Papers by Eilish Mcauliffe
Disability and Rehabilitation: Assistive Technology, Apr 22, 2023
HRB Open Research, 2021
Background: Given the unprecedented nature of the COVID-19 pandemic, the Irish health system requ... more Background: Given the unprecedented nature of the COVID-19 pandemic, the Irish health system required the redeployment of public sector staff and the recruitment of dedicated contact tracing staff in the effort to contain the spread of the virus. Contact tracing is crucial for effective disease control and is normally carried out by public health teams. Contact tracing staff are provided with rapid intensive training but are operating in a dynamic environment where processes and advice are adapting continuously. Real-time data is essential to inform strategy, coordinate interconnected processes, and respond to needs. Given that many contact tracers have been newly recruited or redeployed, they may not have significant experience in healthcare and may experience difficulties in managing the anxieties and emotional distress of the public. Aim: (i) identify emerging needs and issues and feed this information back to the Health Service Executive for updates to the COVID-19 Contact Manag...
International Journal of Qualitative Methods, 2019
Realist evaluations are increasingly used in the study of complex health interventions. The metho... more Realist evaluations are increasingly used in the study of complex health interventions. The methodological procedures applied within realist evaluations however are often inexplicit, prompting scholars to call for increased transparency and more detailed description within realist studies. This publication details the data analysis and synthesis process used within two realist evaluation studies of community health interventions taking place across Uganda, Tanzania, and Kenya. Using data from several case studies across all three countries and the data analysis software NVivo, we describe in detail how data were analyzed and subsequently synthesized to refine middle-range theories. We conclude by discussing the strengths and weaknesses of the approach taken, providing novel methodological recommendations. The aim of providing this detailed descriptive account of the analysis and synthesis in these two studies is to promote transparency and contribute to the advancement of realist ev...
BMJ Open, 2019
IntroductionScaling-up is essential to ensure universal access of effective health interventions.... more IntroductionScaling-up is essential to ensure universal access of effective health interventions. Scaling-up is a complex process, which occurs across diverse systems and contexts with no one-size-fits-all approach. To date, little attention has been paid to the process of scaling-up in how to make adaptations for local fit. The aim of this research is to develop theory on what actions can be used to make adaptations to health interventions for local fit when scaling-up across diverse contexts that will have practical application for implementers involved in scaling-up.Methods and analysisGiven the complexity of this subject, a realist review methodology was selected. Specifically, realist review emphasises an iterative, non-linear process, whereby the review is refined as it progresses. The identification of how the context may activate mechanisms to achieve outcomes is used to generate theories on what works for whom in what circumstances. This protocol will describe the first com...
Human Resources for Health, 2017
Background: It is estimated that over one billion persons worldwide have some form of disability.... more Background: It is estimated that over one billion persons worldwide have some form of disability. However, there is lack of knowledge and prioritisation of how to serve the needs and provide opportunities for people with disabilities. The community-based rehabilitation (CBR) guidelines, with sufficient and sustained support, can assist in providing access to rehabilitation services, especially in less resourced settings with low resources for rehabilitation. In line with strengthening the implementation of the health-related CBR guidelines, this study aimed to determine what workforce characteristics at the community level enable quality rehabilitation services, with a focus primarily on less resourced settings. Methodology: This was a two-phase review study using (1) a relevant literature review informed by realist synthesis methodology and (2) Delphi survey of the opinions of relevant stakeholders regarding the findings of the review. It focused on individuals (health professionals, lay health workers, community rehabilitation workers) providing services for persons with disabilities in less resourced settings. Results: Thirty-three articles were included in this review. Three Delphi iterations with 19 participants were completed. Taken together, these produced 33 recommendations for developing health-related rehabilitation services. Several general principles for configuring the community rehabilitation workforce emerged: communitybased initiatives can allow services to reach more vulnerable populations; the need for supportive and structured supervision at the facility level; core skills likely include case management, social protection, monitoring and record keeping, counselling skills and mechanisms for referral; community ownership; training in CBR matrix and advocacy; a tiered/teamwork system of service delivery; and training should take a rights-based approach, include practical components, and involve persons with disabilities in the delivery and planning. Conclusion: This research can contribute to implementing the WHO guidelines on the interaction between the health sector and CBR, particularly in the context of the Framework for Action for Strengthening Health Systems, in which human resources is one of six components. Realist syntheses can provide policy makers with detailed and practical information regarding complex health interventions, which may be valuable when planning and implementing programmes.
BMJ open, Aug 16, 2016
Understanding what enhances the motivation and performance of community health workers (CHWs) in ... more Understanding what enhances the motivation and performance of community health workers (CHWs) in humanitarian emergencies represents a key research gap within the field of human resources for health. This paper presents the research protocol for the Performance ImprovEment of CHWs in Emergency Settings (PIECES) research programme. Enhancing Learning and Research in Humanitarian Action (ELRHA) funded the development of this protocol as part of their Health in Humanitarian Crises (R2HC) call (No.19839). PIECES aims to understand what factors improve the performance of CHWs in level III humanitarian emergencies. The suggested protocol uses a realist evaluation with multiple cases across the 3 country sites: Turkey, Iraq and Lebanon. Working with International Medical Corps (IMC), an initial programme theory was elicited through literature and document reviews, semistructured interviews and focus groups with IMC programme managers and CHWs. Based on this initial theory, this protocol pr...
