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Developing health systems research capacities through north-south partnership: An evaluation of collaboration with South Africa and Thailand
Susannah H Mayhew, Jane Doherty, Siriwan Pitayarangsarit
Health Research Policy and Systems , 2008, DOI: 10.1186/1478-4505-6-8
Abstract: This study aims to evaluate the partnerships developed between the Health Economics and Financing Programme of the London School of Hygiene and Tropical Medicine and three research partners in South Africa and Thailand to strengthen health economics-related research capacity.Data from programme documents were collected over five years to measure quantitative indicators of capacity development. Qualitative data were obtained from 25 in-depth interviews with programme staff from South Africa, Thailand and London.Five years of formal partnership resulted in substantial strengthening of individual research skills and moderate instituonalised strengthening in southern partner institutions. Activities included joint proposals, research and articles, staff exchange and post-graduate training. In Thailand, individual capacities were built through post-graduate training and the partner institution developed this as part of a package aimed at retaining young researchers at the institution. In South Africa, local post-graduate teaching programs were strengthened, regular staff visits/exchanges initiated and maintained and funding secured for several large-scale, multi-partner projects. These activities could not have been achieved without good personal relationships between members of the partner institutions, built on trust developed over twenty years. In South Africa, a critical factor was the joint appointment of a London staff member on long-term secondment to one of the partner institutions.As partnerships mature the needs of partners change and new challenges emerge. Partners' differing research priorities (national v international; policy-led v academic-led) need to be balanced and equitable funding mechanisms developed recognising the needs and constraints faced by both southern and northern partners. Institutionalising partnerships (through long-term development of trust, engagement of a broad range of staff in joint activities and joint appointment of staff), and dev
Approaches to developing the capacity of health policy analysis institutes: a comparative case study
Sara Bennett, Adrijana Corluka, Jane Doherty, Viroj Tangcharoensathien
Health Research Policy and Systems , 2012, DOI: 10.1186/1478-4505-10-7
Abstract: Comparative case studies of six health policy analysis institutes (3 from Asia and 3 from Africa) were conducted. In each region an NGO institute, an institute linked to government and a university based institute were included. Data collection comprised document review, semi-structured interviews with stakeholders and discussion of preliminary findings with institute staff.The findings are organized around four key themes: (i) Financial resources: three of the institutes had received substantial external grants at start-up, however two of these institutes subsequently collapsed. At all but one institute, reliance upon short term, donor funding, created high administrative costs and unpredictability. (ii) Human resources: the retention of skilled human resources was perceived to be key to institute success but was problematic at all but one institute. In particular staff often moved to better paid positions elsewhere once having acquired necessary skills and experience, leaving remaining senior staff with heavy workloads. (iii) Governance and management: board structures and roles varied according to the nature of institute ownership. Boards made important contributions to organizational capacity through promoting continuity, independence and fund raising. Routine management systems were typically perceived to be strong. (iv) Networks: linkages to policy makers helped promote policy influences. External networks with other research organizations, particularly where these were longer term institutional collaborations helped promote capacity.The development of strong in-country analytical and research capacity to guide health policy development is critical, yet many health policy analysis institutes remain very fragile. A combination of more strategic planning, active recruitment and retention strategies, and longer term, flexible funding, for example through endowments, needs to be promoted. Specific recommendations to funders and institutes are provided.In-country c
Developing a new mid-level health worker: lessons from South Africa's experience with clinical associates
Jane Doherty,Daphney Conco,Ian Couper,Sharon Fonn
Global Health Action , 2013, DOI: 10.3402/gha.v6i0.19282
Abstract: Background: Mid-level medical workers play an important role in health systems and hold great potential for addressing the human resource shortage, especially in low- and middle-income countries. South Africa began the production of its first mid-level medical workers – known as clinical associates – in small numbers in 2008. Objective: We describe the way in which scopes of practice and course design were negotiated and assess progress during the early years. We derive lessons for other countries wishing to introduce new types of mid-level worker. Methods: We conducted a rapid assessment in 2010 consisting of a review of 19 documents and 11 semi-structured interviews with a variety of stakeholders. A thematic analysis was performed. Results: Central to the success of the clinical associate training programme was a clear definition and understanding of the interests of various stakeholders. Stakeholder sensitivities were taken into account in the conceptualisation of the role and scope of practice of the clinical associate. This was achieved by dealing with quality of care concerns through service-based training and doctor supervision, and using a national curriculum framework to set uniform standards. Conclusions: This new mid-level medical worker can contribute to the quality of district hospital care and address human resource shortages. However, a number of significant challenges lie ahead. To sustain and expand on early achievements, clinical associates must be produced in greater numbers and the required funding, training capacity, public sector posts, and supervision must be made available. Retaining the new cadre will depend on the public system becoming an employer of choice. Nonetheless, the South African experience yields positive lessons that could be of use to other countries contemplating similar initiatives.
