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The political economy of results-based financing:the experience of the health system in Zimbabwe

Global Health Research and Policy 2019年第1期4卷 180-196页

作者： Sophie Witter yotamu chirwa Pamela Chandiwana Shungu Munyati Mildred Pepukai Maria Paola Bertone ReBUILD programme Queen Margaret UniversityEdinburgh EH216UUUK ReBUILD and Biomedical Research and Training Institute P O Box CY 1753HarareZimbabwe Biomedical Research and Training Institute P O Box CY 1753HarareZimbabwe

Background:Since 2000,results based financing(RBF)has proliferated in health sectors in Africa in particular,including in fragile and conflict affected settings(FCAS)and there is a growing but still contested literature about its relevance and *** examined are the political economy factors behind the adoption of the RBF policy,as well as the shifts in influence and resources which RBF may bring *** this article,we examine these two topics,focusing on Zimbabwe,which has rolled out RBF nationwide in the health system since 2011,with external ***:The study uses an adapted political economy framework,integrating data from 40 semi-structured interviews with local,national and international experts in 2018 and thematic analysis of 60 policy documents covering the decade between 2008 and ***:Our findings highlight the role of donors in initiating the RBF policy,but also how the Zimbabwe health system was able to adapt the model to suit its particular circumstances-seeking to maintain a systemic approach,and avoiding *** Zimbabwe was highly resource dependent after the political-economic crisis of the 2000s,it retained managerial and professional capacity,which distinguishes it from many other FCAS *** active adaptation has engendered national ownership over time,despite initial resistance to the RBF model and despite the complexity of RBF,which creates dependence on external technical *** was also aided by ideological retro-fitting into an earlier government performance management *** main beneficiaries of RBF were frontline providers,who gained small but critical additional resources,but subject to high degrees of control and ***:This study highlights resource-seeking motivations for adopting RBF in some low and middle income settings,especially fragile ones,but also the potential for local health system actors to shape and adapt RBF to suit their needs in some circ

关键词： Political economy analysis Results-based financing Zimbabwe Health financing reforms Fragile and crisis-affected settings

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(How)does RBF strengthen strategic purchasing of health care?Comparing the experience of Uganda,Zimbabwe and the Democratic Republic of the Congo

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Global Health Research and Policy 2019年第1期4卷 374-393页

作者： Sophie Witter Maria Paola Bertone Justine Namakula Pamela Chandiwana yotamu chirwa Aloysius Ssennyonjo Freddie Ssengooba Queen Margaret University EdinburghUK School of Public Health Makerere UniversityKampalaUganda Biomedical Research and training Institute HarareZimbabwe

Background:Results-Based Financing(RBF)has proliferated in health sectors of low and middle income countries,especially fragile and conflict-affected ones,and has been presented as a way of reforming and strengthening strategic ***,few studies have empirically examined how RBF impacts on health care purchasing in these *** article examines the effects of several RBF programmes on health care purchasing functions in three fragile and post-conflict settings:Uganda,Zimbabwe and the Democratic Republic of Congo(DRC)over the past ***:The article is based on a documentary review,including 110 documents from 2004 to 2018,and 98 key informant(KI)interviews conducted with international,national and district level stakeholders in early 2018 in the selected districts of the three *** and analysis followed an adapted framework for strategic purchasing,which was also used to compare across the case ***:Across the cases,at the government level,we find little change to the accountability of purchasers,but RBF does mobilise additional resources to support *** relation to the population,RBF appears to bring in improvements in specifying and informing about entitlements for some ***,the engagement and consultation with the population on their needs was found to be *** relation to providers,RBF did not impact in any major way on provider accreditation and selection,or on treatment ***,it did introduce a more contractual relationship for some providers and bring about(at least partial)improvements in provider payment systems,data quality,increased financial autonomy for primary providers and enforcing equitable *** generally,RBF has been a source of much-needed revenue at primary care level in under-funded health *** context-particularly the degree of stability and authority of government-,the design of the RBF programme and the potential for effective int

