the promotion of reflection and accountability enabled this enhancement. Lastly, the literature reviewed revealed five interrelated elements for harnessing PAR to strengthen health managers capacity. These were: a shared purpose, skilled facilitation and social psychological safety, activity integration into organizational procedures, organizational support and supportive external monitoring.

Conclusions:

Health managers have a central role in strengthening health systems; hence the formalization of their role, especially within the public-sector, is needed. In addition, significant investments into developing and strengthening their capacity is required. Strengthening the capacity of health managers is an iterative process that draws synergies from different approaches. The process leans on formal trainings as well as more engaging means of learning, such as PAR. As an engaging approach to learning, PAR expands interaction spaces, provides inclusiveness and flexibility, promotes local ingenuity and shared responsibility, and allows for monitoring and learning. PAR had positive effects on the strengthening of the capacity of health managers while at the same time achieving other project outcomes. Participatory approaches are hence relevant for dealing with the complex challenges bedevilling health systems. The approach nonetheless should be applied with a more nuanced appreciation of the challenges when using it and the elements for harnessing it to strengthen health systems.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå universitet, 2018. s. 67
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1956
Nyckelord
Participatory Action Research, Qualitative Research, Management, Health Managers, Systems Strengthening, Health Systems, Districts, Uganda
Nationell ämneskategori
Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi
Forskningsämne
folkhälsa
Identifikatorer
urn:nbn:se:umu:diva-146957 (URN)978-91-7601-866-8 (ISBN)
Disputation
2018-05-18, Lärosal N440, Naturvetarhuset, Umeå, 09:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2018-04-27 Skapad: 2018-04-24 Senast uppdaterad: 2018-06-09Bibliografiskt granskad
Ajeani, J., Ayiasi, R. M., Tetui, M., Ekirapa-Kiracho, E., Namazzi, G., Kananura, R. M., . . . Beyeza-Kashesya, J. (2017). A cascade model of mentorship for frontline health workers in rural health facilities in Eastern Uganda: processes, achievements and lessons. Global Health Action, 10, Article ID 1345497.
Öppna denna publikation i ny flik eller fönster >>A cascade model of mentorship for frontline health workers in rural health facilities in Eastern Uganda: processes, achievements and lessons
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2017 (Engelska)Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, artikel-id 1345497Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: There is increasing demand for trainers to shift from traditional didactic training to innovative approaches that are more results-oriented. Mentorship is one such approach that could bridge the clinical knowledge gap among health workers.

Objectives: This paper describes the experiences of an attempt to improve health-worker performance in maternal and newborn health in three rural districts through a mentoring process using the cascade model. The paper further highlights achievements and lessons learnt during implementation of the cascade model.

Methods: The cascade model started with initial training of health workers from three districts of Pallisa, Kibuku and Kamuli from where potential local mentors were selected for further training and mentorship by central mentors. These local mentors then went on to conduct mentorship visits supported by the external mentors. The mentorship process concentrated on partograph use, newborn resuscitation, prevention and management of Post-Partum Haemorrhage (PPH), including active management of third stage of labour, preeclampsia management and management of the sick newborn. Data for this paper was obtained from key informant interviews with district-level managers and local mentors.

Results: Mentorship improved several aspects of health-care delivery, ranging from improved competencies and responsiveness to emergencies and health-worker professionalism. In addition, due to better district leadership for Maternal and Newborn Health (MNH), there were improved supplies/medicine availability, team work and innovative local problem-solving approaches. Health workers were ultimately empowered to perform better.

Conclusions: The study demonstrated that it is possible to improve the competencies of frontline health workers through performance enhancement for MNH services using locally built capacity in clinical mentorship for Emergency Obstetric and Newborn Care (EmONC). The cascade mentoring process needed strong external mentorship support at the start to ensure improved capacity among local mentors to provide mentorship among local district staff.

Ort, förlag, år, upplaga, sidor
Taylor & Francis, 2017
Nyckelord
maternal health, mentorship, newborn, health workers, implementation science
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
urn:nbn:se:umu:diva-144883 (URN)10.1080/16549716.2017.1345497 (DOI)000423214500005 ()28816629 (PubMedID)
Anmärkning

Supplement: 4

Special Issue: MANIFEST (Maternal and Neonatal Implementation for Equitable Systems Study)

Tillgänglig från: 2018-02-19 Skapad: 2018-02-19 Senast uppdaterad: 2018-11-13Bibliografiskt granskad
Tetui, M., Coe, A.-B., Hurtig, A.-K., Bennett, S., Kiwanuka, S. N., George, A. & Kiracho, E. E. (2017). A participatory action research approach to strengthening health managers' capacity at district level in Eastern Uganda. Health Research Policy and Systems, 15, Article ID 110.
Öppna denna publikation i ny flik eller fönster >>A participatory action research approach to strengthening health managers' capacity at district level in Eastern Uganda
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2017 (Engelska)Ingår i: Health Research Policy and Systems, ISSN 1478-4505, E-ISSN 1478-4505, Vol. 15, artikel-id 110Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Many approaches to improving health managers' capacity in poor countries, particularly those pursued by external agencies, employ non-participatory approaches and often seek to circumvent (rather than strengthen) weak public management structures. This limits opportunities for strengthening local health managers' capacity, improving resource utilisation and enhancing service delivery. This study explored the contribution of a participatory action research approach to strengthening health managers' capacity in Eastern Uganda.

