My PhD private defence on realist evaluation of health managers capacity building programme examining scope for organisational change in public health services in a district setting in southern India. A less technical version from the public defence is here: http://www.slideshare.net/PrashanthSrinivas/public-defence-realist-evaluation-of-capacity-building-programme-of-health-managers-in-tumkur-india
More details at http://www.daktre.com/2015/05/studying-organisational-change-in-indian-district-health-systems
Public defence: Realist evaluation of capacity building programme of health m...Prashanth N S
This is the presentation at my PhD in public health public defence on April 21, 2015 at Universite Catholique de Louvain, Brussels. A more technical version of this can be found here: http://www.slideshare.net/PrashanthSrinivas/phd-private-defence-realist-evaluation-of-a-capacity-building-programme-for-health-managers-in-tumkur-india. For more details on the dissertation, see: http://www.daktre.com/2015/05/studying-organisational-change-in-indian-district-health-systems
Patterns, process & action on tribal health: mapping of process & outcomes un...Prashanth N S
Presentation at the India Alliance Conclave 2021 based on the process and outcomes of THETA project. For more on THETA project, see https://wellcomeopenresearch.org/articles/4-202
Reflections from practice: Community engagement & COVID-19Prashanth N S
Slides used in the DBT/Wellcome Trust India Alliance Ask the Experts Webinar series 7 on community engagement. See full webinar details here: https://www.indiaalliance.org/news/434
The document proposes a home-based care model for patients with late-stage dementia by integrating the District Mental Health Program (DMHP) and palliative care services in Kerala, India. It involves training and task-sharing between the two programs' staff to provide comprehensive care, including management of behavioral and psychological symptoms, at patients' homes. The model has the potential for wider application and could address policy barriers by promoting collaboration across healthcare silos through resource-pooling, shared personnel, and coordinated care plans.
The document discusses the rationale for reforming health professions education and systems for health using an ICF framework. It argues this could ultimately result in personalized, predictive healthcare through the use of big data and patient-driven data obtained by utilizing an ICF paradigm. This reform seeks to move towards community-based, holistic care with shared decision-making and reduce institutionalized silos. It is dependent on technology and utilizing the ICF framework could contribute to reaching health equity goals by strengthening systems for universal healthcare coverage.
Innovative Participatory Health Education ‘IPHE’ ™ An approach for QUALITY and RELEVANCE of health professional education
Dr. Khalifa Elmusharaf, PhD Researcher in health system & Policy
Head of Reproductive & Child Health Research Unit 'RCRU’
University of Medical Sciences & Technology
This document outlines a presentation on applying systems thinking to health systems research and programme implementation. It includes an introduction to systems thinking methodologies, examples of how systems thinking has been applied in Options' programmes through stakeholder mapping, participatory approaches, embedded technical assistance, and process mapping. The document also discusses challenges of applying systems thinking like linear reporting mechanisms and limited programme timelines, and how these challenges have been addressed through theories of change.
This document describes an interprofessional learning collaboration between universities and the NHS in the UK. It aims to introduce interprofessional education into undergraduate health and social care programs to improve team-based care. Students from 11 professions complete 3 interprofessional learning units that include classroom and practice-based components. They learn in small interprofessional groups, conducting projects on real issues. Evaluation found the experience improved students' understanding of teamwork, roles, and interprofessional practice. Many student projects were subsequently implemented in practice settings. The collaboration aims to develop healthcare graduates prepared to work collaboratively in team-based care models.
Public defence: Realist evaluation of capacity building programme of health m...Prashanth N S
This is the presentation at my PhD in public health public defence on April 21, 2015 at Universite Catholique de Louvain, Brussels. A more technical version of this can be found here: http://www.slideshare.net/PrashanthSrinivas/phd-private-defence-realist-evaluation-of-a-capacity-building-programme-for-health-managers-in-tumkur-india. For more details on the dissertation, see: http://www.daktre.com/2015/05/studying-organisational-change-in-indian-district-health-systems
Patterns, process & action on tribal health: mapping of process & outcomes un...Prashanth N S
Presentation at the India Alliance Conclave 2021 based on the process and outcomes of THETA project. For more on THETA project, see https://wellcomeopenresearch.org/articles/4-202
Reflections from practice: Community engagement & COVID-19Prashanth N S
Slides used in the DBT/Wellcome Trust India Alliance Ask the Experts Webinar series 7 on community engagement. See full webinar details here: https://www.indiaalliance.org/news/434
The document proposes a home-based care model for patients with late-stage dementia by integrating the District Mental Health Program (DMHP) and palliative care services in Kerala, India. It involves training and task-sharing between the two programs' staff to provide comprehensive care, including management of behavioral and psychological symptoms, at patients' homes. The model has the potential for wider application and could address policy barriers by promoting collaboration across healthcare silos through resource-pooling, shared personnel, and coordinated care plans.
The document discusses the rationale for reforming health professions education and systems for health using an ICF framework. It argues this could ultimately result in personalized, predictive healthcare through the use of big data and patient-driven data obtained by utilizing an ICF paradigm. This reform seeks to move towards community-based, holistic care with shared decision-making and reduce institutionalized silos. It is dependent on technology and utilizing the ICF framework could contribute to reaching health equity goals by strengthening systems for universal healthcare coverage.
Innovative Participatory Health Education ‘IPHE’ ™ An approach for QUALITY and RELEVANCE of health professional education
Dr. Khalifa Elmusharaf, PhD Researcher in health system & Policy
Head of Reproductive & Child Health Research Unit 'RCRU’
University of Medical Sciences & Technology
This document outlines a presentation on applying systems thinking to health systems research and programme implementation. It includes an introduction to systems thinking methodologies, examples of how systems thinking has been applied in Options' programmes through stakeholder mapping, participatory approaches, embedded technical assistance, and process mapping. The document also discusses challenges of applying systems thinking like linear reporting mechanisms and limited programme timelines, and how these challenges have been addressed through theories of change.
This document describes an interprofessional learning collaboration between universities and the NHS in the UK. It aims to introduce interprofessional education into undergraduate health and social care programs to improve team-based care. Students from 11 professions complete 3 interprofessional learning units that include classroom and practice-based components. They learn in small interprofessional groups, conducting projects on real issues. Evaluation found the experience improved students' understanding of teamwork, roles, and interprofessional practice. Many student projects were subsequently implemented in practice settings. The collaboration aims to develop healthcare graduates prepared to work collaboratively in team-based care models.
The ICF has potential to improve communication and collaboration (through its universal concepts and language) among health professionals working within multidisciplinary teams in research and practice to impact health outcomes for patients. Thus, it is timely for clinicians and trainees working in health-related fields to incorporate its framework into practice and research. It is hoped that professional programs will model our approach to develop similar courses within their professional curriculum to build capacity for application of the ICF. Education and training through a combination of peer support and mentorship for health professionals in the use of the ICF could assist with facilitating its uptake.
This document discusses leadership and change management in complex health systems. It begins by outlining where change efforts can go wrong, such as weak design and implementation. It then provides guidance on strengthening design through co-design and considering implementation. The document emphasizes that change must be led and managed, occurring through people. It discusses the importance of building commitment to change through sensemaking, communication, and addressing people's values. It also recommends embracing complexity and learning through small wins and feedback loops to increase the chances of success in health system strengthening efforts.
Health workforce education and development and Human Resource in the health s...MAK1stABMSC2019
The document discusses health workforce challenges in Africa, including shortages of health workers and high rates of migration. It notes that health professions education is critical and must be synchronized with health systems to produce workers that are fit for purpose. However, challenges remain such as insufficient education and training capacity, lack of funding for research, and poor retention of health workers due to lack of career development and low pay. Recommendations include expanding education and improving retention strategies through better working conditions and linking performance to rewards.
This document provides an overview of Community-Based Participatory Research (CBPR) including its history, principles, challenges, and benefits. Some key points:
1) CBPR aims to equitably involve community partners in all stages of research to address issues important to the community and promote social change.
2) Its roots trace back to action research and empowerment models that recognize communities as partners rather than subjects.
3) Challenges include balancing academic and community priorities, building trust over time, and ensuring research is culturally appropriate and sustainable.
4) Benefits include enhancing relevance, validity, translation and sustainability of research findings to improve community health.
steps in planning - Public health dentistrySNISHAMG
This document outlines the 10 step process for planning: 1) Identify the problem through needs assessment, 2) Determine priorities by analyzing data, 3) Develop goals, objectives and activities, 4) Identify required resources, 5) Identify constraints, 6) Identify alternative strategies, 7) Develop an implementation strategy, 8) Implement the plan, 9) Monitor the implementation, 10) Evaluate whether objectives were achieved. Planning is a systematic process that involves assessing needs, setting priorities, developing a course of action to address the problem, and evaluating outcomes.
Results from student-facilitated roundtable discussions at PACE Great Streets townhall meeting in Memphis, TN. This project represents an experiential learning activity at The University of Memphis, Health Promotion concentration in the Department of Health and Sport Sciences.
DH Policy on transition - Karen Turner
NHS Improving Quality held an event in London on 31 July 2013 to progress the children and young people transition to adult services work with a focus on turning the rhetoric into practice entitled “Working to Define a Generic Service Specification for Transition”
Given the universal concepts and language of the ICF, it is timely for clinicians, educators, researchers and everyone working with youth and adolescents with disabilities and chronic health conditions to incorporate its framework in transition practice and research. The ICF has potential to improve communication and collaboration among health professionals working within multidisciplinary teams to impact adult health outcomes that are meaningful to youth and families. The ICF also encourages a holistic approach to care by focusing on personal and environmental factors beyond health, thus professionals should embrace its theory, framework and applications in practice and research. We present the YouthKIT, a tool that uses concepts of the ICF to address transition needs of adolescents with chronic health conditions.