Value of a mobile information system to improve quality of care by community health workers
Mark Tomlinson,Mary Jane Rotheram-Borus,Tanya Doherty,Dallas Swendeman
South African Journal of Information Management , 2013, DOI: http://dx.doi.org/10.4102/sajim.v15i1.528
Abstract: Background: We will be unable to achieve sustained impact on health outcomes with community health worker (CHW)-based interventions unless we bridge the gap between small scale efficacy studies and large scale interventions. Effective strategies to support the management of CHWs are central to bridging the gap. Mobile phones are broadly available, particularly in low and middle income countries (LAMIC), where the penetration rate approaches 100%.Objectives: In this article, we describe how mobile phones and may be combined with mobile web-based technology to assist in the management of CHWs in two projects in South Africa.Methods: This article is a descriptive study, drawing lessons from two randomised controlled trials outlining how a mobile phone information system can be utilised to enhance the quality of health interventions. We organised our comprehensive management and supervision system around a previously published management framework. The system is composed of mobile phones utilised by CHWs and a web-based interface utilised by CHW supervisors. Computerised algorithms were designed with intervention and assessment protocols to aid in the real-time supervision and management of CHWs.Results: Community health workers used mobile phones to initiate intervention visits and trigger content to be delivered during the course of intervention visits. Supervisors used the web-based interface for real-time monitoring of the location, timing and content of intervention visits. Additional real-time support was provided through direct support calls in the event of crises in the field.Conclusion: Mobile phone-based information system platforms offer significant opportunities to improve CHW-delivered interventions. The extent to which these efficiency gains can be translated into realised health gains for communities is yet to be tested.
Women's evaluation of abuse and violence care in general practice: a cluster randomised controlled trial (weave)
Kelsey L Hegarty, Jane M Gunn, Lorna J O'Doherty, Angela Taft, Patty Chondros, Gene Feder, Jill Astbury, Stephanie Brown
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-2
Abstract: weave is a cluster randomised controlled trial involving 40 general practices in Victoria, Australia. Approximately 500 women (16-50 years) seen by the GP in the previous year are mailed a short lifestyle survey containing an item to screen for IPA. Women who indicate that they were afraid of a partner/ex-partner in the last year and provide contact details are invited to participate. Once baseline data are collected, GPs are randomly assigned to either a group involving healthy relationship and responding to IPA training plus inviting women for up to 6 sessions of counselling or to a group involving basic education and usual care for women. Outcomes will be evaluated by postal survey at 6 and 12 months following delivery of the intervention. There will be an economic evaluation, and process evaluation involving interviews with women and GPs, to inform understanding about implementation and outcomes.The weave trial responds to an urgent need for more evidence on what can be achieved in primary care with regard to responding to women who experience IPA. It will provide important knowledge about the effectiveness of a brief method of screening, professional IPA training program and brief counselling for women.[ACTRN12608000032358]Intimate partner abuse (IPA) or violence is defined as any behaviour within an intimate relationship that causes physical, psychological or sexual harm to those in the relationship [1]. Behaviours include acts of physical aggression such as slapping and kicking; psychological abuse such as intimidation and humiliation; forced intercourse and other forms of sexual coercion; and various controlling behaviours such as isolating a person from their family and friends, monitoring their movements, and restricting access to information or assistance. IPA sits within the broader context of gendered violence and the majority of assaults by partners are directed at females [1,2]. Moreover, sexual abuse and partner violence resulting in significant inju
