The Relationship of Repeated Technical Assistance Support Visits to the Delivery of Positive Health, Dignity, and Prevention (PHDP) Messages by Healthcare Providers in Mozambique: A Longitudinal Multilevel Analysis.

BACKGROUND: Positive health, dignity, and prevention (PHDP) is Mozambique's strategy to engage clinicians in the delivery of prevention messages to their HIV-positive clients. This national implementation strategy uses provider trainings on offering key messages and focuses on intervening on 9 evidence-based risk reduction areas. We investigated the impact of longitudinal technical assistance (TA) as an addition to this basic training. METHODS: We followed 153 healthcare providers in 5 Mozambican provinces over 6 months to evaluate the impact of on-site, observation-based TA on PHDP implementation. Longitudinal multilevel models were estimated to model change in PHDP message delivery over time among individual providers. RESULTS: With each additional TA visit, providers delivered about 1 additional PHDP message ( P < .001); clinicians and nonclinicians started at about the same baseline level, but clinicians improved more quickly ( P = .004). Message delivery varied by practice sector; maternal and child health sectors outperformed other sectors. CONCLUSION: Longitudinal TA helped reach the programmatic goals of the PHDP program in Mozambique.

Taxa de perdas de recém-graduados das instituições de formação em saúde e suas razões no momento da colocação no serviço nacional de saúde em moçambique / Rate of loss of recent graduates from health training institutions and reasons associated to these losses at the time of placement in the national healh srvice

Introdução: Moçambique enfrenta escassez de recursos humanos de saúde para prestar cuidados à população. Este cenário é agravado pelo alastramento do HIV e SIDA que aumenta a demanda pelos serviços de saúde, e pelas possíveis perdas de recém-graduados no momento da colocação no Serviço Nacional de Saúde após a formação, embora não haja dados fiáveis que quantifiquem estas perdas em Moçambique. Métodos: Foi realizado um estudo transversal que envolveu os 2.246 recém-graduados dos anos 2007 e 2008 de 12 Instituições de Formação em Saúde do país, com o propósito de determinar as taxas de perdas de recém-graduados na colocação e identificar razões associadas a essas perdas. Os dados foram obtidos dos livros de registos das Instituições de Formação em Saúde, Departamento dos Recursos Humanos do Ministério da Saúde, Direcções Provinciais de Saúde, listas de pagamento de subsídios de almoço e através de chamadas telefónicas aos recém-graduados considerados como perdidos no Serviço Nacional de Saúde. Os dados foram introduzidos no software ACESS e analisados no SPSS, onde foi feita a análise estatística descritiva e aplicado o teste Qui-Quadrado com o nível de significância de =5%. Resultados: Os registos das Direcções Provinciais de Saúde mostraram uma perda de 688 (30,6%) recém graduados. Ao se consultar as listas de pagamento de subsídio de almoço, estas perdas ficaram reduzidas a 241 (10,7%), ou seja, recuperaram-se 447 recém-graduados dos considerados como perdidos pelos registos das Direcções Provinciais de Saúde. Ainda, recuperaram-se mais 150 recém-graduados através de chamadas telefónicas aos considerados como perdidos pelas listas de pagamento de subsídio de almoço, perfazendo uma perda final de 91 (4,05%) recém-graduados. Estes últimos foram considerados realmente perdidos no Serviço Nacional de Saúde. Destes, 16 % (91) consentiram em ser inquiridos sobre as razões que estive ram na origem das perdas, tendo referido a necessidade de continuação dos estudos (38%), baixos salários (31%) e local de colocação distante do da família (31%). Conclusão: Os resultados revelam a existência de falhas no sistema de registo e seguimento dos recém graduados desde o nível central, provincial, distrital até à unidade sanitária.

Introduction: Mozambique lacks human resources to provide health care services to population. This scenario is exacerbated by the spread of HIV and AIDS which increases the demand for health services as well as by the possible loss of recent graduates at the time of placement in the National Health Service. However, there are no reliable data quantifying these losses in Mozambique. Methods: A cross-sectional study was conducted. This study included all 2.246 recent graduates of 2007 and 2008 of 12 health training institutions. The aim of the study was to determine the rates of loss of recent graduates at the time of placement and to identify reasons for these losses. Data were obtained from record books from health training institutions, the Department of Human Resources of the Ministry of Health, Provincial Health Directorates, lists of lunch subsidy payment and also through telephone calls to recent graduates who were considered lost in the National Health Service. Data were introduced in the ACESS software and were analyzed through SPSS. Descriptive statistical analysis was performed and a chi-square test was used. The level of statistical significance was = 5%. Results: The record books from Provincial Health Directorates revealed that 688 (30%) recent-graduates were lost. However, when the lists of lunch subsidy payments were examined, the number of losses de creased to 241 (10,7%), it means that, 447 recent graduates who had been considered lost were regained. Moreover, more than 150 recent graduated who had been considered lost in the lunch subsidylists, were regained through telephone calls. Thus, the final list of lost graduates totalizes 91 (4,05%) cases. These 91 were really considered lost in the National Health Service. About 16% of these 91 graduated gave us permission to interrogate them about the reasons associated to their loss. They presented the following reasons: need to proceed with their studies (38%), low wages (31%), and placement distant from their families (31%) Conclusion: The results of this study indicate failures in the system of record and monitoring of recent graduates at all levels: central, provincial, district and health center unit.