Author
Baltazar Chilundo
Bio: Baltazar Chilundo is an academic researcher from Eduardo Mondlane University. The author has contributed to research in topics: Health care & Population. The author has an hindex of 12, co-authored 29 publications receiving 531 citations.
Papers
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TL;DR: Internal migration is an important contributor to capital flight from the public sector, accounting for more cases of physician loss than external migration in Mozambique.
Abstract: Introduction
Trained human resources are fundamental for well-functioning health systems, and the lack of health workers undermines public sector capacity to meet population health needs. While external brain drain from low and middle-income countries is well described, there is little understanding of the degree of internal brain drain, and how increases in health sector funding through global health initiatives may contribute to the outflow of health workers from the public sector to donor agencies, non-governmental organisations (NGOs), and the private sector.
89 citations
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TL;DR: Primary data from seven country studies on the effects of three GHIs on coordination of HIV/AIDS programmes are reviewed to identify residual national and subnational obstacles to effective coordination and optimal use of funds by focal GHIs.
Abstract: Background: A coordinated response to HIV/AIDS remains one of the ‘grand challenges’ facing policymakers today. Global health initiatives (GHIs) have the potential both to facilitate and exacerbate coordination at the national and subnational level. Evidence of the effects of GHIs on coordination is beginning to emerge but has hitherto been limited to single-country studies and broad-brush reviews. To date, no study has provided a focused synthesis of the effects of GHIs on national and subnational health systems across multiple countries. To address this deficit, we review primary data from seven country studies on the effects of three GHIs on coordination of HIV/AIDS programmes: the Global Fund to Fight AIDS, Tuberculosis and Malaria, the President’s Emergency Plan for AIDS Relief (PEPFAR), and the World Bank’s HIV/AIDS programmes including the Multi-country AIDS Programme (MAP). Methods: In-depth interviews were conducted at national and subnational levels (179 and 218 respectively) in seven countries in Europe, Asia, Africa and South America, between 2006 and 2008. Studies explored the development and functioning of national and subnational HIV coordination structures, and the extent to which coordination efforts around HIV/AIDS are aligned with and strengthen country health systems. Results: Positive effects of GHIs included the creation of opportunities for multisectoral participation, greater political commitment and increased transparency among most partners. However, the quality of participation was often limited, and some GHIs bypassed coordination mechanisms, especially at the subnational level, weakening their effectiveness. Conclusions: The paper identifies residual national and subnational obstacles to effective coordination and optimal use of funds by focal GHIs, which these GHIs, other donors and country partners need to collectively address.
78 citations
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TL;DR: In‐depth analysis of policy change for integrated community case management of childhood illness in six sub‐Saharan African countries shows how iCCM policies developed and the barriers and facilitators to policy change.
Abstract: Objective: To report an in-depth analysis of policy change for integrated community case management of childhood illness (iCCM) in six sub-Saharan African countries. We analysed how iCCM policies developed and the barriers and facilitators to policy change. Methods: Qualitative retrospective case studies drawing from document reviews semi-structured interviews and in-country validation workshops were conducted in Burkina Faso Kenya Malawi Mali Mozambique and Niger. These countries were selected to maximise variation in iCCM policy status community health worker (CHW) models and different African regions. Results: Country iCCM policies evolved in an ad hoc fashion but were substantially influenced by the history of primary health care and the nature of CHW programmes. Technical officers within Ministries of Health led iCCM policy change with support from international donors but neither communities nor political leadership was mobilised. Concerns about achieving the Millennium Development Goals together with recognition of the shortcomings of existing child health programmes led to the adoption of iCCM policies. Availability of external financing played a critical role in facilitating policy change. Conclusions: iCCM policy change has been promoted by international agencies but national governments have struggled to align iCCM with country health systems. Greater investment is needed in tailoring global policy initiatives to match country needs. High-level political ownership of iCCM policies could facilitate policy change as could clearer strategies for ensuring the long-term sustainability of such policies.
66 citations
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TL;DR: GHIs could assist in these strategies, provided that they are flexible enough to incorporate country-specific needs in terms of funding, that they coordinate at global-level and minimise conditionality for countries.
