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Search Results: 1 - 10 of 2666 matches for " Guy Kegels "
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Global Health Actors Claim To Support Health System Strengthening—Is This Reality or Rhetoric?
Bruno Marchal ,Anna Cavalli,Guy Kegels
PLOS Medicine , 2009, DOI: 10.1371/journal.pmed.1000059
Abstract:
Turning around an ailing district hospital: a realist evaluation of strategic changes at Ho Municipal Hospital (Ghana)
Bruno Marchal, McDamien Dedzo, Guy Kegels
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-787
Abstract: A realist case study design was used to analyse how specific management practices might contribute to improving the performance of an urban district hospital in Ho, Volta Region, in Ghana. Mixed methods were used to collect data, including document review, in-depth interviews, group discussions, observations and a review of routine health information.At Ho Municipal Hospital, the management team dealt with the crisis engulfing the ailing urban district hospital by building an alliance between hospital staff to generate a sense of ownership with a focus around participative problem analysis. The creation of an alliance led to improving staff morale and attitude, and contributed also to improvements in the infrastructure and equipment. This in turn had a positive impact on the revenue generating capacity of the hospital. The quick turn around in the state of this hospital showed that change was indeed possible, a factor that greatly motivated the staff.In a second step, the management team initiated the development of a strategic plan for the hospital to maintain the dynamics of change. This was undertaken through participative methods and sustained earlier staff involvement, empowerment and feelings of reciprocity. We found that these factors acted as the core mechanisms underlying the changes taking place at Ho Municipal Hospital.This study shows how a hospital management team in Ghana succeeded in resuscitating an ailing hospital. Their high commitment management approach led to the active involvement and empowerment of staff. It also showed how a realist evaluation approach such as this, could be used in the research of the management of health care organisations to explain how management interventions may or may not work.Over the last 20 years, a number of strategies aimed at improving the performance of health services have been implemented in low- and middle-income countries (LMIC). Each strategy has had its specific perspective and focused on one particular is
A realist evaluation of the management of a well- performing regional hospital in Ghana
Bruno Marchal, McDamien Dedzo, Guy Kegels
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-24
Abstract: We developed a realist evaluation framework for hypothesis formulation, data collection, data analysis and synthesis of the findings. Focusing on the role of human resource management in hospital performance, we formulated our hypothesis around the high commitment management concept. Mixed methods were used in data collection, including individual and group interviews, observations and document reviews.We found that the human resource management approach (the actual intervention) included induction of new staff, training and personal development, good communication and information sharing, and decentralised decision-making. We identified 3 additional practices: ensuring optimal physical working conditions, access to top managers and managers' involvement on the work floor. Teamwork, recognition and trust emerged as key elements of the organisational climate. Interviewees reported high levels of organisational commitment. The analysis unearthed perceived organisational support and reciprocity as underlying mechanisms that link the management practices with commitment.Methodologically, we found that realist evaluation can be fruitfully used to develop detailed case studies that analyse how management interventions work and in which conditions. Analysing the links between intervention, mechanism and outcome increases the explaining power, while identification of essential context elements improves the usefulness of the findings for decision-makers in other settings (external validity). We also identified a number of practical difficulties and priorities for further methodological development.This case suggests that a well-balanced HRM bundle can stimulate organisational commitment of health workers. Such practices can be implemented even with narrow decision spaces. Realist evaluation provides an appropriate approach to increase the usefulness of case studies to managers and policymakers.In the wake of the numerous global health initiatives, the health workforce of low
Evaluation of Capacity-Building Program of District Health Managers in India: A Contextualized Theoretical Framework
N. S. Prashanth,Guy Kegels,Bart Criel
Frontiers in Public Health , 2014, DOI: 10.3389/fpubh.2014.00089
Abstract: Performance of local health services managers at district level is crucial to ensure that health services are of good quality and cater to the health needs of the population in the area. In many low- and middle-income countries, health services managers are poorly equipped with public health management capacities needed for planning and managing their local health system. In the south Indian Tumkur district, a consortium of five non-governmental organizations partnered with the state government to organize a capacity-building program for health managers. The program consisted of a mix of periodic contact classes, mentoring and assignments and was spread over 30 months. In this paper, we develop a theoretical framework in the form of a refined program theory to understand how such a capacity-building program could bring about organizational change. A well-formulated program theory enables an understanding of how interventions could bring about improvements and an evaluation of the intervention. In the refined program theory of the intervention, we identified various factors at individual, institutional, and environmental levels that could interact with the hypothesized mechanisms of organizational change, such as staff’s perceived self-efficacy and commitment to their organizations. Based on this program theory, we formulated context–mechanism–outcome configurations that can be used to evaluate the intervention and, more specifically, to understand what worked, for whom and under what conditions. We discuss the application of program theory development in conducting a realist evaluation. Realist evaluation embraces principles of systems thinking by providing a method for understanding how elements of the system interact with one another in producing a given outcome.