关键词： Results-based financing Performance-based financing Strategic purchasing Mother and child health care Uganda DRC Zimbabwe

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Mineral sulphide-lime reactions and effect of CaO/C mole ratio during carbothermic reduction of complex mineral sulphides

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International Journal of Minerals,Metallurgy and Materials 2014年第1期21卷 1-11页

作者： yotamu Stephen Rainford Hara Institute for Materials Research(IMR) School of ProcessEnvironmental and Materials Engineering(SPEME)University of Leeds

Mineral sulphide （MS）-lime （CaO） ion exchange reactions （MS ＋ CaO = MO ＋ CaS） and the effect of CaO/C mole ratio during carbothermic reduction （MS ＋ CaO ＋ C = M ＋ CaS ＋ CO（g）） were investigated for complex froth flotation mineral sulphide concentrates. Phases in the partially and fully reacted samples were characterised by X-ray diffraction （XRD） and scanning electron microscopy （SEM）. The primary phases during mineral sulphide-lime ion exchange reactions are Fe304, CaSO4 Cu2S, and CaS. A complex liquid phase of Ca2CuFeO3S forms during mineral sulphide-lime exchange reactions above 1173 K. The formation mechanisms of Ca2CuFeO3S liquid phase are determined by characterising the partially reacted samples. The reduction rate and extent of mineral sulphides in the presence of CaO and C increase with the increase in CaO/C ratio. The metallic phases are surrounded by the CaS rich phase at CaO/C 〉 1, but the metallic phases and CaS are found as separate phases at CaO/C 〈 1. Experimental results show that the stoichiometric ratio of carbon should be slightly higher than that of CaO. The reactions between CaO and gangue minerals （SiO2 and A1203） are only observed at CaO/C 〉 1 and the reacted samples are excessively sintered.

关键词： sulphide minerals ion exchange carbothermic reduction lime

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Assessment of Payment for Ecosystem Services in Zomba Mountain Forest Catchment Area, Malawi

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Journal of Environmental Science and Engineering(B) 2016年第6期5卷 286-292页

作者： Willie Sagona Paxie chirwa Thokozani Kanyerere Herbert Jenya Forestry Research Institute of Malawi Kufa Road Zomba 270 Malawi Department of Plant Sciences University of Pretoria Pretoria Hartfield 0028 South Africa Department of Earth Science University of Western Cape Robert Sobukwe Road Bellville 7535 Republic of South Africa

The emergence of Payment for Ecosystem Services （PES） concept has raised expectations that ecosystem conservation can be achieved through popular payments rather than through unpopular measures of command and control. A study on PES was conducted in Zomba Mountain Forest （ZMF） catchment area in southern Malawi between August and December 2009. The aim was to assess stakeholders＇ role that would promote payment for ecosystem services as a management tool. A purposive sampling was used to identify the respondents who were randomly sampled for interviews. The findings show that PES can be used as a management tool in ZMF as there are key stakeholders who benefit from the catchment area in terms of services. While there is moderate level of PES awareness among the community and other stakeholders, the current forest policy does not address PES which may derail implementation of a fully fledged PES arrangement. The study revealed that existing management challenges originate from inadequate funding that ZMF Reserve gets from government. However, this challenge offers opportunities to stakeholders through PES to contribute and participate in conserving ZMF for sustained flow of benefits.

关键词： Conservation forest catchment management Payment for Ecosystem Services stakeholders' role.

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Experiences of women with the support they received from their birth companions during labour and delivery in Malawi

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Health 2013年第1期5卷 45-52页

作者： Esther Kungwimba Address Malata Alfred Maluwa Ellen chirwa Department of Maternal and Child Health University of Malawi Kamuzu College of Nursing Blantyre Malawi Department of Maternal and Child Health University of Malawi Kamuzu College of Nursing Lilongwe Malawi Malawi College of Health Sciences Blantyre Malawi Research Directorate University of Malawi Kamuzu College of Nursing Lilongwe Malawi

