plueme/wizJson huggingface dataset:
location: nan, 'Global 
year: 2017 source: BMC 
title: The experience of a nationwide Community of Practice to set up Regional Prevention Plans in Italy 
abstract:BackgroundIn 2010, the Italian Ministry of Health decided to start the planning process to elaborate the National Plan of Prevention 2010–2012 jointly with the 21 Regions. The National Institute of Health was responsible for supporting regional planners (RPs) by an original participatory approach of a web-based Community of Practice (CoP) to set up their own Regional Plans of Prevention. In this paper, we summarise the theoretical framework adopted, the main phases characterising the lifecycle of the nationwide CoP, the evaluation approach adopted and its findings.MethodsFollowing the CoP theoretical framework from Wenger, an initial group of RPs were trained on Project Cycle Management as a planning method and thereafter they started interacting on a web-based Moodle platform for 8 months. The CoP evaluation mainly took into account aspects of ‘immediate value’, such as members interactions within the website, and several quantitative and qualitative tools were used to monitor changes over time. Data were retrieved from Moodle statistics or directly from the RPs by the means of a Knowledge, Attitude and Practice survey, a reaction survey, SWOT analysis and focus groups.ResultsThe level of individual RPs knowledge increased after the initial course from 55.7% to 75%, attitudes and competence perception about the planning process method also showed an overall favourable change. During the CoP life span, the number of members increased from the original 98 RPs to include up to 600 new members on the basis of spontaneous demand. From April 2010 to January 2011, the ‘vital signs’ of the CoP were monitored, including RP logins (13,450 total logins and 3744 unique logins), views (27,522) and posts (1606) distributed in 326 forum discussion threads. Data and information retrieved from quantitative and qualitative evaluation approaches proved to be useful for the management and follow-up of the CoP.ConclusionsThe CoP experience was successful as 19 out of 20 Regions submitted their Regional Preventive Plan to their Ministry of Health within the due deadline. The CoP has proved to be an approach able to optimise resources and expertise, capitalising and generating new knowledge. However, more efforts should be deployed to define innovative ways to evaluate its values, tangible and intangible, as well as the return of investment.
location: nan, 'Global 
year: 2017 source: BMC 
title: The factors affecting the institutionalisation of two policy units in Burkina Faso’s health system: a case study 
abstract:BackgroundThis paper is one of three linked studies that attempts to understand the process of institutionalisation of policy units within Burkina Faso’s health system. It examines the relationships between the existence of an institutional framework, data production capacity and other resource availability in the institutionalisation of policy units in health systems. It therefore contributes to our understanding of the dynamics linking the key drivers and indicators of institutionalisation. Additionally, it examines how factors within the managerial setting, including workplace environment, and budgetary and human resource availability, may influence the institutionalisation process.MethodsThe study used an explanatory qualitative case study approach, examining two policy units in Burkina Faso’s Ministry of Health, the first of which had been institutionalised successfully and the other less so. Data were collected from key policymakers, including 13 connected with the first policy unit and 10 with the second, plus two funders. We also conducted a documentary analysis of the National Program for Health Development, two mid-term strategic plans, 230 action plans, eight Ministry of Health state budgets, eight Ministry of Health annual statistics reports, 16 policy unit budgets and published literature.ResultsThe framework within which the government gave the policy unit its mandate and policy focus had the strongest effect on the institutionalisation process. Institutionalisation depended on political will, in both the host government and any donors, and the priority given to the policy unit’s focus. It was also affected by the leadership of the policy unit managers. These factors were influenced by human resource capacity, and our findings suggest that, for successful institutionalisation in Burkina Faso’s health system, policy units need to be given sufficient human resources to achieve their objectives.ConclusionPolicy units’ institutionalisation in Burkina Faso’s health system depend on the leadership of the unit managers to implement relevant activities, mobilise funding, and recruit and maintain enough human resources, as well as the mandate given by the government.
location: nan, 'Global 
year: 2017 source: BMC 
title: Travelling models and the challenge of pragmatic contexts and practical norms: the case of maternal health 
abstract:As in other areas of international development, we are witnessing the proliferation of ‘traveling models’ developed by international experts and introduced in an almost identical format across numerous countries to improve some aspect of maternal health systems in low- and middle-income countries. These policies and protocols are based on ‘miracle mechanisms’ that have been taken out of their original context but are believed to be intrinsically effective in light of their operational devices.In reality, standardised interventions are, in Africa and elsewhere, confronted with pragmatic implementation contexts that are always varied and specific, and which lead to drifts, distortions, dismemberments and bypasses. The partogram, focused antenatal care, the prevention of mother-to-child transmission of HIV or performance-based payment all illustrate these implementation gaps, often caused by the routine behaviour of health personnel who follow practical norms (and a professional culture) that are often distinct from official norms – as is the case with midwives.Experiences in maternal and child health in Africa suggest that an alternative approach would be to start with the daily reality of social and practical norms instead of relying on models, and to promote innovations that emerge from within local health systems.
