Strengthening Evidence-Based Planning of Integrated Health Service Delivery Through Local Measures of Health Intervention Delivery Times

ArticleinThe Journal of Infectious Diseases 205 Suppl 1(suppl 1):S40-8 · March 2012with4 Reads
DOI: 10.1093/infdis/jir775 · Source: PubMed
Abstract
Immunization services in developing countries are increasingly used as platforms for delivery of other health interventions. A challenge for scaling up interventions on existing platforms is insufficient resources allocated to the integrated platform with the risk of overburdening a health worker. Determining the length of time to deliver priority interventions can be useful information in planning integrated services and mitigating this risk. We designed and tested a methodology for collecting the time needed to deliver selected interventions. At 18 health facilities in Mali, Ethiopia, and Cameroon, we observed delivery of 11 maternal and child health interventions to determine delivery times. We interviewed health workers to estimate self-reported delivery times. Based on observations, vitamin A supplementation (median, 2:00 minutes per child) and vaccinations (median, 2:22 minutes) took the least amount of time to deliver, whereas human immunodeficiency virus counseling and testing and sick infant treatment interventions were among the longest to deliver. Health worker-reported times to deliver interventions were consistently higher than observed times. Using locally-obtained data can be useful to step for planners to determine how best to use existing platforms for delivering new interventions, particularly since these interventions may require substantially more time to deliver compared to immunizations.
    • "One view is that co-implementation of interventions can effectively make it easier for community volunteers, because they only have one multi-layered intervention to be responsible for which results in increased community volunteer efficiency, reduced reporting requirements, increased intervention utilisation as well as reduced time and transportation costs [10][11][12]. In contrast, by requesting community volunteer to be responsible for an intervention with multiple and additional services, there is the view that they will become overburdened, resulting in increased time and a subsequent decline effect in their performance [13, 14]. Diaries have been used in many contexts as a research tool to monitor daily experiences and behaviours which are expected to change over time. "
    [Show abstract] [Hide abstract] ABSTRACT: Background Trusted literate, or semi-literate, community drug distributors (CDDs) are the primary implementers in integrated preventive chemotherapy (IPC) programmes for Neglected Tropical Disease (NTD) control. The CDDs are responsible for safely distributing drugs and for galvanising communities to repeatedly, often over many years, receive annual treatment, create and update treatment registers, monitor for side-effects and compile treatment coverage reports. These individuals are ‘volunteers’ for the programmes and do not receive remuneration for their annual work commitment. Methods A mixed methods approach, which included pictorial diaries to prospectively record CDD use of time, structured interviews and focus group discussions, was used to triangulate data on how 58 CDDs allocated their time towards their routine family activities and to NTD Programme activities in Uganda. The opportunity costs of CDD time were valued, performance assessed by determining the relationship between time and programme coverage, and CDD motivation for participating in the programme was explored. Results Key findings showed approximately 2.5 working weeks (range 0.6–11.4 working weeks) were spent on NTD Programme activities per year. The amount of time on NTD control activities significantly increased between the one and three deliveries that were required within an IPC campaign. CDD time spent on NTD Programme activities significantly reduced time available for subsistence and income generating engagements. As CDDs took more time to complete NTD Programme activities, their treatment performance, in terms of validated coverage, significantly decreased. Motivation for the programme was reported as low and CDDs felt undervalued. Conclusions CDDs contribute a considerable amount of opportunity cost to the overall economic cost of the NTD Programme in Uganda due to the commitment of their time. Nevertheless, programme coverage of at least 75 %, as required by the World Health Organisation, is not being achieved and vulnerable individuals may not have access to treatment as a consequence of sub-optimal performance by the CDDs due to workload and programmatic factors. Electronic supplementary material The online version of this article (doi:10.1186/s13071-016-1606-2) contains supplementary material, which is available to authorized users.
    Full-text · Article · Dec 2016
  • [Show abstract] [Hide abstract] ABSTRACT: Integration of routine vaccination and other maternal and child health services is becoming more common and the services being integrated more diverse. Yet knowledge gaps remain regarding community members and health workers acceptance, priorities, and concerns related to integration. Qualitative health worker interviews and community focus groups were conducted in 4 African countries (Kenya, Mali, Ethiopia, and Cameroon). Integration was generally well accepted by both community members and health workers. Most integrated services were perceived positively by the communities, although perceptions around socially sensitive services (eg, family planning and human immunodeficiency virus) differed by country. Integration benefits reported by both community members and health workers across countries included opportunity to receive multiple services at one visit, time and transportation cost savings, increased service utilization, maximized health worker efficiency, and reduced reporting requirements. Concerns related to integration included being labor intensive, inadequate staff to implement, inadequately trained staff, in addition to a number of more broad health system issues (eg, stockouts, wait times). Communities generally supported integration, and integrated services may have the potential to increase service utilization and possibly even reduce the stigma of certain services. Some concerns expressed related to health system issues rather than integration, per se, and should be addressed as part of a wider approach to improve health services. Improved planning and patient flow and increasing the number and training of health staff may help to mitigate logistical challenges of integrating services.
    Article · Mar 2012