A study was conducted to describe the experiences of primiparous women with the support they received from their birth companions during labour and delivery in Malawi. The study design was descriptive and utilized qualitative data collection and analysis method on a sample of 20 primiparous women. The women were recruited from the postnatal ward of Bwaila hospital and were interviewed regarding their experiences on the support they received from their birth companions during labour and delivery using an open ended interview guide. Data was manually analyzed using content analysis. Primiparous women described the support they received from their birth companions as useful and beneficial. Birth companions provided advice, physical, emotional and spiritual support to the women during their labour and delivery. In addition, the birth companions were viewed as guardians of the women during labour and delivery. Results however, show that some women were not properly assisted by their companions because both the mothers and companions lacked knowledge on birth companionship. The results further show that birth companions play important roles during the birth and delivery of primiparous women and thereby improving birth outcomes. Therefore, there is a need to train the companions regarding support to a woman during labour and delivery. Primiparous women also need to be trained during antenatal care education so that they properly understand the roles of a birth companion as opposed to those of the midwives.

关键词： Primiparous Woman Birth Companion Labour Delivery Support Antenatal Clinic Education Birth Experience

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Midwives’ adherence to guidelines on the management of birth asphyxia in Malawi

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Open Journal of Nursing 2012年第4期2卷 351-357页

作者： Bertha Chikuse Ellen chirwa Alfred Maluwa Address Malata Jon Odland Department of Maternal and Child Health University of Malawi Kamuzu College of Nursing Blantyre Malawi Department of Maternal and Child Health University of Malawi Kamuzu College of Nursing Lilongwe Malawi Faculty of Health Sciences University of Tromso Norwegian Agency for Development Cooperation Tromso Norway Ntcheu District Hospital Ntcheu Malawi Research Directorate University of Malawi Kamuzu College of Nursing Lilongwe Malawi

A study was conducted to determine midwives adherence to guidelines on management of birth asphyxia at Queen Elizabeth Central Hospital in Blantyre district, Malawi. The study design was descriptive cross sectional using quantitative data analysis method on 75 midwives that were working in the maternity unit of the hospital. A structured questionnaire was used to collect data on participant’s demographic characteristics and midwives’ comprehension of birth asphyxia and an observational check list was used to observe midwives’ adherence to WHO resuscitation guidelines. In addition midwives were observed on their adherence to the Integrated Maternal and Neonatal Health guidelines that were developed by the Malawi Ministry of Health. The findings indicate that the midwives had knowledge of birth asphyxia in general. However, there were gaps in their ability to identify warning signs of birth asphyxia through partograph use. In addition the midwives did not adhere to 9 out of the 21 steps of the resuscitation guideline. Generally there was substandard adherence to guidelines on identification of warning signs of birth asphyxia and neonatal resuscitation. On the other hand, the facility did not have adequate resuscitation equipment and supplies. The results are discussed in relation to the importance of adhering to resuscitation guidelines in the management of birth asphyxia for babies that do not breathe at birth. Training of the midwives on partograph use and resuscitation to improve neonatal outcomes is recommended. It is recommended further that the health facility should have adequate resuscitation equipment and supplies.

关键词： Birth Asphyxia Resuscitation Guidelines Neonates Use of Partograph Virginia Apgar Scoring

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Assessment of quality of postnatal care services offered to mothers in Dedza district, Malawi

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Open Journal of Nursing 2013年第4期3卷 343-350页

作者： Lydia Kanise Chimtembo Alfred Maluwa Angela Chimwaza Ellen chirwa Mercy Pindani Dean of Faculty Kamuzu College of Nursing University of Malawi Lilongwe Malawi Dedza District Hospital Dedza Malawi Department of Maternal and Child Health Kamuzu College of Nursing University of Malawi Blantyre Malawi Department of Medical Surgical Nursing Kamuzu College of Nursing University of Malawi Blantyre Malawi Research Directorate Kamuzu College of Nursing University of Malawi Lilongwe Malawi

