A5020402495- Global Maternal and Child Health
- HIV/AIDS Research and Interventions
- Health Policy Implementation Science
- Health Systems, Economic Evaluations, Quality of Life
- HIV/AIDS Impact and Responses
- HIV, Drug Use, Sexual Risk
- Healthcare Systems and Reforms
- Primary Care and Health Outcomes
- Vaccine Coverage and Hesitancy
- Interprofessional Education and Collaboration
- Mobile Health and mHealth Applications
- Viral Infections and Outbreaks Research
- Adolescent Sexual and Reproductive Health
- Global Health Workforce Issues
- Global Health and Surgery
- Evaluation and Performance Assessment
- Community Health and Development
- Blood Pressure and Hypertension Studies
- ICT in Developing Communities
- Cervical Cancer and HPV Research
- Global Health Care Issues
- Infant Development and Preterm Care
- Maternal and Neonatal Healthcare
- Entrepreneurship Studies and Influences
- Global Public Health Policies and Epidemiology
University of Washington
2016-2025
Seattle University
2011-2023
Philipps University of Marburg
2023
Ministry of Health, Community Development, Gender, Elderly and Children
2023
University of Cape Town
2023
Western Cape Department of Health
2023
Emmanuel Bible College
2023
Harvard Global Health Institute
2023
Harvard University
2023
Directorate of Health
2022
In 2004, Mozambique, supported by large increases in international disease-specific funding, initiated a national rapid scale-up of antiretroviral treatment (ART) and HIV care through vertical "Day Hospital" approach. Though this model showed substantial people receiving treatment, it diverted scarce resources away from the primary health (PHC) system. 2005, Ministry Health (MOH) began an effort to use HIV/AIDS as means strengthen their PHC The MOH worked closely with number NGOs integrate...
Introduction Trained human resources are fundamental for well-functioning health systems, and the lack of workers undermines public sector capacity to meet population needs. While external brain drain from low middle-income countries is well described, there little understanding degree internal drain, how increases in funding through global initiatives may contribute outflow donor agencies, non-governmental organisations (NGOs), private sector. Methods An observational study was conducted...
Primary health care is recognized as a main driver of equitable service delivery. For it to function optimally, routine information systems (HIS) are necessary ensure adequate provision and the development appropriate policies. Concerns about quality administrative data have undermined their use in resource-limited settings. This evaluation was designed describe availability, reliability, validity sample primary HIS from nine facilities across three districts Sofala Province, Mozambique....
Large increases in health sector investment and policies favoring upgrading expanding the public network have prioritized maternal child Mozambique and, over past decade, has achieved substantial improvements indicators. Over this same period, government of continued to decentralize management resources district level, including sector, with aim bringing decision-making closer service beneficiaries. Weak level capacity hindered decentralization process, building is an important link ensure...
Abstract Objectives To assess the relationship between health system factors and facility‐level EHP stock‐outs in Mozambique. Methods Service provisions were assessed 26 facilities 13 district warehouses Sofala Province, Mozambique, from July to August 2011–2013. Generalised estimating equations used model associated with availability of essential drugs, supplies equipment. Results Stock‐out rates for drugs ranged 1.3% oral rehydration solution 20.5% Depo‐Provera condoms, a mean stock‐out...
High-quality data are critical to inform, monitor and manage health programs. Over the seven-year African Health Initiative of Doris Duke Charitable Foundation, three five Population Implementation Training (PHIT) partnership projects in Mozambique, Rwanda, Zambia introduced strategies improve quality evaluation routinely-collected at primary care level, stimulate its use evidence-based decision-making. Using Consolidated Framework for Research (CFIR) as a guide, this paper: 1) describes...
We assessed the effects of a three-year national-level, ministry-led health information system (HIS) data quality intervention and identified associated facility factors. Monthly summary HIS concordance between gold standard audit routine was in 26 facilities Sofala Province, Mozambique across four indicators (outpatient consults, institutional births, first antenatal care visits, third dose diphtheria, pertussis, tetanus vaccination) five levels aggregation (daily paper registers, monthly...
Despite significant increases in global health investment and the availability of low-cost, efficacious interventions to prevent mother-to-child HIV transmission (pMTCT) low- middle-income countries with high burden, translation scientific advances into effective delivery strategies has been slow, uneven incomplete. As a result, pediatric infection remains largely uncontrolled. A five-step, facility-level systems analysis improvement intervention (SAIA) was designed maximize effectiveness...
Since 2012 Gavi, the Vaccine Alliance has provided financial support for HPV vaccine introduction in low- and middle-income countries (LMICs); however, funding been contingent on establishing a demonstration project prior to national scale-up, order gauge effectiveness of delivery models. Although by 2016, most beneficiary had completed projects, few have scaled up nationwide. An important barrier was dearth published, country-specific implementation recommendations. We employed Consolidated...
