Global Health: Health System Strengthening and Health Development
Training health workers to improve quality of care: Development of a theory-based training package in patient-centered services and health center management in Uganda
11/13/2012 11:30:00 AM
, Florence Nankya
, Lilian Taaka
, Catherine Maiteki-Sebuguzi
, Sarah Staedke
, Clare Chandler
London School of Hygiene and Tropical Medicine, Kampala, Uganda,
Uganda Malaria Surveillance Project, Infectious Disease Research Collaboration, Kampala, Uganda,
London School of Hygiene and Tropical Medicine, London, United Kingdom
Universal access to appropriate malaria case management is advocated by the World Health Organization and others to reduce malaria morbidity and mortality in low income settings. However, increasing access to services has proven challenging and the evidence base is poor. In eastern Uganda, care seekers are discouraged from attending public health facilities due poor health center management, frequent drug stock-outs, limited skills and motivation of health facility staff, and poor relationships between health workers and communities. A large cluster randomized trial, the PRIME study, is evaluating a multi-faceted health facility-based intervention to address these shortcomings in Tororo, Uganda. Field activities began in December 2010, and the intervention was rolled out in May-June 2011. Study follow-up will continue until April 2013. A central component of the PRIME intervention is a series of nine interactive training modules to strengthen health worker-patient interactions to be more patient-centered and to improve health center management in line with a revised system for maintaining supplies of rapid diagnostic tests and artemether-lumefantrine. The design of such interventions is rarely presented, reflected in the poor evidence base available for program planning. The methods used to design the PRIME modules, consisting of empirical formative research in the local area, a review of evidence of other interventions, articulation of a theory-based behavior change model, and piloting of the training modules will be reviewed. The impact of these training modules on proximal outcomes at 10 health facilities randomly assigned to receive the intervention, compared to 10 assigned to continue standard care, will be presented including daily patient attendance data, availability and management of key malaria commodities, and patient satisfaction with the health facility visit.
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