1,720,965 research outputs found
Pay for performance in Maternal Health in Tanzania perceptions,expectations and experiences in Mvomero district
Full text linkIn 2008, Tanzania was one of the 11 countries responsible for 65% of all maternal deaths in the world. The Ministry of Health and Social Welfare of Tanzania in 2008 acknowledged lack of commendable progress in reducing maternal deaths. At the heart of the lack of progress are challenges in human resources for health, including poor motivation among health workers.\ud
In 2009, the Government of Tanzania decided to introduce P4P in mother, newborn and child health (MNCH), in order to bring down the MMR and accelerate progress towards Millennium Development Goals 5&4 addressing mother and child health. Pay for performance links incentives with performance and assumes that better health worker performance improves acceptability, utilisation and quality of health services. The study explores how service provision and the use of incentives in maternal health is perceived by health practitioners and community members\ud
The study was carried out in Mvomero district in Tanzania, at 5 health facilities. The study‟s approach was qualitative. Twelve in-depth interviews were conducted with health workers and 3 focus group discussions were also conducted with community members. A number of perceived barriers to the access of health services were reported. The barriers existed on both the provider and the user side. By and large, provider side factors seemed to play a major role in the low-utilisation of health services and of these, supply shortages were the mostly cited impediment to the provision of health services. Health workers reported dissatisfaction and demotivation with the current working conditions citing mainly the perceived unfair remuneration system and supply shortages as major factors.\ud
Mixed views to the use of incentives in health care were reported. There were some concerns that P4P might undermine the quality of health services by promoting unethical behaviours such cheating, emphasis on quantity against quality or prioritisation of rewarded services. On the other hand P4P was perceived to have the potential of increasing health worker motivation, cooperation and teamwork at facility level.\ud
The study concluded that in view of health workers and community members‟ perceptions and experiences related to incentives and service provision, steps should be taken to ensure that the conditions for successful implementation should be in place before the P4P programme is scaled up. This involves ensuring the availability of basic equipments, staff and routines at facility level.\u
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Results-Based Financing (RBF) in the health sector of a low-income country. From agenda setting to implementation: The case of Tanzania
Full text linkBackground: During the last decade there has been growing concern about lack of results in the health sector of many low-income countries. Prompted by a need to achieve progress, Results-Based Financing (RBF) has become an increasingly popular policy option and has been seen as a solution for the unmet Millennium Development Goals 4 and 5, for child health and maternal health. RBF pays for results of chosen health indicators rather than inputs and therefore appealing to both recipient and donor countries. In 2015, over 30 low-income countries with the majority in sub-Saharan Africa including Tanzania were implementing RBF programmes to improve health services provision. Tanzania implemented a provider side RBF, aiming to motivate health workers by paying them financial incentives based on predetermined performance targets. Despite the widespread uptake of RBF in low-income contexts, there is little evidence to support that it works. Studies on RBF show mixed results and most of these studies focus on aspects of effectiveness and efficiency of these programmes. What is explored less are the policy processes that lead to the introduction of RBF programmes in low-income countries and how RBF affects the working environment and the interaction between health workers and health service users. This may in turn affect the overall success of RBF programmes. Aim: The study aim to generate policy relevant knowledge on processes leading up to the introduction of RBF in a resource constrained health sector, and the challenges related to its implementation. To achieve this, the study investigates the roles played by both internal and external policy actors in the RBF policy process in Tanzania. It further critically examines the experiences of health workers with RBF and how they responded to it, paying particular attention to the social and cultural context. Methods: A qualitative case study design was used in the study. Data was collected in Mvomero and Rufiji districts and Dar es Salaam in Tanzania and in Oslo in Norway. The study followed both the local Tanzanian RBF programme in Mvomero and the donor-funded Pwani pilot in Rufiji district. In-depth interviews (IDIs), focus group discussions (FGDs), policy document reviews and participation in RBF meetings were the main methods for data collection. A total of 70 IDIs and 27 FGDs were conducted between 2010 and 2013. Field notes and informal