Browsing by Author "Ssengooba, F."
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Item Assessing the scalability of a health management-strengthening intervention at the district level: a qualitative study in Ghana, Malawi and Uganda(BioMed Central Ltd, 2022-07) Bulthuis, S.; Kok, M.; Onvlee, O.; Martineau, T.; Raven, J.; Ssengooba, F.; Namakula, J.; Banda, H.; Akweongo, P.; Dieleman, M.Background: The scale-up of successfully tested public health interventions is critical to achieving universal health coverage. To ensure optimal use of resources, assessment of the scalability of an intervention is recognized as a crucial step in the scale-up process. This study assessed the scalability of a tested health management-strengthening intervention (MSI) at the district level in Ghana, Malawi and Uganda. Methods: Qualitative interviews were conducted with intervention users (district health management teams, DHMTs) and implementers of the scale-up of the intervention (national-level actors) in Ghana, Malawi and Uganda, before and 1 year after the scale-up had started. To assess the scalability of the intervention, the CORRECT criteria from WHO/ExpandNet were used during analysis. Results: The MSI was seen as credible, as regional- and national-level Ministry of Health officials were championing the intervention. While documented evidence on intervention effectiveness was limited, district- and national-level stakeholders seemed to be convinced of the value of the intervention. This was based on its observed positive results regarding management competencies, teamwork and specific aspects of health workforce performance and service delivery. The perceived need for strengthening of management capacity and service delivery showed the relevance of the intervention, and relative advantages of the intervention were its participatory and sustainable nature. Turnover within the DHMTs and limited (initial) management capacity were factors complicating implementation. The intervention was not contested and was seen as compatible with (policy) priorities at the national level. Conclusion: We conclude that the MSI is scalable. However, to enhance its scalability, certain aspects should be adapted to better fit the context in which the intervention is being scaled up. Greater involvement of regional and national actors alongside improved documentation of results of the intervention can facilitate scale-up. Continuous assessment of the scalability of the intervention with all stakeholders involved is necessary, as context, stakeholders and priorities may change. Therefore, adaptations of the intervention might be required. The assessment of scalability, preferably as part of the monitoring of a scale-up strategy, enables critical reflections on next steps to make the intervention more scalable and the scale-up more successful.Item Building the field of health policy and systems research: An agenda for action(PLoS Medicine, 2011-08) Bennett, S.; Agyepong, I.A.; Sheikh, K.; Hanson, K.; Ssengooba, F.; Gilson, L.The lack of clarity and shared understanding regarding the scientific foundations of Health Policy and Systems Research (HPSR) [1] potentially has very negative consequences for the field [2]. Disagreement over the value of different types of theoretical frameworks and research methods can lead to inappropriate evaluations of research proposals, contradictory reviews of the same paper, and delays in publication. Excessive time may be spent communicating broad frameworks to other researchers within HPSR, inhibiting progression to more detailed and specific conversations. Communication barriers may discourage inter-disciplinary collaboration, driving researchers back to their disciplinary safety zones, and creating potential for conflict that may discourage younger researchers who may be less secure in their career from staying in the field. As the second paper in this series concluded [1], there is an urgent need to build understanding across disciplinary boundaries. This final paper in the “Building the Field of HPSR” series turns to practical questions concerning how to remove structural barriers that currently inhibit the development of the HPSR field and thus unlock HPSR capacities. HPSR suffers from many of the same problems as other branches of health research in low- and middle-income countries (LMICs): major imbalances between the resources available in high- versus low- and middle-income contexts [3], acute shortages of skilled researchers (especially senior ones), and relatively few organizations that house HPSR expertise [4]. Historically, low levels of funding for HPSR compared to clinical or biomedical research have compounded these problems. Many papers provide relevant recommendations to address health research capacity issues in LMICs [5]–[8]. However, there is also a nexus of issues specific to HPSR that currently constrains development of the field. This paper builds on the analysis of the previous papers in this series [1],[9] to investigate the practical problems faced and then develops an agenda for building the HPSR field.Item Building the field of health policy and systems research: Framing the questions(PLoS Medicine, 2011-08) Sheikh, K.; Gilson, L.; Agyepong, I.A.; Hanson, K.; Ssengooba, F.; Bennett, S.The field of Health Policy and SystemsResearch (HPSR) is currently experienc-ing an unprecedented level of interest. TheFirst Global Symposium on Health Sys-tems Research, held in Montreux, Swit-zerland, in November 2010, is the mostrecent of a succession of conferences andtask force deliberations that have spun offa series of debates about the nature of thefield and the future directions it shouldtake. Establishing the identity and terrainof HPSR is part of these debates, which ismade difficult by the fact that it is anessentially multidisciplinary field delimitednot by methodology but by the topic andscope of research questions asked. In thispaper, the first of a series of threeaddressing the current challenges andopportunities for the development ofHPSR, we introduce and map the typesof research questions that it has addressedover its natural course of evolution,analyze the nature of current heightenedattention, and highlight emerging oppor-tunities and challenges for the develop-ment of the field.We use the extended term Health Policyand Systems Research for a field that isoften referred to simply as Health SystemsResearch. For us, the broader term bettercaptures the terrain of work it encompass-es because it explicitly identifies theinterconnections between policy and sys-tems, and highlights the social and polit-ical nature of the field. The geographicalfocus of our concern is low- and middle-income countries (LMICs) [1], but wesuggest that our approach also has valuefor high-income countries. Our under-standing of the evolution of HPSR draws primarily from the English languageliterature, which we acknowledge as alimitation. However, this reflects globaldiscussion about the field, which hastended to neglect literature in otherlanguages.Item A new scale to assess health-facility level management: the development and validation of the facility management scale in Ghana, Uganda, and Malawi(BMC Health Services Research, 2024) Aikins, M.; Mubiri, P.; Ssengooba, F.Background The increased recognition of governance, leadership, and management as determinants of health system performance has prompted calls for research focusing on the nature, quality, and measurement of this key health system building block. In low- or middle-income contexts (LMIC), where facility-level management and performance remain a challenge, valid tools to measure management have the potential to boost performance and accelerate improvements. We, therefore, sought to develop a Facility-level Management Scale (FMS) and test its reliability in the psychometric properties in three African contexts. Methods The FMS was administered to 881 health workers in; Ghana (n=287; 32.6%), Malawi (n=66; 7.5%) and Uganda (n=528; 59.9%). Half of the sample data was randomly subjected to exploratory factor analysis (EFA) and Monte Carlo Parallel Component Analysis to explore the FMS’ latent structure. The construct validity of this structure was then tested on the remaining half of the sample using confirmatory factor analysis (CFA). The FMS’ convergent and divergent validity, as well as internal consistency, were also tested. Results Findings from the EFA and Monte Carlo PCA suggested the retention of three factors (labelled ‘Supportive Management’, ‘Resource Management’ and ‘Time management’). The 3-factor solution explained 51% of the variance in perceived facility management. These results were supported by the results of the CFA (N=381; χ2=256.8, df=61, p<0.001; CFI=0.94; TLI=0.92; RMSEA [95% CI]=0.065 [0.057–0.074]; SRMR=0.047). Conclusion The FMS is an open-access, short, easy-to-administer scale that can be used to assess how health workers perceive facility-level management in LMICs. When used as a regular monitoring tool, the FMS can identify key strengths or challenges pertaining to time, resources, and supportive management functions at the health facility level