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  1. Article ; Online: Conducting rapid research to aid the design of a health systems governance intervention in the Somali Region of Ethiopia.

    Pieterse, Pieternella

    Frontiers in sociology

    2022  Volume 7, Page(s) 947970

    Abstract: Introduction: The rapid research described in this chapter was conducted as an assignment for a UN agency in Ethiopia's Somali Region. The agency's aim was support the implementation of an interim citizen engagement intervention, with a view of ... ...

    Abstract Introduction: The rapid research described in this chapter was conducted as an assignment for a UN agency in Ethiopia's Somali Region. The agency's aim was support the implementation of an interim citizen engagement intervention, with a view of supporting of the Ethiopian Government's Citizen Score Card at primary healthcare facilities and hospitals in future. Many health facilities in Somali Region struggle with budget shortages related to ineffective budget planning and budget execution at woreda health office levels. In this context, an intervention to first improve budget accountability, through the implementation of citizen audits, was proposed.
    Methodology: The rapid study focused on five woredas (districts) within Somali Region, where interviews were conducted with the heads of woreda health offices. In the same five woredas, directors of healthcare facilities were interviewed and offices and healthcare facilities were observed. The framework of assessment and analysis was based on health systems literature on fragile and conflict affected states guided the questions for the health authorities and health facility management.
    Findings: The research yielded five distinct
    Results: The findings demonstrated that the capacity for healthcare planning and budgeting Somali Region at woreda level varied significantly and that little guidance was available from regional level health authorities. Frontline health services clearly suffered from budget shortages as a result.
    Conclusion: The research provided an evidence base for the delay of the roll-out of the Community Scorecard implementation across Somali Region. In a context whereby health facilities remain under-resourced due to budgeting constraints, a citizen-service provider-focused accountability intervention would have been of limited utility. The rapid case study research, conducted by condensing the usual case study research process, allowed for the production of evidence that was "robust enough" to demonstrate heterogeneity and challenges regarding budgeting quality across the five research sites. This evidence clearly transcended the hitherto anecdotal evidence that woreda-level health budget planning remains an area that faces significant shortcomings.
    Language English
    Publishing date 2022-09-08
    Publishing country Switzerland
    Document type Journal Article
    ISSN 2297-7775
    ISSN (online) 2297-7775
    DOI 10.3389/fsoc.2022.947970
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  2. Article ; Online: Unsalaried health workers in Sierra Leone: a scoping review of the literature to establish their impact on healthcare delivery.

    Pieterse, Pieternella / Saracini, Federico

    International journal for equity in health

    2023  Volume 22, Issue 1, Page(s) 255

    Abstract: Background: The World Health Organisation (WHO) estimates a 10 million health worker shortage by 2030. Despite this shortage, some low-income African countries paradoxically struggle with health worker surpluses. Technically, these health workers are ... ...

