| 1. |
- Saulnier, Dell, et al.
(author)
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Truth, humane treatment, and identity: perspectives on the legitimacy of the public and private health sectors during Covid in Zambia
- 2024
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In: Humanities & Social Sciences Communications. - 2662-9992. ; 11
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Journal article (peer-reviewed)abstract
- Legitimacy is necessary for resilience and trust helps to legitimize health systems. Providing services during Covid has relied on both the private and public sectors but there is little information on differences in trust between these sectors during shocks like Covid and how it may impact the health system’s legitimacy. The purpose of this study was to explore community trust in the public and private sectors of the Zambian health system during Covid, to generate understanding on how trust in the different sectors may influence the system’s legitimacy. Twelve focus groups discussions and 22 key informant interviews were conducted in 2022 with community members who used public, private, and faith-based services during Covid and service providers, and thematic analysis identified perceptions of trust between the different sectors. The themes ‘Humane, patient-centred treatment’ and ‘Communicating the truth’ describe the desire for humane interactions and truthfulness during Covid, compromised by fear, uncertainty, and suspicions of the motives of the sectors, and alleviated by support, security, and shared identity. The legitimacy of the public sector was influenced by shared spaces, values, and identities with communities. The private sector maintained its legitimacy through service quality and its identity as a non-governmental business. Interpersonal trust was important, but identity played a larger role than high-quality interactions for legitimacy in Zambia during the pandemic. To enhance legitimacy and resilience during shocks, potential strategies include strengthening the quality of public sector interactions to meet private sector standards, emphasizing the public sector as a public good, and clarifying the public sector’s role vis-à-vis the government during crises.
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| 2. |
- Zulu, Davy Wadula, et al.
(author)
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Integration of systematic screening for tuberculosis in outpatient departments of urban primary healthcare facilities in Zambia : a case study of Kitwe district
- 2022
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In: BMC Health Services Research. - : Springer Nature. - 1472-6963. ; 22:1
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Journal article (peer-reviewed)abstract
- Background: Tuberculosis (TB) is the leading cause of death from a single infectious agent globally, killing about 1.5 million people annually, yet 3 million cases are missed every year. The World Health Organization recommends systematic screening of suspected active TB patients among those visiting the healthcare facilities. While many countries have scaled-up systematic screening of TB, there has been limited assessment of the extent of its integration into the health system. This study sought to explore factors that shape the integration of systematic screening of TB in outpatient departments of primary healthcare facilities in Kitwe district, Zambia. Methods: This was a qualitative case study with health providers including district managers, TB focal point persons and laboratory personnel working in six purposively selected primary healthcare facilities. Data was collected through key informant (n = 8) and in-depth (n = 15) interviews. Data analysis was conducted using QDA Miner software and guided by Atun’s Integration framework. Results: The facilitators to integration of systematic screening for TB into out patient departments of primary health facilities included the perceived high burden TB, compatibility of the systematic screening for TB program with healthcare workers training and working schedules, stakeholder knowledge of each others interest and values, regular performance management and integrated outreach of TB screening services. Constraining factors to integration of systematic screening for TB into outpatient departments included complexity of screening for TB in children, unbalanced incentivization mechanisms, ownership and legitimacy of the TB screening program, negative health worker attitudes, social cultural misconceptions of TB and societal stigma as well as the COVID-19 pandemic. Conclusion: Systematic screening of TB is not fully integrated into the primary healthcare facilities in Zambia to capture all those suspected with active TB that make contact with the health system. Finding the missing TB cases will, therefore, require contextual adaptation of the systematic screening for TB program to local needs and capacities as well as strengthening the health system.
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| 3. |
- Banda, Emmanuel, et al.
