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East African journal of public health [journal]
- A retrospective study on the unseen epidemic of road traffic injuries and deaths due to accidents in Mwanza City - Tanzania. [Journal Article]
- East Afr J Public Health 2013 Jun; 10(2):487-92.
Sixty percent of the global deaths and injuries occur in the developing world and mostly are due to Road traffic accidents (RTAs. looking at the etiological related factors which include, carelessness of the driver, condition of the vehicle or motorcycle, poor condition of roads, risky behavior of the driver, most of these factors can be prevented to some extent. This study therefore, determined the pattern of cases and deaths due to traffic road accidents in Mwanza City Tanzania.In this retrospective study, records, registers and case notes In the surgical ward and causality, medical records and central police station from 2008 to 2011 were used. The study focused on the two referral hospitals (Sekouture regional hospital and Bugando Medical Center).There were 3450 cases due to accidents reported at both centers (Sekouture regional hospital and Bugando Medical Center of which 3224 (93.4%) had complete information for analysis.2225 (69%) were male and 999 (31%) were female, and the most affected group were male. Among the RTAs2809 cases (87%) were due to motor cycle accidents which were the leading cause of RTAs with case fatality rate of 5% while motor vehicle has case fatality rate of 24% which is 5 times that of motor cycle.Among all RTAs the leading cause of injuries is Motor cycle traffic accidents followed by motor vehicle. RTAs are on increase particularly the motor cycle traffic accidents and has claimed a good number of innocent people's lives however most of them are preventable, therefore driving course to be introduced to motor cycle drivers with emphasize on the road posters signal, rules and regular checkup of their motor cycles especially commercial motor cycle.
- Challenges towards realization of health care sector goals of Tanzania development vision 2025: training and deployment of graduate human resource for health. [Journal Article]
- East Afr J Public Health 2013 Jun; 10(2):476-86.
Human resource for health (HRH) is an essential building block for effective and efficient health care system. In Tanzania this component is faced by many challenges which in synergy with others make the health care system inefficient. In vision 2025 the country recognizes the importance of the health care sector in attaining quality livelihood for its citizens. The vision is in its 13th year since its launch. Given the central role of HRH in attainment of this vision, how the HRH is trained and deployed deserves a deeper understanding.To analyze the factors affecting training and deployment process of graduate level HRH of three core cadres; Medical Doctors, Doctor of Dental Surgery and Bachelor of Pharmacy towards realization of development vision 2025.Explorative study design in five training institutions for health and Ministry of Health and Social Welfare (MoHSW) headquarters utilizing in-depth interviews, observations and review of available documents methodology.The training Institutions which are cornerstone for HRH training are understaffed, underfunded (donor dependent), have low admitting capacities and lack co-ordination with other key stakeholders dealing with health. The deployment of graduate level HRH is affected by; limited budget, decision on deployment handled by another ministry rather than MoHSW, competition between health care sector and other sectors and lack of co-ordination between employer, trainers and other key health care sector stakeholders. Awareness on vision 2025 is low in the training institutions.For the vision 2025 health care sector goals to be realized well devised strategies on raising its awareness in the training institutions is recommended. Quality livelihood as stated in vision 2025 will be a forgotten dream if the challenges facing the training and deployment of graduate level HRH will not be addressed timely. It is the authors' view that reduction of donor dependency syndrome, extension of retirement age for academic Staffs in the training institutions for health and synergizing the training and deployment of the graduate level HRH can be among the initial strategies towards addressing these challenges.
- A descriptive analysis of the institutional frameworks for disaster management in Uganda: structures, functions and gaps. [Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.]
- East Afr J Public Health 2013 Jun; 10(2):469-75.
