Umeå University's logo

umu.sePublications
EnglishSvenskaNorsk
Change search
Refine search result
1 - 8 of 8
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 1.
    Chavula, Malizgani Paul
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. School of Public Health, Department of Health Promo‑ tion and Policy Management, University of Zambia, Ridgeway Campus, Lusaka, Zambia.
    Zulu, Joseph Mumba
    School of Public Health, Department of Health Promo‑ tion and Policy Management, University of Zambia, Ridgeway Campus, Lusaka, Zambia.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Factors influencing the integration of comprehensive sexuality education into educational systems in low- and middle-income countries: a systematic review2022In: Reproductive Health, E-ISSN 1742-4755, Vol. 19, no 1, article id 196Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: Comprehensive sexuality education (CSE) plays a critical role in promoting youth and adolescent's sexual and reproductive health and wellbeing. However, little is known about the enablers and barriers affecting the integration of CSE into educational programmes. The aim of this review is to explore positive and negative factors influencing the integration of CSE into national curricula and educational systems in low- and middle-income countries.

    METHODS: We conducted a systematic literature review (January 2010 to August 2022). The results accord with the Preferred Reporting Items for Systematic Reviews and Meta-analysis standards for systematic reviews. Data were retrieved from the PubMed, Cochrane, Google Scholar, and Web of Hinari databases. The search yielded 442 publications, of which 34 met the inclusion criteria for full-text screening. The review is guided by an established conceptual framework that incorporates the integration of health innovations into health systems. Data were analysed using a thematic synthesis approach.

    RESULTS: The magnitude of the problem is evidenced by sexual and reproductive health challenges such as high teenage pregnancies, early marriages, and sexually transmitted infections. Awareness of these challenges can facilitate the development of interventions and the implementation and integration of CSE. Reported aspects of the interventions include core CSE content, delivery methods, training materials and resources, and various teacher-training factors. Reasons for adoption include perceived benefits of CSE, experiences and characteristics of both teachers and learners, and religious, social and cultural factors. Broad system characteristics include strengthening links between schools and health facilities, school and community-based collaboration, coordination of CSE implementation, and the monitoring and evaluation of CSE. Ultimately, the availability of resources, national policies and laws, international agendas, and political commitment will impact upon the extent and level of integration.

    CONCLUSION: Social, economic, cultural, political, legal, and financial contextual factors influence the implementation and integration of CSE into national curricula and educational systems. Stakeholder collaboration and involvement in the design and appropriateness of interventions is critical.

    Download full text (pdf)
    fulltext
    Publisher's full text
  • 2.
    chilambe, Kunda
    et al.
    Department of Health Policy and Education, School of Public Health, University of Zambia, Lusaka, Zambia.
    Mulubwa, Chama
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Health Policy and Education, School of Public Health, University of Zambia, Lusaka, Zambia.
    Zulu, Joseph Mumba
    Department of Health Policy and Education, School of Public Health, University of Zambia, Lusaka, Zambia.
    Malizgani, Chavula Paul
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Health Policy and Education, School of Public Health, University of Zambia, Lusaka, Zambia.
    Experiences of teachers and community-based health workers in addressing adolescents’ sexual reproductive health and rights problems in rural health systems: a case of the RISE project in Zambia2023In: BMC Public Health, E-ISSN 1471-2458, Vol. 23, no 1, article id 335Article in journal (Refereed)
    Abstract [en]

    Background: Adolescents in low-and-middle-income countries like Zambia face a high burden of sexual, reproductive, health and rights problems including coerced sex, teenage pregnancies, and early marriages. The Zambia government through Ministry of Education has integrated comprehensive sexuality education (CSE) in the education and school system to contribute towards addressing Adolescents sexual, reproductive, health and rights (ASRHR) problems. This paper sought to explore teachers and community based health workers (CBHWs)’ experiences in addressing ASRHR problems in in rural health systems in Zambia.