(author)
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Acceptability of an economic support component to reduce early pregnancy and school dropout in Zambia : a qualitative case study
- 2019
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In: Global Health Action. - : Taylor & Francis. - 1654-9716 .- 1654-9880. ; 12:1
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Journal article (peer-reviewed)abstract
- Background: Cash Transfer (CT) schemes have become popular poverty reducing measures in many low and middle-income countries. Research indicates that when provided to girls in resource poor settings, cash transfers can increase education and postpone marriage and pregnancy. However, a few studies indicate that they can also have negative effects which can affect their acceptability, such as generating intra-community tensions.Objective: Conceptually informed by Rogers’ diffusion of innovation theory, this paper explores factors affecting the acceptability of economic support in a randomized controlled trial in rural Monze and Pemba Districts of Southern Province in Zambia.Methods: Qualitative data were collected through five focus group discussions and six in-depth, semi-structured interviews and analysed using thematic analysis. This study was done in the combined arm of a trial where girls received both economic support and participated in youth clubs offering sexuality and life-skills education.Results: In the study communities, acceptability was encouraging by the belief that economic support provided benefits beyond beneficiaries and that it improved access to education, and reduced teen pregnancies, marriages and school drop-out. However, provision of economic support only to selected girls and their parents and fear among some that the support was linked to satanic practices negatively affected acceptability. These fears were mitigated through community sensitisations.Conclusion: The study demonstrated that relative advantage, observability, simplicity and compatibility were key factors in influencing acceptability of the economic support. However, to enhance acceptability of cash transfer schemes aimed at addressing early marriage and pregnancy, it is important to explore socio-cultural factors that create suspicions and negative perceptions and to provide schemes that are perceived as relatively better than available similar schemes, understood, compatible and viable beyond the immediate beneficiary.
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| 4. |
- Byskov, Jens, et al.
(author)
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A systems perspective on the importance of global health strategy developments for accomplishing today’s Sustainable Development Goals
- 2019
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In: Health Policy and Planning. - : Oxford University Press. - 0268-1080 .- 1460-2237. ; 34:9, s. 635-645
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Journal article (peer-reviewed)abstract
- Priority setting within health systems has not led to accountable, fair and sustainable solutions to improving population health. Providers, users and other stakeholders each have their own health and service priorities based on selected evidence, own values, expertise and preferences. Based on a historical account, this article analyses if contemporary health systems are appropriate to optimize population health within the framework of cross cutting targets of the Sustainable Development Goals (SDGs). We applied a scoping review approach to identify and review literature of scientific databases and other programmatic web and library-based documents on historical and contemporary health systems policies and strategies at the global level. Early literature supported the 1977 launching of the global target of Health for All by the year 2000. Reviewed literature was used to provide a historical overview of systems components of global health strategies through describing the conceptualizations of health determinants, user involvement and mechanisms of priority setting over time, and analysing the importance of historical developments on barriers and opportunities to accomplish the SDGs. Definitions, scope and application of health systems-associated priority setting fluctuated and main health determinants and user influence on global health systems and priority setting remained limited. In exploring reasons for the identified lack of SDG-associated health systems and priority setting processes, we discuss issues of accountability, vested interests, ethics and democratic legitimacy as conditional for future sustainability of population health. To accomplish the SDGs health systems must engage beyond their own sector boundary. New approaches to Health in All Policies and One Health may be conducive for scaling up more democratic and inclusive priority setting processes based on proper process guidelines from successful pilots. Sustainable development depends on population preferences supported by technical and managerial expertise.
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| 5. |
- Byskov, Jens, et al.
(author)
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The accountability for reasonableness approach to guide priority setting in health systems within limited resources : findings from action research at district level in Kenya, Tanzania, and Zambia
- 2014
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In: Health Research Policy and Systems. - : BioMed Central. - 1478-4505. ; 12
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Journal article (peer-reviewed)abstract
- Background: Priority-setting decisions are based on an important, but not sufficient set of values and thus lead to disagreement on priorities. Accountability for Reasonableness (AFR) is an ethics-based approach to a legitimate and fair priority-setting process that builds upon four conditions: relevance, publicity, appeals, and enforcement, which facilitate agreement on priority-setting decisions and gain support for their implementation. This paper focuses on the assessment of AFR within the project REsponse to ACcountable priority setting for Trust in health systems (REACT). Methods: This intervention study applied an action research methodology to assess implementation of AFR in one district in Kenya, Tanzania, and Zambia, respectively. The assessments focused on selected disease, program, and managerial areas. An implementing action research team of core health team members and supporting researchers was formed to implement, and continually assess and improve the application of the four conditions. Researchers evaluated the intervention using qualitative and quantitative data collection and analysis methods. Results: The values underlying the AFR approach were in all three districts well-aligned with general values expressed by both service providers and community representatives. There was some variation in the interpretations and actual use of the AFR in the decision-making processes in the three districts, and its effect ranged from an increase in awareness of the importance of fairness to a broadened engagement of health team members and other stakeholders in priority setting and other decision-making processes. Conclusions: District stakeholders were able to take greater charge of closing the gap between nationally set planning and the local realities and demands of the served communities within the limited resources at hand. This study thus indicates that the operationalization of the four broadly defined and linked conditions is both possible and seems to be responding to an actual demand. This provides arguments for the continued application and further assessment of the potential of AFR in supporting priority-setting and other decision-making processes in health systems to achieve better agreed and more sustainable health improvements linked to a mutual democratic learning with potential wider implications.
