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ObjectivesThe burden of malaria has persistently been high in Ebonyi state and Nigeria despite long-standing collaborations with international partners with huge and increased amounts of financial investments. We explored the system-wide governance challenges of the Ebonyi State Malaria Elimination Programme (SMEP) and the factors responsible in order to make recommendations for malaria health system strengthening.DesignWe did a qualitative study informed by the health system governance framework by Mikkelsen-Lopezet aland Savedoff’s concept of governance.Setting and participantsBetween 18 October 2022 and 8 November 2022, 25 semistructured face-to-face in-depth interviews were conducted in English with purposively selected key stakeholders in the Ebonyi SMEP aged 18 years or older with at least 2 years of involvement in the SMEP and who gave consent.AnalysisData were analysed deductively and the analytical strategy was informed by the framework method for the analysis of qualitative data by Galeet al.ResultsMany system-wide governance challenges of the SMEP were identified including the absence of state’s strategic vision and plans for malaria elimination; very weak primary and secondary healthcare systems; inadequate financial allocation and untimely release of budgeted funds by the state government; lack of human resources for health and very poor mosquito net distribution system. Other challenges were inadequate stakeholders’ participation; poor accountability culture; impaired transparency and corruption and impaired ability to address corruption. The fundamental responsible factors were the lack of state government’s concern for people’s welfare and lack of interest and commitment to the malaria elimination effort, chronic non-employment of staff and lack of human resources in the entire health sector including SMEP, and nepotism and godfatherism.ConclusionsThe system-wide governance challenges and the responsible factors call for changing the ‘business as usual’ and refocusing on strengthening malaria health system governance in addressing the persisting malaria health problems in Ebonyi state (and Nigeria).
ObjectivesThe burden of malaria has persistently been high in Ebonyi state and Nigeria despite long-standing collaborations with international partners with huge and increased amounts of financial investments. We explored the system-wide governance challenges of the Ebonyi State Malaria Elimination Programme (SMEP) and the factors responsible in order to make recommendations for malaria health system strengthening.DesignWe did a qualitative study informed by the health system governance framework by Mikkelsen-Lopezet aland Savedoff’s concept of governance.Setting and participantsBetween 18 October 2022 and 8 November 2022, 25 semistructured face-to-face in-depth interviews were conducted in English with purposively selected key stakeholders in the Ebonyi SMEP aged 18 years or older with at least 2 years of involvement in the SMEP and who gave consent.AnalysisData were analysed deductively and the analytical strategy was informed by the framework method for the analysis of qualitative data by Galeet al.ResultsMany system-wide governance challenges of the SMEP were identified including the absence of state’s strategic vision and plans for malaria elimination; very weak primary and secondary healthcare systems; inadequate financial allocation and untimely release of budgeted funds by the state government; lack of human resources for health and very poor mosquito net distribution system. Other challenges were inadequate stakeholders’ participation; poor accountability culture; impaired transparency and corruption and impaired ability to address corruption. The fundamental responsible factors were the lack of state government’s concern for people’s welfare and lack of interest and commitment to the malaria elimination effort, chronic non-employment of staff and lack of human resources in the entire health sector including SMEP, and nepotism and godfatherism.ConclusionsThe system-wide governance challenges and the responsible factors call for changing the ‘business as usual’ and refocusing on strengthening malaria health system governance in addressing the persisting malaria health problems in Ebonyi state (and Nigeria).
Background Health workforce governance has been proposed as key to improving health services delivery, yet few studies have examined the conceptualisation of health workforce governance in detail and exploration in literature remains limited. Methods A literature review using PubMed, Google Scholar and grey literature search was conducted to map out the current conceptualisation of health workforce governance. We identified all published literature relating to governance in health workforce since 2000 and analysed them on two fronts: the broad definition of governance, and the operationalisation of broad definition into key dimensions of governance. Results Existing literature adopts governance concepts established in health literature and does not adapt understanding to the health workforce context. Definitions are largely quoted from health literature whilst dimensions are focused around the sub-functions of governance which emphasise operationalising governance practices over further conceptualisation. Two sub-functions are identified as essential to the governance process: stakeholder participation and strategic direction. Conclusions Although governance in health systems has gained increasing attention, governance in health workforce remains poorly conceptualised in literature. We propose an improved conceptualisation in the form of a stakeholder-driven network governance model with the national government as a strong steward against vested stakeholder interests. Further research is needed to explore and develop on the conceptual thinking behind health workforce governance.
Highlights: Managing human resources for surge capacity in three referral hospital at West Kalimantan was evaluated. Availability, mobilization and recruitment, duties division, and hospital staff welfare are the reasons for referral hospitals in West Kalimantan are not optimal to face surge capacity during the Covid-19 pandemic. Provincial Health Office role had not been optimal in the HR management at referral hospitals during the Covid-19 pandemic. Abstract: One of the components of effective disaster response management to deal with surge capacity in referral hospitals in West Kalimantan, Indonesia, was to ensure the adequacy of the number of human resources (health workers). This study was conducted to evaluate three referral hospitals and identify the role of the West Kalimantan Provincial Health Office in managing human resources for health workers facing surge capacity due to the Covid-19 pandemic. This study used Rapid Assessment Procedures with qualitative and quantitative methods. Data were collected through observation and interview by using instruments adopted from the Checklist of WHO Hospital Readiness for Covid-19. Based on the checklist, 51.1% of referral hospitals had implemented HR management regarding staff availability. However, the readiness of referral hospitals in West Kalimantan to face surge capacity had not been optimal in several key components, such as staff availability, staff mobilization and recruitment, division of staff duties, and hospital staff welfare during the Covid-19 pandemic. The role of the Provincial Health Office had not been optimal in managing HR at referral hospitals. The Provincial Health Office only played an active role at the beginning of the Covid-19 pandemic, especially for the provision of volunteers. Meanwhile, in the second year of the Covid-19 pandemic, the role of the Provincial Health Office had decreased, especially in the staff availability and training at the referral hospitals. Therefore, the role of the West Kalimantan Provincial Health Office in HR management at the referral hospitals was highly not dominant (17.78%). The central government should regulate the authority of the Provincial Health Office as the leading sector in all types of referral hospitals to integrate all potencies and human resources of local governments to maximize HR management in referral hospitals to face surge capacity due to the increased cases of Covid-19.
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