Methods: This was a qualitative study that used open-ended key informant interviews, combined with review of meeting minutes and observations to collect data. Both inductive and deductive thematic analysis was undertaken. The Competing Values Framework of organisational management functions guided the deductive process of analysis and the interpretation of the findings. The framework builds on four earlier models of management and regards them as complementary rather than conflicting, and identifies four managers' capacities (collaborate, create, compete and control) by categorising them along two axes, one contrasting flexibility versus control and the other internal versus external organisational focus.

Results: The findings indicate that the participatory action research approach enhanced health managers' capacity to collaborate with others, be creative, attain goals and review progress. The enablers included expanded interaction spaces, encouragement of flexibility, empowerment of local managers, and the promotion of reflection and accountability. Tension and conflict across different management functions was apparent; for example, while there was a need to collaborate, maintaining control over processes was also needed. These tensions meant that managers needed to learn to simultaneously draw upon and use different capacities as reflected by the Competing Values Framework in order to maximise their effectiveness.

Conclusions: Improved health manager capacity is essential if sustained improvements in health outcomes in low-income countries are to be attained. The expansion of interaction spaces, encouragement of flexibility, empowerment of local managers, and the promotion of reflection and accountability were the key means by which participatory action research strengthened health managers' capacity. The participatory approach to implementation therefore created opportunities to strengthen health managers' capacity.

Ort, förlag, år, upplaga, sidor
BioMed Central, 2017
Nyckelord
competing values framework, district health managers, health systems, participatory action research, Uganda
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
urn:nbn:se:umu:diva-143689 (URN)10.1186/s12961-017-0273-x (DOI)000419507300007 ()29297346 (PubMedID)
Anmärkning

Supplement: 2

Tillgänglig från: 2018-01-05 Skapad: 2018-01-05 Senast uppdaterad: 2018-06-09Bibliografiskt granskad
Kananura, R. M., Wamala, R., Ekirapa-Kiracho, E., Tetui, M., Kiwanuka, S. N., Waiswa, P. & Atuhaire, L. K. (2017). A structural equation analysis on the relationship between maternal health services utilization and newborn health outcomes: a cross-sectional study in Eastern Uganda. BMC Pregnancy and Childbirth, 17, Article ID 98.
Öppna denna publikation i ny flik eller fönster >>A structural equation analysis on the relationship between maternal health services utilization and newborn health outcomes: a cross-sectional study in Eastern Uganda
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2017 (Engelska)Ingår i: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 17, artikel-id 98Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Neonatal and maternal health services have a bearing on neonatal mortality. Direct and indirect factors affecting neonatal health outcomes therefore require understanding to enable well-targeted interventions. This study, therefore, assessed the interrelationship between newborn health outcomes and maternal service utilization factors.

Methods: We investigated maternal health utilization factors using health facility delivery and at least four Antenatal Care (ANC) visits; and newborn health outcomes using newborn death and low birth weight (LBW). We used data from a household cross-sectional survey that was conducted in 2015 in Kamuli, Pallisa and Kibuku districts. We interviewed 1946 women who had delivered in the last 12 months. The four interrelated (Endogenous) outcomes were ANC attendance, health facility delivery, newborn death, and LBW. We performed analysis using a structural equation modeling technique.

Results: A history of newborn death (aOR = 12.64, 95% CI 5.31–30.10) and birth of a LBW baby (aOR = 3.51, 95% CI 1.48–8.37) were directly related to increased odds of newborn death. Factors that reduced the odds of LBW as a mediating factor for newborn death were ANC fourth time attendance (aOR = 0.62, 95% CI 0.45–0.85), having post-primary level education (aOR = 0.68, 95% CI 0.46–0.98) compared to none and being gravida three (aOR = 0.49, 95% CI 0.26–0.94) compared to being gravida one. Mother’s age group, 20–24 (aOR = 0.24, 95% CI 0.08–0.75) and 25–29 years (aOR = 0.20, 95% CI 0.05–0.86) compared to 15–19 years was also associated with reduced odds of LBW. Additionally, ANC visits during the first trimester (aOR = 2.04, 95% CI 1.79–2.34), and village health teams (VHTs) visits while pregnant (aOR = 1.14, 95% CI 1.01–1.30) were associated with increased odds of at least four ANC visits, which is a mediating factor for health facility delivery, LBW and newborn death. Surprisingly, newborn death was not significantly different between health facility and community deliveries.