location: nan, 'Global 
year: 2017 source: BMC 
title: Free versus subsidised healthcare: options for fee exemptions, access to care for vulnerable groups and effects on the health system in Burkina Faso 
abstract:BackgroundThe many forms of healthcare fee exemptions implemented in Burkina Faso since the 2000s have varied between total exemption (free) and cost subsidisation. This article examines both options, their contextual variations and the ways in which they affect access to healthcare for vulnerable people as well as the operation of the health system. This research is part of an interdisciplinary regional program on the elimination of user fees for health services in West Africa (Burkina Faso, Mali and Niger).MethodA conceptual framework and a chronological review of policy interventions are used as references to summarise the results of the three qualitative studies presented. Historical reference points are used to describe the emergence of healthcare fee exemption policies in Burkina Faso and the events that influenced their adoption. The joint analysis of opinions on options for fee exemption focuses on the different types of repercussions on access to healthcare and the operation of the health system.ResultsIn conjunction with the twists and turns of the gradual development of a national health policy and in response to international recommendations, healthcare fee exemptions have evolved since colonisation. The limitations of the changes introduced with cost recovery and the barriers to healthcare access for the poorest people led to the adoption of the current sectorial fee exemptions. The results provide information on the reasons for the changes that have occurred over time. The nuanced perspectives of different categories of people surveyed about fee exemption options show that, beyond the perceived effects on healthcare access and the health system, the issue is one of more equitable governance.ConclusionsIn principle, the fee exemption measures are intended to provide improved healthcare access for vulnerable groups. In practice, the negative effects on the operation of the health system advocate for reforms to harmonise the changes to multifaceted fee exemptions and the actual needs to promote effectiveness and sustainability.
location: nan, 'Global 
year: 2017 source: BMC 
title: Understanding the state of health policy and systems research in West Africa and capacity strengthening needs: scoping of peer-reviewed publications trends and patterns 1990–2015 
abstract:BackgroundThe need for locally-driven, locally-generated evidence to guide health policy and systems decision-making and implementation in West Africa remains urgent. Thus, health policy and systems research (HPSR) is a field with great potential for addressing many of the sub-region’s intransigent health challenges. This paper presents an analysis of trends and patterns of peer-reviewed HPSR publications across the Economic Community of West African States (ECOWAS), to help understand trends and patterns of HPSR publication and the degree of involvement of West African researchers in HPSR evidence generation in the sub-region. Our goal was to use the findings to inform the development of a sub-regional strategy to strengthen HPSR and its use to inform development and improvement of health outcomes.MethodsA scoping review was conducted over a 25-year period from January 1990 to September 2015. Literature searches were conducted in English and French using Google Scholar, PubMed Central and Cairn.info.ResultsA total of 258 articles were retrieved. Of these, 246 were statistically analysed, with 54% having West African lead authors. Two thirds of the papers originated from three out of the 15 countries of the ECOWAS, specifically Nigeria (28.86%), Burkina Faso (21.54%) and Ghana (17.07%). Most authors were based in academic institutions and participation of authors from ministries of health, hospitals and non-governmental organisations was limited. English was the predominant language for publication even for papers originating from Francophone West African countries. There has been a progressive increase in publications over the studied period.ConclusionDespite progressive improvements over time, West Africa remains a weak sub-region in terms of peer-reviewed HPSR publications. Within the overall weakness, there is country-to-country variation. The fact that only a handful of countries accounted for nearly 70% of the total volume of publications in West Africa attests to the great disparities in individual, institutional and contextual capacities for HPSR evidence generation. Bridging the gap between lead institutions (universities and research centres) and the practice community (ministries, hospitals, non-governmental organisations) is indispensable for ensuring the practical use of HPSR evidence. There remains a major need for investments in HPSR capacity building in West Africa.