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| 6. |
- Byskov, Jens, et al.
(author)
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The Need for Global Application of the Accountability for Reasonableness Approach to Support Sustainable Outcomes Comment on "Expanded HTA Enhancing Fairness and Legitimacy"
- 2017
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In: International Journal of Health Policy and Management. - : Kerman University of Medical Sciences. - 2322-5939. ; 6:2, s. 115-118
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Journal article (peer-reviewed)abstract
- The accountability for reasonableness (AFR) concept has been developed and discussed for over two decades. Its interpretation has been studied in several ways partly guided by the specific settings and the researchers involved. This has again influenced the development of the concept, but not led to universal application. The potential use in health technology assessments (HTAs) has recently been identified by Daniels et al as yet another excellent justification for AFR-based process guidance that refers to both qualitative and a broader participatory input for HTA, but it has raised concerns from those who primarily support the consistency and objectivity of more quantitative and reproducible evidence. With reference to studies of AFR-based interventions and the through these repeatedly documented motivation for their consolidation, we argue that it can even be unethical not to take AFR conditions beyond their still mainly formative stage and test their application within routine health systems management for their expected support to more sustainable health improvements. The ever increasing evidence and technical expertise are necessary but at times contradictory and do not in isolation lead to optimally accountable, fair and sustainable solutions. Technical experts, politicians, managers, service providers, community members, and beneficiaries each have their own values, expertise and preferences, to be considered for necessary buy in and sustainability. Legitimacy, accountability and fairness do not come about without an inclusive and agreed process guidance that can reconcile differences of opinion and indeed differences in evidence to arrive at a by all understood, accepted, but not necessarily agreed compromise in a current context -until major premises for the decision change. AFR should be widely adopted in projects and services under close monitoring and frequent reviews.
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| 7. |
- Chavula, Malizgani Paul, et al.
(author)
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Factors influencing the integration of comprehensive sexuality education into educational systems in low- and middle-income countries : a systematic review
- 2022
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In: Reproductive Health. - : BioMed Central. - 1742-4755. ; 19:1
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Research review (peer-reviewed)abstract
- BACKGROUND: Comprehensive sexuality education (CSE) plays a critical role in promoting youth and adolescent's sexual and reproductive health and wellbeing. However, little is known about the enablers and barriers affecting the integration of CSE into educational programmes. The aim of this review is to explore positive and negative factors influencing the integration of CSE into national curricula and educational systems in low- and middle-income countries.METHODS: We conducted a systematic literature review (January 2010 to August 2022). The results accord with the Preferred Reporting Items for Systematic Reviews and Meta-analysis standards for systematic reviews. Data were retrieved from the PubMed, Cochrane, Google Scholar, and Web of Hinari databases. The search yielded 442 publications, of which 34 met the inclusion criteria for full-text screening. The review is guided by an established conceptual framework that incorporates the integration of health innovations into health systems. Data were analysed using a thematic synthesis approach.RESULTS: The magnitude of the problem is evidenced by sexual and reproductive health challenges such as high teenage pregnancies, early marriages, and sexually transmitted infections. Awareness of these challenges can facilitate the development of interventions and the implementation and integration of CSE. Reported aspects of the interventions include core CSE content, delivery methods, training materials and resources, and various teacher-training factors. Reasons for adoption include perceived benefits of CSE, experiences and characteristics of both teachers and learners, and religious, social and cultural factors. Broad system characteristics include strengthening links between schools and health facilities, school and community-based collaboration, coordination of CSE implementation, and the monitoring and evaluation of CSE. Ultimately, the availability of resources, national policies and laws, international agendas, and political commitment will impact upon the extent and level of integration.CONCLUSION: Social, economic, cultural, political, legal, and financial contextual factors influence the implementation and integration of CSE into national curricula and educational systems. Stakeholder collaboration and involvement in the design and appropriateness of interventions is critical.
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| 8. |
- chilambe, Kunda, et al.