    Abstract Background: The World Health Organisation (WHO) estimates a 10 million health worker shortage by 2030. Despite this shortage, some low-income African countries paradoxically struggle with health worker surpluses. Technically, these health workers are needed to meet the minimum health worker-population ratio, but insufficient job opportunities in the public and private sector leaves available health workers unemployed. This results in emigration and un- or underemployment, as few countries have policies or plans in place to absorb this excess capacity. Sierra Leone, Liberia and Guinea have taken a different approach; health authorities and/or public hospitals 'recruit' medical and nursing graduates on an unsalaried basis, promising eventual paid public employment. 50% Sierra Leone's health workforce is currently unsalaried. This scoping review examines the existing evidence on Sierra Leone's unsalaried health workers (UHWs) to establish what impact they have on the equitable delivery of care.
    Methods: A scoping review was conducted using Joanna Briggs Institute guidance. Medline, PubMed, Scopus, Web of Science were searched to identify relevant literature. Grey literature (reports) and Ministry of Health and Sanitation policy documents were also included.
    Results: 36 texts, containing UHW related data, met the inclusion criteria. The findings divide into two categories and nine sub-categories: Charging for care and medicines that should be free; Trust and mistrust; Accountability; Informal provision of care, Private practice and lack of regulation. Over-production of health workers; UHW issues within policy and strategy; Lack of personnel data undermines MoHS planning; Health sector finance.
    Conclusion: Sierra Leone's example demonstrates that UHWs undermine equitable access to healthcare, if they resort to employing a range of coping strategies to survive financially, which some do. Their impact is wide ranging and will undermine Sierra Leone's efforts to achieve Universal Health Coverage if unaddressed. These findings are relevant to other LICs with similar health worker surpluses.
    MeSH term(s) Humans ; Health Workforce ; Sierra Leone ; Delivery of Health Care ; Health Personnel ; Employment
    Language English
    Publishing date 2023-12-09
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2092056-8
    ISSN 1475-9276 ; 1475-9276
    ISSN (online) 1475-9276
    ISSN 1475-9276
    DOI 10.1186/s12939-023-02066-3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Unsalaried health workers in Sierra Leone

    Pieternella Pieterse / Federico Saracini

    International Journal for Equity in Health, Vol 22, Iss 1, Pp 1-

    a scoping review of the literature to establish their impact on healthcare delivery

    2023  Volume 29

    Abstract: Abstract Background The World Health Organisation (WHO) estimates a 10 million health worker shortage by 2030. Despite this shortage, some low-income African countries paradoxically struggle with health worker surpluses. Technically, these health workers ...

    Abstract Abstract Background The World Health Organisation (WHO) estimates a 10 million health worker shortage by 2030. Despite this shortage, some low-income African countries paradoxically struggle with health worker surpluses. Technically, these health workers are needed to meet the minimum health worker-population ratio, but insufficient job opportunities in the public and private sector leaves available health workers unemployed. This results in emigration and un- or underemployment, as few countries have policies or plans in place to absorb this excess capacity. Sierra Leone, Liberia and Guinea have taken a different approach; health authorities and/or public hospitals ‘recruit’ medical and nursing graduates on an unsalaried basis, promising eventual paid public employment. 50% Sierra Leone’s health workforce is currently unsalaried. This scoping review examines the existing evidence on Sierra Leone’s unsalaried health workers (UHWs) to establish what impact they have on the equitable delivery of care. Methods A scoping review was conducted using Joanna Briggs Institute guidance. Medline, PubMed, Scopus, Web of Science were searched to identify relevant literature. Grey literature (reports) and Ministry of Health and Sanitation policy documents were also included. Results 36 texts, containing UHW related data, met the inclusion criteria. The findings divide into two categories and nine sub-categories: Charging for care and medicines that should be free; Trust and mistrust; Accountability; Informal provision of care, Private practice and lack of regulation. Over-production of health workers; UHW issues within policy and strategy; Lack of personnel data undermines MoHS planning; Health sector finance. Conclusion Sierra Leone’s example demonstrates that UHWs undermine equitable access to healthcare, if they resort to employing a range of coping strategies to survive financially, which some do. Their impact is wide ranging and will undermine Sierra Leone’s efforts to achieve Universal Health Coverage if unaddressed. ...
    Keywords Unsalaried Health workers ; Sierra Leone ; Health systems ; Healthcare Financing ; Access to Healthcare ; Universal Health Coverage ; Public aspects of medicine ; RA1-1270
    Subject code 360 ; 306
    Language English
    Publishing date 2023-12-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Citizen feedback in a fragile setting: social accountability interventions in the primary healthcare sector in Sierra Leone.

    Pieterse, Pieternella

    Disasters

    2019  Volume 43 Suppl 2, Page(s) S132–S150

    Abstract: Fragile and conflict-affected states are frequently characterised by their inability to fulfil three core governance functions: provision of security, effective delivery of basic public goods and services, and managing political participation and ... ...

