Retention of health workers is an area of sustained focus as health care organizations realize the impact of poor retention on cost, quality and continuity of care. An in-depth understanding of the experiences of health workers (HWs) and factors which cause them to leave their jobs is the fundamental basis of forming effective retention strategies. The lack of evidence on these experiences poses a challenge to health managers within the Private-Not-For-Profit (PNFP) sub-sector in Uganda on how to develop effective retention strategies. This research examined HWs experiences of working in PNFP hospitals and how these influence retention decisions. This mixed methods study included a quantitative survey (n=118) examining length of stay in the hospitals and the determinants. Experiences of 32 HWs including managers were explored through semi-structured interviews using a life cycle lens that took into account motivation for joining the profession, experiences of working in the hospitals and current retention strategies and their perceived effectiveness in influencing retention. God’s calling, role models in the medical field, death of close relatives and hopes for immediate employment influenced decisions to join the profession and there was a link between some of these reasons and retention. Median duration working in a PNFP facility was 3.8 years. The only individual factors statistically associated with retention were age and cadre. Three perceptions of organizational characteristics namely: having good interpersonal relationships, well-defined reporting lines, and good career growth potential were independently associated with a 75%, 51% and 35% respectively higher working length at a hospital. Interviews with HWs showed that PNFP organizational culture was predominantly bureaucratic with non-participative management styles and emphasized control and efficiency. Hospitals were implementing some limited retention strategies with weak evidence for their effectiveness. Systematic planning of retention strategies and transformation in organizational culture are necessary to improve retention of HWs.

No description available.

BACKGROUND: The Wise Mama (WM) study was a randomized trial to assess the effectiveness of real-time electronic drug monitoring (EDM) on antiretroviral therapy (ART) adherence for prevention of mother-to-child transmission of HIV (PMTCT) for newly diagnosed, ART-naive HIV+ pregnant women in Uganda. Intervention mothers received real-time ART reminders via EDM technology and control mothers received standard of care. All infants born to women in the WM study were to receive standard PMTCT care: 6 weeks of nevirapine (NVP) ART prophylaxis following birth and HIV DNA testing at 6 weeks of life. OBJECTIVE: To test whether infants born to intervention mothers would have improved adherence to infant PMTCT guidelines. Methods: Information on delivery, infant NVP prophylaxis, and timing to first infant HIV test were abstracted from medical registers. Descriptive statistics and differences in 1) infant prophylaxis administration, and 2) time to infant HIV testing were generated and analyzed. RESULTS: Of the 121 WM women eligible for WIN, 97 consented and enrolled (80%). There were no differences in receipt of 6-week NVP supply (86.7% of control infants, 82.0% of intervention infants, p=0.53). Infants delivered at non-study health facilities were less likely to receive any NVP prophylaxis. There was no difference in mean days to infant's first HIV test (control 51.9, intervention 51.3, p=0.86). CONCLUSION: There were no significant differences in infant adherence to PMTCT guidelines between intervention and control groups, though all infants could have had improved access to NVP prophylaxis and decreased time to first HIV test. / 2019-02-28T00:00:00Z

Despite advances in recent years, human immunodeficiency virus (HIV) and tuberculosis (TB) are major contributors to global morbidity and mortality. Progress in mitigating the spread and impact of both infectious diseases is being made in many settings, but there is an ongoing gap in hard- to-reach and marginalized populations. Early diagnosis and treatment of infectious diseases is a core component of global efforts to mitigate infectious disease burden. The cost effectiveness of enhanced screening through systematic screening and self-testing (ST) is imperative prior to scaling up these programs given the reality of finite resources within any health care setting. We have undertaken a systematic review to summarize the current economic literature around systematic screening for active TB and ST for HIV. The inputs from the HIVST systematic review were used to create a combined decision tree and Markov model to evaluate the cost utility of HIVST along with digital and community-based programs to support downstream linkage to care.

No description available.

Mental illness affects 1.2 million children and youth in Canada. Female adolescents, in particular, suffer significant consequences associated with this. While family physicians are often the first line of contact for a health-related concern, little is known about how the promotion of lifestyle medicine to enhance the mental wellbeing of female adolescents is being communicated. Using a qualitative content analysis approach, a survey about counseling on lifestyle medicine was completed by 126 Hamilton Family Physicians giving a response rate of 25.2%. Key informants discussed with the highest agreement the following three themes: lifestyle medicine factors, barriers, and improvements for communication to female adolescent patients. The global prevalence of female adolescent mental health issues in combination with the use of screening tools was showcased within this study population. Results indicated that Hamilton family physicians integrate global recommendations into their line of care with patient-centered dialogue, awareness of patient needs, and lifestyle medicine education. / Thesis / Master of Science (MSc)

