Health Workers for Change: developing the initiative.
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This paper describes an intervention developed in South Africa for health workers at the health facility level, and designed to explore interpersonal relations among health workers and between health workers and female clients. Several participatory methods to explore the provider-client relationship were tested with health workers. Health workers identified many constraints to the provision of adequate health services and that these constraints affected their work in general and their relationship with women clients in particular. Constraints included inadequacies and inefficiencies in management and the lack of gender sensitivity training. The participatory approach was found to be acceptable to the participants and effective in exploring interpersonal relationships. (+info)
Health providers' opinions on provider-client relations: results of a multi-country study to test Health Workers for Change.
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A multi-centre study in four African countries was undertaken to test the acceptability and effectiveness of Health Workers for Change, a methodology to explore provider-client relations within a gender-sensitive context. This intervention addresses the interpersonal component of quality of care. The methodology, consisting of six workshops, was implemented by research teams in Zambia, Senegal, Mozambique and Uganda. It was found to be acceptable within in a range of cultural and primary health care settings. The workshops allowed difficult issues such as prejudice and bribery to be discussed openly, fostered problem solving and the development of practical plans to address problems that could strengthen district health systems. (+info)
An evaluation of Health Workers for Change in seven settings: a useful management and health system development tool.
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This paper presents the findings of a multi-centre study assessing the impact of Health Workers for Change (HWFC) workshops in seven different primary care sites, based on the common core protocol described in this paper. The paper discusses a common methodology used by the studies, consisting of a triangulation of qualitative and quantitative methods. Such methodologies are inherently complex as they require comparisons across systems, sites and procedures. The studies were conducted in six sites in Africa and one site in Argentina. Generally, the intervention resulted either in positive change or in no change, except in the area of staff relationships where conflicts were more frequent after the intervention than before. This may reflect a willingness to confront problems or contentious issues. Implementing the HWFC workshops improved provider-client relations, facility level functioning and aspects of staff interrelationships, and had some impact at the system level. All studies indicated that overall health system development is essential for improved service provision including quality of care. The findings also indicated that this intervention complemented and could assist health sector reform efforts and can play a role in sensitizing health workers to gender issues. The paper concludes with a discussion of the robustness of the methodology used in the studies. (+info)
The health workers for change impact study in Kenya.
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This paper reports the detailed results of a study of the impact of the Health Workers for Change (HWFC) workshop series on clients' perceptions of health services, relationships within the health centre and relations between the health facility and the district health system. The study was carried out in three stages: baseline, intervention and evaluation over a period of 20 months. Data, both qualitative and quantitative, were collected at three levels: client, facility and system. Results indicate that relations between health workers and clients improved a great deal after the intervention while those between the facility and the system remained to a large extent unchanged. The paper concludes that, with external support and help, especially from the health system level, health workers can work towards improving health services and their job satisfaction, which can lead to better health worker-client relations. (+info)
An assessment of the impact of Health Workers for Change in Avellaneda, province of Buenos Aires, Argentina.
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This paper describes the evaluation of the Health Workers for Change (HWFC) workshop series in a primary health care clinic in Avellaneda, Argentina. The study found that there was an important impact at the facility level 2 months after the intervention (T2). Health workers were motivated and willing to examine their own practices critically in an effort to improve quality of care. Informants from the community also perceived that patients were being treated more kindly. Eleven months later (T3), however, the impact at the facility level had receded significantly. At the system level the main benefit of the workshops was to focus attention on the health workers themselves, particularly their perception that there was little communication with the authorities. As a result, the number of system level supervisors increased and they were urged to spend more time in the clinics. Reasons for the limited impact at T3 are discussed and suggestions are made for improving the intervention. (+info)
Health Workers for Change as a health systems management and development tool.
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In this paper we draw overall conclusions concerning the Health Workers for Change (HWFC) methodology as a management and health systems development tool. We examine how HWFC has contributed to an elucidation of the four main themes with which this special Issue is concerned, namely: the value of participatory training; the need for gender sensitivity in health services; the impact of the HWFC intervention on gender sensitivity and quality of care in health services; and the ability to replicate the HWFC intervention in a variety of cultural and geographical sites. The paper concludes that HWFC is a useful health systems development tool, discusses other applications of HWFC beyond those reported in this Issue and makes several recommendations concerning its future use. (+info)
Response to: What counts as success in genetic counselling?
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Clinical genetics encompasses a wider range of activities than discussion of reproductive risks and options. Hence, it is possible for a clinical geneticist to reduce suffering associated with genetic disease without aiming to reduce the birth incidence of such diseases. Simple cost-benefit analyses of genetic-screening programmes are unacceptable; more sophisticated analyses of this type have been devised but entail internal inconsistencies and do not seem to result in changed clinical practice. The secondary effects of screening programmes must be assessed before they can be properly evaluated, including the inadvertent diagnosis of unsought conditions, and the wider social effects of the programmes on those with mental handicap. This has implications for the range of prenatal tests that should be made available. While autonomy must be fully respected, it cannot itself constitute a goal of clinical genetics. The evaluation of these services requires interdepartmental comparisons of workload, and quality judgements of clients and peers. (+info)
In vitro fertilisation: the major issues--a comment.(40/453)