    Methodology: The study was conducted under Research Initiative to Support the Empowerment of Girls (RISE) community randomized trial that aims to measure the effectiveness of economic and community interventions in reducing early marriages, teenage pregnancies, and school dropout in Zambia. We conducted qualitative 21 in-depth interviews with teachers and CBHWs involved in the implementation of CSE in communities. Thematic analysis was used to analyse teachers and CBHWs´ roles, challenges, and opportunities in promoting ASRHR services.

    Results: The study identified teachers and CBHWs roles, and challenges experienced in promoting ASRHR and suggested strategies to enhance delivery of the intervention. The role of teachers and CBHWs in addressing ASRHR problems included mobilizing and sensitizing the community for meetings, providing SRHR counseling services to both adolescents and guardians, and strengthening referral to SRHR services if needed. The challenges experienced included stigmatization associated with difficult experiences such as sexual abuse and pregnancy, shyness among girls to participate when discussing SRHR in the presence of the boys and myths about contraception. The suggested strategies for addressing the challenges included creating safe spaces for adolescents to discuss SRHR issues and engaging adolescents in coming up with the solution.

    Conclusion: This study provides significant insight on the important roles that teachers CBHWs can play in addressing adolescents SRHR related problems. Overall, the study emphasizes the need to fully engage adolescents in addressing adolescents SRHR problems.

    Download full text (pdf)
    fulltext
    Publisher's full text
  • 3.
    Malizgani, Chavula Paul
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia.
    Matenga, Tulani Francis L.
    Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia.
    Maritim, Patricia
    Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia; Yakini Health Research Institute, Lusaka, Zambia.
    Munakampe, Margarate N.
    Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia; Yakini Health Research Institute, Lusaka, Zambia.
    Habib, Batuli
    Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia.
    Liusha, Namakando
    Ministry of Health, Kitwe Teaching Hospital, P.O. Box 20969, Off Kumboka Drive, Kitwe, Zambia.
    Banda, Jeremiah
    Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia.
    Sinyangwe, Ntazana N.
    Department of Environmental Health, School of Public Health, University of Zambia, Lusaka, Zambia.
    Halwiindi, Hikabasa
    Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia.
    Mweemba, Chris
    Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia.
    Mubanga, Angel
    Ministry of Health, Ndeke House, P.O. box 30205, Haile Selassie Avenue, Lusaka, Zambia.
    Kaonga, Patrick
    Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia.
    Chewe, Mwimba
    Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia.
    Phiri, Henry
    Ministry of Health, Ndeke House, P.O. box 30205, Haile Selassie Avenue, Lusaka, Zambia.
    Zulu, Joseph Mumba
    Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia; Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia.
    Collaboration for implementation of decentralisation policy of multi drug-resistant tuberculosis services in Zambia2024In: Health Research Policy and Systems, E-ISSN 1478-4505, Vol. 22, no 1, article id 112Article in journal (Refereed)
    Abstract [en]

    Background: Multi-drug-resistant tuberculosis (MDR-TB) infections are a public health concern. Since 2017, the Ministry of Health (MoH) in Zambia, in collaboration with its partners, has been implementing decentralised MDR-TB services to address the limited community access to treatment. This study sought to explore the role of collaboration in the implementation of decentralised multi drug-resistant tuberculosis services in Zambia.

    Methods: A qualitative case study design was conducted in selected provinces in Zambia using in-depth and key informant interviews as data collection methods. We conducted a total of 112 interviews involving 18 healthcare workers, 17 community health workers, 32 patients and 21 caregivers in healthcare facilities located in 10 selected districts. Additionally, 24 key informant interviews were conducted with healthcare workers managers at facility, district, provincial, and national-levels. Thematic analysis was employed guided by the Integrative Framework for Collaborative Governance.

