Strengthening human resources for health in resource-limited countries: The case of Medic to Medic in Malawi

Bickton, Fanuel

doi:10.4314/mmj.v31i1.17

Cited by 10 publications

(12 citation statements)

References 6 publications

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“…Staffing and low medical resources identified in our study reflect Tanzania's health care funding shortages 20 and correlate with prior reports on staffing deficiencies in RLS 21 …”

Section: Discussionsupporting

confidence: 83%

“…These include (1) patient-centered initiatives, such as enhanced parental instructional materials about the hazards of potentially toxic herbal remedies or delayed care-seeking behavior; (2) provider-facing awareness campaigns about existing institutional protocols for pediatric sepsis management and specialized training sessions to improve the use of standardized handoff tools and placing pediatric intravenous catheters; and (3) system-level cross-collaboration to disseminate information regarding best practices for interhospital transfers and antibiotic stewardship. Such strategies have been effective in other resource limited settings 11,18,21,24–28 . Future studies might examine the effects of these strategies in situ at BMC.…”

Section: Discussionmentioning

confidence: 99%

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Recognition and Management of Pediatric Sepsis in a Resource-Limited Emergency Department in Mwanza, Tanzania

et al. 2021

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Objective:The World Health Organization aims to reduce worldwide under-five mortality rates (U5MR), with a focus on resource-limited settings (RLS). Tanzania reports a mean U5MR of 54 per 1000 live births, largely due to treatable infectious diseases that may lead to sepsis, accounting for 40% of the under-five deaths. Bugando Medical Centre in Mwanza, Tanzania represents a resource-limited setting in Sub-Saharan Africa and estimates a 14% pediatric mortality rate. We sought to better understand provider experience in recognizing and managing pediatric sepsis in the emergency department (ED) at Bugando Medical Centre in Mwanza, Tanzania. Methods:We conducted a qualitative study with a purposive sampling of 14 Bugando Medical Centre ED providers from January to February 2019, via minimally structured interviews, to identify factors influencing the recognition and management of children presenting to the ED with concern for sepsis. Interviews were conducted in English, audio recorded, and transcribed. Data saturation determined the sample size. Three primary coders independently coded all transcripts and developed an initial coding list. Consensus among all authors generated a final coding scheme. A grounded theory approach guided data analysis. Results:We achieved thematic saturation after 13 interviews. Responses identified patient-, provider-, and health care system-related factors influencing sepsis recognition and management in children presenting to the ED. Patient-related factors include the use of traditional healers, limited parent health literacy, and geographic factors impacting access to medical care. Provider-related factors include limited knowledge of pediatric sepsis, lack of a standard communication process among providers, and insufficient experience with procedural skills on children. Health care systemrelated factors include limited personnel and resources, delayed transfers from referral hospitals, and lack of standard antibiotic-use guidelines.Conclusions: This qualitative study identified patient, provider, and health care system-related factors that influence the emergency care of children with suspected sepsis in a quaternary hospital in Mwanza, Tanzania. These factors may serve as a framework for educational opportunities to improve the early recognition and management of pediatric sepsis in a resource-limited setting.

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“…Staffing and low medical resources identified in our study reflect Tanzania's health care funding shortages 20 and correlate with prior reports on staffing deficiencies in RLS 21 …”

Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Recognition and Management of Pediatric Sepsis in a Resource-Limited Emergency Department in Mwanza, Tanzania

et al. 2021

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“…This is a widespread problem in the country. In 2018, Malawi reported having 0.019 doctors and 0.283 nurses and midwives per 1,000 population, which falls below the WHO 'critical shortage' threshold of 2.28 doctors, nurses, and midwives per 1,000 population (Bickton & Lillie, 2019). While NGO workers did support government providers by taking on HIV services, task shifting did not solve the overarching problem of staff shortages.…”

Section: Healthcare System Left Behindmentioning

confidence: 99%

Limits of neoliberalism: HIV, COVID-19, and the importance of healthcare systems in Malawi

Zhou

2021

Global Public Health

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Countries in sub-Saharan Africa have been seriously affected by HIV and now face a new pandemic -COVID-19. How have prior experiences with managing HIV prepared countries for To what extent has the structure of the global health field enabled or constrained countries' ability to respond? Drawing on qualitative methods, this article examines the impact of HIV interventions on the healthcare system in Malawi and its implications for addressing COVID-19. I argue that the historical and continued influence of neoliberalism in global health manifests in the structures and routines of clinical practice. In Malawi's health centres, a parallel NGO system of care has become grafted onto state healthcare, with NGOs managing HIV commodities and providing care to HIV patients. While HIV NGOs do support the work of government providers, it is limited to tasks that align with their programmatic goals. Outside of donor priorities, the conditions of public healthcare are left behind, and government providers struggle with shortages of staff, medical resources, and basic infrastructure. In the context of COVID-19, risks are compounded as public healthcare facilities not only struggle with resources to treat patients, but also become a site of risk itself for COVID-19 infection.

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“…These improvements have been due in large part to a focus on essential service delivery in maternal–child health. 1 , 2 Eighty per cent of the country’s population live in rural communities, whereas the majority of doctors work in the country’s four urban central hospitals. 3 Most rural care in Malawi is provided by clinical officers, who have undergone a 3-year clinical training, and by medical assistants, who have undergone a 2-year clinical training.…”

Section: The Contextmentioning

confidence: 99%

Strengthening management of non-communicable diseases in primary care, Malawi: A short report

Mailosi

Miller

Hodge

et al. 2021

African Journal of Primary Health Care & Family Medicine

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Within the community-orientated primary care module for training family physicians at the Kamuzu University of Health Sciences in Malawi, a relationship was formed between Nkhoma Mission Hospital’s Family Medicine Department and the Diamphwe Community Health Centre (HC) to strengthen the continuity of healthcare and capacity team building. The initial focus was on improving the management of hypertension and diabetes in terms of diagnosis, tracking of the patients in a registry and timely referral to secondary care facilities The relationship has received positive support from Diamphwe healthcare workers, which then improved the management of non-communicable diseases and patient care at Diamphwe. It has also shown how family medicine physicians can improve HC capacity through support and mentorship.

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Strengthening human resources for health in resource-limited countries: The case of Medic to Medic in Malawi

Cited by 10 publications

References 6 publications

Recognition and Management of Pediatric Sepsis in a Resource-Limited Emergency Department in Mwanza, Tanzania

Recognition and Management of Pediatric Sepsis in a Resource-Limited Emergency Department in Mwanza, Tanzania

Limits of neoliberalism: HIV, COVID-19, and the importance of healthcare systems in Malawi

Strengthening management of non-communicable diseases in primary care, Malawi: A short report

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