(author)
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Experiences of teachers and community-based health workers in addressing adolescents’ sexual reproductive health and rights problems in rural health systems : a case of the RISE project in Zambia
- 2023
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In: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 23:1
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Journal article (peer-reviewed)abstract
- Background: Adolescents in low-and-middle-income countries like Zambia face a high burden of sexual, reproductive, health and rights problems including coerced sex, teenage pregnancies, and early marriages. The Zambia government through Ministry of Education has integrated comprehensive sexuality education (CSE) in the education and school system to contribute towards addressing Adolescents sexual, reproductive, health and rights (ASRHR) problems. This paper sought to explore teachers and community based health workers (CBHWs)’ experiences in addressing ASRHR problems in in rural health systems in Zambia.Methodology: The study was conducted under Research Initiative to Support the Empowerment of Girls (RISE) community randomized trial that aims to measure the effectiveness of economic and community interventions in reducing early marriages, teenage pregnancies, and school dropout in Zambia. We conducted qualitative 21 in-depth interviews with teachers and CBHWs involved in the implementation of CSE in communities. Thematic analysis was used to analyse teachers and CBHWs´ roles, challenges, and opportunities in promoting ASRHR services.Results: The study identified teachers and CBHWs roles, and challenges experienced in promoting ASRHR and suggested strategies to enhance delivery of the intervention. The role of teachers and CBHWs in addressing ASRHR problems included mobilizing and sensitizing the community for meetings, providing SRHR counseling services to both adolescents and guardians, and strengthening referral to SRHR services if needed. The challenges experienced included stigmatization associated with difficult experiences such as sexual abuse and pregnancy, shyness among girls to participate when discussing SRHR in the presence of the boys and myths about contraception. The suggested strategies for addressing the challenges included creating safe spaces for adolescents to discuss SRHR issues and engaging adolescents in coming up with the solution.Conclusion: This study provides significant insight on the important roles that teachers CBHWs can play in addressing adolescents SRHR related problems. Overall, the study emphasizes the need to fully engage adolescents in addressing adolescents SRHR problems.
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| 9. |
- Duffey, Keeva, et al.
(author)
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A cross-sectional study of sexual health knowledge, attitudes, and reported behavior among Zambian adolescent girl participants in a football program
- 2019
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In: Journal of Sport for Development. - 2330-0574. ; 7:12, s. 46-58
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Journal article (peer-reviewed)abstract
- Limited research has assessed whether sports participation can be linked to decreasing risky sexual behavior among adolescent girls in sub-Saharan Africa. The current study aimed to assess whether participation in a football league that provides sexual and reproductive health and rights lessons before each football match strengthened adolescent Zambian girls’ sexual health knowledge, attitudes, and behavior. Adolescent female participants in the girls-only football league run by the organization Futebol dá Força (FDF, n=120) completed a questionnaire assessing sexual health knowledge, reported attitudes, and reported behavior. Logistic regressions were used to assess associations between participants’ self-reported program exposure and their sexual health knowledge, reported attitudes, and reported behavior. After examining all exposure levels and adjusting for age, participants with at least six months of reported exposure to the FDF program had better sexual health knowledge and attitudes compared to those reporting less than six months exposure (AOR 4.74, 95% CI 1.70-13.19). Those in the more exposed group also had higher odds of reporting using a condom at last sex (AOR=11.64, 95% CI=1.08-124.57). These findings suggest that sports-based educational programs may improve sexual health knowledge and attitudes among African adolescent girls, potentially reducing the risk of sexually transmitted disease and early aged pregnancy.
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| 10. |
- Malama, Annie, et al.
(author)
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Health research knowledge translation into policy in Zambia : policy-maker and researcher perspectives
- 2021
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In: Health Research Policy and Systems. - : BioMed Central. - 1478-4505. ; 19:1
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Journal article (peer-reviewed)abstract
- Background: The translation of public health research evidence into policy is critical to strengthening the capacity of local health systems to respond to major health challenges. However, a limited amount of public health research evidence generated in developing countries is actually translated into policy because of various factors. This study sought to explore the process of health research knowledge translation into policy and to identify factors that facilitate or hinder the process in Zambia.Methods: This work was an exploratory qualitative study comprising two phases. Firstly, a document review of health policies and strategic frameworks governing research was undertaken to understand the macro-environment for knowledge translation in Zambia. Secondly, key informant interviews were conducted with those responsible for health research and policy formulation. The study interviewed 15 key informants and a thematic analysis approach was used.Results: The document review showed that there are policy efforts to promote knowledge translation through improvement of the research macro-environment. However, the interviews showed that coordination and linkage of the knowledge creation, translation and policy-making processes remains a challenge owing to lack of research knowledge translation capacity, limited resources and lack of knowledge hubs. Emerging local research leadership and the availability of existing stock of underutilized local health research data provide an opportunity to enhance knowledge translation to feed into policy processes in Zambia.Conclusions: Public health research knowledge translation into policy remains a challenge in Zambia. To enhance the uptake of research evidence in policy-making, this study suggests the need for improved coordination, financing and capacity-building in knowledge translation processes for both health researchers and policy-makers.
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