Background: Efficacious interventions to prevent mother-to-child HIV transmission (PMTCT) have not translated well into effective programs. Previous studies of systems engineering applications PMTCT lacked comparison groups or randomization. Methods: Thirty-six health facilities in Côte d'Ivoire, Kenya, and Mozambique were randomized usual care a intervention, stratified by country volume. The intervention guided facility staff iteratively identify then rectify barriers implementation....
Background and Aims: The burden of stroke stroke-related disability in Peru – a low- to middle-income country is nearly 50% higher than the global average. Gaps post-stroke care include insufficient rehabilitation post-acute care, limited caregiver training, lack national palliative program. To address these gaps, we designed piloted hospital-based training intervention support patients discharging home after severe stroke. Methods: Between June 1st, November 30th, 2023, randomized...
Objetivo: identificar los patrones de consumo alcohol asociados a la adherencia al tratamiento antirretroviral (TARV) en pacientes con VIH. Material y métodos: Estudio transversal una población 4000 mayores 18 años que recibieron TARV por Estrategia Sanitaria Nacional Prevención Control ITS- VIH/SIDA desde el 2004 un hospital Lima. El estudio se realizó entre setiembre 2017 enero 2018. tamaño muestral fue 351 seleccionados aleatoriamente. Se evaluaron usando prevalencia alguna vez vida,...
Despite large investments to prevent mother-to-child-transmission (PMTCT), pediatric HIV elimination goals are not on track in many countries. The Systems Analysis and Improvement Approach (SAIA) study was a cluster randomized trial test whether package of systems engineering tools could strengthen PMTCT programs. We sought (1) define core adaptable components the SAIA intervention, (2) explain heterogeneity SAIA's success between facilities.The Consolidated Framework for Implementation...
We describe wait and consult times across public-sector clinics identify health facility determinants of times.We observed 8,102 patient arrivals departures from clinical service areas 12 in Sofala Manica Provinces between January April 2011. Negative binomial generalized estimating equations were used to model associated factors.Mean (in minutes) were: 26.1 for reception; 43.5 outpatient consults; 58.8 antenatal visits; 16.2 well-child 8.0 pharmacy; 15.6 laboratory. Mean consultation 5.3...
The objective of the prevention Mother-to-Child Transmission (pMTCT) cascade analysis tool is to provide frontline health managers at facility level with means rapidly, independently and quantitatively track patient flows through pMTCT cascade, readily identify priority areas for clinic-level improvement interventions. Over a period six months, five experienced maternal-child researchers iteratively adapted tested this systems services. They prioritized components inclusion, disseminated...
In this essay, we seek to understand how the stunning rise of data vacuuming, necessitated by pretense ‘partnership’ within global health, has fundamentally altered routine health in poor countries is collected, analyzed, prioritized, and used inform management policy. Writing as a team authors with experiences on multiple sides partnerships United States, Mozambique, Nepal, Lesotho, Kenya, Cote d’Ivoire, argue that solidarity-based partnership between donor recipient impossible when...
With the rollout of "Option B+" in Mozambique 2013, initial data indicated major challenges to early retention antiretroviral therapy (ART) among HIV-positive pregnant women. We sought develop and test a pilot intervention 6 large public clinics central improve mothers starting ART antenatal care. The results from formative research this study described here were used design intervention.The was initiated 2013 completed 2014 each consisted (1) patient flow mapping measurement through...
Cascades have been used to characterize sequential steps within a complex health system and are in diverse disease areas across prevention, testing, treatment. Routine data great potential inform prioritization system, but often inaccessible frontline care workers (HCWs) who may the greatest opportunity innovate improvement.
Abstract Background Healthcare systems in low-resource settings need simple, low-cost interventions to improve services and address gaps care. Though routine data provide opportunities guide these efforts, frontline providers are rarely engaged analyzing them for facility-level decision making. The Systems Analysis Improvement Approach (SAIA) is an evidence-based, multi-component implementation strategy that engages use of promote systems-level thinking quality improvement (QI) efforts...
The shortage of health workers impedes universal coverage quality HIV services, especially in those countries hardest hit by the epidemic. dramatic increase international aid to scale-up including antiretroviral therapy (ART), has highlighted workforce deficiencies and provided an opportunity strengthen systems capacity. In Mozambique, a country with high burden staggering deficit, Ministry Health looked past experience expansion rapidly build ART delivery capacity, reliance on existing...
Aim We highlight key components of emerging academic structures in global health nursing and explain how this investment can expand nursing's broader engagement policy development. Background Engaging development is vital to ensure the scale‐up effective programmes. Globally, nurses promote interprofessional healthcare teams who are responsible for translating sound evidence‐based programming into practice. However, role within forums on influential decision‐making bodies space remains...
The introduction of option B+-rapid initiation lifelong antiretroviral therapy regardless disease status for HIV-infected pregnant and breastfeeding women-can dramatically reduce HIV transmission during pregnancy, birth, breastfeeding. Despite significant investments to scale-up Option B+, results have been mixed, with high rates loss follow-up, sub-optimal viral suppression, continued pediatric transmission, HIV-associated maternal morbidity. Systems Analysis Improvement Approach (SAIA)...