Conclusions: Attending ANC at least four times was a mediating factor for reduced newborn death and low birth weight. Interventions in maternal health and newborn health should focus on factors that increase ANC fourth time attendance and those that reduce LBW especially in resource-limited settings. Targeting women with high-risk pregnancies is also crucial for reducing newborn deaths.

Nyckelord
Interrelationship, Structural equation modeling, Maternal health utilization, Newborn outcomes
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
urn:nbn:se:umu:diva-133744 (URN)10.1186/s12884-017-1289-5 (DOI)000397439500001 ()28347281 (PubMedID)
Tillgänglig från: 2017-05-08 Skapad: 2017-05-08 Senast uppdaterad: 2018-06-09Bibliografiskt granskad
Kiwanuka, S. N., Akulume, M., Tetui, M., Kananura, R. M., Bua, J. & Ekirapa-Kiracho, E. (2017). Balancing the cost of leaving with the cost of living: drivers of long-term retention of health workers: an explorative study in three rural districts in Eastern Uganda. Global Health Action, 10, Article ID 1345494.
Öppna denna publikation i ny flik eller fönster >>Balancing the cost of leaving with the cost of living: drivers of long-term retention of health workers: an explorative study in three rural districts in Eastern Uganda
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2017 (Engelska)Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, artikel-id 1345494Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Health worker retention in rural and underserved areas remains a persisting problem in many low and middle income countries, and this directly affects the quality of health services offered.

Objective: This paper explores the drivers of long-term retention and describes health worker coping mechanisms in rural Uganda.

Methods: A descriptive qualitative study explored the factors that motivated health workers to stay, in three rural districts of Uganda: Kamuli, Pallisa, and Kibuku. In-depth interviews conducted among health workers who have been retained for at least 10 years explored factors motivating the health workers to stay within the district, opportunities, and the benefits of staying.

Results: Twenty-one health workers participated. Ten of them male and 11 female with the age range of 33-51 years. The mean duration of stay among the participants was 13, 15, and 26 years for Kamuli, Kibuku, and Pallisa respectively. Long-term retention was related to personal factors, such as having family ties, community ties, and opportunities to invest. The decentralization policy and pension benefits also kept workers in place. Opportunities for promotion or leadership motivated long stay only if they came with financial benefits. Workload reportedly increased over the years, but staffing and emoluments had not increased. Multiple job, family support, and community support helped health workers cope with the costs of living, and holding a secure pensionable government job was valued more highly than seeking uncertain job opportunities elsewhere.

Conclusion: The interplay between the costs of leaving and the benefit of staying is demonstrated. Family proximity, community ties, job security, and pension enhance staying, while higher costs of living and an unpredictable employment market make leaving risky. Health workers should be able to access investment opportunities in order to cope with inadequate remuneration. Promotions and leadership opportunities only motivate if accompanied by financial benefits.

Ort, förlag, år, upplaga, sidor
Taylor & Francis, 2017
Nyckelord
Human resource management, retention, implementation science, Uganda
Nationell ämneskategori
Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
urn:nbn:se:umu:diva-144881 (URN)10.1080/16549716.2017.1345494 (DOI)000423214500007 ()
Anmärkning

Supplement: 4

Special Issue: MANIFEST (Maternal and Neonatal Implementation for Equitable Systems Study)

Tillgänglig från: 2018-02-21 Skapad: 2018-02-21 Senast uppdaterad: 2018-06-09Bibliografiskt granskad
Mutebi, A., Kananura, R. M., Ekirapa-Kiracho, E., Bua, J., Kiwanuka, S. N., Nammazi, G., . . . Tetui, M. (2017). Characteristics of community savings groups in rural Eastern Uganda: opportunities for improving access to maternal health services. Global Health Action, 10, Article ID 1347363.
Öppna denna publikation i ny flik eller fönster >>Characteristics of community savings groups in rural Eastern Uganda: opportunities for improving access to maternal health services
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2017 (Engelska)Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, artikel-id 1347363Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Rural populations in Uganda have limited access to formal financial Institutions, but a growing majority belong to saving groups. These saving groups could have the potential to improve household income and access to health services.

Objective: To understand organizational characteristics, benefits and challenges, of savings groups in rural Uganda.

