Search

Additional file 1: Supplementary file 1. Overview of differentstructures of Ghana, Malawi, Uganda.

Supplementary Material 1

Supplementary Material 3

Supplementary Material 2

Introduction: Intensified Case Finding (ICF) is a cost-effective strategy for tuberculosis (TB) control and improving quality of life however, its implementation by health workers is generally reported as low in Uganda. There is limited information on the level of ICF implementation and the barriers or facilitators to its implementation among public health facilities in Kampala Capital City Authority (KCCA). In this study we determined the level of ICF implementation, facilitators and its barriers in KCCA public health facilities. Methods: We conducted a cross-sectional study between May-July 2015. We purposively selected six KCCA public health facilities and conducted exit interviews with patients attending Anti-Retroviral Therapy (ART) clinics to assess whether they were screened for TB. In-depth and key informant interviews with health workers were conducted to explore their experiences in implementing ICF. Results: Overall, ICF implementation was sub optimal. Less than 10% (30/321) clients reported being screened for current cough, fever, weight loss or night sweats. Conversely, 90.0% (289/321) clients screened for at least one TB symptom with cough being the most frequently asked symptom 87.5% (281/321). Of 131 clients who were screened and reported having at least one TB symptom, 36.6% (48/131) were sent to the laboratory, 2.3% (3/131) for X-Ray and 61.1% (80/131) to pharmacy. Training, support supervision, proper coordination, and support from implementing partners were facilitators of ICF implementation. Poor staff attitude, irregular supply of ICF related inputs/materials, high workload, transport and stigma were key barriers to ICF policy implementation. Conclusion: ICF implementation at ART clinics in KCCA public health facilities was sub optimal. Health workers’ attitude, training, support supervision and stigma of TB clients should be addressed for better ICF implementation.

Background: Decentralisation has been adopted by many governments to strengthen national systems, including the health system. Decision space is used to describe the decision‐making power devolved to local government. Human resource Management (HRM) is a challenging area that District Health Management Teams (DHMT) need some control over its functions to develop innovative ways of improving health services. The study aims to examine the use of DHMTs' reported decision space for HRM functions in Uganda. Methods: Mixed methods approach was used to examine the DHMTs' reported decision space for HRM functions in three districts in Uganda, which included self‐assessment questionnaires and focus group discussions (FGDs). Results: The decision space available for the DHMTs varied across districts, with Bunyangabu and Ntoroko DHMTs reporting having more control than Kabarole. All DHMTs reported full control over the functions of performance management, monitoring policy implementation, forecasting staffing needs, staff deployment, and identifying capacity needs. However, they reported narrow decision space for developing job descriptions, resources mobilisation, and organising training; and no control over modifying staffing norms, setting salaries and developing an HR information system (HRIS). Nevertheless, DHMTs tried to overcome their limitations by adjusting HR policies locally, better utilising available resources and adapting the HRIS to local needs. Conclusions: Decentralisation provides a critical opportunity to strengthen HRM in low‐and‐middle‐income countries. Examining decision space for HRM functions can help identify areas where district health managers can change or improve their actions. In Uganda, decentralisation helped the DHMTs be more responsive to the local workforce needs and analysing decision space helped identify areas for improvement in HRM. There are some limitations and more power over HRM functions and strong management competencies would help them become more resourceful.

While there is a growing body of literature on how to attract and retain health workers once they are trained, there is much less published on what motivates people to train as health professions in the first place in low- and middle-income countries and what difference this makes to later retention. In this article, we examine patterns in expressed motivation to join the profession across different cadres, based on 103 life history interviews conducted in northern Uganda, Sierra Leone, Cambodia, and Zimbabwe. A rich mix of reported motivations for joining the profession was revealed, including strong influence of "personal calling," exhortations of family and friends, early experiences, and chance factors. Desire for social status and high respect for health professionals were also significant. Economic factors are also important-not just perceptions of future salaries and job security but also more immediate ones, such as low cost or free training. These allowed low-income participants to access the health professions, to which they had shown considerably loyalty. The lessons learned from these cohorts, which had remained in service through periods of conflict and crisis, can influence recruitment and training policies in similar contexts to ensure a resilient health workforce. [Abstract copyright: Copyright © 2018 John Wiley & Sons, Ltd.]

This article is grounded in a research programme which set out to understand how to rebuild health systems post-conflict. Four countries were studied – Uganda, Sierra Leone, Zimbabwe, and Cambodia – which were at different distances from conflict and crisis, as well as each having a unique conflict story. During the research process, the Ebola epidemic broke out in West Africa. Zimbabwe has continued to face a profound economic crisis. Within our research on health worker incentives, we captured insights from 128 life history interviews with a variety of staff that had remained in service. This article aims to draw together lessons from these four contexts which can provide lessons for enhancing staff and therefore health system resilience in future, especially in similarly fragile and conflict-affected contexts. We examine the reported effects, both personal and professional, of the three different types of shock (conflicts, epidemics and prolonged political-economic crises), and how staff coped. We find that the impact of shocks and coping strategies are similar between conflict/post-conflict and epidemic contexts – particularly in relation to physical threats and psychosocial threats – while all three contexts create challenges and staff responses for working conditions and remuneration. Health staff showed considerable inventiveness and resilience, and also benefited from external assistance of various kinds, but there are important gaps which point to ways in which they should be better protected and supported in the future. Health systems are increasingly fragile and conflict-prone, and shocks are often prolonged or repeated. Resilience should not be taken for granted or used as an excuse for abandoning frontline health staff. Strategies should be in place at local, national and international levels to prepare for predictable crises of various sorts, rather than waiting for them to occur and responding belatedly, or relying on personal sacrifices by staff to keep services functioning.

This study aimed at exploring the lessons we can learn from adolescents' perceptions on sex education strategies in Uganda. This study was guided by the social learning theory. Methods: This was a qualitative study based on purposive sampling. In depth interviews were conducted with 23 boys and girls aged 15-19 years, in Kampala and Kiboga districts, who were either in-school or out of school. The interviews were recorded, transcribed and analysed. Results: Research findings indicated that there is more to sex education than HIV/AIDS prevention. Another major finding was that adolescents are exposed to a variety of sources of sex education. The paternal Aunt as a source was mentioned the least, implying that adolescents did not attach as much importance to it as was attached traditionally. However, the media had a lot of influence on adolescent' sexual behaviour since it was the most mentioned source. Another finding was that there is a relationship between what adults say and adolescents would like to know. Adults say what should/can be done' while adolescents ask how?'. The study also revealed that adolescents tend to have different needs and these needs require different messages. Adolescents also evaluate messages differently. There were factors that influenced which person adolescents turn to when they have questions related to sexuality. These included trust, openness, gender, knowlegeability, proximity and age. Conclusion: We can learn a lot from adolescents' perceptions, experiences and reflections if adolescents are given a chance to express their views. However, the issue of trust is important as it creates a favourable environment for openness in communication about sex and sexuality. Master of Philosophy in Gender and Development GAD350 MAPS-GAD