How to develop a theory-driven evaluation design? Lessons learned from an adolescent sexual and reproductive health programme in West Africa
Sara B Van Belle, Bruno Marchal, Dominique Dubourg, Guy Kegels
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-741
Abstract: Based on our experience and the existing literature, we developed a six-step framework for the design of theory-driven evaluations, which we applied in the ex-post evaluation of the networking component of the intervention. The protocol was drafted with the input of the intervention designer. The programme theory, the central element of theory-driven evaluation, was constructed on the basis of semi-structured interviews with designers, implementers and beneficiaries and an analysis of the intervention's logical framework.The six-step framework proved useful as it allowed for a systematic development of the protocol. We describe the challenges at each step. We found that there is little practical guidance in the existing literature, and also a mix up of terminology of theory-driven evaluation approaches. There is a need for empirical methodological development in order to refine the tools to be used in theory driven evaluation. We conclude that ex-post evaluations of programmes can be based on such an approach if the required information on context and mechanisms is collected during the programme.Theory-driven evaluation (TDE) was invented to provide an answer to problems of evaluation approaches that are limited to before-after and input-output designs traditionally used in programme evaluation [1,2]. This was a reaction to the position of Campbell & Stanley [3], who stated that internal validity is the most essential issue in research, and Cronbach's position that evaluation cannot serve policymaking if its external validity is not guaranteed [4]. Chen and Rossi aimed at providing a perspective on evaluation that ensures both types of validity. These authors hold that for any intervention, a programme theory that explains how the planners expect the intervention to work can be described. The programme theory is the often implicit set of assumptions that steers the choice and design of an intervention. Making these assumptions explicit allows to understand what is b
Management of Chronic Diseases in Sub-Saharan Africa: Cross-Fertilisation between HIV/AIDS and Diabetes Care
Josefien van Olmen,Fran?ois Schellevis,Wim Van Damme,Guy Kegels,Freya Rasschaert
Journal of Tropical Medicine , 2012, DOI: 10.1155/2012/349312
Abstract: There is growing attention for chronic diseases in sub-Saharan Africa (SSA) and for bridges between the management of HIV/AIDS and other (noncommunicable) chronic diseases. This becomes more urgent with increasing numbers of people living with both HIV/AIDS and other chronic conditions. This paper discusses the commonalities between chronic diseases by reviewing models of care, focusing on the two most dominant ones, diabetes mellitus type 2 (DM2) and HIV/AIDS. We argue that in order to cope with care for HIV patients and diabetes patients, health systems in SSA need to adopt new strategies taking into account essential elements of chronic disease care. We developed a “chronic dimension framework,” which analyses the “disease dimension,” the “health provider dimension,” the patient or “person dimension,” and the “environment dimension” of chronic diseases. Applying this framework to HIV/AIDS and DM2 shows that it is useful to think about management of both in tandem, comparing care delivery platforms and self-management strategies. A literature review on care delivery models for diabetes and HIV/AIDS in SSA revealed potential elements for cross-fertilisation: rapid scale-up approaches through the public health approach by simplification and decentralisation; community involvement, peer support, and self-management strategies; and strengthening health services. 1. Introduction There is growing attention for chronic life-long conditions (CLLCs) in sub-Saharan Africa (SSA) and for the challenge that these countries face in coping with rising numbers of patients with such diseases. The strong advocacy for managing noncommunicable diseases (NCD) appropriately, many of which are life-long, and the more general focus on health systems strengthening has catalysed attention for chronic care [1, 2]. This trend provides an opportunity to move away from the traditional divide between infectious and noninfectious diseases towards new frameworks for managing disease in a broader perspective [3, 4]. HIV/AIDS is the most eye-catching new chronic disease since antiretroviral treatment (ART) became available at large-scale. Despite this recognition, the models of care and approach for HIV/AIDS and other infectious diseases and for chronic NCD have historically grown separately and bringing these together is no easy task. Health systems in SSA have developed with their major objective being the control of acute infections and improving maternal and child health. The rise of HIV/AIDS brought about a major change, because for the first time a chronic health problem received