There is insufficient documentation of the institutional frameworks for disaster management and resilience at different levels in sub-Saharan Africa. The objective of this study was to describe the institutional framework for disaster management in Uganda, and to identify actionable gaps at the different levels.This was part of a multi-country assessment in which 6 countries in Eastern Africa developed and applied a common tool. The assessment was qualitative in nature employing a mixed methods approach including review of documents, interviews with key informants from agencies involved in disaster management in Uganda, group discussions with stakeholder and synthesis meetings of the assessment team.The Office of the Prime Minister is the lead agency for disaster management, but management of disasters of a technical nature is devolved to line ministries (e.g. epidemics by the Health Ministry and Epizootics by the Agriculture Ministry). A new policy spells out disaster management structures at national, district, sub-county, and village levels. Key challenges included coordination, more focus on prevention than risk reduction, differences in capacity between sectors and inadequate inter-sectoral collaboration. The new policy and structures have not yet been rolled out to districts and sub-district levels, and districts lack a line item budget for disaster capacity building.The institutional framework for disaster management in Uganda needs to be strengthened at all levels through initiation of the relevant structures, training, and resource allocation so that they develop disaster management plans.
- Performance of district disaster management teams after undergoing an operational level planners' training in Uganda. [Journal Article]
- East Afr J Public Health 2013 Jun; 10(2):459-68.
Uganda is vulnerable to several natural, man-made and a hybrid of disasters including drought, famine, floods, warfare, and disease outbreaks. We assessed the district disaster team's performance, roles and experiences following the training.The disasters most commonly experienced by the district teams were epidemics of diseases in humans (7 of 12), animals (epizoonotics) (3 of 12) and crops (3 of 12); hailstorms and floods (3 of 12). The capabilities viewed most useful for management of disasters were provision of health care services (9/12) and response management (8 of 12). The capability domains most often consulted during the disasters were general response management (31%), health services (29%) and water and sanitation (17%). The skills areas perceived to be vital following the training were response to epidemics 10/12, disaster management planning 8/12, hazards and vulnerability analysis 7/12 and principles of disaster planning 7/12 respectively. Main challenges mentioned by district teams were inadequacy of finance and logistics, lack of commitment by key partners towards disaster preparedness and response.The most common disaster experienced disasters related to outbreaks of diseases in man, animals and crops. The most frequently applied capabilities were response management and provision of emergency health services. The activities most frequently implemented following disaster management teams training were conducting planning meetings, refinement of plans and dissemination of skills gained. The main challenges were related to limited budget allocations and legal frameworks for disaster management that should be addressed by both central and local governments.
- Regional approach to building operational level capacity for disaster planning: the case of the Eastern Africa region. [Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.]
- East Afr J Public Health 2013 Jun; 10(2):447-58.
The Eastern Africa region is regularly affected by a variety of disasters ranging from drought, to human conflict and population displacement. The magnitude of emergencies and response capacities is similar across the region. In order to strengthen public health disaster management capacities at the operational level in six countries of the Eastern Africa region, the USAID-funded leadership project worked through the HEALTH Alliance, a network of seven schools of public health from six countries in the region to train district-level teams.To develop a sustainable regional approach to building operational level capacity for disaster planning.This project was implemented through a higher education leadership initiative. Project activities were spear-headed by a network of Deans and Directors of public health schools within local universities in the Eastern Africa region. The leadership team envisioned a district-oriented systems change strategy. Pre-service and in-service curricula were developed regionally and district teams were formed to attend short training courses. Project activities began with a situational analysis of the disaster management capacity at national and operational levels. The next steps were chronologically the formation of country training teams and training of trainers, the development of a regional disaster management training curriculum and training materials, the cascading of training activities in the region, and the incorporation of emerging issues into the training curriculum. An evaluation model included the analysis of preparedness impact of the training program.The output from the district teams was the creation of individual district-level disaster plans and their implementation. This 4-year project focused on building operational level public health emergency response capacity, which had not previously been part of any national program. Use of the all-hazard approach rather than a scenario-based contingency planning led to the development of a standardized curriculum for training both in-service and pre-service personnel. Materials developed during the implementation phases of the project have been incorporated into public health graduate curricula in the seven schools. This systems-based strategy resulted in demonstrable outcomes related to district preparedness and university engagement in disaster management.University partnerships are an effective method to build district-level disaster planning capacity. Use of a regional network created a standardized approach across six countries.