location: nan, 'Global 
year: 2017 source: BMC 
title: Spanning maternal, newborn and child health (MNCH) and health systems research boundaries: conducive and limiting health systems factors to improving MNCH outcomes in West Africa 
abstract:BackgroundDespite improvements over time, West Africa lags behind global as well as sub-Saharan averages in its maternal, newborn and child health (MNCH) outcomes. This is despite the availability of an increasing body of knowledge on interventions that improve such outcomes. Beyond our knowledge of what interventions work, insights are needed on others factors that facilitate or inhibit MNCH outcome improvement. This study aimed to explore health system factors conducive or limiting to MNCH policy and programme implementation and outcomes in West Africa, and how and why they work in context.MethodsWe conducted a mixed methods multi-country case study focusing predominantly, but not exclusively, on the six West African countries (Burkina Faso, Benin, Mali, Senegal, Nigeria and Ghana) of the Innovating for Maternal and Child Health in Africa initiative. Data collection involved non-exhaustive review of grey and published literature, and 48 key informant interviews. We validated our findings and conclusions at two separate multi-stakeholder meetings organised by the West African Health Organization. To guide our data collection and analysis, we developed a unique theoretical framework of the link between health systems and MNCH, in which we conceptualised health systems as the foundations, pillars and roofing of a shelter for MNCH, and context as the ground on which the foundation is laid.ResultsA multitude of MNCH policies and interventions were being piloted, researched or implemented at scale in the sub-region, most of which faced multiple interacting conducive and limiting health system factors to effective implementation, as well as contextual challenges. Context acted through its effect on health system factors as well as on the social determinants of health.ConclusionsTo accelerate and sustain improvements in MNCH outcomes in West Africa, an integrated approach to research and practice of simultaneously addressing health systems and contextual factors alongside MNCH service delivery interventions is needed. This requires multi-level, multi-sectoral and multi-stakeholder engagement approaches that span current geographical, language, research and practice community boundaries in West Africa, and effectively link the efforts of actors interested in health systems strengthening with those of actors interested in MNCH outcome improvement.
location: nan, 'Global 
year: 2017 source: BMC 
title: Promoting research to improve maternal, neonatal, infant and adolescent health in West Africa: the role of the West African Health Organisation 
abstract:West Africa has adopted numerous strategies to counter maternal and infant mortality, provides national maternal and infant health programmes, and hosts many active technical and financial partners and non-governmental organisations. Despite this, maternal and infant morbidity and mortality indicators are still very high. In this commentary, internal actors and officials of the West African Health Organisation (WAHO) examine the regional organisation’s role in promoting research as a tool for strengthening maternal and infant health in West Africa.As a specialised institution of the Economic Community of West African States (ECOWAS) responsible for health issues, WAHO’s mission is to provide the sub-region’s population with the highest possible health standards by harmonising Member States’ policies, resource pooling, and cooperation among Member States and third countries to collectively and strategically combat the region’s health problems. To achieve this, WAHO’s main intervention strategy is that of facilitation, as this encourages the generation and use of evidence to inform decision-making and reinforce practice.WAHO’s analysis of interventions since 2000 showed that it had effected some changes in research governance, management and funding, as well as in individual and institutional capacity building, research dissemination, collaboration and exchanges between the various stakeholders. It also revealed several challenges such as process ownership, member countries’ commitment, weak individual and institutional capacity, mobilisation, and stakeholder commitment. To better strengthen evidence-based decision-making, in 2016, WAHO created a unique programme aimed at improving the production, dissemination and use of research information and results in health programme planning to ultimately improve population health.While WAHO’s experiences to date demonstrate how a regional health institution can integrate research promotion into the fight against maternal and infant mortality, the challenges the organisation has encountered also demonstrate the importance of cohesion among actors promoting such an initiative, the importance of leadership and commitment among member country actors steering the process, and the need for collaboration and coordination among all partners in member countries and in the region.
location: nan, 'Global 
year: 2017 source: BMC 
title: The change-makers of West Africa 
abstract:West Africa was the focus of global attention during the Ebola virus disease outbreak, when systemic health system weaknesses compounded a serious emergency and complicated response efforts. Following the crisis, calls were made to strengthen health systems, but investments to date have fallen short of delivering the support needed to build strong health systems able to prevent and manage future outbreaks.In part, this reality serves to highlight the shortcomings of the solutions being repeatedly prioritised by external funders and experts, solutions that often fail to consider the wealth of West African evidence and actors actively working to strengthen the leadership and health systems needed to drive and sustainably improve national health outcomes. Unfortunately, this knowledge and experience are rarely heard in the global arena.This journal supplement is a contribution, although small, to changing this practice by putting the perspectives, experiences and knowledge of West Africans on the table. It presents findings from a series of research and capacity development projects in West Africa funded by the International Development Research Centre's Maternal and Child Health programme (formerly Governance for Equity in Health Systems).The evidence presented here centres around two key themes. First, the theme that context matters. The evidence shows how context can change the shape of externally imposed interventions or policies resulting in unintended outcomes. At the same time, it highlights evidence showing how innovative local actors are developing their own approaches, usually low-cost and embedded in the context, to bring about change. Second, the collection of articles discusses the critical need to overcome the existing fragmentation of expertise, knowledge and actors, and to build strong working relationships amongst all actors so they can effectively work together to identify priority issues that can realistically be addressed given the available windows of opportunity.Vibrant West African-led collaborations amongst researchers, decision-makers and civil society, which are effectively supported by national, regional and global funding, need to foster, strengthen and use locally-generated evidence to ensure that efforts to strengthen health systems and improve regional health outcomes are successful. The solutions are clearly not to be found in the ‘travelling models’ of standardised interventions.
