Evaluating a streamlined clinical tool and educational outreach intervention for health care workers in Malawi: the PALM PLUS case study

BMC International Health and Human Rights

Research Article

Alexandra Martiniuk¹  Egnat Katengeza²  Sandy Thompson²  Barry Burciul²  Sumeet Sodhi³  Michael J Schull⁴  Merrick Zwarenstein⁵  Eric Bateman⁶  Beverley Draper⁶  Gill Faris⁶  Lara Fairall⁶  Ruth Cornick⁶  Damson Kathyola⁷  Martias Joshua⁸  Martha Mondiwa⁹  Lifah Sanudi^1,10  Hastings Banda^1,10 

[1] Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7, Toronto, Canada;George Institute for Global Health; University of Sydney, 341 George Street, 2000, Sydney, Australia;Sunnybrook Health Sciences Center, 2075 Bayview Ave, M4N 3M5, Toronto, Canada;Dignitas International, 2 Adelaide Street West, Suite 200, M5H 1L6, Toronto, Canada;Dignitas International, 2 Adelaide Street West, Suite 200, M5H 1L6, Toronto, Canada;Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 263 McCaul Street, 5th Floor, M5T 1W7, Toronto, Canada;Department of Family and Community Medicine, University Health Network, Toronto Western Hospital, 399 Bathurst Street, M5T 2S8, Toronto, Canada;Dignitas International, 2 Adelaide Street West, Suite 200, M5H 1L6, Toronto, Canada;Sunnybrook Health Sciences Center, 2075 Bayview Ave, M4N 3M5, Toronto, Canada;Department of Health Policy, Management and Evaluation, 155 College Street, Suite 425, M5T 3M6, Toronto, Canada;Department of Medicine, University of Toronto, 200 Elizabeth Street, M5G 2C4, Toronto, Canada;Dignitas International, 2 Adelaide Street West, Suite 200, M5H 1L6, Toronto, Canada;Sunnybrook Health Sciences Center, 2075 Bayview Ave, M4N 3M5, Toronto, Canada;Department of Health Policy, Management and Evaluation, 155 College Street, Suite 425, M5T 3M6, Toronto, Canada;IHCAR, Karolinska Institute, 9, Nobelsveg, Stockholm, Sweden;Knowledge Translation Unit, University of Cape Town Lung Institute, University of Cape Town, PO Box 34560, 7937, Groote Schuur, South Africa;Malawi, Ministry of Health Malawi, POB 3, Lilongwe, Malawi;Malawi, Ministry of Health Malawi, POB 3, Lilongwe, Malawi;Zomba Central Hospital, Kamuzu Highway, Zomba, Malawi;Nurses and Midwives Council of Malawi, POB 30361, Lilongwe, Malawi;Research for Equity and Community Health (REACH) Trust, POB 1597, Lilongwe, Malawi;

关键词: Health Centre;    Health Care Worker;    Control Site;    Intervention Site;    Primary Care Service;   

DOI  :  10.1186/1472-698X-11-S2-S11

来源: Springer

【 摘 要 】

BackgroundNearly 3 million people in resource-poor countries receive antiretrovirals for the treatment of HIV/AIDS, yet millions more require treatment. Key barriers to treatment scale up are shortages of trained health care workers, and challenges integrating HIV/AIDS care with primary care.The researchPALM PLUS (Practical Approach to Lung Health and HIV/AIDS in Malawi) is an intervention designed to simplify and integrate existing Malawian national guidelines into a single, simple, user-friendly guideline for mid-level health care workers. Training utilizes a peer-to-peer educational outreach approach. Research is being undertaken to evaluate this intervention to generate evidence that will guide future decision-making for consideration of roll out in Malawi. The research consists of a cluster randomized trial in 30 public health centres in Zomba District that measures the effect of the intervention on staff satisfaction and retention, quality of patient care, and costs through quantitative, qualitative and health economics methods.Results and outcomesIn the first phase of qualitative inquiry respondents from intervention sites demonstrated in-depth knowledge of PALM PLUS compared to those from control sites. Participants in intervention sites felt that the PALM PLUS tool empowered them to provide better health services to patients. Interim staff retention data shows that there were, on average, 3 to 4 staff departing from the control and intervention sites per month. Additional qualitative, quantitative and economic analyses are planned.The partnershipDignitas International and the Knowledge Translation Unit at the University of Cape Town Lung Institute have led the adaptation and development of the PALM PLUS intervention, using experience gained through the implementation of the South African precursor, PALSA PLUS. The Malawian partners, REACH Trust and the Research Unit at the Ministry of Health, have led the qualitative and economic evaluations. Dignitas and Ministry of Health have facilitated interaction with implementers and policy-makers.Challenges and successesThis initiative is an example of South-South knowledge translation between South Africa and Malawi, mediated by a Canadian academic-NGO hybrid. Our success in developing and rolling out PALM PLUS in Malawi suggests that it is possible to adapt and implement this intervention for use in other resource-limited settings.

【 授权许可】

Unknown   
© Sodhi et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.