    Findings: The principled engagement was shaped by the global health agenda/summit meeting influence on the decentralisation of TB, engagement of stakeholders to initiate decentralisation, a supportive policy environment for the decentralisation process and guidelines and quarterly clinical expert committee meetings. The factors that influenced the shared motivation for the introduction of MDR-TB decentralisation included actors having a common understanding, limited access to health facilities and emergency transport services, a shared understanding of challenges in providing optimal patient monitoring and review and their appreciation of the value of evidence-based decision-making in the implementation of MDR- TB decentralisation. The capacity for joint action strategies included MoH initiating strategic partnerships in enhancing MDR-TB decentralisation, the role of leadership in organising training of healthcare workers and of multidisciplinary teams, inadequate coordination, supervision and monitoring of laboratory services and joint action in health infrastructural rehabilitation.

    Conclusions: Principled engagement facilitated the involvement of various stakeholders, the dissemination of relevant policies and guidelines and regular quarterly meetings of clinical expert committees to ensure ongoing support and guidance. A shared motivation among actors was underpinned by a common understanding of the barriers faced while implementing decentralisation efforts. The capacity for joint action was demonstrated through several key strategies, however, challenges such as inadequate coordination, supervision and monitoring of laboratory services, as well as the need for collaborative efforts in health infrastructural rehabilitation were observed. Overall, collaboration has facilitated the creation of a more responsive and comprehensive TB care system, addressing the critical needs of patients and improving health outcomes.

    Download full text (pdf)
    fulltext
    Publisher's full text
  • 4.
    Malizgani, Chavula Paul
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia.
    Silumbwe, Adam
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Health Policy and Management, School of Public Health, University of Zambia, P.O Box 50110, Lusaka, Cell, Zambia.
    Munakampe, Margarate Nzala
    Department of Health Policy and Management, School of Public Health, University of Zambia, P.O Box 50110, Lusaka, Cell, Zambia.
    Zulu, Joseph Mumba
    Department of Health Policy and Management, School of Public Health, University of Zambia, P.O Box 50110, Lusaka, Cell, Zambia.
    Zulu, Wanga
    Department of Public Health, National TB and Leprosy programme, Ministry of Health, Lusaka, Zambia.
    Michelo, Charles
    Strategic Centre for Health Systems Metrics (SCHEME), Global Health Institute, Nkwazi Research University, PO Box 50650, Lusaka, Zambia.
    Mulubwa, Chama
    Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia.
    Halting and re-issuing of the Zambia community health strategy (2017–2021): a retrospective analysis of the policy process and implications for community health systems2024In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 24, article id 971Article in journal (Refereed)
    Abstract [en]

    Background: Over the years, low-and middle-income countries have adopted several policy initiatives to strengthen community health systems as means to attain Universal Health Coverage (UHC). In this regard, Zambia passed a Community Health Strategy in 2017 that was later halted in 2019. This paper explores the processes that led to the halting and re-issuing of this strategy with the view of drawing lessons to inform the development of such strategies in Zambia and other similar settings.

    Methods: We employed a qualitative case study comprising 20 semi-structured interviews with key stakeholders who had participated in either the development, halting, or re-issuing of the two strategies, respectively. These stakeholders represented the Ministry of Health, cooperating partners and other non-government organizations. Inductive thematic analysis approach was used for analysis.

    Results: The major reasons for halting and re-issuing the community health strategy included the need to realign it with the national development framework such as the 7th National Development Plan, lack of policy ownership, political influence, and the need to streamline the coordination of community health interventions. The policy process inadequately addressed the key tenets of community health systems such as complexity, adaptation, resilience and engagement of community actors resulting in shortcomings in the policy content. Furthermore, the short implementation period, lack of dedicated staff, and inadequate engagement of stakeholders from other sectors threatened the sustainability of the re-issued strategy.

    Conclusion: This study underscores the complexity of community health systems and highlights the challenges these complexities pose to health policymaking efforts. Countries that embark on health policymaking for community health systems must reflect on issues such as persistent fragmentation, which threaten the policy development process. It is crucial to ensure that these complexities are considered within similar policy engagement processes.

