Health systems barriers to effective use of infectious disease surveillance data in the context of decentralization in Georgia: a qualitative study.

OBJECTIVES: In Georgia, a country where there has been extensive decentralization of public health responsibilities, an intervention was recently piloted to strengthen district-level vaccine-preventable disease (VPD) surveillance and response activities. The purpose of this qualitative research study is to provide an in-depth assessment of the perceived value and need for the analysis and use of VPD surveillance data at various levels of the infectious disease surveillance and response (IDSR) system in Georgia. METHODS: Focus groups were conducted with individuals working at different levels of the IDSR system in intervention districts in order to obtain qualitative data to better understand the process of surveillance and barriers to data availability, analysis, and response. RESULTS: The results of the study suggest that in Georgia, health care system has many barriers to effective analysis and use of VPD surveillance data for decision-making at local level. Extensive decentralization that took place in Georgia may have adversely affected the IDSR system. CONCLUSION: In resource poor countries, decentralization can leave districts with insufficient resources, which may seriously affect the ability to carry out IDSR. In Georgia, this seems to be related to inadequate financing of IDSR with major gaps observed at the local level.

Health system barriers to strengthening vaccine-preventable disease surveillance and response in the context of decentralization: evidence from Georgia.

BACKGROUND: A critical challenge in the health sector in developing countries is to ensure the quality and effectiveness of surveillance and public health response in an environment of decentralization. In Georgia, a country where there has been extensive decentralization of public health responsibilities over the last decade, an intervention was recently piloted to strengthen district-level local vaccine-preventable disease surveillance and response activities through improved capacity to analyze and use routinely collected data. The purpose of the study is 1) to assess the effectiveness of the intervention on motivation and perceived capacity to analyze and use information at the district-level, and 2) to assess the role that individual- and system-level factors play in influencing the effectiveness of the intervention. METHODS: A pre-post quasi-experimental research design is used for the quantitative evaluation. Data come from a baseline and two follow-up surveys of district-level health staff in 12 intervention and 3 control Center of Public Health (CPH) offices. These data were supplemented by record reviews in CPH offices as well as focus group discussions among CPH and health facility staff. RESULTS: The results of the study suggest that a number of expected improvements in perceived data availability and analysis occurred following the implementation of the intervention package, and that these improvements in analysis could be attributable to the intervention package. However, the study results also suggest that there exist several health systems barriers that constrained the effectiveness of the intervention in influencing the availability of data, analysis and response. CONCLUSION: To strengthen surveillance and response systems in Georgia, as well as in other countries, donor, governments, and other stakeholders should consider how health systems factors influence investments to improve the availability of data, analysis, and response. Linking the intervention to broader health sector reforms in management processes and organizational culture will be critical to ensure that efforts designed to promote evidence-based decision-making are successful, especially as they are scaled up to the national level.

Maternal violence, victimization, and child physical punishment in Peru.

OBJECTIVES: This study examined whether mothers' experience of violence was a risk factor for physical punishment. METHODS: Data were derived from the nationally representative 2000 Peru Demographic and Family Health Survey. Participants were 12,601 currently married women who were living with biological children aged 0-17 years and were responsible for disciplining the children. A multinomial logit model was used to determine the probabilities of using no physical punishment, slapping/spanking only, beating only, and both slapping/spanking and beating to discipline children. RESULTS: The study found that childhood history of physical punishment, a greater variety of intimate partner emotional violence and experience of intimate partner physical violence increased significantly a mother's probability of using physical punishment with her children, even after controlling for confounding factors. A mother's history of physical violence victimization by someone other than the current partner was also a significant factor for beating children as opposed to using non-physical forms of punishment. CONCLUSIONS: Mothers were at substantially increased risk of using physical punishment if they were victims of parental physical violence in childhood, intimate partner violence in the current union, and physical violence by someone other than the current partner. PRACTICE IMPLICATIONS: Increased public education is needed of the negative consequences of intimate partner emotional and physical violence victimization for mothers' childrearing strategies. There is a need to integrate intimate partner violence into child welfare programs and develop effective screening mechanisms for maternal violence victimization and child maltreatment.