Redesigning a Ministry of Health's organizational structure: exploring implementation challenges through Botswana's experiences.

INTRODUCTION: The Botswana's Ministry of Health redesigned and adopted a new organizational structure in 2005, which was poorly implemented. This article explores factors that influenced the implementation of this organizational structure. METHODS: This article draws from data collected through in-depth interviews with 54 purposively selected key informants comprising policy makers, senior managers and staff of the Ministry of Health (N = 40) and senior officers from various stakeholder organizations (N = 14). FINDINGS: Participants generally felt that the review of the Ministry of Health organizational structure was important. The previous structure was considered obsolete with fragmented functions that limited the overall performance of the health system. The new organizational structure was viewed to be aligned to current national priorities with potential to positively influence performance. Some key weaknesses identified included lack of consultation and information sharing with workers during the restructuring process, which affected the understanding of their new roles, failure to mobilize key resources to support implementation of the new structure and inadequate monitoring of the implementation process. CONCLUSION: Redesigning an organizational structure is a major change. There is a need for effective and sustained leadership to plan, direct, coordinate, monitor and evaluate the implementation phase of the reform. Copyright © 2014 John Wiley & Sons, Ltd.

Treatment-associated changes in malocclusion and oral health-related quality of life: A 4-year cohort study.

INTRODUCTION: The impact of orthodontic treatment on oral health-related quality of life (OHRQoL) in adolescents being treated in orthodontic practices has not yet been explored longitudinally. The aim of this cohort study was to describe the changes in both malocclusion and OHRQoL with orthodontic treatment. METHODS: One hundred seventy-four patients (ages, 10-17 years; 64.4% girls; 81.6% European) underwent 2-arch, fixed-appliance treatment in a 4-year prospective study conducted across 19 specialist orthodontic practices throughout New Zealand. They were assessed before treatment, at debond (when 87.4% of the baseline sample were reassessed), and at a mean 21 months postdebond (when 59.4% of the baseline sample were reassessed). OHRQoL was measured using the Child Perceptions Questionnaire, and the Dental Aesthetic Index was used to measure occlusion. RESULTS: Among the 104 patients who took part in all 3 assessments, little change in OHRQoL overall was seen at the end of treatment, despite considerable improvement in malocclusion (with the mean Dental Aesthetic Index score falling from 35.9 at baseline to 21.3 at debond). The mean Child Perceptions Questionnaire 11-14 was slightly greater at debond, and this was most notable in the functional limitations subscale. By the end of the study (21 months postdebond, on average), the decreases in Child Perceptions Questionnaire 11-14 scores were all substantial, especially in the emotional well-being and social well-being subscales. CONCLUSIONS: Malocclusion affects orthodontic patients' OHRQoL before treatment. A temporary increase in symptomatic impacts seen by the debond stage appears to ameliorate with time, with the benefits of orthodontic treatment for OHRQoL manifesting themselves some months later.

Oral hygiene behaviours and readiness to change using the TransTheoretical Model (TTM).

OBJECTIVE: The aim of this pilot study was to investigate the Transtheoretical Model (TTM) in relation to measures of readiness to change oral hygiene behaviours. RESEARCH DESIGN: Participants (N = 105) were recruited from a dental hygiene patient waiting list. A self-administered questionnaire was designed; it included four measures related to inter-dental cleaning used for TTM staging, confidence and frequency measures of future interdental cleaning and toothbrushing, together with items seeking demographic details. Data collection occurred before a dental hygiene appointment where oral health advice was offered, and then at three and six months afterwards, in order to measure readiness to change post-intervention. RESULTS: All three questionnaires were returned by 91.4% of participants. The confidence measures for maintaining toothbrushing twice per day and for interdental cleaning were associated with TTM staging at baseline (respective correlation coefficients of 0.200; P = 0.042 and 0.584; P < 0.001). Participants were likely to be in a higher TTM stage at 3 months after attendance at the dental hygiene clinic and then decline to a lower TTM stage by 6 months (baseline to 3 months and 6 months: Wilcoxon signed rank tests of p= 0.024 and p = 0.627). Of the 31 participants (33%) who improved their TTM staging between baseline and 3 months, 11 (35%) fell back to a lower category between 3 months and 6 months, 14 (45%) maintained their improvement, and 6 (19%) improved further. CONCLUSIONS: Understanding a person's readiness to change could improve the way in which oral hygiene interventions and advice are given in the clinical setting. The TTM staging measurement tool used here provides insight into people's readiness to change their oral hygiene behaviours, and its use would aid practitioners in the delivery of oral health messages. The initial improvement in TTM stage and subsequent regression was consistent with the TTM's relapse phenomenon and reinforces the concept that on-going support is crucial to maintaining behaviour change.

Development of the National Health Information Systems in Botswana: Pitfalls, prospects and lessons.

BACKGROUND: Studies evaluating development of health information systems in developing countries are limited. Most of the available studies are based on pilot projects or cross-sectional studies. We took a longitudinal approach to analysing the development of Botswana's health information systems. OBJECTIVES: We aimed to: (i) trace the development of the national health information systems in Botswana (ii) identify pitfalls during development and prospects that could be maximized to strengthen the system; and (iii) draw lessons for Botswana and other countries working on establishing or improving their health information systems. METHODS: This article is based on data collected through document analysis and key informant interviews with policy makers, senior managers and staff of the Ministry of Health and senior officers from various stakeholder organizations. RESULTS: Lack of central coordination, weak leadership, weak policy and regulatory frameworks, and inadequate resources limited development of the national health information systems in Botswana. Lack of attention to issues of organizational structure is one of the major pitfalls. CONCLUSION: The ongoing reorganization of the Ministry of Health provides opportunity to reposition the health information system function. The current efforts including development of the health information management policy and plan could enhance the health information management system.