- Use of the Automated Disaster and Emergency Planning Tool in developing district level public health emergency operating procedures in three East African countries. [Journal Article, Research Support, Non-U.S. Gov't]
- East Afr J Public Health 2013 Jun; 10(2):439-46.
Sub-Saharan Africa is vulnerable to several natural and man-made disasters. We used the CDC Automated Disaster and Emergency Planning Tool (ADEPT) to develop all-hazards disaster management plans at district level in three eastern African countries.During July 2008-February 2011, we used the automated disaster and emergency planning tool to conduct training on disaster planning and management in the three east African countries namely Kenya, Tanzania and Uganda. We trained district disaster teams per country. We held 7 trainings in Tanzania, 8 in Uganda and 10 in Kenya respectively. The district disaster management teams trained comprised five district administrative personnel and a national Red Cross officer. The training took 5 days.A total of 100 districts teams (40 in Uganda and 35 in Kenya and Tanzania respectively) were trained using the ADEPT and consequently 100 district disaster response plans were developed during 2008-2011. A total 814 district disaster team members from these districts were trained. Our experience has shown that the Automated Disaster Emergency Planning Tool is a relatively quick, easy, practical, participatory and inexpensive approach to developing emergency operating plans at the sub-national (district) level.The ADEPT can be used relatively easily, quickly and inexpensively at the sub-national levels to develop emergency operating procedures to improve disaster management. Although the ADEPT enables district disaster response teams to generate their disaster response plans, the use of the ADEPT may be hampered by lack of computer skills and knowledge of MS computer programme by district personnel in resource limited settings.
- Prioritization of disasters and their management in Rwanda. [Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.]
- East Afr J Public Health 2013 Jun; 10(2):428-38.
Rwanda has been experiencing quite a significant number of disastrous events of both natural and man-made origin in the last 2 decades. Many cases of disasters are particularly linked to the geographic, historical and socio-cultural aspects of the country. The overall objective of the present article is to perform a situation analysis of disasters in Rwanda and to highlight the institutional and legal framework of disaster management.An assessment questionnaire focused on the current capacity, institutional frameworks and on-going initiatives for disaster management at country level and operational level was administered. The assessment was descriptive and used mainly qualitative methods. These included review of records (country policies and policy briefs, programme documents), interviews with key informants from line ministries, and interviews with key informants from stakeholder agencies.The Rwandan hazard profile, its vulnerability and capacity assessment shows top seven disasters which are related to epidemics, hails storms/floods; roads accidents; environmental degradation and earthquakes/volcanic eruption. Currently, the Institutional framework for disaster management and response is coordinated by Ministry of Disaster Management and Refugee Affairs through the Rwanda National Disasters Operation Center. Although disaster risk reduction has been integrated into sustainable policies and plans, most districts do not have adequate capacity to plan for disasters and the majority of districts disaster committees have not yet been trained.Rwanda has established a legal and institutional framework for disasters management. There is a need to build capacity in disaster management at operational level (District).
- Achievements and challenges of resource allocation for health in a decentralized system in Tanzania: perspectives of national and district level officers. [Comparative Study, Journal Article, Research Support, Non-U.S. Gov't]
- East Afr J Public Health 2013 Jun; 10(2):416-27.
The goal of this study was to identify the achievements and challenges of a resource allocation process in a decentralized health system in Tanzania as they are perceived by national and district level officers.This study was conducted between May 2011 and July 2012 in two districts of Dodoma region: Kongwa and Bahi. Data were collected from 25 key people involved in policy, planning and management aspects for the allocation of financial resources from the central government to local government districts. Thus, the recruitment of the study participants was purposive, as it took account of their positions and experience in health resource allocation and management. The data were collected through conversation in face-to-face in-depth interviews with the officers concerned. The data were analysed manually using qualitative content analysis.The study has identified the achievements and challenges of resource allocation in a decentralized health system of Tanzania. The achievements include: the design and use of a needs-based resource allocation formula; reduced resource allocation inequalities between rural and urban districts; and a wide discretion by the district council to mobilize and utilize health insurance funds and user fees. On the other hand, the challenges are: the disbursed funds fall far short of centrally determined budget ceilings, and the funds are sent late; Council Health Management Teams (CHMT) develop budgets but are restricted on the percentage they can allocate to different areas--so there is severe under-funding of disease prevention and health promotion initiatives at the community level.This study has identified achievements that should be further nurtured and challenges that should be worked on for the improvement of the decentralized health system. Thus, as a way forward, it is recommended that the equitable allocation of resources should go beyond the recurrent costs for the delivery of health services.
