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Search Results: 1 - 10 of 8318 matches for " Bruno Marchal "
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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
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
Prediction and overview of the RpoN-regulon in closely related species of the Rhizobiales
Bruno Dombrecht, Kathleen Marchal, Jos Vanderleyden, Jan Michiels
Genome Biology , 2002, DOI: 10.1186/gb-2002-3-12-research0076
Abstract: A highly specific weight-matrix-based screening method was applied to predict members of the RpoN-regulon, which were stored in a highly annotated and manually curated dataset. Possible enhancer-binding proteins (EBPs) controlling the expression of RpoN-dependent genes were predicted with a profile hidden Markov model.The methodology used to predict RpoN-binding sites proved highly effective as nearly all known RpoN-controlled genes were identified. In addition, many new RpoN-dependent functions were found. The dependency of several of these diverse functions on RpoN seems species-specific. Around 30% of the identified genes are hypothetical. Rhizobia appear to have recruited RpoN for symbiotic processes, whereas the role of RpoN in A. tumefaciens and B. melitensis remains largely to be elucidated. All species screened possess at least one uncharacterized EBP as well as the usual ones. Lastly, RpoN could significantly broaden its working range by direct interfering with the binding of regulatory proteins to the promoter DNA.The bacterial alternative sigma factor RpoN recognizes and binds a -24/-12-type promoter with the following consensus sequence: 5'-TGGCACG-N4-TTGCW-3' (the bold G and C are situated at position -24 and -12 relative to the transcription start site, respectively) [1]. Subsequently, the core DNA-dependent RNA polymerase (core-RNAP) binds to the RpoN-DNA secondary complex to form a stable closed promoter complex. The closed promoter complex is unable to initiate transcription by itself. For this, melting of the double-stranded (ds) DNA within the closed complex is required [2]. This is accomplished by the nucleotide hydrolysis activity of an activator or enhancer-binding protein (EBP). EBPs bind to enhancer sites situated 100 base-pairs (bp) or more upstream of the transcription initiation site. Each EBP is controlled by its own signal transduction pathway, thereby responding to different conditions [3,4,5]. As there is almost no leaky expression in
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
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
Appropriate training and retention of community doctors in rural areas: a case study from Mali
Monique Van Dormael, Sylvie Dugas, Yacouba Kone, Seydou Coulibaly, Mansour Sy, Bruno Marchal, Dominique Desplats
Human Resources for Health , 2008, DOI: 10.1186/1478-4491-6-25
Abstract: Programme evaluation distinguished trainees' opinions, competences and behaviour. Data were collected through participant observation, group discussions, satisfaction questionnaires, a monitoring tool of learning progress, and follow up visits. Retention was assessed for all 65 trainees between 2003 and 2007.The programme consisted of four classroom modules – clinical skills, community health, practice management and communication skills – and a practicum supervised by an experienced rural doctor. Out of the 65 trained doctors between 2003 and 2007, 55 were still engaged in rural practice end of 2007, suggesting high retention for the Malian context. Participants viewed the training as crucial to face technical and social problems related to rural practice. Discussing professional experience with senior rural doctors contributed to socialisation to novel professional roles. Mechanisms underlying training effects on retention include increased self confidence, self esteem as rural doctor, and sense of belonging to a professional group sharing a common professional identity. Retention can however not be attributed solely to the training intervention, as rural doctors benefit from other incentives and support mechanisms (follow up visits, continuing training, mentoring...) affecting job satisfaction.Training increasing self confidence and self esteem of rural practitioners may contribute to retention of skilled professionals in rural areas. While reorientations of curricula in training institutions are necessary, other types of professional support are needed. This experience suggests that professional associations dedicated to strengthening quality of care can contribute significantly to rural practitioners' morale.Staffing of health centres in rural and remote areas is a problem all over the world, affecting particularly sub-Saharan African countries [1-3]. In Mali, a country with critical shortage of health professionals [4], overall availability of skilled health w
Interface flow process audit: using the patient's career as a tracer of quality of care and of system organisation
Jean-Pierre Unger,Bruno Marchal,Sylvie Dugas,Marie-Jeanne Wuidar
International Journal of Integrated Care , 2004,
Abstract: Objectives: This case study aims to demonstrate the method's feasibility and capacity to improve quality of care. Several drawbacks attached to tracer condition and selected procedure audits oblige clinicians to rely on external evaluators. Interface flow process audit is an alternative method, which also favours integration of health care across institutions divide. Methods: An action research study was carried out to test the feasibility of interface flow process audit and its impact on quality improvement. An anonymous questionnaire was carried out to assess the participants' perception of the process. Results: In this study, interface flow process audit brought together general practitioners and hospital doctors to analyse the co-ordination of their activities across the primary-secondary interface. Human factors and organisational characteristics had a clear influence on implementation of the solutions. In general, the participants confirmed that the interface flow process audit helped them to analyse the quality of case management both at primary and secondary care level. Conclusions: The interface flow process audit appears a useful method for regular in-service self-evaluation. Its practice enabled to address a wide scope of clinical, managerial and economical problems. Bridging the primary-secondary care gap, interface flow process audit's focus on the patient's career combined with the broad scope of problems that can be analysed are particularly powerful features. The methodology would benefit from an evaluation of its practice on larger scale.