Medical management of acute upper respiratory infections in an urban primary care out-of-hours facility: cross-sectional study of patient presentations and expectations
Andrew O’Regan,Aoife O’Neill,Claire McMahon,Colum P Dunne,Jane O’Doherty,Raymond O’Connor
- , 2019, DOI: 10.1136/bmjopen-2018-025396
Abstract: Objectives The purpose of this study was to examine the expectations of patients attending an urban primary care out-of-hours (OOH) facility with acute upper respiratory tract infection (acute URTI) regarding clinical examination, symptom management, information on their condition, reassurance, antibiotic treatment and other possible options including referral. Design Cross-sectional design. Setting One urban primary care OOH facility located in the midwest of Ireland. Participants 457 patients filled out a questionnaire while waiting in the OOH facility; 22 surveys were excluded as the patients did not present with symptoms of acute URTI resulting in 435 patients’ data being included in this study. There were 59.5% female participants and 40.5% male participants. Results 435 patients with acute URTI symptoms participated in the survey, representing 25.4% of those attending the single branch where the survey was conducted (n=1715). Of the study participants, 43% were aged under 6？years and 60% were women. The most common presenting symptoms were cough (72%), throat ache (46%) and common cold (26%). The most common expectations were for further examination (53%), reassurance (51%), information (49%) and medication for cough (47%), with 34% expecting an antibiotic. Conclusions Only one in three patients attending this primary care OOH facility with acute URTI symptoms had an expectation of antibiotics, with most seeking further assessment, information and reassurance. Recognition of such expectations may be important considerations for clinicians when deciding on management options for patients with acute URTI
Cost-effectiveness analysis for priority-setting in South Africa – what are the possibilities?
J Doherty
South African Medical Journal , 2010,
Abstract: Priority-setting in the health system is necessary because resources are constrained. The role of cost-effectiveness analysis in supporting decision-making around health care priorities in South Africa is explored by referring to South African studies that have provided clinical and policy guidance at the levels of the patient, the service and the population. Cost-effectiveness evidence is positioned in relation to other concerns such as equity and the overall performance of the health system.
Political Behavior and Candidate Emergence in the Hmong-American Community
Steven Doherty
Hmong Studies Journal , 2008,
Abstract: This research focuses on the major social, cultural and political factors that have shaped Hmong-American political behavior in the United States and also more specifically on the issue of Hmong-American candidates who have run for electoral office. Electoral turnout and the partisan direction of Hmong-American voters will receive some general examination. Special attention is also given to the unusually rapid emergence of candidates for electoral office from the Hmong-American community in the Upper Midwest, and the specific motivations and strategies of Hmong-American electoral candidates.
Green Butterflies
W. Doherty
Psyche , 1891, DOI: 10.1155/1891/60942
Abstract:
“CANARIES IN THE COAL MINE:” THE DEINDUSTRIALIZATION OF NEW ENGLAND AND THE RISE OF THE GLOBAL ECONOMY, 1923-1975
Maura Doherty
Essays in Economic & Business History , 1999,
Abstract: This essay discusses the process that led to the decline of New England’s traditional industries and to the creation of its depressed milltowns. It argues that the decline of the New England textile and shoe industries was part of the maturation of industrial capitalism. This deindustrialization had along-term structural impact on the local economies of many New England communities and would have implications for other industries and communities in the creation of the global economy. These depressed milltowns were the first casualties of a strategy of capital mobility that would become institutionalized in the multinational corporation and the global economy.
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