Are Expert Patients an Untapped Resource for ART Provision in Sub-Saharan Africa?
Tom Decroo,Wim Van Damme,Guy Kegels,Daniel Remartinez,Freya Rasschaert
AIDS Research and Treatment , 2012, DOI: 10.1155/2012/749718
Abstract: Since the introduction of antiretroviral treatment, HIV/AIDS can be framed as a chronic lifelong condition, requiring lifelong adherence to medication. Reinforcement of self-management through information, acquisition of problem solving skills, motivation, and peer support is expected to allow PLWHA to become involved as expert patients in the care management and to decrease the dependency on scarce skilled medical staff. We developed a conceptual framework to analyse how PLWHA can become expert patients and performed a literature review on involvement of PLWHA as expert patients in ART provision in Sub-Saharan Africa. This paper revealed two published examples: one on trained PLWHA in Kenya and another on self-formed peer groups in Mozambique. Both programs fit the concept of the expert patient and describe how community-embedded ART programs can be effective and improve the accessibility and affordability of ART. Using their day-to-day experience of living with HIV, expert patients are able to provide better fitting solutions to practical and psychosocial barriers to adherence. There is a need for careful design of models in which expert patients are involved in essential care functions, capacitated, and empowered to manage their condition and support fellow peers, as an untapped resource to control HIV/AIDS. 1. Introduction By the end of 2010, approximately 5,1 million people were receiving antiretroviral therapy (ART) in sub-Saharan Africa (SSA) representing only 49% of people in need of treatment [1]. For those fortunate enough to access ART, HIV infection became a chronic disease requiring lifelong treatment. However, retention in ART is a huge challenge. In 2010, a systematic review reported 80.2% (CI 78.0–82.4%), 76.1% (CI 72.4–79.7%), and 72.3% (67.4–76.9%) retention in ART at 12, 24, and 36 months of treatment, respectively, [2]. Frequently mentioned barriers to adherence in SSA are stigma, forgetfulness, lack of awareness, and loss of employment due to frequent absences from work. Shortage of human resources results in inaccessible staff, long waiting times, and poor quality of health services. Moreover, long distances to health facilities, scarce availability and high cost of transport limit access [3, 4]. Although barriers to retention in ART are well studied, they remain in place as a large number of patients keep on defaulting. We postulate that the dominant provider-centred ART delivery model needs to be challenged, taking into account supporting factors for adherence such as adequate information, sense of self-worth, acquisition of
The growing caseload of chronic life-long conditions calls for a move towards full self-management in low-income countries
Josefien van Olmen, Grace Ku, Raoul Bermejo, Guy Kegels, Katharina Hermann, Wim Van Damme
Globalization and Health , 2011, DOI: 10.1186/1744-8603-7-38
Abstract: The aim of this paper is to show that present provider-centred models of chronic care are not adequate and to propose 'full self-management' as an alternative for low-income countries, facilitated by expert patient networks and smart phone technology.People with chronic life-long conditions need to 'rebalance' their life in order to combine the needs related to their chronic condition with other elements of their life. They have a crucial role in the management of their condition and the opportunity to gain knowledge and expertise in their condition and its management. Therefore, people with chronic life-long conditions should be empowered so that they become the centre of management of their condition. In full self-management, patients