    Download full text (pdf)
    fulltext
    Publisher's full text
  • 5.
    Malizgani, Chavula Paul
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Health Policy Management, Promotion and Education, School of Public Health, The University of Zambia, Lusaka, Zambia.
    Zulu, Joseph Mumba
    Department of Health Policy Management, Promotion and Education, School of Public Health, The University of Zambia, Lusaka, Zambia.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Unlocking policy synergies, challenges and contradictions influencing implementation of the Comprehensive Sexuality Education Framework in Zambia: a policy analysis2023In: Health Research Policy and Systems, E-ISSN 1478-4505, Vol. 21, no 1, article id 97Article in journal (Refereed)
    Abstract [en]

    Background: Comprehensive sexuality education (CSE) has recently become salient, but adolescent sexual reproductive health and rights (ASRHR) challenges are still a global health problem. Studying policies which have implications for CSE implementation is a crucial but neglected issue, especially in low and middle-income countries (LMICs) like Zambia. We analyzed policy synergies, challenges and contradictions influencing implementation of CSE framework in Zambia.

    Methods: We conducted a document review and qualitative interviews with key stakeholders from Non-Governmental Organizations, as well as health and education ministries at the National and all (10) provincial headquarters. Our methods allowed us to capture valuable insights into the synergies, challenges and contradictions that exist in promoting CSE framework in Zambia.

    Results: The study highlighted the synergies between policies that create opportunities for implementation of CSE through the policy window for adoption of sexual reproductive health and rights (SRHR) that opened around the 1990s in Zambia, promotion of inclusive development via education, adoption of an integrated approach in dealing with SRHR problems, and criminalization of gender-based violence (GBV). This analysis also identified the policy challenges and contradictions including restricted delivery of education on contraception in schools; defining childhood: dual legal controversies and implications for children, grey zones on the minimum age to access SRHR services; inadequate disability inclusiveness in SRHR legal frameworks; policy silences/contentious topics: LGBTQI + rights, abortion, and grey zones on the minimum age to access SRHR services.

    Conclusion: While many policies support the implementation of CSE in schools, the existence of policy silences and challenges are among the barriers affecting CSE implementation. Thus, policy reformulation is required to address policy silences and challenges to enhance effective promotion and integration of the CSE framework.

    Download full text (pdf)
    fulltext
    Publisher's full text
  • 6.
    Ngoma-Hazemba, Alice
    et al.
    Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia.
    Malizgani, Chavula Paul
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia.
    Sichula, Noah
    Ministry of Health, Ndeke House, PO Box, Haile Selassie Avenue, Lusaka, Zambia.
    Silumbwe, Adam
    Department of Community Education and Lifelong Learning, School of Education, University of Zambia, Box 32379, Lusaka, Zambia; Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia.
    Mweemba, Oliver
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Mweemba, Mable
    Department of Health Promotion, School of Public Health, University of Zambia, Lusaka, Zambia.
    Simpungwe, Matildah Kakungu
    Department of Health Promotion, School of Public Health, University of Zambia, Lusaka, Zambia.
    Phiri, Henry
    Ministry of Health, Ndeke House, PO Box, Haile Selassie Avenue, Lusaka, Zambia.
    Kasengele, Chowa Tembo
    Ministry of Health, Ndeke House, PO Box, Haile Selassie Avenue, Lusaka, Zambia.
    Halwiindi, Hikabasa
    Ministry of Health, Ndeke House, PO Box, Haile Selassie Avenue, Lusaka, Zambia.
    Munakampe, Margarate N.
    Department of Community Education and Lifelong Learning, School of Education, University of Zambia, Box 32379, Lusaka, Zambia; Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia.
    Zulu, Joseph Mumba
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia.
    Exploring the barriers, facilitators, and opportunities to enhance uptake of sexual and reproductive health, HIV and GBV services among adolescent girls and young women in Zambia: a qualitative study2024In: BMC Public Health, E-ISSN 1471-2458, Vol. 24, no 1, article id 2191Article in journal (Refereed)
    Abstract [en]

    Introduction: Adolescents and young women in low-middle-income countries face obstacles to accessing HIV, Sexual and Reproductive Health (SRH), and related Gender-Based Violence (GBV) services. This paper presents facilitators, opportunities, and barriers to enhance uptake of HIV, GBV, and SRH services among Adolescent Girls and Young Women (AGYW) in selected districts in Zambia.