Qualitative Methods Course: Moving from Afterthought to ForethoughtMEASURE Evaluation
This document provides an overview of an innovative qualitative methods course for rigorous evaluation. The course was developed by a curriculum advisory committee and piloted with 28 participants from 10 countries. It aims to enhance participants' abilities to conceptualize, design, and manage qualitative evaluation. The course covers major concepts, approaches to qualitative evaluation questions, methods, analysis, standards, and ethics. It uses varied teaching methods including discussions, presentations, and activities like developing a short evaluation protocol. Challenges included balancing theory and practice, integrating gender, and meeting participant needs. Pilot evaluations found the content and facilitation were strong but that timeline, hotel, and data analysis instruction could be improved.
The PERFORM project aims to understand how strengthening management can improve health workforce performance in Ghana, Tanzania and Uganda over 4 years. It uses an action research approach where district health management teams will identify barriers to performance, develop strategies to address them, implement the strategies, and observe the impact on performance. The expected outcome is evidence on how management strengthening can improve workforce performance and health systems in Sub-Saharan Africa.
An agricultural extension programme involves a collaborative planning process between extension staff and local communities. It includes:
1) An analysis of the current situation and problems facing the local area
2) Objectives and goals determined by the community to address key problems
3) Recommended solutions and a plan of action to achieve objectives over the short and long-term.
The planning process is progressive, involving fact-finding, analysis, priority-setting, and establishing measurable objectives. It requires input from representatives of the people and is an ongoing process that is periodically evaluated and modified based on results.
This document discusses various planning tools that can be used in implementing health programs, including affinity diagrams, tree diagrams, interrelationship diagrams, process decision program charts, matrix diagrams, prioritization matrices, and activity network diagrams. It provides examples of each tool and describes how and when they should be used, such as for problem solving, developing strategies, clarifying relationships between factors, scheduling complex projects with interdependent tasks, and prioritizing options when resources are limited.
This document discusses the process of extension program planning. It defines key terms like "extension program" and outlines assumptions and principles of extension planning. The main steps in the extension program planning process are identified as: 1) collecting relevant facts, 2) analyzing the situation, 3) identifying problems, 4) determining objectives and goals, 5) developing a plan of work and calendar, 6) implementing the plan, 7) evaluating progress, and 8) reconsidering and revising the program. The document emphasizes analyzing needs, setting clear and realistic objectives, involving local stakeholders, and continuously evaluating and improving the program.
The document discusses current trends, issues, and challenges in nursing in India. Some key trends include the reduction in distance due to improved communication technologies, increased computerization of patient care records, an emphasis on quality assurance and continuing nursing education. Issues outlined are the need for renewal of nursing registration, debates around degree vs. diploma qualifications, specialization, and establishing nursing care standards. Challenges discussed relate to nursing education, administration, research, and ensuring an adequate future for the nursing profession in India amidst globalization and technological advancements.
Nursing is focused on providing quality care to individuals regardless of personal attributes. The document discusses trends in the nursing profession globally and in Nepal. Key trends include increased education levels, specialization, and the use of new technologies. Nursing faces challenges from aging populations and resource constraints. In Nepal, issues include low funding for education, lack of faculty, and limited leadership opportunities for nurses in the health system. The profession aims to improve training, standards of care, and recognition of nursing's role.
This document calls for international collaboration to develop a mobile application (mICF) based on the International Classification of Functioning, Disability and Health (ICF) framework to improve continuity of care and strengthen health systems. It discusses how the mICF could incorporate ICF-related information to provide a holistic overview of patients and allow information sharing between providers. An international group of 25 partners is sought to provide feedback and analyze data to help define and develop the mICF project.
Kate Bukowski
ProCare Health Limited
(Friday, 3.00, Innovation in Practice 3)
Explores two domains which, on the surface, may seem very different – the US policy directing metrics to measure HIT adoption across the nation and the implementation and utilisation of a practice management system auditing tool (Dr Info) within a region of New Zealand’s general practices. Yet, when looked at under a different view, there are similarities which drive the use of HIT to improve results that engage patients in self-management of their health and clinicians in population health management. Both can improve the delivery of healthcare and provide value for money but both also need support and systems that foster innovation at a patient and practice level. This will continue to be an issue as the health workforce ages and becomes smaller. It is therefore crucially important how we utilise and train our workforce, that they have HIT systems that support their work with the approach that through showing results and improving results, clinicians will engage and want to use the technology to improve their practice. At the same time patients will need support to self-manage their conditions through the utilisation of patient portals and other innovative HIT initiatives.
Reflections from a realist evaluation in progress: Scaling ladders and stitch...Debbie_at_IDS
In this session, Isabel Vogel, Melanie Punton and Rob Lloyd will reflect on the first year of a three-year realist impact evaluation, examining the Building Capacity to Use Research Evidence (BCURE) programme funded by the UK Department for International Development.
The document discusses the author's methodological journey and critiques of empirical approaches. Some key points:
- The author is from a humanities background but works with technology and has been influenced by various methodological approaches.
- Empiricism and positivism do not account for social and political factors. Paradigm shifts in science show understanding does not come just from gradual truth discovery.
- Cybernetics provides alternative ways to conceptualize information and self-reference that are helpful for understanding lived experience.
- Phenomenology, grounded theory, and action research were also influential but lack strong methods for cumulative results.
- Empirical approaches are advocated for by policymakers but may not always provide
The ICF has potential to improve communication and collaboration (through its universal concepts and language) among health professionals working within multidisciplinary teams in research and practice to impact health outcomes for patients. Thus, it is timely for clinicians and trainees working in health-related fields to incorporate its framework into practice and research. It is hoped that professional programs will model our approach to develop similar courses within their professional curriculum to build capacity for application of the ICF. Education and training through a combination of peer support and mentorship for health professionals in the use of the ICF could assist with facilitating its uptake.
This document discusses leadership and change management in complex health systems. It begins by outlining where change efforts can go wrong, such as weak design and implementation. It then provides guidance on strengthening design through co-design and considering implementation. The document emphasizes that change must be led and managed, occurring through people. It discusses the importance of building commitment to change through sensemaking, communication, and addressing people's values. It also recommends embracing complexity and learning through small wins and feedback loops to increase the chances of success in health system strengthening efforts.
Health workforce education and development and Human Resource in the health s...MAK1stABMSC2019
The document discusses health workforce challenges in Africa, including shortages of health workers and high rates of migration. It notes that health professions education is critical and must be synchronized with health systems to produce workers that are fit for purpose. However, challenges remain such as insufficient education and training capacity, lack of funding for research, and poor retention of health workers due to lack of career development and low pay. Recommendations include expanding education and improving retention strategies through better working conditions and linking performance to rewards.
This document provides an overview of Community-Based Participatory Research (CBPR) including its history, principles, challenges, and benefits. Some key points:
1) CBPR aims to equitably involve community partners in all stages of research to address issues important to the community and promote social change.
2) Its roots trace back to action research and empowerment models that recognize communities as partners rather than subjects.
3) Challenges include balancing academic and community priorities, building trust over time, and ensuring research is culturally appropriate and sustainable.
4) Benefits include enhancing relevance, validity, translation and sustainability of research findings to improve community health.
steps in planning - Public health dentistrySNISHAMG
This document outlines the 10 step process for planning: 1) Identify the problem through needs assessment, 2) Determine priorities by analyzing data, 3) Develop goals, objectives and activities, 4) Identify required resources, 5) Identify constraints, 6) Identify alternative strategies, 7) Develop an implementation strategy, 8) Implement the plan, 9) Monitor the implementation, 10) Evaluate whether objectives were achieved. Planning is a systematic process that involves assessing needs, setting priorities, developing a course of action to address the problem, and evaluating outcomes.
Results from student-facilitated roundtable discussions at PACE Great Streets townhall meeting in Memphis, TN. This project represents an experiential learning activity at The University of Memphis, Health Promotion concentration in the Department of Health and Sport Sciences.
DH Policy on transition - Karen Turner
NHS Improving Quality held an event in London on 31 July 2013 to progress the children and young people transition to adult services work with a focus on turning the rhetoric into practice entitled “Working to Define a Generic Service Specification for Transition”
Given the universal concepts and language of the ICF, it is timely for clinicians, educators, researchers and everyone working with youth and adolescents with disabilities and chronic health conditions to incorporate its framework in transition practice and research. The ICF has potential to improve communication and collaboration among health professionals working within multidisciplinary teams to impact adult health outcomes that are meaningful to youth and families. The ICF also encourages a holistic approach to care by focusing on personal and environmental factors beyond health, thus professionals should embrace its theory, framework and applications in practice and research. We present the YouthKIT, a tool that uses concepts of the ICF to address transition needs of adolescents with chronic health conditions.
Qualitative Methods Course: Moving from Afterthought to ForethoughtMEASURE Evaluation
This document provides an overview of an innovative qualitative methods course for rigorous evaluation. The course was developed by a curriculum advisory committee and piloted with 28 participants from 10 countries. It aims to enhance participants' abilities to conceptualize, design, and manage qualitative evaluation. The course covers major concepts, approaches to qualitative evaluation questions, methods, analysis, standards, and ethics. It uses varied teaching methods including discussions, presentations, and activities like developing a short evaluation protocol. Challenges included balancing theory and practice, integrating gender, and meeting participant needs. Pilot evaluations found the content and facilitation were strong but that timeline, hotel, and data analysis instruction could be improved.
The PERFORM project aims to understand how strengthening management can improve health workforce performance in Ghana, Tanzania and Uganda over 4 years. It uses an action research approach where district health management teams will identify barriers to performance, develop strategies to address them, implement the strategies, and observe the impact on performance. The expected outcome is evidence on how management strengthening can improve workforce performance and health systems in Sub-Saharan Africa.