This study was conducted to assess quality of postnatal care that midwives provide to women seeking postnatal services in health facilities in Dedza district, the central region ofMalawi. The study design was descriptive cross sectional and utilized quantitative data collection and analysis method to determine structural, process and outcome components of postnatal care in two facilities that offer emergency obstetric and neonatal care and five that offer basic emergency obstetric and neonatal care. All 60 midwives who were providing postnatal care during the time of study in the district were interviewed using a structured questionnaire. In addition, the midwives actual practice was observed and compared to a standard checklist on postnatal care practice which was developed by the Malawi Ministry of Health. Data were analyzed using SPSS version 16.0. Results show that structure for providing postnatal counseling services was inappropriate and inadequate. Furthermore, the contents of postnatal services were below reproductive health standards because the clients were neither monitored nor examined physically on discharge. On average, all the seven facilities scored 48% on postnatal services rendered which is far below the recommended 80% according to the Reproductive Health Standards. There is a need to provide basic infrastructure in all the basic emergency obstetric and neonatal care facilities. In addition, refresher training courses for midwives in maternal and neonatal health with emphasis on postnatal care are recommended. There is also a need to restructure the maternal and neonatal health departments in the facilities so that the postnatal care units become stand-alone priority sites to improve the quality of the postnatal care services rendered.

关键词： Quality Postnatal Care Reproductive Health Standards Postnatal Care Structure Process and Outcome Maternal and Neonatal Health Postnatal Care Standards

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COVID-19 Pandemic through the Lenses of Nurses and Midwives in Zambia: Exploring Depression, Anxiety and Stress

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Open Journal of Psychiatry 2022年第1期12卷 11-22页

作者： Lonia Mwape Kestone Lyambai Esther chirwa Mavis Mtonga Patricia Katowa-Mukwato Agatha Lloyd School of Nursing Sciences Levy Mwanawasa Medical University Lusaka Zambia School of Nursing Sciences University of Zambia Lusaka Zambia Lusaka District Health Office Lusaka Zambia

Following the declaration of COVID-19 as an international health emergency, Zambia like many other countries implemented measures to limit human interaction and curb the spread of the disease. In the midst of these measures, nurses and midwives continue to provide care to suspected and confirmed cases of COVID-19, which puts them at risk of contracting the disease and compromising their psychological wellbeing. The aim of this study was to assess the levels of depression, anxiety, and stress experienced by nurses and midwives working in health facilities in two districts of Zambia during the COVID-19 pandemic. This descriptive cross-sectional study involving 187 nurses and midwives was conducted between July and December 2020 in selected health facilities in Lusaka and Chilanga Districts. The Depression Anxiety and Stress Scale (DASS) 21 was used to collect the data which was analysed using univariate analysis. Majority of the respondents were female (84%) and mean age at 30.1 (SD 9.05) years, 58.3 percent were married, and 50.84 percent had children. The mean work experience was 6.63 (SD 4.75) years, and 54 percent had worked for less than five years. Overall, 22.5 percent of nurses and midwives reported depression, 52.4 percent had anxiety and almost half (42.2%) had varying levels of stress. Anxiety and stress correlated significantly with working in COVID Isolation departments (P = 0.001). Strategies such as strict adherence to infection prevention measures, seeking help from family and friends and recognition by hospital management were a significant supportive measure (P < 0.001). Nurses and Midwives working directly with COVID-19 patients reported greater incidence of depression, anxiety and stress, similar to findings from previous research around the world. Therefore, efforts should be focused on developing and providing counselling and other support services to mitigate the effects of COVID-19 and enhance psychological wellbeing for health professions.

