Friday, 24 October 2014

Training health workers in management skills bears fruit

The Challenge
Every day, health service leaders face challenges like working with limited resources while delivering results, managing change, and keeping staff motivated. Decentralisation adds to these challenges, as many health workers have both clinical and managerial responsibilities.

However, little attention is paid to leadership and management skills during their health training.
Communities, donors, local politicians and opinion leaders are demanding accountability and results, which is achievable with simple leadership and management skills.



Our Intervention
In partnership with the districts, who select the candidates, the Makerere University School of Public Health is training health workers in three areas: planning and management of health services, improving management of logistics and improving management of labor and newborn care.

A six-month distance health services management certificate course, targeting district and health facility managers, caters for the first two thematic areas, the focus for this article. In the first phase, 30 health service delivery personnel were drawn from the three study districts (10 from each), and another 30 are attending the second phase of training. The results have been tremendous, with beneficiaries already registering significant improvements back at their work places.



Initial Success
Stephen Otukor, a clinical officer in Pallisa district, said that the financial management skills he acquired during the training are invaluable.

Before the training, spending and finances were not streamlined. Now all his staff know how his clinic's financial resources are used.
"The other good thing is that when we collect the data nowadays, we analyse it, and we utilize it," adds Stephen. "This has helped us in decision making. For instance, if we plot a graph and find problems, we trace the root causes of why. We then find solutions to the challenges."
For Edith Bogere, a senior nursing officer with Kamuli district, turning support supervision into a blame game and police-like interrogation had failed to solve a long-standing problem. But, while still on the course, Edith decided to employ her new skills by suggesting the involvement of the in-charge of the health centre and the staff to find solutions.
"The in-charge gave us her views, and one of them was to change a midwife that was there to another health facility and get her another one or two. And the district health management team respected her opinion. We have since seen deliveries increasing in this facility, even the OPD attendance is improving. When you compare the HMIS report 105 of Bupadhengo now and those before, you see a marked improvement. This is simply because we were able to change our approach to supervision and problem solving."
And in the case of Anek Santurinah, a midwife in Pallisa, time management was a problem. "Things like phone calls and visitors who came unnecessarily would take my time. I would sometimes attend to these visitors and ignore clients. But this changed after the training."

By the end of the study, each of the three districts will have had 30 key personnel trained in health services management.

By Kakaire Ayub Kirunda, FHS Uganda Policy Influence and Research Uptake Officer
[Editor's note: This article is the first in a series of updates from the FHS Uganda team that were also compiled in their recent Showcase.]

Thursday, 23 October 2014

Journal of Peasant Studies new special issue: critical perspectives on Food Sovereignty

A new special issue on ‘Critical perspectives on food sovereignty’ from the Journal of Peasant Studies has been released, with free articles available for a limited period. The guest editors are Marc Edelman, James C. Scott, Amita Baviskar, Saturnino M. Borras Jr., Deniz Kandiyoti, Eric Holt-Gimenez, Tony Weis and Wendy Wolford.

The issue is volume 2 in a series on Global Agrarian Transformations (Volume 1 is also still accessible for free from the Taylor and Francis website).

As JPS’s contribution to the ongoing food sovereignty debate, the journal is also making available for free for a limited time three commentary articles:

Related articles

Wednesday, 22 October 2014

Journal of Peasant Studies new special issue: critical perspectives on Food Sovereignty

A new special issue on ‘Critical perspectives on food sovereignty’ from the Journal of Peasant Studies has been released, with free articles available for a limited period. The guest editors are Marc Edelman, James C. Scott, Amita Baviskar, Saturnino M. Borras Jr., Deniz Kandiyoti, Eric Holt-Gimenez, Tony Weis and Wendy Wolford.

The issue is volume 2 in a series on Global Agrarian Transformations (Volume 1 is also still accessible for free from the Taylor and Francis website).

As JPS’s contribution to the ongoing food sovereignty debate, the journal is also making available for free for a limited time three commentary articles:

Minimising delays for maternal health seeking in Uganda through saving schemes

The Challenge
When Mrs X (real name withheld) went to her local health centre in one of our intervention districts for a final check-up just one month before her expected due date, she never anticipated what the midwife told her. She was told to make plans to deliver at the health centre or a general hospital because there was a likelihood of her delivery being complicated.

Mrs X had an unusually large baby and needed to deliver in a health facility where caesarean section could easily be offered in time if the need arose. Sadly Mrs X had not saved for the anticipated expenses in form of transport fares, upkeep and the surgery. By the time Mrs X went into labour, her family could hardly raise the transport fare and by the time her husband got the money, a traditional birth attendant had been called in and was failing to help. Mrs X and the baby were lost a few metres from the hospital!

Without any kind of savings in the house to cater for transport Mrs X's family delayed reaching care. The family of Mrs X is not in isolation. There are many more like it.

Our Intervention
Households and individual community members are being educated and encouraged to join or start financial social networks, like saving groups, which offer financial protection. In addition to the business funds, the networks are advised to have a separate fund to cater for maternal and newborn health needs. Members can access these funds to cater for emergency transport to and from the health facility for pregnant women, mothers and newborns. The fund is also meant to provide funds to cater for birth items. Saving groups are similarly encouraged to enter into partnership with transporters.
At inception of the study in 2013, 816 existing groups of all manner and 795 transporters (boda boda drivers) were oriented on the new initiative.

Initial Success
Twambagane Saving Group is one of the groups that has been established in Kamuli district as a result of the orientation and training. With 34 members — 26 women and 8 men — the leader Godfrey Kisubi, who is also a CHW, says membership is closed. His strategy is to encourage groups with manageable numbers that only open up to more members after gaining experience.

Group member Miriam Kisakye is very proud and happy to be part of the initiative. "When the labour started we did not have readily available funds for transport to hospital but our savings in the group came in handy. Let those who have not started such groups act immediately because they are very beneficial," says Miriam who had given birth just two weeks prior to our visit.

There is good news in Pallisa as well, as Betty Opolot, the leader of Puti Puti Central Saving Group explains:
"I attended training organized by MANIFEST. After the training, we organized the women and talked to them about the issues related to maternal and newborns and the reasons why we need to save money specifically for maternal and newborn emergencies. 21 women managed to join the group. The saving group started this year (2014) and so far we have saved 500,000 Uganda shillings [. So far one woman has accessed the funds to cater for her transport needs to the hospital."
If this momentum is not lost, it is believed that the cases of Mrs. X will be greatly reduced. As at end of August 2014, a total of 1260 groups had an MCH (maternal and child health) fund.

By Kakaire Ayub Kirunda, FHS Uganda Policy Influence and Research Uptake Officer

[Editor's note: This article is the first in a series of updates from the FHS Uganda team that were also compiled in their recent Showcase.]

Melissa Leach on Ebola & inequality – lecture text & audio

Some materials are now available from the recent Sussex Development Lecture on Equality, Sustainability, Security: Interlaced challenges in a global development era by former STEPS Director Melissa Leach. The text is available to download below as a PDF, and you can listen to Melissa's lecture online, courtesy of the Institute of Development Studies.

In the lecture, Melissa uses Ebola as a lens to look at how inequalities, unsustainability and insecurity can interact, enhanced by misguided interventions, to render people and places deeply vulnerable. Addressing these interactions must become central to a renewed vision of development for all.


Further reading
Ebola: difficult questions for development blogpost by Ian Scoones, 13 October 2014
Our resources on Ebola and other animal-to-human diseases