    Methods: This study was conducted in Chongwe, Mazabuka, and Mongu Districts among adolescent girls and young women in Zambia. Key informants (n = 29) and in and out-of-school adolescents and young people (n = 25) were interviewed. Purposive sampling was used to select and recruit the study participants. Interviews were transcribed verbatim, and a content analysis approach was used for analysis.

    Results: The facilitators that were used to enhance the uptake of services included having access to health education information on comprehensive adolescent HIV and gender-based violence services. Non-governmental organisations (NGOs) were the main source of this information. The opportunities bordered on the availability of integrated approaches to service delivery and strengthened community and health center linkages with referrals for specialised services. However, the researchers noted some barriers at individual, community, and health system levels. Refusal or delay to seek the services, fear of side effects associated with contraceptives, and long distance to the health facility affected the uptake of services. Social stigma and cultural beliefs also influenced the understanding and use of the available services in the community. Health systems barriers were; inadequate infrastructure, low staffing levels, limited capacity of staff to provide all the services, age and gender of providers, and lack of commodities and specialised services.

    Conclusion: The researchers acknowledge facilitators and opportunities that enhance the uptake of HIV, GBV, and SRH services. However, failure to address barriers at the individual and health systems level always negatively impacts the uptake of known and effective interventions. They propose that programme managers exploit the identified opportunities to enhance uptake of these services for the young population.

    Download full text (pdf)
    fulltext
    Publisher's full text
  • 7.
    Zulu, Joseph Mumba
    et al.
    School of Public Health, University of Zambia, Lusaka, Zambia; Center for Community Health Systems and Implementation Research, Lusaka, Zambia.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Chavula, Malizgani Paul
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. School of Public Health, University of Zambia, Lusaka, Zambia.
    Mulubwa, Chama
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. School of Public Health, University of Zambia, Lusaka, Zambia.
    Michelo, Charles
    School of Public Health, University of Zambia, Lusaka, Zambia.
    Musonda, Patrick
    School of Public Health, University of Zambia, Lusaka, Zambia.
    Matafwali, Beatrice
    School of Education, University of Zambia, Lusaka, Zambia.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    How does integration of comprehensive sexuality education in schools shape sexuality decisions among adolescents in Zambia? A community based participatory research driven realist evaluation study protocol: [¿Cómo influye la integración de la educación sexual integral en las escuelas en las decisiones sobre sexualidad de los adolescentes de Zambia? Un protocolo de estudio de evaluación realista basado en la investigación participativa comunitaria]2024In: Journal of Community Systems for Health, E-ISSN 3035-692X, Vol. 1, no 1Article in journal (Refereed)
    Abstract [en]

    Introduction: Many adolescents in low- and middle-income countries face challenges related to sexual and reproductive health and rights, which are exacerbated by gender inequalities. One approach to address these issues is the integration of Comprehensive Sexuality Education (CSE) in schools. However, the process of effectively implementing CSE in these settings is often suboptimal. There is a significant lack of research exploring the specific conditions and methods that effectively lead to enhanced knowledge and improved decision-making in sexuality and gender equality among adolescents through CSE. This realist evaluation protocol will address this gap by exploring how the nature and pattern through which CSE is provided has a) changed adolescents’ knowledge regarding sexuality and gender relations and b) shaped adolescents’ capacity to make positive decisions.

    Methods: This study uses a multiple-case design, combining realist evaluation with participatory action research methods to explore Comprehensive Sexuality Education (CSE) integration across multiple levels in Eastern province—from provincial to community levels. Data collection will occur in phases, utilizing interviews, photovoice, drawings, reviews, and observations. The study involves several key steps: 1) identifying challenges to CSE integration, 2) creating an initial theory or action plan that explains how CSE promotes positive decisions among adolescents about sexuality, 3) testing this theory through case studies, and 4) refining the theory and formulating recommendations to improve future CSE integration. Additionally, the study will document informal, contextual, and horizontal factors (ICAMO configurations) that influence the integration of CSE at the school level and affect adolescents' understanding and decision-making regarding sexuality and gender relations.