    Abstract Fragile and conflict-affected states are frequently characterised by their inability to fulfil three core governance functions: provision of security, effective delivery of basic public goods and services, and managing political participation and accountability. This article explores the utility of social accountability interventions in fragile environments. Successful social accountability interventions can lead to joint examinations of public service standards by service-users and providers, resulting in collaborative improvement efforts. The few available studies of such interventions implemented in fragile or conflict-affected states show reasons for optimism as well as challenges. This article advocates the continued use of social accountability methods in fragile settings and provides examples of social accountability interventions in the health sector in Sierra Leone. The study suggests that social accountability can improve interaction between citizens and public service providers. Successful social accountability interventions can also lead to better quality and more accessible public services, which, in turn, can enhance state legitimacy.
    MeSH term(s) Community-Institutional Relations ; Empirical Research ; Health Care Sector ; Humans ; Primary Health Care ; Review Literature as Topic ; Sierra Leone ; Social Responsibility
    Language English
    Publishing date 2019-03-01
    Publishing country England
    Document type Journal Article
    ZDB-ID 1482668-9
    ISSN 1467-7717 ; 0361-3666
    ISSN (online) 1467-7717
    ISSN 0361-3666
    DOI 10.1111/disa.12331
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  5. Article ; Online: What are the mechanisms and contexts by which care groups achieve social and behavioural change in low- and middle-income countries? Group motivation findings from a realist synthesis.

    Pieterse, Pieternella / Walsh, Aisling / Chirwa, Ellen / Matthews, Anne

    Public health nutrition

    2022  , Page(s) 1–12

    Abstract: Objective: Infant and under-five mortality rates in low- and middle-income countries (LMIC) can be reduced by encouraging behaviours such as sleeping under insecticide-treated bed nets, exclusive breast-feeding for the first 6 months, regular ... ...

    Abstract Objective: Infant and under-five mortality rates in low- and middle-income countries (LMIC) can be reduced by encouraging behaviours such as sleeping under insecticide-treated bed nets, exclusive breast-feeding for the first 6 months, regular handwashing, etc. Community-based volunteer or peer-to-peer mechanisms are cost-effective ways of promoting these lifesaving practices. However, the sustainability and reach of community-based behaviour change promotion remains a challenge. Our inquiry focuses on the utilisation, by non-governmental organisations (NGO), of Care Groups, a peer-to-peer behaviour change intervention. We asked: What are the mechanisms and contexts by which Care Groups achieve social and behavioural change in nutrition, health and other sectors?
    Design: Realist synthesis reviewing forty-two texts that contained empirical evidence about Care Group interventions.
    Setting: LMIC.
    Participants: We held consultations with a research reference group, which included Care Group and nutrition experts, and Care Group - implementing NGO staff in Malawi.
    Results: Different types of motivation drive the establishment and the sustainability of peer group interventions. A certain amount of motivation was derived from the resources provided by the NGO establishing the Care Groups. Subsequently, both volunteers and neighbourhood group members were motivated by the group dynamics and mutual support, as well as support from the wider community. Finally, volunteers and group members alike became self-motivated by their experience of being involved in group activities.
    Conclusions: When designing and implementing community-based behaviour change interventions, awareness of the multi-directional nature of the motivating drivers that are experienced by peer- or community group members is important, to optimise these groups' reach and sustainability.
    Language English
    Publishing date 2022-06-01
    Publishing country England
    Document type Journal Article
    ZDB-ID 1436024-x
    ISSN 1475-2727 ; 1368-9800
    ISSN (online) 1475-2727
    ISSN 1368-9800
    DOI 10.1017/S1368980022001367
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  6. Article: What are the mechanisms and contexts by which care groups achieve social and behavioural change in low- and middle-income countries? Group motivation findings from a realist synthesis

    Pieterse, Pieternella / Walsh, Aisling / Chirwa, Ellen / Matthews, Anne

    Public health nutrition. 20222022 Oct. 01, June 01, v. 25, no. 10

    2022  

    Abstract: Infant and under-five mortality rates in low- and middle-income countries (LMIC) can be reduced by encouraging behaviours such as sleeping under insecticide-treated bed nets, exclusive breast-feeding for the first 6 months, regular handwashing, etc. ... ...