Globalization and Health, 2016
Background: Good governance may result in strengthened performance of a health system. Coherent p... more Background: Good governance may result in strengthened performance of a health system. Coherent policies are essential for good health system governance. The overall aim of this research is to provide the best available scientific evidence on principles of good policy related leadership and governance of health related rehabilitation services in less resourced settings. This research was also conducted to support development of the World Health Organization's (WHO) Guidelines on health related rehabilitation. Methods: An innovative study design was used, comprising two methods: a systematic search and realist synthesis of literature, and a Delphi survey of expert stakeholders to refine and triangulate findings from the realist synthesis. In accordance with Pawson and Tilley's approach to realist synthesis, we identified context mechanism outcome pattern configurations (CMOCs) from the literature. Subsequently, these CMOCs were developed into statements for the Delphi survey, whereby 18 expert stakeholders refined these statements to achieve consensus on recommendations for policy related governance of health related rehabilitation. Results: Several broad principles emerged throughout formulation of recommendations: participation of persons with disabilities in policy processes to improve programme responsiveness, efficiency, effectiveness, and sustainability, and to strengthen service-user self-determination and satisfaction; collection of disaggregated disability statistics to support political momentum, decision-making of policymakers, evaluation, accountability, and equitable allocation of resources; explicit promotion in policies of access to services for all subgroups of persons with disabilities and service-users to support equitable and accessible services; robust inter-sectoral coordination to cultivate coherent mandates across governmental departments regarding service provision; and 'institutionalizing' programmes by aligning them with preexisting Ministerial models of healthcare to support programme sustainability. Conclusions: Alongside national policymakers, our policy recommendations are relevant for several stakeholders, including service providers and service-users. This research aims to provide broad policy recommendations, rather than a strict formula, in acknowledgement of contextual diversity and complexity. Accordingly, our study proposes general principles regarding optimal policy related governance of health related rehabilitation in less resourced settings, which may be valuable across diverse health systems and contexts.
BMC Health Services Research, 2016
Background: In 2010, the Ministry of Health and Sanitation in Sierra Leone launched their Free He... more Background: In 2010, the Ministry of Health and Sanitation in Sierra Leone launched their Free Health Care Initiative (FHCI) for pregnant and lactating mothers and children under-5. Despite an increase in the update of services, the inequitable distribution of health services and health facilities remain important factors underlying the poor performance of health systems to deliver effective services. This study identifies current gaps in service delivery across two rural locations served by the same District Health Management Team (DHMT). Methods: We employed a cross-sectional household survey using a two-stage probability sampling method to obtain a sample of the population across two rural locations in Bonthe District: the riverine and the mainland. Overall, a total of 393 households across 121 villages were surveyed in the riverine and 397 households across 130 villages were sampled on the mainland. Maternal health, child health and sanitation indicators in Bonthe District were compared using Pearson Chi-Squared test with Yates' Continuity Correction across the two areas. Results: Women across the two regions self-reported significantly different uptake of family planning services. Children on the mainland had significantly greater rates of health facility based deliveries; being born in the presence of a skilled birth attendant; completed immunisation schedules; and higher rates of being brought to the health centre within 24 h of developing a fever or a suspected acute respiratory infection. Households on the mainland also reported significantly greater use of treated water and unrestricted access to a latrine. Conclusions: If the government of Sierra Leone is going to deliver on their promise to free health care for pregnant women and their children, and do so in a way that reduces inequalities, greater attention must be paid to the existing service delivery gaps within each District. This is particularly relevant to health policy post-Ebola, as it highlights the need for more contextualised service delivery to ensure equitable access for women and children.
Health services management, 1991
Open medicine : a peer-reviewed, independent, open-access journal, 2011
Implementation Science, 2014
Background: The systematic involvement of project beneficiaries in community maternal and child h... more Background: The systematic involvement of project beneficiaries in community maternal and child health programmes remains low and limited, especially during the formative stages of the project cycle. Understanding how positive and negative feedbacks obtained from communities can subsequently be used to inform and iterate existing programmes is an important step towards ensuring the success of community health workers for maternal and child health programming and, ultimately, for improving health outcomes. Methods: The study took place over a period of 4 weeks in North Rukiga, Kabale District of southwestern Uganda. Using a cross-sectional qualitative study that employed an epistemological approach of phenomenology, nine focus group discussions and eight in-depth interviews were conducted with a total of 76 female participants across six different sites. Women were identified as either users or non-users of the maternal and child health programme. Purposeful sampling was employed to recruit women from six different locations within the programme catchment area. Translated and transcribed transcripts were subjected to a bottom-up thematic analysis using NVivo 10 Software, whereby themes were arrived at inductively. Results: Predominant themes emerging from the focus groups and key informant interviews identified early trends in programme strengths. Beneficiaries reported confidence in both the programme and the relationships they had forged with community health workers, exhibited pride in the knowledge they had received, and described improved spousal involvement. Beneficiaries also identified a number of programme challenges including barriers to adopting the behaviours promoted by the programme, and highlighted issues with programme dependency and perceived ownership. It also emerged that community health workers were not reaching the entire population of intended programme beneficiaries. Conclusions: This research provides support for the importance of an early-stage participatory evaluation of beneficiaries' perceptions of newly initiated health programmes. Our results support how evaluations conducted in the early phases of programme implementation can provide valuable, timely feedback as well as yield recommendations for programme adjustment or realignment , and in turn, better meet end-user expectations. Potential reasons for the observed lack of community participation in early stages of programme implementation are considered.
