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Int J Health Policy Manag ; 7(12): 1130-1137, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30709088


BACKGROUND: Primary healthcare facility managers (PHFMs) occupy a unique position in the primary healthcare system, as the only cadre combining frontline clinical activities with managerial responsibilities. Often serving as 'street-level bureaucrats,' their perspectives can provide contextually relevant information about interventions for strengthening primary healthcare delivery, yet such perspectives are under-represented in the literature on primary healthcare strengthening. Our objective in this study was to explore perspectives of PHFMs in western Kenya regarding how to leverage human resource factors to improve immunization programs, in order to draw lessons for strengthening of primary healthcare delivery. METHODS: We employed a sequential mixed methods approach. We conducted in-depth interviews with key informants in Kakamega County. Emergent themes guided questionnaire development for a cross-sectional survey. We randomly selected 94 facility managers for the survey which included questions about workload, effects of workload on immunization program, and appropriate measures to address workload effects. Participants provided self-assessment of their general motivation at work, their specific motivation to ensure that all children in their catchment areas were fully immunized, and recommendations to improve motivation. Participants were asked about frequency of supervisory visits, supervisor activities during those visits, and how to improve supervision. RESULTS: The most frequently reported consequences of high workload were reduced accuracy of vaccination records (47%) and poor client counseling (47%). Hiring more clinical staff was identified as an effective remedy to high workload (69%). Few respondents (20%) felt highly motivated to ensure full immunization coverage and only 13% reported being very motivated to execute their role as a health worker generally. Increasing frequency of supervisory visits and acting on the feedback received during those visits were mostly perceived as important measures to improve program effectiveness. CONCLUSION: Besides increasing the number of staff providing clinical care, PHFMs endorsed introducing some financial incentives contingent on specified targets and making supervisory visits meaningful with action on feedback as strategies to increase program effectiveness in primary healthcare facilities in Kenya. Targeting health worker motivation and promoting supportive supervision may reduce missed opportunities and poor client counseling in primary healthcare facilities in Kenya.

Pessoal de Saúde/psicologia , Programas de Imunização/organização & administração , Administração de Recursos Humanos/métodos , Atenção Primária à Saúde/organização & administração , Carga de Trabalho/psicologia , Atitude do Pessoal de Saúde , Estudos Transversais , Pessoal de Saúde/estatística & dados numéricos , Humanos , Quênia , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos
World J Surg ; 39(9): 2147-52, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26067637


BACKGROUND: The worldwide human resource gap in anesthesia services often presents a barrier to accessing life-saving and life-improving surgeries. This paper assessed the impact of a ketamine anesthesia package, Every Second Matters-Ketamine (ESM-Ketamine)™, for use in emergency and life-improving surgeries by non-anesthetist clinicians in a resource-limited setting when no anesthetist was available. METHODS: We analyzed prospectively collected data from 193 surgeries constituting a pilot implementation of the ESM-Ketamine package, among three sub-district hospitals in Western Kenya. The study population comprises patients who required emergency or life-improving surgery when no anesthetist was available. Non-anesthetist clinicians in three sub-district hospitals underwent a 5-day training course in ESM-Ketamine complemented by checklists and an ESM-Ketamine Kit. Data were collected prospectively every time the ESM-Ketamine pathway was invoked. The training cases, although primarily tubal ligations, were included. The primary outcome measures centered on capturing the ability to safely support emergency and life-improving surgeries, when no anesthetist was available, through invoking the ESM-Ketamine pathway. The registry was critically examined using standard descriptive and frequency analysis. RESULTS: 193 surgical procedures were supported using the ESM-Ketamine package by five ESM-Ketamine trained providers. Brief (<30 s) patient desaturation below 92% and hallucinations occurred in 16 out of 186 (8.6%) and 23 out of 190 patients (12.1%), respectively. There were no reported major adverse events such as death, prolonged desaturations (over 30 s), or injury resulting from ketamine use. CONCLUSION: This study provides promising initial evidence that the ESM-Ketamine package can support emergency and life-improving surgeries in resource-limited settings when no anesthetist is available.

Anestesia/métodos , Anestesiologia , Anestésicos Dissociativos/administração & dosagem , Países em Desenvolvimento , Ketamina/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia/efeitos adversos , Anestesiologia/educação , Anestésicos Dissociativos/efeitos adversos , Lista de Checagem , Criança , Pré-Escolar , Emergências , Alucinações/induzido quimicamente , Recursos em Saúde , Humanos , Lactente , Recém-Nascido , Quênia , Ketamina/efeitos adversos , Pessoa de Meia-Idade , Oximetria , Oxigênio/sangue , Projetos Piloto , Recursos Humanos , Adulto Jovem