Effects of devolution on healthcare system performance in Machakos County Level 5 Hospital, Kenya

Background: Globally, there has been a trend of devolving services from the National governments to local governments in order to enhance efficiency, effectiveness, equity, responsiveness, and community participation at the grass root levels. This study evaluated the effects of devolution on healthcare system performance in Machakos Level 5 Hospital in Machakos County. Specifically, it evaluated the effects of devolution on healthcare systems performance on healthcare infrastructure, workforce adequacy and workforce satisfaction. Methods: Descriptive cross-sectional study design was used, with mixed methods of data collection (quantitative and qualitative). Results: The analyzed results revealed that healthcare infrastructure, workforce adequacy and workforce satisfaction improved post devolution period to a great extent. From the inferential statistics analysis, there was a significant improvement in all the three objectives post devolution i.e., p<0.05. Conclusions: Devolution of healthcare system improved the performance of Machakos County Level 5 Hospital. Recommendations were made to roll out the UHC program countrywide, equip all departments, employ more staff, enforce the referral system, similar study be conducted in other county referral hospitals, and similar study be conducted with a focus on other healthcare building blocks.

Production, recruitment, and retention of health workers in rural areas in the Philippines

@#<p style="text-align: justify;"><strong>Objective.</strong> This study aimed to examine capacities and initiatives of the local government units (LGUs) in the Philippines in producing, recruiting and retaining human resources for health (HRH).</p><p style="text-align: justify;"><strong>Methods.</strong> This 2-phase, descriptive, cross-sectional study employed multiple methods such as key informant interviews (KIIs), focus group discussions (FGDs) (for Phase 1) and surveys (for Phase 2) in rural municipalities across the country. Phase 1: We employed qualitative methods to develop a quantitative questionnaire in 22 purposefully selected municipalities. An exhaustive enumeration of responses from the guide questions of the FGDs and KIIs were then translated into a questionnaire. Phase 2: We administered the survey questionnaire from phase 1 to another 67 municipalities to obtain a greater representation of the intended study population as well as quantify results from the qualitative methods. We analyzed data with descriptive statistics.</p><p style="text-align: justify;"><strong>Results.</strong> Initiatives in HRH production were mainly on provision of scholarships. Active recruitment was not done due to lack of available pool of applicants, lack of vacant positions, financial constraints leading to utilization of deployment programs and temporary nature of employment. Recruitment was influenced by budgetary constraints, political biases, dependency on deployment programs and other hired temporary HRH, and set health worker-to-population ratios. Initiatives to retain HRH were largely financial in nature based on pertinent policies. The capacities of LGUs to produce, recruit, and retain needed HRH were strongly dependent on the internal revenue allotment (IRA), along with their local income.</p><p style="text-align: justify;"><strong>Conclusion.</strong> Rural municipalities in the Philippines have initiatives to produce, recruit, and retain HRH. However, these are not enough to meet the needed number of competent and highly motivated HRH that are expected to respond to the unique needs of the rural municipalities. Strategies to increase the capacity of LGUs, address the shortage of HRH, and increase motivation of HRH are recommended.</p>

Adoção tardia, filiação e devolução de crianças: uma realidade brasileira / Adopción tardía, filiación y devolución de niños: una realidad brasileña / Late adoption, filiation, and children devolution: a Brazilian reality / Adoption tardive, filiation et retour des enfants: une réalité brésilienne

O artigo trata da questão da adoção a partir da experiência de uma das autoras no Tribunal de Justiça do Rio de Janeiro. Apresenta as formas de adoção brasileiras, algumas em conformidade com as leis, outras realizadas de maneira informal. Examina as vicissitudes da adoção, entre as quais os casos de devolução. Procura, em seguida discutir suas consequências para o psiquismo, baseando-se nas interrogações sobre a filiação feitas pela psicanálise. Conclui com fragmentos da clínica, em que se trata de escutar os envolvidos ­trabalho a ser feito pela equipe de profissionais ­no intuito de facilitar caminhos pelos quais o sujeito venha a fazer para si um lugar e se exercer como sujeito de desejo