An agricultural extension programme involves a collaborative planning process between extension staff and local communities. It includes:
1) An analysis of the current situation and problems facing the local area
2) Objectives and goals determined by the community to address key problems
3) Recommended solutions and a plan of action to achieve objectives over the short and long-term.
The planning process is progressive, involving fact-finding, analysis, priority-setting, and establishing measurable objectives. It requires input from representatives of the people and is an ongoing process that is periodically evaluated and modified based on results.
This document discusses various planning tools that can be used in implementing health programs, including affinity diagrams, tree diagrams, interrelationship diagrams, process decision program charts, matrix diagrams, prioritization matrices, and activity network diagrams. It provides examples of each tool and describes how and when they should be used, such as for problem solving, developing strategies, clarifying relationships between factors, scheduling complex projects with interdependent tasks, and prioritizing options when resources are limited.
This document discusses the process of extension program planning. It defines key terms like "extension program" and outlines assumptions and principles of extension planning. The main steps in the extension program planning process are identified as: 1) collecting relevant facts, 2) analyzing the situation, 3) identifying problems, 4) determining objectives and goals, 5) developing a plan of work and calendar, 6) implementing the plan, 7) evaluating progress, and 8) reconsidering and revising the program. The document emphasizes analyzing needs, setting clear and realistic objectives, involving local stakeholders, and continuously evaluating and improving the program.
The document discusses current trends, issues, and challenges in nursing in India. Some key trends include the reduction in distance due to improved communication technologies, increased computerization of patient care records, an emphasis on quality assurance and continuing nursing education. Issues outlined are the need for renewal of nursing registration, debates around degree vs. diploma qualifications, specialization, and establishing nursing care standards. Challenges discussed relate to nursing education, administration, research, and ensuring an adequate future for the nursing profession in India amidst globalization and technological advancements.
Nursing is focused on providing quality care to individuals regardless of personal attributes. The document discusses trends in the nursing profession globally and in Nepal. Key trends include increased education levels, specialization, and the use of new technologies. Nursing faces challenges from aging populations and resource constraints. In Nepal, issues include low funding for education, lack of faculty, and limited leadership opportunities for nurses in the health system. The profession aims to improve training, standards of care, and recognition of nursing's role.
This document calls for international collaboration to develop a mobile application (mICF) based on the International Classification of Functioning, Disability and Health (ICF) framework to improve continuity of care and strengthen health systems. It discusses how the mICF could incorporate ICF-related information to provide a holistic overview of patients and allow information sharing between providers. An international group of 25 partners is sought to provide feedback and analyze data to help define and develop the mICF project.
Kate Bukowski
ProCare Health Limited
(Friday, 3.00, Innovation in Practice 3)
Explores two domains which, on the surface, may seem very different – the US policy directing metrics to measure HIT adoption across the nation and the implementation and utilisation of a practice management system auditing tool (Dr Info) within a region of New Zealand’s general practices. Yet, when looked at under a different view, there are similarities which drive the use of HIT to improve results that engage patients in self-management of their health and clinicians in population health management. Both can improve the delivery of healthcare and provide value for money but both also need support and systems that foster innovation at a patient and practice level. This will continue to be an issue as the health workforce ages and becomes smaller. It is therefore crucially important how we utilise and train our workforce, that they have HIT systems that support their work with the approach that through showing results and improving results, clinicians will engage and want to use the technology to improve their practice. At the same time patients will need support to self-manage their conditions through the utilisation of patient portals and other innovative HIT initiatives.
Reflections from a realist evaluation in progress: Scaling ladders and stitch...Debbie_at_IDS
In this session, Isabel Vogel, Melanie Punton and Rob Lloyd will reflect on the first year of a three-year realist impact evaluation, examining the Building Capacity to Use Research Evidence (BCURE) programme funded by the UK Department for International Development.
The document discusses the author's methodological journey and critiques of empirical approaches. Some key points:
- The author is from a humanities background but works with technology and has been influenced by various methodological approaches.
- Empiricism and positivism do not account for social and political factors. Paradigm shifts in science show understanding does not come just from gradual truth discovery.
- Cybernetics provides alternative ways to conceptualize information and self-reference that are helpful for understanding lived experience.
- Phenomenology, grounded theory, and action research were also influential but lack strong methods for cumulative results.
- Empirical approaches are advocated for by policymakers but may not always provide
How and why employment protection legislation impacts on temporary employment...sophieproject
Employment protection legislation (EPL) aims to protect jobs and increase stability but varies by country. Stricter EPL in southern Europe has led to growth in temporary contracts. A realist review found that less restrictive EPL for temporary than permanent workers increases temporary employment through four main mechanisms: flexibility for employers to adjust employment, discrimination in salaries/conditions, avoiding costs of permanent workers, and increased employer authoritarianism. The review synthesized evidence that deregulation and unprotection of workers allows firms more flexibility, discrimination, and control, leading to rising temporary and precarious employment.
Realist evaluation integrated into the social work client database systemMinna Kivipelto
This document discusses integrating a realist evaluation approach into social work client database systems. It explores what this would require from professionals and organizations based on empirical data from social workers. A realist evaluation allows examining how social work goals are reached among clients in different circumstances. The study found that digital tools could help connect information on goals, mechanisms and contexts if developed together with professionals. However, tools need to be simple enough to use in everyday work and not add extra forms. An integrated system across organizations could enable national effectiveness evaluations.
Social Protection Policies: Methods to evaluate policies that reduce health i...sophieproject
"Social Protection Policies: Methods to evaluate policies that reduce health inequalities" by Pat O'Campo and Carles Muntaner, in the framework of the final conference of the European research project SOPHIE. 29th September 2015, Brussels
Inclusive leadership and community participationPrashanth N S
A short presentation on community participation at an exposure visit for students of a leadership development programme. Primarily drawn from my experience at BR Hills synthesised using Susan Rifkin's framework.
Sophie methods: an introduction to realist reviewDavide Malmusi
The document introduces realist reviews as a method for synthesizing research on complex interventions. It explains that realist reviews seek to understand what works, for whom, and in what contexts by unpacking the mechanisms by which interventions succeed or fail. The critical ingredients of a realist review are identified as middle-range theories, demi-regularities, and context-mechanism-outcome configurations. Conducting a realist review is an iterative process of refining theories based on evidence. Experience suggests involving a multidisciplinary team and considering a wide range of evidence sources.
Explanatory Case Study (ECS) method: A Brief Summarysophieproject
SOPHIE members from Centre for Research on Inner City Health based in Toronto, Canada have prepared a presentation to summarize "Explanatory Case Study" metohodology. This methodology tries to understand factors related with decisions: why they were taken, how they were implemented, and with what results.
The document discusses challenges in managing community relationships and participation for projects at the Minnesota History Center, including balancing authenticity with participation, finding the right community members, and marketing programs while building audiences in advance. It addresses tensions between large crowds and historical programming, and notes the labor intensive nature of relinquishing control to community involvement.
This document summarizes the law around private defence and self-defense. It discusses when force can be used in defence, including that it must be necessary and proportionate to the threat. Force cannot be disproportionate to the harm threatened. There is no general duty to retreat but an attempt to disengage or withdraw from combat must be made if possible. The right of private defence extends to defending property as well as persons. Deadly force may be used in defence of one's home. Reasonable force can also be used to prevent crimes against property from occurring.
Performance of Routine Information System Management Framework (PRISM) led by Natasha Kanagat
The PRISM framework consists of four tools to assess Routine Health Information System (RHIS) performance, identify technical, behavioral and organizational factors that affect RHIS, aid in designing priority interventions to improve performance and improve quality and use of routine health data.
Recording: http://universityofnc.adobeconnect.com/p1edhgz9zs7/
PRISM Tool: https://www.cpc.unc.edu/measure/publications/ms-11-46-d
Generating public will by actively securing broad consensus and social commitment among all stakeholders for the elimination of HIV and recognizing that HIV is one of many important community issues
This document outlines principles for community mobilization including engaging the whole community through circles of influence, facilitating a process of social change from awareness to support to action, and providing repeated exposure to ideas while promoting community ownership using a human rights framework.
Community Participation In Primary Health Carecphe
The document discusses the importance of community participation in primary health care from the perspective of people's health movements in the global South. It describes how community participation was a key part of primary health care policies and programs before and after the Alma Ata Declaration of 1978, but was later distorted by the globalization of health systems. People's health movements aim to globalize health solidarity from below and bring "the community back into primary health care."
Community mobilization refers to the process of building social relationships to pursue common community interests. It involves identifying issues, selecting strategies, implementing solutions through community participation, and assessing results. The role of a community mobilizer is to facilitate discussion, encourage participation, and help ensure smooth running of the community mobilization process through skills like active listening, facilitating awareness, and managing conflicts constructively. Effective community mobilization requires continuous effort in utilizing resources, gaining community support, and exploring cooperation with other organizations.
The document provides details about a lesson plan for a session on community participation, including the objectives, overview, introduction, definition of key terms, advantages, stages, and techniques like Participatory Rural Appraisal. The introduction discusses the limitations of past development approaches in India that lacked community involvement. It emphasizes that participation is the key to building confidence and empowering people to take ownership of community initiatives.
This document defines key concepts related to community participation. It begins by defining a community and community participation. The objectives of community participation are to develop self-reliance, critical awareness, and problem-solving skills. There are different types and levels of participation, from passive to active involvement. Factors like education, resources, and leadership can influence participation. The bottom-up approach with community involvement in all stages from planning to evaluation is most effective. Benefits include programs being locally relevant, communities gaining self-reliance, and better community-health worker relationships.
