Routine Health Information System Data Quality and Associated Factors in Selected Public Health Facilitiesof Jigjiga Woreda, Somali Regional State's,Eastern Ethiopia

Background: Health data quality are limited within the health sectors of low-and middle-income countries (LMICs). Although public health decision-making is mainly dependent on the timely availability of quality data, the quality of healthdata is not satisfactory in some countries, including in the Somali Regional State. Therefore, this baseline assessment was aimed at assessing the level of data quality and its determinants in the public health sector of the Somali Regional State, Ethiopia. Methods: A baseline assessment was conducted as part of an implementation research project. The study was conducted in three selected public health facilities of the Jigjiga Woreda, including the Woreda Health Office and the Somali Regional Health Bureau. A total of 179 health care workers participated in the survey. Interviewer guided self-administered, record review, and observation data collection techniques were used for data collection. Data wasanalyzed using descriptive, bivariate, and multivariate logistic models to identify predictors of data quality. A P-value of 0.05 was used as the statistical significance cut-off point. Results:The overall data accuracy and content completeness in the studied facilities was88.12% and 75.75%, respectively. Data accuracy was 92.2% in the Karamara Hospital, 83.1% in Jigjiga Health Center, and 79.8% in the Ayardaga Health Center. Content completeness was 81.6% in the KaramaraHospital, 81.2% in the Jigjiga Health Center, and 69.7% in the Ayardaga health center. Forthe studied variables, the data recording value given by their immediate supervisors was a strong predictor of data accuracy in the study setting. The odds of thosewho felt thatdata recording was notvalued by supervisors had 0.26 times poorer data accuracy than their counterparts (AOR: 0.26, 95%CI: 0.10, 0.66). Conclusion:Both the accuracy and completeness of health data in Eastern Ethiopia were inadequate. As a result, health work force immediate supervisors and Performance Monitoring Teams (PMT) should undertake regular and ongoing supervision and provide timely feedback for corrective action. In addition, specialized training in data recording and documentation would be beneficial in bridging the gap between workers' skill. [Ethiop. J. Health Dev. 2022;36 (SI-1)]

Primary healthcare implementation in practice: evidence from primary healthcare managers in Ghana

Background: Primary healthcare (PHC) is a core part of healthcare in developing countries. However, the implementation of PHC since its inception in developing countries has been lethargic, inconsistent and marred by controversies. Aim: This study investigates some of the controversies surrounding PHC implementation. It also examines how PHC is being implemented in Ghana as well as how the approaches adopted by PHC implementers influence PHC outcomes in developing countries. Setting: This study is set in Ghana and involves national, regional and district managers of PHC. Methods: A qualitative case study was used to gather information from 19 frontline PHC managers through semi-structured interviews. Interviews were recorded and transcribed. They were then qualitatively analysed using the thematic framework analyses approach. Results: Findings uncover a lack of clear meaning of what PHC is and how it should be approached amongst key implementers. It also shows discrepancies between official policy documents and directives, and actual PHC practices. Findings also show a gradual shift from Alma Ata's comprehensive PHC towards a more selective and intervention-specific PHC. Whilst donor and external stakeholders' influence are the key determinants of PHC policy implementation, their support for vertical and other medicine-based interventions have gradually medicalised PHC. Conclusion: There is a need to pay more attention to understanding and addressing the gaps in PHC implementation and its inconsistencies. Furthermore, the role and control of donors and external development partners in PHC policy formulation and implementation, and their concomitant effects on community participation and empowerment, must be critically examined

The African Surgical OutcomeS-2 (ASOS-2) Pilot Trial, a mixed-methods implementation study

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. The working hypothesis is that patients die as a result of failure to rescue following complications in the postoperative period. The African Surgical OutcomeS-2 (ASOS-2) Trial plans to test the efficacy of increased postoperative surveillance in high risk patients for decreasing perioperative morbidity and mortality. This pilot trial aimed i) to evaluate the adequacy of data produced by the data collection strategies of the ASOS-2 Trial, ii) to evaluate the fidelity of implementation of the increased postoperative surveillance intervention, and iii) to understand the acceptability, appropriateness and feasibility of the intervention and the trial processes. Methods: The ASOS-2 Pilot Trial was a mixed-methods (quantitative-qualitative) implementation study focusing on the intervention arm of the proposed ASOS-2 Trial. The intervention is increased postoperative surveillance for high-risk surgical patients. The intervention protocol was implemented at all sites for a seven-day period. A post pilot trial survey was used to collect data on the implementation outcomes. Results: 803 patients were recruited from 16 hospitals in eight African countries. The sampling and data collection strategies provided 98% complete data collection. Seventy-three percent of respondents believed that they truly provided increased postoperative surveillance to high risk patients. In reality 83/125 (66%) of high-risk patients received some form of increased postoperative surveillance. However, the individual components of the increased postoperative surveillance intervention were implemented in less than 50% of high-risk patients (excepting increasing nursing observations). The components most frequently unavailable were the ability to provide care in a higher care ward (32.1%) and assigning the patient to a bed in view of the nurses' station (28.4%). Failure to comply with available components of the intervention ranged from 27.5% to 54.3%. The post pilot survey had a response rate of 30/40 (75%). In Likert scale questions about acceptability, appropriateness, and feasibility of the ASOS-2 intervention, 63% to 87% of respondents indicated agreement. Respondents reported barriers related to resources, trial processes, teamwork and communication as reasons for disagreement. Conclusions: The proposed ASOS-2 Trial appears to be appropriate, acceptable and feasible in Africa. This pilot trial provides support for the proposed ASOS-2 Trial. It emphasises the need for establishing trial site teams which address the needs of all stakeholders during the trial. A concerted effort must be made to help participating hospitals to increase compliance with all the components of the proposed intervention of 'increased postoperative surveillance' during the ASOS-2 Trial