Abstract: Global Health Initiatives (GHIs), aiming at reducing the impact of specific diseases such as Human Immunodeficiency Virus (HIV), have flourished since 2000. Amongst these, PEPFAR and GFATM have provided a substantial amount of funding to countries affected by HIV, predominantly for delivery of antiretroviral therapy (ARV) and prevention strategies. Since the need for additional human resources for health (HRH) was not initially considered by GHIs, countries, to allow ARV scale-up, implemented short-term HRH strategies, adapted to GHI-funding conditionality. Such strategies differed from one country to another and slowly evolved to long-term HRH policies. The processes and content of HRH policy shifts in 5 countries in Sub-Saharan Africa were examined. A multi-country study was conducted from 2007 to 2011 in 5 countries (Angola, Burundi, Lesotho, Mozambique and South Africa), to assess the impact of GHIs on the health system, using a mixed methods design. This paper focuses on the impact of GFATM and PEPFAR on HRH policies. Qualitative data consisted of semi-structured interviews undertaken at national and sub-national levels and analysis of secondary data from national reports. Data were analysed in order to extract countries’ responses to HRH challenges posed by implementation of HIV-related activities. Common themes across the 5 countries were selected and compared in light of each country context. In all countries successful ARV roll-out was observed, despite HRH shortages. This was a result of mostly short-term emergency response by GHI-funded Non-Governmental Organizations (NGOs) and to a lesser extent by governments, consisting of using and increasing available HRH for HIV tasks. As challenges and limits of short-term HRH strategies were revealed and HIV became a chronic disease, the 5 countries slowly implemented mid to long-term HRH strategies, such as formalisation of pilot initiatives, increase in HRH production and mitigation of internal migration of HRH, sometimes in collaboration with GHIs. Sustainable HRH strengthening is a complex process, depending mostly on HRH production and retention factors, these factors being country-specific. GHIs could assist in these strategies, provided that they are flexible enough to incorporate country-specific needs in terms of funding, that they coordinate at global-level and minimise conditionality for countries.
47 citations
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TL;DR: The article draws on new institutional theory to argue that the focus of this program on formal rules, which deemphasize the informal constraints at the point of service delivery, has resulted in limited change and the need for enhancing incentives and enforcement as key mechanisms through which more effective change can be enabled in the future.
Abstract: Health sector reform, including structural and process changes such as the incorporation of feasible information and communication technologies, is a priority in many least developed countries. However, such changes have not been particularly effective, the reasons for which will be explored in this article. Particular attention will be paid to attempts to integrate information systems in HIV/AIDS program in Mozambique. The article draws on new institutional theory to argue that the focus of this program on formal rules (i.e., Sector Wide Approach policy and national plans), which deemphasize the informal constraints at the point of service delivery (i.e., priority given to health care over reporting), has resulted in limited change. Furthermore, the limited overlap between the formal and informal domains raises the need for enhancing incentives and enforcement as key mechanisms through which more effective change can be enabled in the future.
45 citations
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30 Dec 2011
TL;DR: This table lists the most common surnames in the United States used to be Anglicised as "United States", then changed to "United Kingdom" in the 1990s.
Abstract: OUTPU T 29 OUTPU T 30 OUTPU T 31 OUTPU T 32 OUTPU T 25 OUTPU T 26 OUTPU T 27 OUTPU T 28 OUTPU T 21 OUTPU T 22 OUTPU T 23 OUTPU T 24 OUTPU T 17 OUTPU T 18 OUTPU T 19 OUTPU T 20 OUTPU T 13 OUTPU T 14 OUTPU T 15 OUTPU T 16 OUTPU T 9 OUTPU T 10 OUTPU T 11 OUTPU T 12 OUTPU T 5 OUTPU T 6 OUTPU T 7 OUTPU T 8 OUTPU T 1 OUTPU T 2 OUTPU T 3 OUTPU T 4 29 30 31 32 25 26 27 28 21 22 23 24 17 18 19 20 13 14 15 16 9
1,662 citations
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TL;DR: JBl received funding from NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol and by the MRC ConDuCT-II Hub (Collaboration and innovation for Difficult and Complex randomised controlled Trials In Invasive procedures).
Abstract: The UK Medical Research Council’s widely used guidance for developing and evaluating complex interventions has been replaced by a new framework, commissioned jointly by the Medical Research Council and the National Institute for Health Research, which takes account of recent developments in theory and methods and the need to maximise the efficiency, use, and impact of research.
1,080 citations
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TL;DR: The current landscape of the information systems research literature concerned with developing countries is surveyed by examining a range of research articles published from 2000 onward as discussed by the authors, in terms of the key challenges addressed, including the role of technology, and the methodological and theoretical approaches used.
Abstract: The current landscape of the information systems research literature concerned with developing countries is surveyed by examining a range of research articles published from 2000 onward. These are discussed in terms of the key challenges addressed, including the role of technology, and the methodological and theoretical approaches used. Prospects for future research are discussed, based on a conceptual view as to how to study information and communication technologies (ICTs) in developing countries, to classify existing work, identify gaps, and suggest future opportunities. The authors contribute to the important debate on how ICTs in general, and information systems research in particular, can make a positive difference in the developing countries.
569 citations