Papers by Adelaine Karemani
While Action Research (AR) in health systems is well established, there is a dearth of research a... more While Action Research (AR) in health systems is well established, there is a dearth of research about how its reflection phase is pragmatically employed with time-poor healthcare teams, especially within AR implemented in the Global South. This paper presents the findings of a nested qualitative study within PERFORM2Scale, a 5-year Health Systems AR project in Ghana, Malawi, and Uganda. It aimed to unpack the challenges, facilitators, and lessons learned about enacting the reflection phase of the AR cycle with district health management teams (DHMTs) implementing a management strengthening intervention (MSI). Semi-structured interviews and focus groups with district health managers and country research teams (CRTs) were conducted, and thematically analysed. Study findings indicate that pragmatic barriers such as time constraints, high staff turnover, and challenges utilizing a reflection diary impeded enaction of reflection. However, DHMTs more effectively engaged in reflection when...
ACODE is pleased to publish yet another policy research paper from the demand-side component of t... more ACODE is pleased to publish yet another policy research paper from the demand-side component of the 'Community and District Empowerment for Scale-up (CODE) project which it implements under a consortium of the CODES project partners. We are very grateful to UNICEF for managing the funding of this project. The financial resources invested in the whole project and production of this research report is massive. To this end, ACODE Management and Board of Trustees are once again grateful to the Bill and Melinda Gates Foundation through the United States Fund for UNICEF and UNICEF Uganda for funding the CODES project. ACODE is heavily indebted to the Ministry of Health and the District Health Management Teams within each of the 13 CODES Project intervention districts, for their continued support and collaboration. In that same spirit, ACODE is grateful to the hundreds of individuals who participated in the baseline study and a series of community dialogues through offering candid views about their own experiences in seeking, receiving, and providing health services for children under-five years of age.
The International Journal of Health Planning and Management
African Health Sciences
Background: Like other developing countries, Uganda still struggles to meaningfully reduce child ... more Background: Like other developing countries, Uganda still struggles to meaningfully reduce child mortality. A strategy of giving information to communities to spark interest in improving child survival through inducing responsibility and social sanctioning in the health workforce was postulated. By focusing on diarrhea, pneumonia and malaria, a Community and District Empowerment for Scale up (CODES) undertaking used "community dialogues" to arm communities with health system performance information. This empowered them to monitor health service provision and demand for quality child-health services. Methods: We describe a process of community dialoguing through use of citizen report cards, short-text-messages, media and post-dialogue monitoring. Each community dialogue assembled 70-100 members including health workers and community leaders. After each community dialogue, participants implemented activities outlined in generated community contracts. Radio messages promoted demand for child-health services and elicited support to implement accepted activities. Conclusion: The perception that community dialoging is "a lot of talk" that never advances meaningful action was debunked since participant-initiated actions were conceived and implemented. Potential for use of electronic communication in real-time feedback and stimulating discussion proved viable. Post-dialogue monitoring captured in community contracts facilitated process evaluation and added plausibility for observed effects. Capacitated organizations during post-dialogue monitoring guaranteed sustainability.
Journal of Global Oncology
PURPOSE Tobacco use is the leading cause of premature death worldwide. One aspect of tobacco cont... more PURPOSE Tobacco use is the leading cause of premature death worldwide. One aspect of tobacco control is convincing farmers to stop tobacco production. We assessed the willingness of tobacco farmers in Uganda to stop growing tobacco. METHODS We conducted a cross-sectional interview survey with an interviewer-administered questionnaire. Participants were active tobacco farmers in 12 villages of Kanungu district (N = 528) and were interviewed in 2013 to assess their willingness to stop growing tobacco. RESULTS Most farmers (61.7%) grew tobacco only as a cash crop with no supplemental income. A total of 198 farmers (37.5%) were willing to stop growing tobacco. Ninety-two respondents cited coffee as a potential replacement crop for tobacco and 106 mentioned rice. Barriers to growing replacement crops were that tobacco is highly profitable (n = 172) and that the soil (n = 175) and/or weather (n = 22) cannot sustain any crops other than tobacco. Willingness to stop growing tobacco was 1.32...
Journal of Global Oncology, 2016
10 Background: Tobacco use is the leading cause of premature death and disability in both develop... more 10 Background: Tobacco use is the leading cause of premature death and disability in both developed and developing countries. One aspect of tobacco control is convincing farmers to stop tobacco production. Because tobacco is a key contributor to the agricultural economy of many communities, we explored the conflict between tobacco production and public health in the current study. This project aims to assess the willingness of tobacco farmers in Uganda to stop growing tobacco. Methods: A cross-sectional interview survey was conducted with an interviewer administered questionnaire. Participants in the study were active tobacco farmers in 12 villages of Kanungu district (n = 528) and were interviewed in May and June of 2013 to assess their willingness to stop growing tobacco. Results: Most farmers (61.7%) grew tobacco only as a cash crop and had no supplemental income. A total of 198 (37.5%) of the farmers were willing to stop growing tobacco. Ninety-two respondents mentioned coffee a...
10 Background: Tobacco use is the leading cause of premature death and disability in both develop... more 10 Background: Tobacco use is the leading cause of premature death and disability in both developed and developing countries. One aspect of tobacco control is convincing farmers to stop tobacco production. Because tobacco is a key contributor to the agricultural economy of many communities, we explored the conflict between tobacco production and public health in the current study. This project aims to assess the willingness of tobacco farmers in Uganda to stop growing tobacco. Methods: A cross-sectional interview survey was conducted with an interviewer administered questionnaire. Participants in the study were active tobacco farmers in 12 villages of Kanungu district (n = 528) and were interviewed in May and June of 2013 to assess their willingness to stop growing tobacco. Results: Most farmers (61.7%) grew tobacco only as a cash crop and had no supplemental income. A total of 198 (37.5%) of the farmers were willing to stop growing tobacco. Ninety-two respondents mentioned coffee as a replacement for tobacco and 106 mentioned rice. Barriers for replacement were that tobacco is highly profitable (n=172) and that the soil (n=175) and or weather (n=22) cannot sustain any other crop besides tobacco. Willingness to stop growing tobacco was more likely among farmers who said that tobacco use causes respiratory diseases and who received less than less than $300 U.S. dollars from tobacco sales in the previous season. On the other hand, agreeing that tobacco is profitable decreased the likelihood of willingness to stop growing tobacco. Conclusions: Most farmers earned income from tobacco only, and one in three were willing to stop growing tobacco. In order to increase willingness to stop growing tobacco, there is a need to educate farmers on health consequences of tobacco and increase the perception among farmers that other crops may be more profitable than tobacco. These measures should target farmers who receive more money from tobacco sales. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from either author.
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Papers by Adelaine Karemani