Browsing by Author "Gerold, J."
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Item Determinants of safety climate at primary care level in Ghana, Malawi and Uganda: a cross-sectional study across 138 selected primary healthcare facilities(Human Resource for Health, 2021) Vallières, F.; Mubiri, P.; Agyemang, S.A.; Amon, S.; Gerold, J.; Martineau, T.; Nolan, N.; O’Byrne, T.; Sanudi, L.; Sengooba, F.; Prytherch, H.Background: Safety climate is an essential component of achieving Universal Health Coverage, with several organi sational, unit or team-level, and individual health worker factors identifed as infuencing safety climate. Few studies however, have investigated how these factors contribute to safety climate within health care settings in low- and middle-income countries (LMICs). The current study examines the relationship between key organisational, unit and individual-level factors and safety climate across primary health care centres in Ghana, Malawi and Uganda. Methods: A cross-sectional, self-administered survey was conducted across 138 primary health care facilities in nine districts across Uganda, Ghana and Malawi. In total, 760 primary health workers completed the questionnaire. The relationships between individual (sex, job satisfaction), unit (teamwork climate, supportive supervision), organisa tional-level (district managerial support) and safety climate were tested using structural equation modelling (SEM) procedures. Post hoc analyses were also carried out to explore these relationships within each country. Results: Our model including all countries explained 55% of the variance in safety climate. In this model, safety climate was most strongly associated with teamwork (β=0.56, p<0.001), supportive supervision (β=0.34, p<0.001), and district managerial support (β=0.29, p<0.001). In Ghana, safety climate was positively associated with job satis faction (β=0.30, p<0.05), teamwork (β=0.46, p<0.001), and supportive supervision (β=0.21, p<0.05), whereby the model explained 43% of the variance in safety climate. In Uganda, the total variance explained by the model was 64%, with teamwork (β=0.56, p<0.001), supportive supervision (β=0.43, p<0.001), and perceived district managerial sup port (β=0.35, p<0.001) all found to be positively associated with climate. In Malawi, the total variance explained by the model was 63%, with teamwork (β=0.39, p=0.005) and supportive supervision (β=0.27, p=0.023) signifcantly and positively associated with safety climate. Discussion/conclusions: Our fndings highlight the importance of unit-level factors—and in specifc, teamwork and supportive supervision—as particularly important contributors to perceptions of safety climate among primary health workers in LMICs. Implications for practice are discussed.Item How to scale-up: a comparative case study of scaling up a district health management strengthening intervention in Ghana, Malawi and Uganda(BMC Health Services Research, 2023) Bulthuis, S.; Kok, M.; Onvlee, O.; O’Byrne, T.; Amon, S.; Namakula, J.; Chikaphupha, K.; Gerold, J.; Mansour, W.; Raven, J.; Broerse, J.E W.; Dieleman, M.Background The need to scale up public health interventions in low- and middle-income countries to ensure equitable and sustainable impact is widely acknowledged. However, there has been little understanding of how projects have sought to address the importance of scale-up in the design and implementation of their initiatives. This paper aims to gain insight into the facilitators of the scale-up of a district-level health management strengthening intervention in Ghana, Malawi and Uganda. Methods The study took a comparative case study approach with two rounds of data collection (2019 and 2021) in which a combination of different qualitative methods was applied. Interviews and group discussions took place with district, regional and national stakeholders who were involved in the implementation and scale-up of the intervention. Results A shared vision among the different stakeholders about how to institutionalize the intervention into the existing system facilitated scale-up. The importance of champions was also identified, as they influence buy-in from key decision makers, and when decision makers are convinced, political and financial support for scale-up can increase. In two countries, a specific window of opportunity facilitated scale-up. Taking a flexible approach towards scale-up, allowing adaptations of the intervention and the scale-up strategy to the context, was also identified as a facilitator. The context of decentralization and the politics and power relations between stakeholders involved also influenced scale-up. Conclusions Despite the identification of the facilitators of the scale-up, full integration of the intervention into the health system has proven challenging in all countries. Approaching scale-up from a systems change perspective could be useful in future scale-up efforts, as it focuses on sustainable systems change at scale (e.g. improving district health management) by testing a combination of interventions that could contribute to the envisaged change, rather than horizontally scaling up and trying to embed one particular intervention in the system.