location: nan, 'Global 
year: 2017 source: BMC 
title: The West African experience in establishing steering committees for better collaboration between researchers and decision-makers to increase the use of health research findings 
abstract:BackgroundAware of the advantages of a project steering committee (SC) in terms of influencing the development of evidence-based health policies, the West African Health Organisation (WAHO) encouraged and supported the creation of such SCs around four research projects in four countries (Burkina Faso, Nigeria, Senegal and Sierra Leone). This study was conducted to describe the process that was used to establish these committees and its findings aim to assist other stakeholders in initiating this type of process.MethodsThis is a cross-sectional, qualitative study of the initiative’s four projects. In addition to a literature review and a review of the project documents, an interview guide was used to collect data from 14 members of the SCs, research teams, WAHO and the International Development Research Center. The respondents were selected with a view to reaching data saturation. The technique of thematic analysis by simple categorisation was used.ResultsTo set up the SCs, a research team in each country worked with health authorities to identify potential members, organise meetings with these members and sought the authorities’ approval to formalise the SCs. The SCs’ mission was to provide technical assistance to the researchers during the implementation phase and to facilitate the transfer and use of the findings. The ‘doing by learning’ approach used by each research team, combined with WAHO’s catalytic role with each country’s Ministry of Health, helped each SC manage its contextual difficulties and function effectively.ConclusionThe involvement of technical and financial partners motivated the researchers and ministries of health, who, in turn, motivated other actors to volunteer on the SCs. The ‘doing by learning’ approach made it possible to develop strategies adapted to each context to create, facilitate and operate each SC and manage its difficulties. To reproduce such an experience, a strong understanding of the local context and the involvement of strong partners are required.
location: nan, 'Global 
year: 2017 source: BMC 
title: The quality of free antenatal and delivery services in Northern Sierra Leone 
abstract:BackgroundThe number of maternal deaths in sub-Saharan Africa continues to be overwhelmingly high. In West Africa, Sierra Leone leads the list, with the highest maternal mortality ratio. In 2010, financial barriers were removed as an incentive for more women to use available antenatal, delivery and postnatal services. Few published studies have examined the quality of free antenatal services and access to emergency obstetric care in Sierra Leone.MethodsA cross-sectional survey was conducted in 2014 in all 97 peripheral health facilities and three hospitals in Bombali District, Northern Region. One hundred antenatal care providers were interviewed, 276 observations were made and 486 pregnant women were interviewed. We assessed the adequacy of antenatal and delivery services provided using national standards. The distance was calculated between each facility providing delivery services and the nearest comprehensive emergency obstetric care (CEOC) facility, and the proportion of facilities in a chiefdom within 15 km of each CEOC facility was also calculated. A thematic map was developed to show inequities.ResultsThe quality of services was poor. Based on national standards, only 27% of women were examined, 2% were screened on their first antenatal visit and 47% received interventions as recommended. Although 94% of facilities provided delivery services, a minority had delivery rooms (40%), delivery kits (42%) or portable water (46%). Skilled attendants supervised 35% of deliveries, and in only 35% of these were processes adequately documented. None of the five basic emergency obstetric care facilities were fully compliant with national standards, and the central and northernmost parts of the district had the least access to comprehensive emergency obstetric care.ConclusionThe health sector needs to monitor the quality of antenatal interventions in addition to measuring coverage. The quality of delivery services is compromised by poor infrastructure, inadequate skilled staff, stock-outs of consumables, non-functional basic emergency obstetric care facilities, and geographic inequities in access to CEOC facilities. These findings suggest that the health sector needs to urgently investigate continuing inequities adversely influencing the uptake of these services, and explore more sustainable funding mechanisms. Without this, the country is unlikely to achieve its goal of reducing maternal deaths.