Realist theories of crime challenge the idea that human behavior is determined by external forces alone. There are two main realist perspectives: right realism and left realism. Right realists argue that crime stems from poor socialization and lack of self-control. They advocate for stronger law enforcement measures. Left realists acknowledge crime victims but argue relative deprivation and lack of opportunities also contribute to crime. They call for improving social and economic conditions to reduce crime.
1. The document discusses various models and steps for planning and evaluating health promotion interventions. It describes planning models like PRECEDE-PROCEED and PEN-3 which involve assessing the community and identifying factors influencing health behaviors.
2. The planning process involves defining goals and objectives, identifying strategies and resources, and developing indicators. Evaluation determines whether objectives were met and assesses outcomes, using both qualitative and quantitative methods like surveys, focus groups, and experimental studies.
3. Challenges to evaluation include measuring long-term outcomes, limitations of resources, accounting for complex determinants of health, and ensuring use of lessons learned from the evaluation. Overall the document provides an overview of systematic approaches to planning and
Chapter 5 Program Evaluation and Research TechniquesCharlene R. .docxchristinemaritza
Chapter 5 Program Evaluation and Research Techniques
Charlene R. Weir
Evaluation of health information technology (health IT) programs and projects can range from simple user satisfaction for a new menu or full-scale analysis of usage, cost, compliance, patient outcomes, and observation of usage to data about patient's rate of improvement.
Objectives
At the completion of this chapter the reader will be prepared to:
1.Identify the main components of program evaluation
2.Discuss the differences between formative and summative evaluation
3.Apply the three levels of theory relevant to program evaluation
4.Discriminate program evaluation from program planning and research
5.Synthesize the core components of program evaluation with the unique characteristics of informatics interventions
Key Terms
Evaluation, 72
Formative evaluation, 73
Logic model, 79
Program evaluation, 73
Summative evaluation, 73
Abstract
Evaluation is an essential component in the life cycle of all health IT applications and the key to successful translation of these applications into clinical settings. In planning an evaluation the central questions regarding purpose, scope, and focus of the system must be asked. This chapter focuses on the larger principles of program evaluation with the goal of informing health IT evaluations in clinical settings. The reader is expected to gain sufficient background in health IT evaluation to lead or participate in program evaluation for applications or systems.
Formative evaluation and summative evaluation are discussed. Three levels of theory are presented, including scientific theory, implementation models, and program theory (logic models). Specific scientific theories include social cognitive theories, diffusion of innovation, cognitive engineering theories, and information theory. Four implementation models are reviewed: PRECEDE-PROCEED, PARiHS, RE-AIM, and quality improvement. Program theory models are discussed, with an emphasis on logic models.
A review of methods and tools is presented. Relevant research designs are presented for health IT evaluations, including time series, multiple baseline, and regression discontinuity. Methods of data collection specific to health IT evaluations, including ethnographic observation, interviews, and surveys, are then reviewed.
Introduction
The outcome of evaluation is information that is both useful at the program level and generalizable enough to contribute to the building of science. In the applied sciences, such as informatics, evaluation is critical to the growth of both the specialty and the science. In this chapter program evaluation is defined as the “systematic collection of information about the activities, characteristics, and results of programs to make judgments about the program, improve or further develop program effectiveness, inform decisions about future programming, and/or increase understanding.”1 Health IT interventions are nearly always embedded in ...
Evaluation of Gender Aware Health Interventions in South Asia: What do we kn...MEASURE Evaluation
This document summarizes a presentation on evaluating gender-aware health interventions in South Asia. It outlines the objectives, methodology, preliminary findings, discussion questions, limitations, and next steps of the evaluation. The methodology included searching for publications, establishing relevance, abstracting data, and rating interventions on their level of gender integration. Preliminary findings showed variation in study designs, sampling methods, control groups, gender measurement, analysis plans, impact levels, and use of multiple endlines. Discussion questions focused on measurement challenges and how to improve future evaluations. Limitations included the small number of interventions evaluated and use of only English publications. Next steps were to finalize analysis, incorporate a global review, and disseminate findings.
Fidelity assessment in cluster randomized trials of public health interventio...valéry ridde
Presentation by Nanor Minoyan and Myriam Cielo (Université de Montréal).
Global Health Workshop: Methods For Implementation Science in Global Health.
http://www.equitesante.org/implementation-science-methods-in-global-health/
Building M&E capacity in community-based HIV programs in Tanzania: From diagn...MEASURE Evaluation
The document summarizes efforts to build monitoring and evaluation (M&E) capacity in community-based HIV programs in Tanzania. It found that existing M&E systems were inadequate and data quality was poor. A new approach was developed using data quality assessments and community tracing of beneficiaries to identify weaknesses and improve M&E skills through tailored training. This led to measurable improvements in M&E plans, performance, and data quality. However, fully transitioning capacity building to local organizations remained a challenge.
Sustainability and Health Systems Strengthening: What Have We Learned?MEASURE Evaluation
Presented by Xavier Alterescu as part of the Brown Bag Series given at USAID on MEASURE Evaluation's contribution to the Global Health Initiative Principles
This document provides an overview and agenda for training modules on monitoring and evaluation of Population, Health and Environment (PHE) programs. It outlines 7 training modules that cover topics such as conceptual and logic model frameworks, indicators, evaluation design, and more. The target audience is staff involved in monitoring and evaluation of integrated PHE programs. The objectives are to increase understanding of monitoring and evaluation approaches for PHE programs and to gain experience designing M&E plans for such programs. Learning methods include lectures, exercises, small group work and presentations.
Tanzania dissemination meeting presentation on action researchPERFORM Consortium
The PERFORM project uses action research to help district health management teams in Ghana, Tanzania, and Uganda improve health workforce performance. Over four years, the project supports management teams to conduct situation analyses, plan and implement integrated human resource and health systems strategies ("bundles"), observe impacts, and reflect on lessons. The goal is to strengthen district management and ultimately improve service delivery. Key activities include national workshops to analyze problems, develop strategies, and compare results, as well as ongoing support from in-country research teams. Evaluation focuses on changes in workforce performance and health systems during and after implementing the management strengthening intervention.
Running head: QUALITY IMPROVEMENT
Quality improvement 1
Introduction
Health care system consists of various areas that have different functions, and these areas need improvement from time to time to improve the quality of services offered. One of these areas is health care literacy of patients especially the least served; it is defined as the ability of people to access, process and understand basic health information (Lie et al., 2012). An elaborate quality improvement is needed to ensure the provision of quality services. Therefore in a quality improvement plan, each and everyone has a role to play. From the board of directors, middle to department staff in data collection and reporting, reporting implementation progress, orientation and education of staff about the plan and finally evaluation of the plan. Comment by Earl: ok
Roles
Board of directors need to review the quality improvement plan, once approved oversee its implementation by CEO, directors, managers and the staff. Executive leadership oversees the implementation of the plan by the staff. The quality improvement committee analyzes the performance data, evaluates the data and determines the effectiveness of the plan, and makes recommendations on the progress. Medical staffs implement the quality improvement plan. Middle management manages staff and ensures implementation of the plan and is answerable to the executive leadership. The departmental staff handles ensuring that they play their specific role required of them in the implementation of the plan that involves their department (Barrera Jr et al., 2013). Comment by Earl: Discuss roles specific to your project in depth – this is too generic
Data collection and data reporting
Quality improvement committee handles data collection and reporting. The committee should collect data, evaluate and analyzes it and make the necessary recommendations. If the plan is adopted, they determine the functionality of the plan and what changes need to be made to ensure its effectiveness. Comment by Earl: Be specific; explore in more depth
The board of management responsible for reviewing the recommendations and decides whether to adopt them or not. Once they approve they give a go-ahead for its implementation. The management team will take the responsibility of overseeing its implementation.
Changes implemented
There are various changes that need to be implemented to improve health literacy among patients, especially in the underserved population. Firstly is to promote universal access to health information. There needs to be readily accessible health either through their Internet or read materials such as brochures to every patient and should be presented in the simplest manner for the patients to understand..
The STEP Program Logic Model outlines goals for a behavioral health program including increasing workforce capacity, enhancing performance management, and reducing health care disparities. It identifies strengths such as staff dedication and leadership support. Opportunities for improvement include enhancing workforce development and quality assurance processes. Key components of the evaluation plan are to analyze data findings, provide recommendations, and offer training to increase clinical capacity.
A theoretical framework to assess implementation fidelity of adaptive public...valéry ridde
This document proposes a theoretical framework for assessing implementation fidelity of adaptive public health interventions. It begins by discussing the importance of implementation outcomes like feasibility, appropriateness and fidelity. While fidelity concerns delivering an intervention as intended, adaptations are common and can threaten effectiveness if not properly evaluated. The document then describes a study that evaluated fidelity of an empowerment strategy for dengue prevention in Cuba, finding adaptations occurred. It concludes by outlining an adapted framework building on existing models to better capture fidelity and important adaptations by defining expected outcomes, intervention principles and developing intervention-specific descriptors.
This chapter discusses organizational goals and effectiveness in public organizations. It covers different models that have been used to assess effectiveness, including goal models, resource models, and stakeholder satisfaction models. The chapter notes that goals in public organizations tend to be more vague than in private firms. It also discusses challenges in measuring effectiveness, such as conflicting goals and the difficulty converting goals into measurable outcomes. Finally, it addresses issues with comparing public and private sector effectiveness.
Understanding Why, When, and What it Will Take to do Operations and/or Implem...CORE Group
Here are some issues with the objectives and research questions:
- The objectives are not specific enough and focus more on methods rather than the purpose of the research.
- The questions make assumptions that community beliefs are "wrong" rather than trying to understand perspectives.
- Questions 1.1 and 1.2 for the formative research objective are too leading and specific rather than open-ended to understand barriers.
- Objective 2 aims to "prove" effectiveness rather than objectively measure impact, and the questions only measure outcomes rather than factors influencing them.