Methods: This was a cross-sectional descriptive study that employed both quantitative and qualitative data collection techniques. Data on the characteristics of community-based savings groups (CBSGs) were collected from 247 CBSG leaders in the districts of Kamuli, Kibukuand Pallisa using self-administered open-ended questionnaires. To triangulate the findings, we conducted in-depth interviews with seven CBSG leaders. Descriptive quantitative and content analysis for qualitative data was undertaken respectively.

Results: Almost a quarter of the savings groups had 5-14 members and slightly more than half of the saving groups had 15-30 members. Ninety-three percent of the CBSGs indicated electing their management committees democratically to select the group leaders and held meetings at least once a week. Eighty-nine percent of the CBSGs had used metallic boxes to keep their money, while 10% of the CBSGs kept their money using mobile money and banks, respectively. The main reasons for the formation of CBSGs were to increase household income, developing the community and saving for emergencies. The most common challenges associated with CBSG management included high illiteracy (35%) among the leaders, irregular attendance of meetings (22%), and lack of training on management and leadership (19%). The qualitative findings agreed with the quantitative findings and served to triangulate the main results.

Conclusions: Saving groups in Uganda have the basic required structures; however, challenges exist in relation to training and management of the groups and their assets. The government and development partners should work together to provide technical support to the groups.

Ort, förlag, år, upplaga, sidor
Taylor & Francis, 2017
Nyckelord
community-based savings groups, composition and management, implementation science, health insurance
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi
Identifikatorer
urn:nbn:se:umu:diva-144873 (URN)10.1080/16549716.2017.1347363 (DOI)000423214500009 ()28856988 (PubMedID)
Anmärkning

Supplement: 4

Special Issue: MANIFEST (Maternal and Neonatal Implementation for Equitable Systems Study)

Tillgänglig från: 2018-02-21 Skapad: 2018-02-21 Senast uppdaterad: 2018-06-09Bibliografiskt granskad
Kananura, R. M., Tetui, M., Bua, J., Ekirapa-Kiracho, E., Mutebi, A., Namazzi, G., . . . Waiswa, P. (2017). Effect of a participatory multisectoral maternal and newborn intervention on birth preparedness and knowledge of maternal and newborn danger signs among women in Eastern Uganda: a quasi-experiment study. Global Health Action, 10, Article ID 1362826.
Öppna denna publikation i ny flik eller fönster >>Effect of a participatory multisectoral maternal and newborn intervention on birth preparedness and knowledge of maternal and newborn danger signs among women in Eastern Uganda: a quasi-experiment study
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2017 (Engelska)Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, artikel-id 1362826Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Knowledge of obstetric danger signs and adequate birth preparedness (BP) are critical for improving maternal services utilization.

Objectives: This study assessed the effect of a participatory multi-sectoral maternal and newborn intervention on BP and knowledge of obstetric danger signs among women in Eastern Uganda.

Methods: The Maternal and Neonatal Implementation for Equitable Systems (MANIFEST) study was implemented in three districts from 2013 to 2015 using a quasi-experimental pre-post comparison design. Data were collected from women who delivered in the last 12 months. Difference-in-differences (DiD) and generalized linear modelling analysis were used to assess the effect of the intervention on BP practices and knowledge of obstetric danger signs.

Results: The overall BP practices increased after the intervention (DiD = 5, p < 0.05). The increase was significant in both intervention and comparison areas (7-39% vs. 7-36%, respectively), with a slightly higher increase in the intervention area. Individual savings, group savings, and identification of a transporter increased in both intervention and comparison area (7-69% vs. 10-64%, 0-11% vs. 0-5%, and 9-14% vs. 9-13%, respectively). The intervention significantly increased the knowledge of at least three obstetric danger signs (DiD = 31%) and knowledge of at least two newborn danger signs (DiD = 21%). Having knowledge of at least three BP components and attending community dialogue meetings increased the odds of BP practices and obstetric danger signs' knowledge, respectively. Village health teams' home visits, intervention area residence, and being in the 25+ age group increased the odds of both BP practices and obstetric danger signs' knowledge.

Conclusions: The intervention resulted in a modest increase in BP practices and knowledge of obstetric danger signs. Multiple strategies targeting women, in particular the adolescent group, are needed to promote behavior change for improved BP and knowledge of obstetric danger signs.

Ort, förlag, år, upplaga, sidor
Taylor & Francis, 2017
Nyckelord
birth preparedness, implementation science, maternal obstetric danger signs, quasi-experimental study, Uganda
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
urn:nbn:se:umu:diva-144880 (URN)10.1080/16549716.2017.1362826 (DOI)000423214500004 ()
Anmärkning

Supplement: 4

Special Issue: MANIFEST (Maternal and Neonatal Implementation for Equitable Systems Study)

Tillgänglig från: 2018-02-21 Skapad: 2018-02-21 Senast uppdaterad: 2018-06-09Bibliografiskt granskad
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