    Abstract Infant and under-five mortality rates in low- and middle-income countries (LMIC) can be reduced by encouraging behaviours such as sleeping under insecticide-treated bed nets, exclusive breast-feeding for the first 6 months, regular handwashing, etc. Community-based volunteer or peer-to-peer mechanisms are cost-effective ways of promoting these lifesaving practices. However, the sustainability and reach of community-based behaviour change promotion remains a challenge. Our inquiry focuses on the utilisation, by non-governmental organisations (NGO), of Care Groups, a peer-to-peer behaviour change intervention. We asked: What are the mechanisms and contexts by which Care Groups achieve social and behavioural change in nutrition, health and other sectors? Realist synthesis reviewing forty-two texts that contained empirical evidence about Care Group interventions. LMIC. We held consultations with a research reference group, which included Care Group and nutrition experts, and Care Group – implementing NGO staff in Malawi. Different types of motivation drive the establishment and the sustainability of peer group interventions. A certain amount of motivation was derived from the resources provided by the NGO establishing the Care Groups. Subsequently, both volunteers and neighbourhood group members were motivated by the group dynamics and mutual support, as well as support from the wider community. Finally, volunteers and group members alike became self-motivated by their experience of being involved in group activities. When designing and implementing community-based behaviour change interventions, awareness of the multi-directional nature of the motivating drivers that are experienced by peer- or community group members is important, to optimise these groups’ reach and sustainability.
    Keywords behavior change ; behavior modification ; breast feeding ; cost effectiveness ; hand washing ; insecticide application ; mortality ; motivation ; public health ; Malawi
    Language English
    Dates of publication 2022-0601
    Size p. 2908-2919.
    Publishing place Cambridge University Press
    Document type Article
    ZDB-ID 1436024-x
    ISSN 1475-2727 ; 1368-9800
    ISSN (online) 1475-2727
    ISSN 1368-9800
    DOI 10.1017/S1368980022001367
    Database NAL-Catalogue (AGRICOLA)

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    In stock of ZB MED Bonn / Germany

    Z 6998: Show issues

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  7. Article ; Online: Improving breastfeeding support through the implementation of the baby friendly hospital and community initiatives: a scoping review protocol.

    Walsh, Aisling / Pieterse, Pieternella / McCormack, Zoe / Chirwa, Ellen / Matthews, Anne

    HRB open research

    2021  Volume 4, Page(s) 1

    Abstract: Background: ...

    Abstract Background:
    Language English
    Publishing date 2021-04-23
    Publishing country Ireland
    Document type Journal Article
    ISSN 2515-4826
    ISSN (online) 2515-4826
    DOI 10.12688/hrbopenres.13180.2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Exploring how and why Care Groups work to improve infant feeding practices in low- and middle-income countries: a realist review protocol.

    Pieterse, Pieternella / Matthews, Anne / Walsh, Aisling / Chirwa, Ellen

    Systematic reviews

    2020  Volume 9, Issue 1, Page(s) 237

    Abstract: Background: Within our inquiry into the implementation of breastfeeding policy in Malawi, Care Groups have been mentioned as a means to improve maternal and child health and nutrition outcomes. The 'Care Group model' is an approach primarily used in ... ...