The objectives and questions should be more open-ended, focus on understanding rather than proving assumptions, and aim to inform program improvement rather than prove effectiveness.
Evaluating the quality of quality improvement training in healthcareDaniel McLinden
Quality Improvement (QI)in healthcare is an increasingly important approach to improving health outcomes, improving system performance and improving safety for patients. Effectively implementing QI methods requires knowledge of methods for the design and execution of QI projects. Given that this capability is not yet widespread in healthcare, training programs have emerged to develop these skills in the healthcare workforce. In spite of the growth of training programs, limited evidence exists about the merit and worth of these programs. We report here on a multi-year, multi-method evaluation of a QI training program at a large Midwestern academic medical center. Our methodology will demonstrate an approach to organizing a large scale training evaluation. Our results will provide best available evidence for features of the intervention, outcomes and the contextual features that enhance or limit efficacy.
KEYSTONE HPSR Initiative // Module 7: Realist evaluation // Slideshow 1: Realist and theory driven approaches in HPSR
This is the only slideshow of Module 7: Realist evaluation, of the KEYSTONE Teaching and Learning Resources for Health Policy and Systems Research
To access video sessions and slides for all modules copy and past the following link in your browser:
http://bit.ly/25vVVp1
Module 7: Realist evaluation
Programmes and policies are complex in their design and implementation because of the number of interacting agents, components and forces that influence people and organisations in a given system. In this module through the realist evaluation approach explores why programmes/interventions work for some and not for others and getting to the core issue of trying to understand the conditions under which the interventions works.
There is 1 slideshow in this module.
Module 7: Realist evaluation
Module 7 Slideshow 1: Realist and theory- driven approaches in HPSR
The other modules in this series are:
Module 1: Introducing Health Systems & Health Policy
Module 2: Social justice, equity & gender
Module 3: System complexity
Module 4: Health Policy and Systems Research frameworks
Module 5: Economic analysis
Module 6: Policy analysis
Module 8: Systems thinking
Module 9: Ethnography
Module 10: Implementation research
Module 11: Participatory action research
Module 12: Knowledge translation
Module 13: Research Plan Writing
KEYSTONE is a collective initiative of several Indian health policy and systems research (HPSR) organizations to strengthen national capacity in HPSR towards addressing critical needs of health systems and policy development. KEYSTONE is convened by the Public Health Foundation of India in its role as Nodal Institute of the Alliance for Health Policy and Systems Research (AHPSR).
The inaugural KEYSTONE short course was conducted in New Delhi from 23 February – 5 March 2015. In the process of delivering the inaugural course, a suite of teaching and learning materials were developed under Creative Commons license, and are being made available as open access resources. The KEYSTONE teaching and learning resources include 38 videos and 32 slide presentations organized into 13 modules. These materials cover foundational concepts, common approaches used in HPSR, and guidance for preparing a research plan.
These resources were created and are made available through support and funding from the Alliance for Health Policy & Systems Research (AHPSR), WHO for the KEYSTONE initiative.
COUNTDOWN Sally Theobald & Margaret Gyapong - Launch 2015COUNTDOWN on NTDs
This document outlines the themes and approaches for social science research within the COUNTDOWN program. It discusses the need to understand issues from different perspectives within the health system and community. The research will examine factors that influence adherence to mass drug administration programs, experiences of those living with neglected tropical diseases, and how social environments shape disease vulnerability. Methods will include assessments of health systems support for neglected tropical disease programs, roles of community drug distributors, and community perceptions of integrated treatment. The goal is to generate lessons that can strengthen programs and policies to more equitably deliver impacts for at-risk populations.
HS450 Unit 3 Assignment Managing and Leading Change in a.docxwellesleyterresa
HS450 Unit 3 Assignment
Managing and Leading Change in a Health Organization
Course Outcome
● HS450-2: Demonstrate how effective team building optimizes the
implementation of strategic planning.
Unit Outcomes
Differentiate among the different types of teams and task groups and their uses in health care
organizations.
Understand the factors associated with high-performing teams.
Define the communication process and what constitutes effective communication.
Instructions
You are a healthcare leader within a large multi-campus hospital system. The CEO and Board of
Directors have tasked you to facilitate discussion with other health professionals regarding a new
EHR system that will be implemented across the organization. Please complete the assignment as
indicated in the instructions below.
Part
Competency
Assessed
Instructions
1
Build effective teams.
Construct a plan to build effective teams in collaboration for a
selecting a new EHR system. Your plan should include at least
three (2) team/consensus building methods.
2
Interpret concepts of
change management
theories, techniques
and leadership.
Evaluate the concepts of change management theories,
techniques, and leadership by critiquing the challenges with
implementing a new EHR system within the organization. Your
evaluation should include at least three (2) concepts of change
management, risk exposure, organizational design, and/or
mergers.
3
Implement a
departmental strategic
plan.
Demonstrate implementation of a department strategic plan by
analyzing strategic planning, critical thinking for organizational
leadership, and/or benchmarking. Evaluate the best practices in
strategic leadership against the potential pitfalls with implementing
strategic plans.
4. Evaluate the stages
of the procurement
process.
Evaluate the stages of the procurement process by critiquing the
value of a Request for Proposal (RFP), Requisition for Information
(RFI), and Request for Quotation (RFQ). Judge the needs for an
organization by developing a plan to use each procurement
process type.
Assignment Requirements
● Please complete all parts in a Microsoft Word document.
● The body of your document should be at least 1200 words in length.
● Quoting should be less than 10% of the entire paper. Paraphrasing is necessary.
● Students must cite and reference at least 4 credible sources from the KU Library.
● Please be sure visit the Kaplan Writing Center to assist you with meeting APA expectations
for written Assignments.
Submit your work to the appropriate Dropbox.
Assignment Guide for the
HS450 - Unit 3 Assignment
Managing and Leading Change in a Health Organization
Grading Criteria Topics to Study Suggested Resources
Part 1: Student
has demonstrated
the ability to build
effective teams.
Team-building
Consensus building
techniques
“P ...
Capacity building in health and social careDOCMANProject
This document discusses capacity building in health and social care. It defines capacity building as an ongoing process to empower organizations to better meet their missions and goals through skills development, problem solving, and change implementation. Capacity building is necessary because existing systems are struggling to meet demands of aging populations with complex needs. It can be achieved through various approaches like organizational development, partnerships, community organizing, and staff training. The document provides examples of capacity building initiatives and argues that leadership plays an important role in facilitating organizational change.
Achieving UHC & equitable access to TB care in mixed public and private healt...Prashanth N S
Lecture delivered to the Engaging all health providers to End TB: Public-Private Mix (PPM) | May 21 and June 3-7, 2024 cohort at McGill Uniersity, Canada
Tribal health research examples based on work done under DBT/Wellcome Trust I...Prashanth N S
Presentation made based on work done under "Towards Health Equity & Transformative Action on Tribal Health" project under a clinica/public health intermediate fellowship from DBT/Wellcome Trust India Alliance to Prashanth N Srinivas. Presentation made at inauguration of Tribal Health Cell at Chamarajanagar Institute of Medical Sciences, Chamarajanagar, Karnataka at 2-day CME on Tribal health
Patterns, process & action on tribal health: Reflections from Towards Health ...Prashanth N S
Prashanth is a Faculty at IPH Bengaluru and is an MPH and PhD alumnus of ITM Antwerp. From May 2017-2022, through a fellowship from the DBT/Wellcome Trust India Alliance and with ITM Antwerp as his collaborator, he set up and expanded IPH Bengaluru’s ongoing work on health inequalities of indigenous peoples in India. A field station that he co-established with collaborators today continues to deepen community health, public health and social science inquiry into indigenous health through a recent grant from DBT/Wellcome trust to set up a Center for Training Research & Innovation in Tribal Health.
In this seminar Prashanth will share and reflect on the work accomplished in this fellowship and the field station and discuss possible areas for collaboration.
