Browsing by Author "Kemigisa, Margaret"

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    Engaging community health workers in maternal and newborn care in eastern Uganda
    (Informa UK Limited, 2015-03-31) Okuga, Monica; Kemigisa, Margaret; Namutamba, Sarah; Namazzi, Gertrude; Waiswa, Peter
    Background Community health workers (CHWs) have been employed in a number of low- and middle-income countries as part of primary health care strategies, but the packages vary across and even within countries. The experiences and motivations of a multipurpose CHW in providing maternal and newborn health have not been well described. Objective This study examined the perceptions of community members and experiences of CHWs around promoting maternal and newborn care practices, and the self-identified factors that influence the performance of CHWs so as to inform future study design and programme implementation. Design Data were collected using in-depth interviews with six local council leaders, ten health workers/CHW supervisors, and eight mothers. We conducted four focus group discussions with CHWs. Respondents included 14 urban and 18 rural CHWs. Key themes explored included the experience of CHWs according to their various roles, and the facilitators and barriers they encounter in their work particular to provision of maternal and newborn care. Qualitative data were analysed using manifest content analysis methods. Results CHWs were highly appreciated in the community and seen as important contributors to maternal and newborn health at grassroots level. Factors that positively influence CHWs included being selected by and trained in the community; being trained in problem-solving skills; being deployed immediately after training with participation of local leaders; frequent supervision; and having a strengthened and responsive supply of services to which families can be referred. CHWs made use of social networks to identify pregnant and newly delivered women, and were able to target men and the wider family during health education activities. Intrinsic motivators (e.g. community appreciation and the prestige of being ‘a doctor’), monetary (such as a small transport allowance), and material incentives (e.g. bicycles, bags) were also important to varying degrees. Conclusions There is a continued role for CHWs in improving maternal and newborn care and linking families with health services. However, the process for building CHW programmes needs to be adapted to the local setting, including the process of training, deployment, supervision, and motivation within the context of a responsive and available health system.
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    Governance, Performance and Sustainability of Non‐State Social Protection Services in Uganda
    (Partnership for African Social and Governance Research, 2014) Asingwire, Narathius; Muhangi, Dennis; Namara, Rose; Kemigisa, Margaret
    This study uses qualitative and quantitative approaches to fill gaps in previous studies by shedding more light on the nature, governance, and scope of non-state actors (NSAs) in Uganda and related issues of performance and sustainability. The focus of this study is social protection interventions in three districts in Uganda: Rakai (ravaged by HIV especially in the 1980s and 1990s), Bushenyi (relatively stable) and Kole (post-conflict district). The study found that governance of mutual help groups such as burial groups was based on trust and lacked formal and rigid organisational structures. However, these groups offered crucial and timely interventions for felt and immediate needs that are unmet by either the government or externally funded non-governmental organisations (NGOs). The study underscores the need for formulating government policy that complements and enables NSAs rather than inhibiting and stifling the effort of these pivotal community-based organisations. Further, the study demonstrates how it behoves the government, which is charged with monitoring NSAs, to enable them to transition into more promotive and transformative entities. The study noted that NSAs are home-grown solutions to challenges of social protection as they depended mainly on resources generated by members rather than relying on external funding. In other words, NSAs respond appropriately to local circumstances, while operating without rigid and formal controls. In the process NSAs demonstrate more longevity and sustainability than NGOs whose programs are time-bound and are focused on specific problems such as dealing with the effects of civil war in Kole district in northern Uganda. Given the pivotal role NSAs play in providing social protection in Uganda, this study demonstrates that public policy should be geared towards minimising or eradicating the tension between NSAs and the government in the volatile regulatory landscape.