    Abstract Background: Within our inquiry into the implementation of breastfeeding policy in Malawi, Care Groups have been mentioned as a means to improve maternal and child health and nutrition outcomes. The 'Care Group model' is an approach primarily used in international development settings, whereby social and behaviour changes are promoted through supported peer-to-peer (mostly mother-to-mother) knowledge sharing. The aim of most Care Groups is to promote improved infant nutrition, improve hygiene and increase the number of children who are fully vaccinated and exclusively breastfed for the first 6 months. The behavioural changes promoted by Care Groups (such as safe infant feeding, frequent hand washing, consistent mosquito net usage, providing suitable complementary foods from 6 months old) have the potential of averting preventable deaths particularly among children under five. While a variety of approaches are used to promote improved health and nutrition for children under five, the Care Groups model was best known and frequently referenced during our discussions with key stakeholders regarding the delivery at community level of Malawi's National Multi-Sector Nutrition Policy 2018-2022. A better understanding of how Care Groups achieve their social and behaviour change results and how community-based efforts are sustained can potentially help to ensure more effective planning and budgeting for Care Group interventions and enable greater sustainability and increased coverage of infant feeding support countrywide. This realist review is designed to improve our understanding of how, why, to what extent and under what circumstances Care Groups improve infant feeding practices in low- and middle-income countries (LMICs).
    Methods and analysis: A realist review is a theory-driven approach to evidence synthesis. To undertake this realist review, we will gather evidence by conducting peer-reviewed and grey literature database searches in order to find peer reviewed articles, programme guidelines and evaluation reports, among other texts, associated with the implementation of Care Groups in low- and middle-income countries. Our review process has five key steps: (1) locating existing theories; (2) searching for evidence in literature; (3) selecting articles and other suitable evidence; (4) extracting data, identifying configurations of context-mechanism-outcomes; and (5) synthesising the evidence, drawing conclusions.
    Discussion: The results of this realist review will be written up according to RAMESES guidelines and disseminated through a stakeholder workshop in Malawi, through conference presentations and peer-reviewed publications. It is intended to improve the understanding of the potential and limits of working through Care Groups globally and among relevant Malawi Ministry of Health staff and the donor and NGO community, both internationally and within Malawi. This systematic review protocol has been submitted for registration on the PROSPERO database (receipt number: 170261).
    MeSH term(s) Child ; Developing Countries ; Humans ; Infant ; Poverty ; Systematic Reviews as Topic
    Language English
    Publishing date 2020-10-10
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2662257-9
    ISSN 2046-4053 ; 2046-4053
    ISSN (online) 2046-4053
    ISSN 2046-4053
    DOI 10.1186/s13643-020-01497-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Exploring how and why Care Groups work to improve infant feeding practices in low- and middle-income countries

    Pieternella Pieterse / Anne Matthews / Aisling Walsh / Ellen Chirwa

    Systematic Reviews, Vol 9, Iss 1, Pp 1-

    a realist review protocol

    2020  Volume 7

    Abstract: Abstract Background Within our inquiry into the implementation of breastfeeding policy in Malawi, Care Groups have been mentioned as a means to improve maternal and child health and nutrition outcomes. The ‘Care Group model’ is an approach primarily used ...

    Abstract Abstract Background Within our inquiry into the implementation of breastfeeding policy in Malawi, Care Groups have been mentioned as a means to improve maternal and child health and nutrition outcomes. The ‘Care Group model’ is an approach primarily used in international development settings, whereby social and behaviour changes are promoted through supported peer-to-peer (mostly mother-to-mother) knowledge sharing. The aim of most Care Groups is to promote improved infant nutrition, improve hygiene and increase the number of children who are fully vaccinated and exclusively breastfed for the first 6 months. The behavioural changes promoted by Care Groups (such as safe infant feeding, frequent hand washing, consistent mosquito net usage, providing suitable complementary foods from 6 months old) have the potential of averting preventable deaths particularly among children under five. While a variety of approaches are used to promote improved health and nutrition for children under five, the Care Groups model was best known and frequently referenced during our discussions with key stakeholders regarding the delivery at community level of Malawi’s National Multi-Sector Nutrition Policy 2018-2022. A better understanding of how Care Groups achieve their social and behaviour change results and how community-based efforts are sustained can potentially help to ensure more effective planning and budgeting for Care Group interventions and enable greater sustainability and increased coverage of infant feeding support countrywide. This realist review is designed to improve our understanding of how, why, to what extent and under what circumstances Care Groups improve infant feeding practices in low- and middle-income countries (LMICs). Methods and analysis A realist review is a theory-driven approach to evidence synthesis. To undertake this realist review, we will gather evidence by conducting peer-reviewed and grey literature database searches in order to find peer reviewed articles, programme guidelines and evaluation ...
    Keywords Realist review ; Care Groups ; Exclusive breastfeeding ; Infant nutrition ; Malawi ; Medicine ; R
    Subject code 360
    Language English
    Publishing date 2020-10-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  10. Article ; Online: Improving breastfeeding support through the implementation of the Baby-Friendly Hospital and Community Initiatives: a scoping review.