Equity in representation of rare diseases in IndiaPrashanth N S
Presentation made at a panel organised by the Department of Science & Technology Center for Policy Research, Indian Institute of Science Bengaluru in parternship with Ashoka University titled "Rare diseases in public health: The Indian Context" on February 19, 2022. Details here: https://dstcpriisc.org/2022/02/14/rare-diseases-in-public-health/
What’s in the method? Brief introduction to philosophy of science in public h...Prashanth N S
A long-ish interactive talk at the IPH Bangalore methods seminar giving an overview of the philosophy underlying methods choices in public health research especially as relevant to health policy and systems research
Planetary Health Information Center at Pakke Tiger ReservePrashanth N S
Talk at the DBT/Wellcome Trust India Alliance Conclave by Nandini Velho & Prashanth N Srinivas based on the co-production of a planetary health information center that is being set up in collaboration with the Arunahcal Pradesh Forest Department and communities living around Pakke Tiger Reserve. The work is supported by a public engagement grant to Prashanth N Srinivas (2021-22)
Mental health in primary health care in India: The Gumballi experiencePrashanth N S
Invited panel presentation at the 10th European Conference on Tropical Medicine & International Health held at Antwerp (16-20 October 2017) by Prashanth N Srinivas. Presentation based on the book chapter by the same name by Prashanth N S, Sridharan V S, Seshadri T, Sudarshan H, Kishore Kumar K V & Murthy RS in the Palgrave Handbook on socio-cultural perspectives on Global Mental Health
Univeral health coverage and tribal health: Plenary talk at TRIBECON National...Prashanth N S
Plenary talk at the National Conference on Tribal Health held at Pravara Rural Medical College in September 2019 on healht inequities among Adivasi communities and the quest for Universal Health Coverage. Full talk video here: https://www.youtube.com/watch?v=8DCoJ2_yros
Corona in India: PHC Preparedness and lockdown effectsPrashanth N S
The 3rd in the ITM ALUMNI WEBINAR series. Talk by Dr. Prashanth Nuggehalli Srinivas, Faculty & DBT/Wellcome Trust India Alliance Fellow at Institute of Public Health Bangalore. Event details available here: https://www.itg.be/E/Event/itm-alumni-webinar-3-corona-in-india-phc-preparedness
Full recording here: https://youtu.be/nB5SYcRzRjM
Bird Brain: Open Bird Quiz finals by Prashanth & Shyamal (Bangalore Bird Day ...Prashanth N S
Slides from the Bird Brain: Open Bird Quiz finals at the 2019 Bangalore Bird day conducted by Prashanth N S & L Shyamal
See link on blog for details on the quiz: http://www.daktre.com/2020/01/bird-brains-open-quiz-2019/
Bird Brains: Open Bird Quiz at Bangalore Bird Day 2019 (Prelims)Prashanth N S
Quiz conducted at National College Jayanagar on the 2019 Bangalore Bird Day (see http://www.http://birdday.in). Quiz by Prashanth N S (http://www.daktre.com) & L Shyamal (http://www.muscicapa.blogspot.com)
Finals slides here: https://www.slideshare.net/PrashanthSrinivas/bird-brain-open-bird-quiz-finals-by-prashanth-shyamal-bangalore-bird-day-2019
Slides from a TEDx talk at TEDxOakridgeInternationalEinstein in Hyderabad on October 29, 2017. For video and description of talk, see http://www.daktre.com/2017/12/healthy-by-chance-or-by-choice/
Based on a bird quiz conducted at an annual meeting of birders/naturalists. Slides and content by Tanya Seshadri with inputs from Prashanth N S. For details of this quiz, see http://www.daktre.com/2017/11/quizzing-in-the-days-of-ebird/
Building the frontline health workers: Strengthening the role and training o...Prashanth N S
Presentation made at the All India People's medical and health education conference organised in February 2015 by the All India People's Science Network by Tanya Seshadri & Prashanth N S
Questioning improvements in health going beyond averagesPrashanth N S
Presentation made at EQUILOGS, webinar hosted by Shree Chitra Institute. See http://www.healthinequity.com/event/webinar-“questioning-improvements-health-–-going-beyond-averages” for details.
Presentation made at the First Karnataka Bird Festival held in Ranganathittu from 27-29 March 2015. In the presentation, I begin with an introduction to bird lore with a few examples from medieval Europe and going to examples of traditional names/knowledge/perspectives that have inspired Indian bird names. I finally end with examples of local bird names and lore of the Soliga people from southern Karnataka
Income inequalities in health presentationPrashanth N S
Presentation on socio-economic inequalities in health in India made at the National Seminar on Health Equity Evidence and Priorities for Research in India conducted by the Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Trivandrum in 2015
District health action plans & Programme implementation plans (PIP) for Block...Prashanth N S
This document outlines planning concepts and processes for public health programme managers. It discusses planning as a systematic process of setting goals and objectives to achieve them. The planning cycle involves assessing the current situation, setting priorities and targets, implementing plans, and monitoring and evaluating progress through indicators to inform future planning. The document guides participants through activities to discuss their experiences with planning, identify the steps in the planning process, and how to apply these concepts to the National Rural Health Mission's planning process, including developing priority activities and indicators for the annual programme implementation plan.
Stem Cell Solutions: Dr. David Greene's Path to Non-Surgical Cardiac CareDr. David Greene Arizona
Explore the groundbreaking work of Dr. David Greene, a pioneer in regenerative medicine, who is revolutionizing the field of cardiology through stem cell therapy in Arizona. This ppt delves into how Dr. Greene's innovative approach is providing non-surgical, effective treatments for heart disease, using the body's own cells to repair heart damage and improve patient outcomes. Learn about the science behind stem cell therapy, its benefits over traditional cardiac surgeries, and the promising future it holds for modern medicine. Join us as we uncover how Dr. Greene's commitment to stem cell research and therapy is setting new standards in healthcare and offering new hope to cardiac patients.
Let's Talk About It: Breast Cancer (What is Mindset and Does it Really Matter?)bkling
Your mindset is the way you make sense of the world around you. This lens influences the way you think, the way you feel, and how you might behave in certain situations. Let's talk about mindset myths that can get us into trouble and ways to cultivate a mindset to support your cancer survivorship in authentic ways. Let’s Talk About It!
Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...nirahealhty
The South Beach Coffee Java Diet is a variation of the popular South Beach Diet, which was developed by cardiologist Dr. Arthur Agatston. The original South Beach Diet focuses on consuming lean proteins, healthy fats, and low-glycemic index carbohydrates. The South Beach Coffee Java Diet adds the element of coffee, specifically caffeine, to enhance weight loss and improve energy levels.
Michigan HealthTech Market Map 2024. Includes 7 categories: Policy Makers, Academic Innovation Centers, Digital Health Providers, Healthcare Providers, Payers / Insurance, Device Companies, Life Science Companies, Innovation Accelerators. Developed by the Michigan-Israel Business Accelerator
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardso...rightmanforbloodline
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
At Apollo Hospital, Lucknow, U.P., we provide specialized care for children experiencing dehydration and other symptoms. We also offer NICU & PICU Ambulance Facility Services. Consult our expert today for the best pediatric emergency care.
For More Details:
Map: https://cutt.ly/BwCeflYo
Name: Apollo Hospital
Address: Singar Nagar, LDA Colony, Lucknow, Uttar Pradesh 226012
Phone: 08429021957
Opening Hours: 24X7
Unlocking the Secrets to Safe Patient Handling.pdfLift Ability
Furthermore, the time constraints and workload in healthcare settings can make it challenging for caregivers to prioritise safe patient handling Australia practices, leading to shortcuts and increased risks.
About this webinar: This talk will introduce what cancer rehabilitation is, where it fits into the cancer trajectory, and who can benefit from it. In addition, the current landscape of cancer rehabilitation in Canada will be discussed and the need for advocacy to increase access to this essential component of cancer care.
INFECTION OF THE BRAIN -ENCEPHALITIS ( PPT)blessyjannu21
Neurological system includes brain and spinal cord. It plays an important role in functioning of our body. Encephalitis is the inflammation of the brain. Causes include viral infections, infections from insect bites or an autoimmune reaction that affects the brain. It can be life-threatening or cause long-term complications. Treatment varies, but most people require hospitalization so they can receive intensive treatment, including life support.
The best massage spa Ajman is Chandrima Spa Ajman, which was founded in 2023 and is exclusively for men 24 hours a day. As of right now, our parent firm has been providing massage services to over 50,000+ clients in Ajman for the past 10 years. It has about 8+ branches. This demonstrates that Chandrima Spa Ajman is among the most reasonably priced spas in Ajman and the ideal place to unwind and rejuvenate. We provide a wide range of Spa massage treatments, including Indian, Pakistani, Kerala, Malayali, and body-to-body massages. Numerous massage techniques are available, including deep tissue, Swedish, Thai, Russian, and hot stone massages. Our massage therapists produce genuinely unique treatments that generate a revitalized sense of inner serenely by fusing modern techniques, the cleanest natural substances, and traditional holistic therapists.
MBC Support Group for Black Women – Insights in Genetic Testing.pdfbkling
Christina Spears, breast cancer genetic counselor at the Ohio State University Comprehensive Cancer Center, joined us for the MBC Support Group for Black Women to discuss the importance of genetic testing in communities of color and answer pressing questions.
Healthy Eating Habits:
Understanding Nutrition Labels: Teaches how to read and interpret food labels, focusing on serving sizes, calorie intake, and nutrients to limit or include.
Tips for Healthy Eating: Offers practical advice such as incorporating a variety of foods, practicing moderation, staying hydrated, and eating mindfully.
Benefits of Regular Exercise:
Physical Benefits: Discusses how exercise aids in weight management, muscle and bone health, cardiovascular health, and flexibility.
Mental Benefits: Explains the psychological advantages, including stress reduction, improved mood, and better sleep.
Tips for Staying Active:
Encourages consistency, variety in exercises, setting realistic goals, and finding enjoyable activities to maintain motivation.
Maintaining a Balanced Lifestyle:
Integrating Nutrition and Exercise: Suggests meal planning and incorporating physical activity into daily routines.
Monitoring Progress: Recommends tracking food intake and exercise, regular health check-ups, and provides tips for achieving balance, such as getting sufficient sleep, managing stress, and staying socially active.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Rate Controlled Drug Delivery Systems, Activation Modulated Drug Delivery Systems, Mechanically activated, pH activated, Enzyme activated, Osmotic activated Drug Delivery Systems, Feedback regulated Drug Delivery Systems systems are discussed here.
Feeding plate for a newborn with Cleft Palate.pptxSatvikaPrasad
A feeding plate is a prosthetic device used for newborns with a cleft palate to assist in feeding and improve nutrition intake. From a prosthodontic perspective, this plate acts as a barrier between the oral and nasal cavities, facilitating effective sucking and swallowing by providing a more normal anatomical structure. It helps to prevent milk from entering the nasal passage, thereby reducing the risk of aspiration and enhancing the infant's ability to feed efficiently. The feeding plate also aids in the development of the oral muscles and can contribute to better growth and weight gain. Its custom fabrication and proper fitting by a prosthodontist are crucial for ensuring comfort and functionality, as well as for minimizing potential complications. Early intervention with a feeding plate can significantly improve the quality of life for both the infant and the parents.
Feeding plate for a newborn with Cleft Palate.pptx
PhD private defence: Realist evaluation of a capacity building programme for health managers in Tumkur, India
1. How do capacity building programmes work
in local health systems?