What do we want to know? The Millennium Development Goals (MDGs) have stimulated a plethora of re... more What do we want to know? The Millennium Development Goals (MDGs) have stimulated a plethora of research on civil servant remuneration and poverty reduction through improved civil service performance and Decent Work (MDG 1b). Since the year 2000, an emphasis on market forces has directed attention to output-based pay (or pay-for-performance) instead of the payment of decent/liveable fixed salaries that trust public servants to deliver ‘performance-for-pay’, i.e., performance that is contingent on pay rather than vice versa. This systematic review covers the literature from 2000–2010 and focuses on frontline occupations in health (doctors, nurses, mid-level occupations) and in education (teachers), in low- and middle-income countries. It is based on a pre-prepared protocol and used extensive searches of multiple sources. Who wants to know? Employers, policy-makers, the UK Department for International Development and similar departments in other countries. What did we find? The searche...
Disability, CBR & Inclusive Development, 2013
The World Report on Disability highlights some of the major challenges in the path to realisation... more The World Report on Disability highlights some of the major challenges in the path to realisation of the rights of persons with disabilities as per the United Nations Convention. While the recently published guidelines on Community Based Rehabilitation show the way to address these challenges, effective implementation would require not only higher levels of investment in human resources, but also a significantly newer and different skill-set for the additional personnel. The authors suggest that a scientifically sophisticated, systematic and coordinated research programme, with global reach and participation, is needed for the establishment of a useful and robust evidence-base for Community Based Rehabilitation interventions. It is also suggested that the development of a new cadre of rehabilitation workers could be a key component of the programme, and could help to alleviate the extant crisis in human resources for health in many low-income countries.
International Journal of Nonprofit and Voluntary Sector Marketing, 2009
Check sizes, numbering, and orientation of figures § All images in the PDF are downsampled (reduc... more Check sizes, numbering, and orientation of figures § All images in the PDF are downsampled (reduced to lower resolution and file size) to facilitate Internet delivery. These images will appear at higher resolution and sharpness in the printed article § Review figure legends to ensure that they are complete § Check all tables. Review layout, titles, and footnotes COMPLETE COPYRIGHT TRANSFER AGREEMENT (CTA) if you have not already signed one § Please send a scanned signed copy with your proofs by e-mail. Your article cannot be published unless we have received the signed CTA OFFPRINTS § 25 complimentary offprints of your article will be dispatched on publication.
Industrial and Organizational Psychology Help the Vulnerable
Poverty and Psychology, 2003
The model of Technical Assistance (TA) that has dominated the ethos of international aid for the ... more The model of Technical Assistance (TA) that has dominated the ethos of international aid for the last fifty years is increasingly becoming recognised as an inappropriate approach for helping people to develop out of poverty. Its overtones of paternalism, its focus on the hardware of aid (i.e. provision of equipment), and its lack of responsiveness to the needs of local
African Journal of Disability, 2014
Background: The ‘EquitAble’ project carried out content analyses of policies and collected and an... more Background: The ‘EquitAble’ project carried out content analyses of policies and collected and analysed qualitative and quantitative data concerning access to health services in Sudan, Malawi, Namibia and South Africa. Our particular concern was to address the situation of people with disabilities, although not in isolation from other marginalised or vulnerable groups.Objectives: This article reports on the content, context, process and impact of project EquitAble, funded by the European Commission Seventh Research Framework Programme, which brought together researchers from Ireland, Norway, South Africa, Namibia, Sudan and Malawi.Method: After the 4-year project ended in February 2013, all members of the consortium were asked to anonymously complete a bespoke questionnaire designed by the coordinating team. The purpose of the questionnaire was to capture the views of those who collaborated on the research project in relation to issues of content, context, process and impact of the ...
Human Resources in Healthcare, Health Informatics and Healthcare Systems
It is now more than a decade since the acknowledgement of the health human resources crisis that ... more It is now more than a decade since the acknowledgement of the health human resources crisis that exists in many low-income countries. During that decade much attention has focused on addressing the “pull” factors (e.g. developing voluntary international recruitment guidelines and bilateral agreements between recruiting and source countries) and on scaling up the supply of health professionals. Drawing on research conducted in two sub-Saharan African countries, we argue that a critical element in the human resources crisis is the poor working environments in these countries that not only continue to act as a strong “push” factor, but also impact on the motivation and performance of those who remain in their home countries. Unless attention is focused on improving work environments, the human resources crisis will continue in a vicious cycle leading to further decline in the health systems of low-income countries.
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Papers by Eilish Mcauliffe