Browsing by Author "Nabukalu, Joy B."

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    Monitoring Sustainable Development Goals 3: Assessing the Readiness of Low- and Middle-Income Countries
    (International Journal of Health Policy and Management, 2019) Nabukalu, Joy B.; Asamani, James A.; Nabyonga-Orem, Juliet
    The Millennium Development Goals (MDGs) availed opportunities for scaling up service coverage but called for stringent monitoring and evaluation (M&E) focusing mainly on MDG related programs. The Sustainable Development Goals 3 (SDGs) and the universal health coverage (UHC) agenda present a broader scope and require more sophisticated M&E systems. We assessed the readiness of low- and middle-income countries to monitor SDG 3. Methods Employing mixed methods, we reviewed health sector M&E plans of 6 countries in the World Health Organization (WHO) Africa Region to assess the challenges to M&E, the indicator selection pattern and the extent of multisectoral collaboration. Qualitative data were analysed using content thematic analysis while quantitative data were analysed using Excel. Results Challenges to monitoring SDG 3 include weak institutional capacity; fragmentation of M&E functions; inadequate domestic financing; inadequate data availability, dissemination and utilization of M&E products. The total number of indictors in the reviewed plans varied from 38 for Zimbabwe to 235 for Zanzibar. Sixty-nine percent of indicators for the Gambia and 89% for Zanzibar were not classified in any domain in the M&E results chain. Countries lay greater M&E emphasis on service delivery, health systems, maternal and child health as well as communicable diseases with a seeming neglect of the non-communicable diseases (NCDs). Inclusion of SDG 3 indicators only ranged from 48% for Zanzibar to 67% for Kenya. Although monitoring SDG 3 calls for multisectoral collaboration, consideration of the role of other sectors in the M&E plans was either absent or limited to the statistical departments. Conclusion There are common challenges confronting M&E at county-level. Countries have omitted key indicators for monitoring components of the SDG 3 targets especially those on NCDs and injuries. The role of other sectors in monitoring SDG 3 targets is not adequately reflected. These could be bottlenecks to tracking progress towards SDG 3 if not addressed. Beyond providing compendium of indicators to guide countries, we advocate for a more binding minimum set of indicators for all countries to which they may add depending on their context. Ministries of Health (MoHs) should prioritise M&E as an important pillar for health service planning and implementation and not as an add-on activity.
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    Partnership with private for-profit sector for universal health coverage in sub- Saharan Africa: opportunities and caveats
    (BMJ Global Health, 2019) Nabyonga-Orem, Juliet; Nabukalu, Joy B.; Okuonzi, Sam A.
    Sustainable Development Goal 3:“Ensure healthy lives and promote well-being for all at all ages”, with an ambitious target of attaining universal health coverage (UHC), is the aspiration of almost all countries. UHC is defined as access for the whole population to good-quality health services without the risk of financial hardship. 1 Unfortunately, the public sector in most sub-Saharan African (SSA) countries lacks the capacity to provide this range of services to the whole population. Emphasis has been on strengthening the public health sector despite the resource limitations. The private sector is a potential resource for covering the gaps the public sector is unable to fill and this implores us to explore options for meaningful partnerships. The objective of this commentary is to explore the opportunities, caveats and the potential for partnership with the PFP to achieve UHC in the context of low-income countries (LICs).
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    Supportive supervision to improve service delivery in low-income countries: is there a conceptual problem or a strategy problem?
    (BMJ global health, 2019) Avortri, Gertrude S.; Nabukalu, Joy B.; Nabyonga-Orem, Juliet
    Supportive supervision is perceived as an intervention that strengthens the health system, enables health workers to offer quality services and improve performance. Unfortunately, numerous studies show that supervisory mechanisms in many low-income countries (LICs) are suboptimal. Further, the understanding of the concept and its implementation is still shrouded in misinterpretations and inconsistencies. This analysis contributes to a deeper understanding of the concept of supportive supervision and how reorganisation of the approach can contribute to improved performance. The effectiveness of supportive supervision is mixed, with some studies noting that evidence on its role, especially in LICs is inconclusive. Quality of care is a core component of universal health coverage which, accentuates the need for supportive supervision. In the context of LICs, it is imperative for supportive supervision to be implemented as an on-going approach. Factors that affect supportive supervision encompass cultural, social, organizational and context dimensions but the capacity of majority of LIC to address these is limited. To this end, we underscore the need to review the supportive supervision approach to improve its effectiveness, and ensure that facility-based supervision embodies as many of the envisioned qualities as possible. We thus make a case for a stronger focus on internal supportive supervision where internal refers to health facility/unit/ward level. Inherent in the approach is what we refer to as ‘supervisee initiated supportive supervision’. The success of this approach must be anchored on a strong system for monitoring, data and information management at the health facility level.
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    Tuberculosis Control in Resource Limited settings: Health Systems considerations
    (WHO, 2013) Orem, Juliet N.; Nabukalu, Joy B.; Nkolo, Abel; Nanyunja, Miriam
    Tuberculosis (TB) remains a significant public health problem globally, with higher incidence and prevalence in resource limited settings in sub-Saharan Africa and South East Asia (World Health Organization, 2012). This is compounded by the high Human Immunodeficiency Virus (HIV) prevalence in some of the resource limited countries, especially in sub-Saharan Africa where HIV is associated with increasing TB incidence of 5– 10% annually (De Cock & Chaisson, 1999). Globally about 8.7 million new cases of TB …