    Discussion: This study will contribute to the development of strategies for effectively facilitating the integration process of similar programmes within the school system. The study will further contribute to methodological development in participatory research driven realist evaluation.

    Download full text (pdf)
    fulltext
    Publisher's full text
  • 8.
    Zulu, Joseph Mumba
    et al.
    Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia; Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia.
    Maritim, Patricia
    Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia; Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia.
    Halwiindi, Hikabasa
    Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia.
    Malizgani, Chavula Paul
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia.
    Munakampe, Margarate
    Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia; Yakini Health Research Institute, Lusaka, Zambia.
    Matenga, Tulani Francis L.
    Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia.
    Mweemba, Chris
    Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia.
    Sinyangwe, Ntazana N.
    Department of Environmental Health, School of Public Health, University of Zambia, Lusaka, Zambia.
    Habib, Batuli
    Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia.
    Musukuma, Mwiche
    Department of Epidemiology and Biostatics, School of Public Health, University of Zambia, Lusaka, Zambia.
    Silumbwe, Adam
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia.
    Wang, Bo
    Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.
    Kaonga, Patrick
    Department of Epidemiology and Biostatics, School of Public Health, University of Zambia, Lusaka, Zambia.
    Chewe, Mwimba
    Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia.
    Fisa, Ronald
    Department of Epidemiology and Biostatics, School of Public Health, University of Zambia, Lusaka, Zambia.
    Banda, Jeremiah
    Yakini Health Research Institute, Lusaka, Zambia.
    Mubanga, Angel
    Ministry of Health, Lusaka, Zambia.
    Phiri, Henry
    Ministry of Health, Lusaka, Zambia.
    Implementation strategies for decentralized management of multidrug-resistant tuberculosis: insights from community health systems in Zambia2024In: Archives of Public Health, ISSN 0778-7367, E-ISSN 2049-3258, Vol. 82, no 1, article id 157Article in journal (Refereed)
    Abstract [en]

    Background: Decentralized management approaches for multi-drug-resistant tuberculosis (MDR TB) have shown improved treatment outcomes in patients. However, challenges remain in the delivery of decentralized MDR TB services. Further, implementation strategies for effectively delivering the services in community health systems (CHSs) in low-resource settings have not been fully described, as most strategies are known and effective in high-income settings. Our research aimed to delineate the specific implementation strategies employed in managing MDR TB in Zambia.

    Methods: Our qualitative case study involved 112 in-depth interviews with a diverse group of participants, including healthcare workers, community health workers, patients, caregivers, and health managers in nine districts. We categorized implementation strategies using the Expert Recommendations for Implementing Change (ERIC) compilation and later grouped them into three CHS lenses: programmatic, relational, and collective action.

    Results: The programmatic lens comprised four implementation strategies: (1) changing infrastructure through refurbishing and expanding health facilities to accommodate management of MDR TB, (2) adapting and tailoring clinical and diagnostic services to the context through implementing tailored strategies, (3) training and educating health providers through ongoing training, and (4) using evaluative and iterative strategies to review program performance, which involved development and organization of quality monitoring systems, as well as audits. Relational lens strategies were (1) providing interactive assistance through offering local technical assistance in clinical expert committees and (2) providing support to clinicians through developing health worker and community health worker outreach teams. Finally, the main collective action lens strategy was engaging consumers; the discrete strategies were increasing demand using community networks and events and involving patients and family members.

    Conclusion: This study builds on the ERIC implementation strategies by stressing the need to fully consider interrelations or embeddedness of CHS strategies during implementation processes. For example, to work effectively, the programmatic lens strategies need to be supported by strategies that promote meaningful community engagement (the relational lens) and should be attuned to strategies that promote community mobilization (collective action lens).

    Download full text (pdf)
    fulltext
    Publisher's full text
1 - 8 of 8
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
v. 2.45.0
|
WCAG
|
Umeå University Library
|
Register in DiVA
|
Support
|
Search DiVA Portal