关键词： COVID-19 Pandemic Nurses Midwives Depression Anxiety and Stress

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基于新地域主义的马拉维居住建筑可持续设计研究——以利隆圭为例

基于新地域主义的马拉维居住建筑可持续设计研究——以利隆圭为例

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作者：萨米（Sambirani chirwa）长安大学

学位级别：硕士

世界各国都在为人类提供更加安全、舒适的生存环境而不懈努力,可持续研究已成为全球主题。可持续设计概念对于城市发展至关重要。但由于认知和政策支持缺失,这一理念仍未被许多发展中国家接受。可持续设计是区域驱动的,旨在区域环境中... 详细信息

世界各国都在为人类提供更加安全、舒适的生存环境而不懈努力,可持续研究已成为全球主题。可持续设计概念对于城市发展至关重要。但由于认知和政策支持缺失,这一理念仍未被许多发展中国家接受。可持续设计是区域驱动的,旨在区域环境中创造文化、经济和环境一体化空间。其中,可持续住宅建筑对于实现弹性、清洁和城市的可持续发展至关重要。随着全球化进程的加快,非洲地域文脉正在消失,取而代之的是外来的设计元素,这些元素对非洲环境和社会反应不佳。本研究结合新地域主义概念,提出马拉维的新居住建筑设计方法,采用调整和保护区域文化、社会经济和环境要素满足可持续设计目标。本文首先对马拉维利隆圭地区的本土居住建筑和城市居住建筑进行评估。基于新地域表达的本土和新居住建筑的组成部分,本研究从社会经济和文化视角分析了马拉维的住宅设计和空间意义。研究以利隆圭三个城市住宅小区为例,分析不同住宅建筑类型、聚落模式、位置,采用社会和经济数据,结合场地和自然环境,梳理出建筑设计逻辑。从环境、社会和经济三方面着重分析了地域和新建住宅现状。其次,通过软件模拟对利隆圭居住建筑的可持续性进行评估。该研究对典型马拉维居住建筑的实地研究提供了与模拟结果相关的室内空气温度读数以供验证。对三个住宅建筑的评估和优化为建筑立面、窗墙比例和墙体结构提供了可持续设计的解决方案,实现最佳室内热舒适度和碳排放水平的目标。最后,该研究结合设计模拟,结合空间布局,多种住宅类型和生态和地域设计原则,提出了一种强调可持续发展的社会住房设计方法。研究建议将利隆圭作为该项目的选址拟建住宅用地。设计方法旨在通过多种住房选择解决环境因素、城市内的社会住房需求和经济机会。综上所述,本研究通过三部分对可持续建筑进行了探索、定义和解释。首先,对乡土、地域和必要的地域主义三方面的理论进行分析和研究,强调在马拉维实现可持续和新区域建筑的理论原则。其次,通过对当前马拉维建筑现状的探索突出了当地建筑的变化特征。最后,提出综合自然环境、社会经济和建筑环境等地域因素影响的可持续建筑设计框架。

关键词：马拉维居住建筑新地域主义可持续建筑设计

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Associative Factors for Birth Asphyxia at Queen Elizabeth Central Hospital—Malawi

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Journal of Biosciences and Medicines 2017年第5期5卷 22-31页

作者： Edith Tewesa Ellen chirwa Maureen Daisy Majamanda Alfred Maluwa Angela Chimwaza Queen Elizabeth Central Hospital Blantyre Malawi University of Malawi—Kamuzu College of Nursing Malawi

Background: Birth asphyxia is one of the major causes of neonatal deaths worldwide. Queen Elizabeth Central Hospital (QECH) neonatal ward records indicate that 36.5% of neonates admitted in the ward from April to September 2012 had birth asphyxia. This study was conducted to explore associative factors for birth asphyxia at QECH. Methodology: The study design was descriptive cross sectional that employed quantitative methods of data collection and analysis. Data sources were case notes of neonates and their mothers.? Sample size was 87 neonates with birth asphyxia and 87 neonates admitted with conditions other than birth asphyxia as controls. Data were collected from November to December 2013. Statistical Package for Social Science (SPSS) version16.0 was used to analyze data. Results: Findings revealed that there were no maternal associative factors for birth asphyxia, however, foetal distress, prolonged first and second stage of labour were significant associative factors for birth asphyxia. Conclusion: Associative factors for birth asphyxia at QECH are Foetal distress, prolonged first and second stage of labour. These factors can be prevented if quality care is provided to women in labour through close monitoring of foetal heart, appropriate use of the partograph, prompt decision making and early interventions.

关键词： Neonates Birth Asphyxia Risk Factors

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