A realist evaluation of a local health system strengthening intervention
in Tumkur, India
Prashanth Nuggehalli Srinivas
Private defense UCL
February 20, 2015
Promoter: Jean Macq
Co-promoter: Bart Criel
2. Outline
• Part 1: The big picture – Strengthening health
systems in India
• Part 2: Local health systems and
organisational change
• Part 3: Study setting and intervention
• Part 4: Methodology and study design
• Part 5: Analysis and results
• Part 6: Discussion, relevance and lessons
learned
2
Background
Methods
Results &
Discussion
4. Indian health system is pluralistic & evolving
4
Van Damme et al 2010
Part 1
Background
5. Regional improvements, but disparities remain
5
“Accelerated progress to reduce mortality during the neonatal
period and at ages 1–59 months is needed in most Indian
districts.”
- Usha Ram et. al. 2013
Part 1
Background
6. Regional/sub-regional (district-taluka) disparities
Role of (poor) management?
For example, in 2006
Immunisation coverage
– 91% in Kodagu district
and 70% in Raichur.
114 “backward” talukas,
nearly half in “forward”
districts
“Systemic failure” as a
cause?
(George, 2007&2009),
Sen (2006)
6
Part 1
Background
7. Human resources for health
• Good health workforce –
Available & competent
• Improved organisational
outcomes through ‘good HRM’
– Lifelong learning and supportive
(yet firm) supervision
– Competent and responsive
managers who are able to manage
resources and plan health care
services
Part 1
Background
9. • Poor planning and management
contribute to disparate health
outcomes in Indian districts
• Structural reforms such as the
NRHM need well-performing
district & sub-district local health
systems
Prashanth N S (2013) BMJ Rapid Response
http://www.bmj.com/content/347/bmj.f5621/rr/662992 9
11. Local health systems
• More than a sum of the services;
acquire a specific local character
in view of their internal
characteristics and the context
• Interface between top-down
policies and bottom-up
demands
• Locus for conceptualising
organisational change through
building capacity and improving
performance
Van Olmen et. al. 2012
11
Part 2
Background
12. Capacity and performance
• Multi-dimensional nature
of capacity & performance
– individual, organisational,
environmental
• Capacity & capacity
building closely related to
performance, but may not
automatically improve
performance – various
dynamic interactions
between internal and
external factors influence
performance 12
Part 2
Background
Brown, L., LaFond, A., & Macintyre, K. (2001). Measuring capacity
building. Chapel Hill: MEASURE Evaluation.
13. Socio-cultural
Effort
Time
Culture-oriented
change & “new way of
doing things” (shifting
norms, powers,
values)
13
Technical
Programmatic
Quick(er)
Tangible
Task-oriented nature
of change (changing
procedures and
activities)
Potter & Brough 2004
Organisational change
Part 2
14. Capacity-building as an HRM
intervention
• Implemented with the objective of knowledge or
skills transfer through training programmes
• Frequent calls for greater capacity-building in
literature and some studies on effectiveness, but:
– How do these programmes work at the “systems” level?
– Under what circumstances do these lead to behavioural
change and improved performance of the organisations?
– What are the contextual elements that promote (or
hinder) such change?
14
Part 2
Background
15. Rationale for the study
• The literature gap – Review of 28 European
Commission-funded projects shows need for
systemic capacity building & research; and scanty
literature on how it works (Potter & Borough 2005)
• The evidence gap – poor evidence for structuring
capacity-building interventions (Rowe et al 2005)
• The methodological gap – evaluation of complex
HRM interventions
• Timeliness & relevance – National Rural Health
Mission
15
Part 2
Background
16. Asking the how question in healthcare evaluations in India
• Review of health programme
evaluation in India
• Little inter-disciplinarity
• Heavy tilt towards “did
programme work” and comparing
coverage and effectiveness
• Two case studies – maternity
benefit scheme & health
insurance for people below
poverty line Prashanth, N. S., Marchal, B., & Criel, B. (2013). Evaluating
Healthcare Interventions: Answering the “How” Question.
Indian Anthropologist, 43(1), 35–50.
16
Part 2
22. 22
Mentoring
Contact classes
& Assignment
Health managers (medical & non-
medical) at District level – DHO, DS,
Programme officers, DPM, nursing
managers and senior admin staff
Health team at taluka level – THO,
AMO, BPM, AAO
PHC Medical Officers, PRI members
2-3 days per month,
residential contact
classes
At least 5 mentoring
days
1 assignment/month
24. Methodological considerations
• Programme theory and assumptions were
not explicitly formulated
• From effectiveness to mechanisms of
change in organisations
• Mixed methods study
24
Part 4
Methods
25. Scope for realist evaluation
Prashanth, N. S., Marchal, B., & Criel, B. (2013). Evaluating
Healthcare Interventions: Answering the “How” Question.
Indian Anthropologist, 43(1), 35–50.
25
Part 4
Methods
26. Realist approach
Mechanism: what is it about an
intervention which may lead it to
have a particular outcome in a
given context?
Context: what conditions are
needed for an intervention to
trigger mechanisms to produce
particular outcomes patterns?
Outcomes pattern: what are the
practical effects produced by
causal mechanisms being
triggered in a given context?
Pawson & Tilley, 199726
Part 4
Methods
28. Three cycles
• Eliciting the PT
• Macro/meso level
contextual
conditions
• Contrasting cases
within Tumkur
28
Part 4
Methods
29. Data collection
• Field notes of observations during classroom
teaching, mentoring visits, district and taluka
review meetings and supervision visits
• Interview with participants (7+7+8),
supervisors (2), state-level bureaucrats (2) and
implementers (2) in three episodes: early
intervention, mid and post
• Secondary data: annual plans, district-planning
guidelines from state and central government,
programme documents of the NRHM
29
Part 4
Methods
30. Survey
– Attitude towards decentralised planning and
training programmes
– Organisational commitment (Mayer & Allen)
– Self-efficacy (Bandura)
– Supervision (Oldham & Cummings as adapted
from Michigan OA package)
– Respondents (Tumkur and a comparator district):
65+27
30
Part 4
Methods
32. Eliciting the programme theory (PT)
• Described the process of
refining PT
– Understanding the
intervention (IPT)
– Review of literature to
identify mechanisms
reported
– Identify relevant contextual
factors
– Refine PT
– Formulate change scenarios
(C-M-O)
32
Part 4
Methods
33. Key IPT
assumption
Supporting
theory
Key
contextual
factor
Plausible
mechanism
identifiable
from IPT and
theory
Outcome
of interest
Contact
classes’
work
through
improving
knowledge
and/or skills,
which are
eventually
applied. This
results in
improved
performance
Outcomes of
training
programmes
accrue through
four
hierarchical
levels: reaction
(to training
programme),
learning,
behaviour and
impact
(Kirkpatrick
and Kirkpatrick
1998)
Team
dynamics
(nature of
team and
relationship
s) affects
the
individual
with
intention
for positive
change
Motivation of
the
participant
towards
positive
organisational
change - a
“can-do”
attitude in
the IPT
Intention
to make
positive
changes
Context-mechanism-outcome 33
34. Key IPT
assumption
Supporting
theory
Key contextual
factor
Plausible
mechanism
identifiable
from IPT
and theory
Outcome of
interest
Mentoring
participants
at workplace
facilitates
application
of
knowledge
and skills
Workplace
environment in
healthcare
organisations has
been identified
as an important
element that
explains
application of
learning from
training
programmes in
some settings,
while not in
others (Clarke
2005).
Nature of
supervision and
district’s
openness to
“allow” change
Nature of
commitment
to
organisation
Identify/seek
opportunities
to make
positive
change in the
organisation’s
performance
Decentralised
action plans and
decision-making
at district and
lower levels.
State and higher
levels’ openness
to change
proposals
Self-efficacy Improved
annual action
plans – Better
situation
analysis,
problem
identification,
allocation
and
utilisation of
resources 34
Context-mechanism-outcome
35. Key IPT
assumption
Supporting
theory
Key contextual
factor
Plausible
mechanism
identifiable from
IPT and theory
Outcome of
interest
A
capacitate
d health
manager
can
become an
agent of
positive
organisatio
nal change
High
commitment
managemen
t literature
shows the
potential for
change by
committed
staff in
settings
where
resources
could be
mobilised
(Marchal,
Dedzo, and
Kegels
2010a).
Change
proposals by
districts are in
line with state
(or central)
vision as well as
address local
needs.
(Allocation and
strategic
alignment with
external
environment
per Sicotte et
al.’s conceptual
framework)(Sico
tte et al. 1998)
Claiming and
utilising
decision
spaces;
organisational
commitment
and self-
efficacy in
negotiating
with superiors
and
community
leaders
Taluka and
districts plan
improves.
They identify
more needs,
mobilise
more
resources
from state
and utilise it
better
(Efficiency –
both
allocative and
technical –
improves)
35
Context-mechanism-outcome
37. Elicited PT - 1
Contact classes could work through
commitment and efficacy of health
managers who bear an intention to make
positive change by providing them
resources in the form of knowledge and/or
skills; they are likely to apply these
knowledge and skills in talukas where local
team environment supports such change
and the change agenda aligns with the local
PRI and district/state expectations
37
Results &
Discussion
Part 5
38. Mentored participants are more likely to seek
opportunities to improve their local health
systems to make positive change in the
organisation’s performance wherever there is no
hindrance (or there is an alignment) to such
moves either from above or from the
PRI/community structures
Elicited PT - 2
38
Results &
Discussion
Part 5
39. Local health systems could be improved in
decentralising health systems if teams have the
ability to negotiate with various actors about their
change proposals and if they claim decision-spaces
for preparation and implementation of action
plans and local decision-making at district and
lower levels; if the capacity building programme
could work at multiple levels to ensure better
alignments between opposing elements across
various actors and levels in the health system.