This study explores the global health diplomacy phenomenon by focusing on how and why health is integrated into foreign policy. Over the last decade or so, precipitated primarily by a growing concern about the need to strengthen global health security and deliver on the Millennium Development Goals, foreign policymakers have been paying more attention to health as a foreign policy concern and several countries have adopted formal global health policy positions and/or strategies. To elucidate a deeper and clearer understanding of how and why health is integrated into foreign policy, this thesis used a case study research design that incorporated literature and document review and interviews with twenty informants to conduct an in-depth analysis of the United Kingdom’s (UK) Health is Global: A UK Government Strategy 2008-13. Health is Global represents the first example of a formal national global health strategy developed using a multi-stakeholder process. Briefer background case reviews of three nations that are leaders in global health diplomacy - Brazil, Norway and Switzerland, were also conducted to inform the analysis of the in-depth case. Policy analysis included categorizing data into five areas: context (why?), content (what?), actors (who?), process (how?) and impact (so what?). The Multiple Streams Model of Policymaking and Fidler’s health and foreign policy conceptualizations - revolution, remediation and regression - were used to analyze the findings. Based on this analysis, the primary reason that the countries examined have decided to focus more on global health is self-interest - to protect national and international security and their economic interests. Investing in global health was also seen as a way to enhance a state’s international reputation. In terms of self-interest, Brazil was an outlier, however. International solidarity and health as a human right have been the driving forces behind its long-term investment in development cooperation to date. Investing in health for normative reasons was also a prevalent through weaker theme in the UK, Swiss and Norwegian cases. The study highlighted the critical role that policy entrepreneurs who cross the domains of international relations and health play in the global health policymaking process. In regards to advancing a conceptual understanding of global health diplomacy, the findings propose that the whole-of-government global health policymaking process is a form of global health diplomacy. The thesis elucidated factors that underpin this process as well as lessons for other nations, in particular, Canada. While ascertaining the impact of national global health strategies was not the main objective of this thesis, the study provided an initial look at the impact of these policy instruments and processes. Such impacts include better collaboration across government actors leading to enhanced policy coherence and a more strategic focus on global health. Finally, some have argued of late that the global health revolution is over due to the current world economic crisis. Considering the level of interest in whole-of-government global health strategies and the ever growing and sophisticated world-wide global health policy community, based on this thesis, the global health revolution is alive and well.

Global health is an emerging concern in a rapidly changing world in which health issues transcend international borders. This study developed and validated a new self-report questionnaire to assess self-perceived global health competencies among international medical students and how they are influenced by international clinical experiences. A tool consisted of two scales and four subscales with moderate internal consistency. Comparisons between participants who completed retrospective pretest (after the intervention retrospectively) and those who completed traditional pretest (before the intervention) revealed that those participants who completed the questionnaires retrospectively provided lower pretest scores, suggesting that response-shift bias had occurred. Significant increases in scores after international clinical experience were reported for the majority of global health competency measures in IFMSA group. Linear regression identified participant’s age, gross national income (GNI) of country of medical studies, GNI of the country visited, duration of international clinical experience and years of medical school completed, as significant predictors of global health scores. This study contributes valuable information about the newly developed global health competencies measurement tool.

Through the lens of public health, in particular HIV/AIDS, this research first scrutinises China’s compliance with and resistance to the norms and rules embedded in the global health regime, and second, illustrates China’s evolving global role and its intentions for global governance. China’s response to its HIV/AIDS epidemic and its active engagement with the multilateral institutions of global health governance are attributable to both necessity and conscious design. While calling for and welcoming the involvement of multiple actors, a sine qua non for China’s continued engagement with global governance and global health governance is that they should be conducted in accordance with the principles of national sovereignty, non-intervention and territorial integrity. Overall, while China does not seek any radical transformation of the prevailing world order, its vision for the global order is not compatible with that espoused by the West which attaches much weight to liberal democratic values thereby justifying the notion and practice of humanitarian intervention. With a preference for a Westphalian model of governance, China is not a ‘responsible stakeholder’ in the liberal democratic order. Beijing advocates multilateral cooperation in a pluralist ‘harmonious world’ and argues that there is no fixed universal blueprint for development. China adopts a twin strategy in its relations with the outside world. On the one hand, it seeks to defend itself from the encroachment of liberal values while maintaining friendly relations with the leading powers of the West; and on the other, to shore up the principles of national sovereignty and non-intervention as well as strengthen ties with Third World countries so as to consolidate a normative and political bulwark against liberal democratic values on the world stage.

This study explores the global health diplomacy phenomenon by focusing on how and why health is integrated into foreign policy. Over the last decade or so, precipitated primarily by a growing concern about the need to strengthen global health security and deliver on the Millennium Development Goals, foreign policymakers have been paying more attention to health as a foreign policy concern and several countries have adopted formal global health policy positions and/or strategies. To elucidate a deeper and clearer understanding of how and why health is integrated into foreign policy, this thesis used a case study research design that incorporated literature and document review and interviews with twenty informants to conduct an in-depth analysis of the United Kingdom’s (UK) Health is Global: A UK Government Strategy 2008-13. Health is Global represents the first example of a formal national global health strategy developed using a multi-stakeholder process. Briefer background case reviews of three nations that are leaders in global health diplomacy - Brazil, Norway and Switzerland, were also conducted to inform the analysis of the in-depth case. Policy analysis included categorizing data into five areas: context (why?), content (what?), actors (who?), process (how?) and impact (so what?). The Multiple Streams Model of Policymaking and Fidler’s health and foreign policy conceptualizations - revolution, remediation and regression - were used to analyze the findings. Based on this analysis, the primary reason that the countries examined have decided to focus more on global health is self-interest - to protect national and international security and their economic interests. Investing in global health was also seen as a way to enhance a state’s international reputation. In terms of self-interest, Brazil was an outlier, however. International solidarity and health as a human right have been the driving forces behind its long-term investment in development cooperation to date. Investing in health for normative reasons was also a prevalent through weaker theme in the UK, Swiss and Norwegian cases. The study highlighted the critical role that policy entrepreneurs who cross the domains of international relations and health play in the global health policymaking process. In regards to advancing a conceptual understanding of global health diplomacy, the findings propose that the whole-of-government global health policymaking process is a form of global health diplomacy. The thesis elucidated factors that underpin this process as well as lessons for other nations, in particular, Canada. While ascertaining the impact of national global health strategies was not the main objective of this thesis, the study provided an initial look at the impact of these policy instruments and processes. Such impacts include better collaboration across government actors leading to enhanced policy coherence and a more strategic focus on global health. Finally, some have argued of late that the global health revolution is over due to the current world economic crisis. Considering the level of interest in whole-of-government global health strategies and the ever growing and sophisticated world-wide global health policy community, based on this thesis, the global health revolution is alive and well.