- Hazard analysis of Arid and semi-Arid (ASAL) regions of Kenya. [Journal Article]
- East Afr J Public Health 2013 Jun; 10(2):410-5.
This paper describes a situationanalysis on hazards in the Arid and semi-Arid lands of Kenya. The leading hazards affecting the Arid and semi-arid lands are mainly natural and include among others drought, floods, and landslides. Other hazards of importance were found to be war and conflict, HIV/AIDS and fires. Over 80% of these are weather related.The overall objective of this study was to prioritize hazards in the ASAL region. Specifically, the study identified the top ten hazards in the ASAL Districts of Kenya, determined Probability of occurrence; Analyzed the potential impact of the hazard and utilizing multiplier effect prioritized the Hazards using a hypothetical model.This was a descriptive study conducted in over half of the Kenya's ASAL Districts in four regions of Lower and Upper Eastern, North Eastern and part of the Coast region. Six Districts were purposively selected per region with six officers from each District all totaling one hundred and forty four. The sectors where respondents were sourced from were Agriculture, Health, local Government, and Provincial Administration, Environment and NGO. The members through a consensus process analyzed hazards in groups of their respective districts using a tool that had been developed and respondents trained on its use.One hundred and forty four (144) officers from Twenty four Districts in the four regions were recruited. One hundred twenty seven (81%) were male and only 27 (19% ) were female The representation of participants per sector was Governance 25% followed by Civil society organizations 21%, Health 16%, Agriculture and arid lands 15%, Research and scientific institutions 13%. The top Priority Hazards identified using the mean score were Drought and famine (5.4) Epidemics and epizootics (3.8), HIV/AIDS (3.6), War and conflict (2.5), Floods (2.5) CONCLUSIONS: The exercise confirmed the priority hazards in the Arid and semi-arid regions of Kenya and described vulnerability factors that included water scarcity, poverty and low educational levels. The region suffers from a variety of hazards in particular Drought and famine, Epidemics including HIV/AIDS and War and conflict. Environmental degradation though given a low score may be more of a perception. There is need to undertake a comprehensive hazard and Vulnerability analysis at regional and country level to inform interventions and other developmental activities. Women should be targeted at the community and leadership level, and efforts to empower them should be stepped up.
- Opportunities for strategic use of e-learning in scaling up disaster management capacity in Eastern Africa: a descriptive analysis. [Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.]
- East Afr J Public Health 2013 Jun; 10(2):403-9.
The growing need for disaster management skills at all levels in Eastern Africa requires innovative approaches to training planners at all levels. While information technology tools provide a viable option, few studies have assessed the capacity for training institutions to use technology for cascading disaster management skills.The design was an explorative survey. A pre-training survey was conducted among 16 faculty members (9 academic staff and 7 information technology (IT) staff) from 7 schools of public health in Eastern Africa. Key informant interviews with 4 students and 4 staff members were conducted at the school of public health in Makerere. IT staff also conducted observations on trends of use of information technology infrastructure.Current levels of use of ICT among teaching and IT staff is variable. On-site use of the internet is high, but off-site access is low. Personal computers, e-mail, discussion forums and other web-based learning management platforms and open education resources (OERs) have been variably used by faculty and students to facilitate learning. On the other hand, videos, web-conferencing, social media, web-based document management tools, and mobile telephone applications were much less frequently used. A disaster management short course produced by the Health Emergencies Management Project (HEMP) has been adapted to a web-based open education resource and an interactive CD-ROM. Challenges included low levels of awareness and skills in technology options among students and faculty and access to reliable internet.Despite the existing challenges, technology tools are a viable platform for cascading disaster management skills in Eastern Africa.