El artículo aborda el tema de la adopción a partir de la experiencia de una de las autoras en el Tribunal de Justicia de Rio de Janeiro. Presenta las formas de adopción brasileñas, algunas de acuerdo con las leyes, otras hechas de manera informal. Examina las vicisitudesde la adopción, incluso los casos de devolución. En seguida, busca discutir sus consecuencias para el psiquismo, basándose en las preguntas sobre la filiación planteadas por el psicoanálisis. Concluye con fragmentos de la clínica, en la cual se trata de escuchar a los implicados ­trabajo que debe realizar el equipe de profesionales ­para facilitar que lo sujeto venga a hacerse un lugar y se ejercer como sujeto de deseo

The article deals with the issue of adoption from the experience of one of the authors in the Court of Justice of Rio de Janeiro. It presents the Brazilian forms of adoption, some in accordance with the laws, others made informally. It examines the vicissitudes of adoption, including the cases of devolution. It then seeks to discuss its consequences for the psychism, based on the process of filiation as it is discussed by psychoanalysis. It concludes, using fragments of the clinic, in which it is about listening to those involved ­work to be done by the team of professionals ­,to facilitate the ways through which the subject will make himself a place and exercise himself as a subject of desire

L'article examine la question de l'adoption sur la base de l'expérience de l'un des auteurs de la Cour de Justice de Rio de Janeiro. Il présente les formes d'adoption brésilienne, certaines conformes aux lois, d'autres réalisées de manière informelle. Il examine les vicissitudes de l'adoption, y compris les cas de dévolution. Ensuite, il cherche à discuter ses conséquences sur le psychisme, à partir des questions d'affiliation posées par la psychanalyse. Il conclut, à partir de fragments de la clinique, qu'il s'agit d'écouter les personnes impliquées -travail à faire par l'équipe de professionnels -, facilitant ainsi les manières dont le sujet puisse faire un lieu pour soi et pour s'exercer en tant que sujet du désir

Autoria, subjetividade e poder: devolução de dados em um centro de saúde na Guariroba (Ceilândia/DF) / Authority, subjectivity and power: data devolution at a primary care unit in Guariroba (Ceilândia/Federal District/Brazil)

ResumoA devolução, restituição ou compartilhamento pode significar, dentre outras possibilidades, entregar produtos aos partícipes de um empreendimento de pesquisa/extensão. A entrega de resultados não é uma prática nova na antropologia, embora ainda seja pouco usual, sistematizada e valorizada. Neste artigo, relato e discuto uma experiência de devolução de materiais de um projeto de extensão da antropologia, que foi desenvolvido dentro de um centro de saúde, na região periférica do Distrito Federal. As reações aos materiais foram muito diferentes do esperado pela equipe do projeto, mas ainda assim permitiu fazer avançar o diálogo entre os envolvidos e, mais do que isso, permitiu que o conhecimento sobre as relações de trabalho dentro dessa instituição de saúde fosse aprofundado. Não é somente porque foi logrado o aval de comitês de ética que as negociações sobre a entrada e permanência em projetos acadêmicos estão garantidas continuamente. As relações de subjetividade, poder e autoria permeiam qualquer iniciativa antropológica, antes de começá-la e muito depois de, supostamente, terminá-la.

AbstractDevolution, restitution or sharing can mean, within other possibilities, to offer products to participants of a research or an extension project. Far from a new practice in Anthropology, returning results is still unusual, little organized and valued. This paper presents and discusses a devolution experience by an extension project in Anthropology that was developed in a primary care unit in the outskirts of Distrito Federal (Brazil). Local reactions were very different from what was expected by the project's staff, but still permitted dialogue with the health professionals and, more important, deepened our knowledge about work relations in this health institution. Even though IRB approval has been granted, negotiations about starting and continuing academic projects have to be negotiated continuously. Subjectivity, power and authority permeate any anthropological initiative from its beginning and much after it supposedly has been concluded.