    Walsh, Aisling / Pieterse, Pieternella / Mishra, Nita / Chirwa, Ellen / Chikalipo, Maria / Msowoya, Chimwemwe / Keating, Ciara / Matthews, Anne

    International breastfeeding journal

    2023  Volume 18, Issue 1, Page(s) 22

    Abstract: Background: Improved breastfeeding practices have the potential to save the lives of over 823,000 children under 5 years old globally every year. The Baby-Friendly Hospital Initiative (BFHI) is a global campaign by the World Health Organization and the ... ...

    Abstract Background: Improved breastfeeding practices have the potential to save the lives of over 823,000 children under 5 years old globally every year. The Baby-Friendly Hospital Initiative (BFHI) is a global campaign by the World Health Organization and the United Nations Children's Fund, which promotes best practice to support breastfeeding in maternity services. The Baby-Friendly Community Initiative (BFCI) grew out of step 10, with a focus on community-based implementation. The aim of this scoping review is to map and examine the evidence relating to the implementation of BFHI and BFCI globally.
    Methods: This scoping review was conducted according to the Joanna Briggs Institute methodology for scoping reviews. Inclusion criteria followed the Population, Concepts, Contexts approach. All articles were screened by two reviewers, using Covidence software. Data were charted according to: country, study design, setting, study population, BFHI steps, study aim and objectives, description of intervention, summary of results, barriers and enablers to implementation, evidence gaps, and recommendations. Qualitative and quantitative descriptive analyses were undertaken.
    Results: A total of 278 articles were included in the review. Patterns identified were: i) national policy and health systems: effective and visible national leadership is needed, demonstrated with legislation, funding and policy; ii) hospital policy is crucial, especially in becoming breastfeeding friendly and neonatal care settings iii) implementation of specific steps; iv) the BFCI is implemented in only a few countries and government resources are needed to scale it; v) health worker breastfeeding knowledge and training needs strengthening to ensure long term changes in practice; vi) educational programmes for pregnant and postpartum women are essential for sustained exclusive breastfeeding. Evidence gaps include study design issues and need to improve the quality of breastfeeding data and to perform prevalence and longitudinal studies.
    Conclusion: At a national level, political support for BFHI implementation supports expansion of Baby-Friendly Hospitals. Ongoing quality assurance is essential, as is systematic (re)assessment of BFHI designated hospitals. Baby Friendly Hospitals should provide breastfeeding support that favours long-term healthcare relationships across the perinatal period. These results can help to support and further enable the effective implementation of BFHI and BFCI globally.
    MeSH term(s) Infant, Newborn ; Child ; Female ; Humans ; Pregnancy ; Child, Preschool ; Breast Feeding ; World Health Organization ; United Nations ; Postnatal Care ; Hospitals
    Language English
    Publishing date 2023-04-15
    Publishing country England
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 2227239-2
    ISSN 1746-4358 ; 1746-4358
    ISSN (online) 1746-4358
    ISSN 1746-4358
    DOI 10.1186/s13006-023-00556-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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