Elicited PT - 3
39
Results &
Discussion
Part 5
44. But structural problems…
44
The NRHM appointed “managers” were contractual appointees
within teams with very senior clinically trained doctor-managers
Results &
Discussion
Part 5
45. “What is the use of putting my time into
the PIP, if they will change it anyway at the
state (level)?”
a district level health manager
“They seemed to make more noise than
usual”
a senior state-level official
45
“At village level they do not really know
much planning. They are actually not
bothered about plans and all.”
a taluka health manager
“What do they know? After all, many of
them are uneducated? What is the need
for them to oversee our decisions?”
a taluka health manager
“BPMs should provide data as and when
required and prepare good reports. They
are too young and cannot understand the
health department’s work.”
a taluka health manager
Part 5
Perceptions across the health bureaucracy
48. Case analysis
The hypothetical CMO frames offer a context-
sensitive, theory-informed lens to analyse the
intervention
– In purposively chosen talukas with and without a
positive outcome (relate-able to the
intervention), what were the differing contexts?
– What were the differences in the nature of
commitment of the individuals in these
contrasting talukas?
– ..…
48
Results &
Discussion
Part 5
49. Explaining organisational change
• Identified case studies based
on diversity of context
and/or outcome after
scanning context,
mechanism and outcome
elements
• Confronted the reformulated
PT and first round of CMO-
based change scenarios to
these cases
49
Results &
Discussion
Part 5
50. Case selection
• a mix of individual, organisational and
contextual factors
– intervention exposure
– socio-economic development index of taluka
– mentoring interest & supervision received
– stability of team
– proxy measures of outcomes logically related
to improvements in the talukas.
50
Results &
Discussion
Part 5
51. Degree
of
classroo
m
participat
ion
(attendan
ce and
classroo
m
activity)
(0-1.0)
Degree
of
mentorin
g
received
(0-1.0)
Rete
ntion
of
ment
or
inter
est
by
taluk
a
High
-
Mod
erate
-Low
Organisa
tional
commitm
ent
Affective
commitm
ent(AC),
normativ
e
commitm
ent (NC)
&
continua
nce
commitm
ent (CC)
(0-5)
Self-
effica
cy
(0-
100)
Support
ive
degree
of
supervi
sion
supervi
sion
(1-5; 1
being
most
support
ive and
5 being
most
authorit
ative)
Perce
ntage
of
ever-
traine
d
memb
ers
who
expres
sed
intenti
on to
make
chang
e
Stabi
lity
of
team
–
turnv
over
(Hig
h-
Mod
erate
-
low)
Devel
opme
nt
index
Net
chang
e in
percen
tage
budge
t
utiliza
tion
(2008-
2012)
Net
change
in
proport
ion of
LSCS
among
total
deliveri
es
(2008-
2012)
Ne
t
cha
ng
e
in
stil
lbi
th
rat
e
(20
08
20
12)
Gubbi 0.7 0.7 High AC 2.66
NC 2.47
CC 2.42
68 2.5 50 Mod
erate
0.95 2 1 -16
Tumkur 0.7 0.7 Mod
erate
AC 2.85
NC 2.46
CC 2.69
68 2.6 75 Low 1.21 6 1.5 -8
CN Halli 0.6 0.5 Mod
erate
AC 2.75
NC 2.29
CC 2.71
70 2.2 100 High 1.02 4 0.1 0
Turuvekere 0.6 0.4 Low AC 2.81
NC 2.80
CC 2.47
68 2.4 83 High 1.06 5 5.8 -4
Tiptur 0.5 0.5 Mod
erate
AC 2.25
NC 2.33
CC 3.17
86 2.5 75 Low 1.25 -4 12.6 -1
Koratagere 0.4 0.5 Low AC 2.87
NC 2.73
CC 3.07
71 2.3 20 Mod
erate
0.89 3 1.8 -3
Madhugiri 0.5 0.5 Low AC 2.50
NC 2.03
CC 2.50
83 2.4 40 High 0.82 4 1.3 -1
Pavagada 0.6 0.5 Mod
erate
AC 2.50
NC 2.05
CC 2.28
79 2.3 0 High 0.78 6 0 1
Kunigal 0.6 0.5 High AC 2.12
NC 2.59
CC 2.83
83 2.2 75 Mod
erate
0.96 2 4.9 -4
Sira 0.7 0.9 High AC 1.80
NC 2.00
CC 2.67
68 2.2 100 Mod
erate
0.81 6 8.3 2
51
52. Committed and mentored teams with low-
moderate intention to make change
“In my taluka for example, I think we can
make big change. It is not that everybody
in my taluka want to make changes. Only
one-third of them are motivated to make
changes. And that is enough. I think I can
make a lot of improvement by motivating
these people.”
- a Gubbi taluka helath manager
“More resources mean more
opportunities to make change. If they
slowly give more and more power to us
at taluka level, we can make many more
improvements. Right now, very little is
possible at taluka level. “
- another taluka health manager from
Gubbi (g2)
52
Results &
Discussion
Part 5
Committed health management teams could
utilise new opportunities for organisational
improvement presented by decentralising
health systems wherever their change agenda
aligns with the expectations of higher levels of
the bureaucracy.
53. 53
What PIP? What decentralisation? I sent
so many requirements for staff and
proposals for improvement. Only thing I
got is more work, less staff and zero
solutions. On one hand, I have to answer
the local ZP members’ complaints and on
the other hand, I have to just keep
implementing plans and schemes coming
from above. Nothing can be done without
more staff.
- a health manager from CN Halli (cnh1)
We felt that we have to do it. So many
mothers were just being referred to Tumkur.
The delivery load is high and for several
months, we had only one obstetrician, but
somehow we managed. I know how the
pressure is at the distict hospital, so having
LSCS facility at Sira decreases the burden at
the district hospital. It’s not easy, but
somehow it is happening.
- a Sira health manager (s1)
“Nothing much can be done without
giving powers at taluka level and
PHCs. I cannot even appoint a Group
D staff. Where is decentralisation in
this?”
- a PHC staff from CN Halli taluka
Tapping commitment for organisational change
could be frustrating in low-resource local
health systems where health managers
working in poorly resourced talukas, in spite of
their improved management capacities and
intentions to make change, could get
frustrated by the lack of facilitating action from
above.
Poorly resourced teams with varying commitment
levels/types & high intention for change
56. Lessons learned – capacity building
• Capacity building programmes seek to influence health
manager decisions and choices: capacity to manage
alignments matter, not only determinants
• Pushing public health service organisations towards change
in decentralising health organisations: need to engage with
multiple levels in the bureaucracy
• Capacity building strategies need to invest more in local
goal-setting and negotiation and coping skills of health
managers, and not entirely focus on knowledge/skill
transfer
• Capacity building programmes could seek to become the
context for change through facilitating a desire for change
(or harness pre-existing feeling of unhappiness with the
current status) 56
Results &
Discussion
Part 6
57. • Application of insights from organisational sciences
and social sciences in health systems strengthening
• Using PT refinement and realist evaluation as an
operational tool for implementation
• Need for more case diversity and further iterations
could improve the final refined theory
Lessons learned - methods
57
Results &
Discussion
Part 6
58. Relevance
• Building a human resources
management strategy for
improved district health system
functioning in Karnataka
• Improving the design of existing
state and district level capacity
building efforts
• Teaching material for teaching
organisational change
approaches within health
servcies and for teaching theory-
driven and realist approaches for
evaluating healthcare
interentions
58
Results &
Discussion
Part 6
61. Dimensions of organisational commitment measures (AC, NC & CC – Meyer & Allen) by taluka
61
Results &
Discussion
Editor's Notes
Introduce a bit that the study looked at organisational change in response to an intervention at a local health system.
Clarify the deviation from the dissertation structure coming up due to the iterative nature of the inquiry process
Indian health system – describe – acknowledge that all HS are evolving but these are interesting times in India with a realisation of the need to improve financing of the public sector on one hand and also the poor regulation on the other and the upsurge in the private-for-profit and corporate sector in health. Testing times for public services and “primary health care”.
Although the health system includes actors in both public & private sectors, one of the key focus of health system strengthening initiatives has focused on strengthening the governance and management of government health services. In this presentation, we will largely focus on the government health services as well, while acknowledging that the non-governmental health actors are also significant. The reason for this is the position/mandate of IPH in strengthening the public health system, as a way of realising an equitable and public-oriented health system. WE also focus on several other public sector actors somewhat outside the traditional boundaries of the government health services and system (shown in red).
Disparities everywhere, introduce Karnataka as the focus state. Southern states have done somewhat better, but a lot of regional disparities remain. Even across neighboring states, there are wide variations in health outcomes.
When you go further within these states, further regional and sub-regional disparities emerge. Some of these failures/gaps have been pointed out to be “systemic”. Introduce the taluka. In India, health is a state subject and hence Indian states vary significantly in the way they organise and manage health services. Some of the possible contributing factors for the success stories within India has been the human resource management within health. See for example the Tamil nadu model.
A systematic effort at building a strong base for human resources in health is needed at various levels, both at policy as well as in the operational levels in hospitals and health centres.
Remember to highlight the role of communities and the new community participation structures that may be an opportunity or a threat with respect to the health servcies.
This is where policy meets practice.
Discuss Tamil Nadu system of public health cadre here possibly.
PT not being formulated is often the case in many HSS interventions in the south.
We initially began with exploring the scope for using realist evaluation, considering that the intervention sought to make changes within a local health system. Given the various internal and external dynamic interactions of local health systems, realist and theory-driven approaches seemed to be suited for this study.
Clashes in the organisational culture of the talukas. How did they manage this where they did becomes important for organisational change.
We scanned role of individual mechanisms and their interaction with the context
Reflect on the overall message of the dissertation using the refined PT