R le des bactéries sulfurogènes dans la corrosion du fer Involvment of Sulfidogenic Bacteria in Iron Corrosion
Marchal R.
Oil & Gas Science and Technology , 2006, DOI: 10.2516/ogst:1999054
Abstract: Cet article fait le point sur les connaissances concernant l'implication des bactéries sulfurogènes dans la corrosion des aciers au carbone. Après la description de quelques cas récents tirés de l'industrie pétrolière, la physiologie des bactéries sulfurogènes qui jouent le r le principal dans le mécanisme de la corrosion anaérobie d'origine bactérienne est examinée. La participation des bactéries productrices d'H2S à la constitution de biofilms est une condition importante à la manifestation des phénomènes de corrosion. Les différentes hypothèses de mécanismes décrites par la littérature sont passées en revue. Indépendamment du r le physicochirnique joué par les sulfures de fer, non couvrants, bons conducteurs électriques, il en ressort que l'acidification résultant du métabolisme cellulaire est un facteur crucial, non seulement en termes d'électrochimie, mais également en termes de croissance microbienne. L'acidification métabolique explique vraisemblablement la fourniture des ions ferreux pour le micro-organisme dans un environnement chargé d'ions sulfures et finalement la persistance de son activité physiologique dans un micro environnement riche en H2S. The involvement of sulfidogenic bacteria in the corrosion of carbon steel is reviewed. After a brief description of some recent cases drawn from the petroleum industry, the physiology of the sulfidogenic bacteria which plays the most important role in the mechanism of anaerobic bacterial corrosion is examined. The involvement of H2S-producing bacteria to the biofilm formation is a prerequisite for biocorrosion. The hypothetical mechanisms described in the literature are reviewed. Regardless of the physicochemical role played by iron sulfides, which have been shown to be non-covering and to have good properties of electric conductivity, the acidification arising from cellular metabolism has been found to be an important parameter, not only in terms of electrochemistry but also in terms of microbial growth. Metabolic acidification probably explains the ferrous ion supply to the microorganism in an environment with a high level of sulfide ions and finally the persistence of the microbial H2S-producing activity.
La fermentation acétonobutylique. Synthèse bibliographique et orientations actuelles Butanol-Acetone Fermentation. Bibliographie Synthesis and Current Trends
Marchal R.
Oil & Gas Science and Technology , 2006, DOI: 10.2516/ogst:1982020
Abstract: Cet article présente une synthèse des connaissances sur la fermentation acétonobutylique tant d'un point de vue microbiologique que technologique. Divers aspects du métabolisme et de la régulation du microorganisme mis en oeuvre sont abordés. Les performances de la fermentation sur ses substrats traditionnels (farine de ma s ou mélasses) sont comparées avec celles qui ont été récemment obtenues à partir du topinambour à l'Institut Fran ais du Pétrole, dans le cadre d'un nouveau développement de cette fermentation pour la production de carburants. This article gives a synthesis of what is known about butylacetone fermentation from both the microbiological and technological standpoints. Different aspects of the metabolism of the microorganism used and of how it is regulated are considered. The performances of fermentation on traditional substrates (cornmeal or molasses) are compared with those recently obtained using Jerusalem artichokes at Institut Fran ais du Pétrole as part of a new project on this fermentation for the purpose of producing substitute fuel.
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