conversations during fieldwork were other very important sources of data for the study. Results: The introduction of RBF in Tanzania was controversial. The process was long and contested. The actors, both external and internal, fought for their values and interests. It resulted in tensions, mistrust and frustrations in the health sector partnership, and in the end, Tanzania did not get space to act as an agent of her own development. The results further showed that the two RBF programmes that were implemented in Tanzania, one which received donor support and another which did not, were implemented differently. The locally funded RBF diverted from its programme design and paid health workers flat bonus regardless of performance. This was partly due to lack of capacity and partly due to concerns for equity and fairness. The donor funded RBF adhered to its design, including paying health workers according to performance and contribution towards RBF performance indicators that is, Reproductive and Child Health (RCH) staff, working directly with RBF performance indicators were paid more bonuses than non RCH staff. This system of payment was reported to be unfair and it was revealed that it had affected social relations at health facilities. Leadership at health facilities was concerned this would lead to the disruption of work and preferred a flat rate with a similar logic as in the local RBF programme. Moreover, the study revealed that in the local RBF programme, health workers used coercive strategies in order to meet RBF performance targets. It was noted that these strategies are detrimental to health outcomes. Discussion The study showed that understanding processes behind the implementation of RBF is important as these help to explain why RBF programmes may fail or succeed. Additionally, the study revealed that RBF programmes can affect social relations among health workers and with health service users. The Tanzanian experience presents a picture where the country was overwhelmed by external influence in the RBF policy process and in the end could not follow its own development trajectory. As the theory of partnership in development aid posits, donor countries prefer an instrumental version of partnership, which entails imposition of their priorities, while disregarding country ownership. When Tanzania chose to follow her own path by launching a local RBF programme, partners in the Health Basket Fund withdrew their funding. Tanzania went ahead with the local RBF programme, but with little success. Payment in the programme used flat rates, partly due to lack of resources and partly due to the concern of fairness. The donor-funded RBF was better managed and resourced but the payment system of bonuses, which paid health workers differently by their centrality to performance indicators, was reported as fundamentally unfairness as predicted by workplace social justice theory, the Referent Cognitions Theory. Health workers changed their behaviors in response to RBF, as presumed by the Principal- Agent Theory. In both districts, RBF negatively affected social relations among health workers and with their patients. It was revealed that RBF can lead to the use of coercive strategies as a means to reach performance targets in resource constrained settings. RBF has the potential of disrupting social relations, teamwork and intrinsic motivation among health workers. The Self-Determination Theory and Bourdieu’s concept of capital elucidates on how RBF is potentially detrimental to social relations and intrinsic motivation of health workers. Therefore the study recommends that caution is needed when implementing RBF programmes in low-income contexts, and that particular attention has to be paid to policy processes, social-cultural and contextual factors
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
I Buy Medicines From the Streets Because I Am Poor: A Qualitative Account on why the Informal Market for Medicines Thrive in Ivory Coast
Full text linkThe informal market for medicines has been growing. In Ivory Coast, this informal market is an unofficial core part of the health system. Given the risks associated with the informal market for medicines, it is important to understand why this market continues to grow. It becomes even more important in the context of COVID-19, as a huge chunk of falsified medical products end up at the informal market. A qualitative case study design was chosen for this study, with in-depth interviews (IDIs) and focus group discussions (FGDs) being the methods for data collection. 20 IDIs and 3 FGDs were conducted. Participants in this study are sellers, buyers, and pharmaceutical experts. We found out that the informal market for medicines thrives because it is highly accessible, convenient, affordable, and that it is used for various social, cultural, and religious reasons. The study concludes that although this informal market presents a clear danger to public health, it is thriving. For authorities to address this public health challenge, there is need for a holistic and multi-pronged approach, which includes addressing health systems factors and strengthening regulatory framework.publishedVersio
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
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