become the hub of management of their own care and take full responsibility for their condition, supported by peers, professionals and information and communication tools.We will elaborate on two current trends that can enhance the capacity for self-management and coping: the emergence of peer support and expert-patient networks and the development and distribution of smart phone technology both drastically expand the possibilities for full self-management.Present provider-centred models of care for people with chronic life-long conditions are not adequate and we propose 'full self-management' as an alternative for low-income countries, supported by expert networks and smart phone technology.The problem of chronic diseases has risen up the agenda of global health policy makers in recent years [1-6]. The growing numbers of patients with Chronic Life-Long Conditions (CLLC), such as diabetes and hypertension, puts an immense burden on health systems and populations, because of increased needs for health care providers and steadily rising costs of health care services.The present response of health systems, both in high and in low income countries, is highly inadequate. The professionalised models of chronic care that have been developed
The contribution of international health volunteers to the health workforce in sub-Saharan Africa
Geert Laleman, Guy Kegels, Bruno Marchal, Dirk Van der Roost, Isa Bogaert, Wim Van Damme
Human Resources for Health , 2007, DOI: 10.1186/1478-4491-5-19
Abstract: Rapid survey among organizations sending international health volunteers and group discussions with experienced medical officers from sub-Saharan African countries.We contacted 13 volunteer organizations having more than 10 full-time equivalent international health volunteers in sub-Saharan Africa and estimated that they employed together 2072 full-time equivalent international health volunteers in 2005. The numbers sent by secular non-governmental organizations (NGOs) is growing, while the number sent by development NGOs, including faith-based organizations, is mostly decreasing. The cost is estimated at between US$36 000 and US$50 000 per expatriate volunteer per year. There are trends towards more employment of international health volunteers from low-income countries and of national medical staff.Country experts express more negative views about international health volunteers than positive ones. They see them as increasingly paradoxical in view of the existence of urban unemployed doctors and nurses in most countries. Creating conditions for employment and training of national staff is strongly favoured as an alternative. Only in exceptional circumstances is sending international health volunteers viewed as a defendable temporary measure.We estimate that not more than 5000 full-time equivalent international health volunteers were working in sub-Saharan Africa in 2005, of which not more than 1500 were doctors. A distinction should be made between (1) secular medical humanitarian NGOs, (2)development NGOs, and (3) volunteer organizations, as Voluntary Service Overseas (VSO) and United Nations volunteers (UNV). They have different views, undergo different trends and are differently appreciated by government officials.International health volunteers contribute relatively small numbers to the health workforce in sub-Saharan Africa, and it seems unlikely that they will do more in the future. In areas where they play a role, their contribution to service delivery is s
L’analyse d’impact de la réglementation (AIR) : un outil pour améliorer la prise de décision politique ?
Chantal Kegels,Katrien Debeuckelaere
Pyramides : Revue du Centre d'Etudes et de Recherches en Administration Publique , 2011,
Abstract: L’analyse d’impact de la réglementation (AIR) est une technique qui se développe de plus en plus en Europe pour aider à améliorer la qualité des réglementations. Cette technique recouvre une série de méthodes d’évaluation ex ante permettant de mieux prendre en compte l’incidence des décisions politiques. Cette technique permet de nourrir le débat démocratique en structurant l’information et en identifiant les arbitrages mais en aucun cas, elle n’est destinée à remplacer la prise de décision politique. Le présent article propose une introduction à l’AIR et à ses principales applications, ainsi qu’un premier aper u de la mise en uvre de cette technique en Belgique.
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