Isidore Sieleunou

Assessing communities of practice in health policy: a conceptual framework as a first step towards empirical research

Communities of Practice (CoPs) are groups of people that interact regularly to deepen their knowledge on a specific topic. Thanks to information and communication technologies, CoPs can involve experts distributed across countries and adopt a ‘transnational’ membership. This has allowed the strategy to be applied to domains of knowledge such as health policy with a global perspective. CoPs represent a potentially valuable tool for producing and sharing explicit knowledge, as well as tacit knowledge and implementation practices. They may also be effective in creating links among the different ‘knowledge holders’ contributing to health policy (e.g., researchers, policymakers, technical assistants, practitioners, etc.).CoPs in global health are growing in number and activities. As a result, there is an increasing need to document their progress and evaluate their effectiveness. This paper represents a first step towards such empirical research as it aims to provide a conceptual framework for the analysis and assessment of transnational CoPs in health policy.The framework is developed based on the findings of a literature review as well as on our experience, and reflects the specific features and challenges of transnational CoPs in health policy. It organizes the key elements of CoPs into a logical flow that links available resources and the capacity to mobilize them, with knowledge management activities and the expansion of knowledge, with changes in policy and practice and, ultimately, with an improvement in health outcomes. Additionally, the paper addresses the challenges in the operationalization and empirical application of the framework.

Transferring the Purchasing Role from International to National Organizations During the Scale-Up Phase of Performance-Based Financing in Cameroon

Abstract—The World Bank and the government of Cameroon launched a performance-based financing (PBF) program in Cameroon in 2011. To ensure its rapid implementation, the performance purchasing role was sub-contracted to a consultancy firm and a nongovernmental organization, both international. However, since the early stage, it was agreed upon that this role would later be transferred to a national entity. This explanatory case study aims at analyzing the process of this transfer using Dolowitz and Marshs framework. We performed a document review and interviews with various stakeholders (n = 33) and then conducted thematic analysis of interview recordings. Sustainability, ownership, and integration of the PBF intervention into the health system emerged as the main reasons for the transfer. The different aspects of transfer from international entities to a national body consisted of (1) the decision-making power, (2) the “soft” elements (e.g., ideas, expertise), and (3) the “hard” elements (e.g., computers, vehicles). Factors facilitating the transfer included the fact that it was planned from the start and the modification of the legal status of the national organization that became responsible for strategic purchasing. Other factors hindered the transfer, such as the lack of a legal act clarifying the conditions of the transfer and the lack of posttransition support agreements. The Cameroonian experience suggests that key components of a successful transfer of PBF functions from international to national organizations may include clear guidelines, co-ownership and planning of the transition by all parties, and posttransition support to new actors.

Setting performance-based financing in the health sector agenda: a case study in Cameroon

BackgroundMore than 30 countries in sub-Saharan Africa have introduced performance-based financing (PBF) in their healthcare systems. Yet, there has been little research on the process by which PBF was put on the national policy agenda in Africa. This study examines the policy process behind the introduction of PBF program in Cameroon.MethodsThe research is an explanatory case study using the Kingdon multiple streams framework. We conducted a document review and 25 interviews with various types of actors involved in the policy process. We conducted thematic analysis using a hybrid deductive-inductive approach for data analysis.ResultsBy 2004, several reports and events had provided evidence on the state of the poor health outcomes and health financing in the country, thereby raising awareness of the situation. As a result, decision-makers identified the lack of a suitable health financing policy as an important issue that needed to be addressed. The change in the political discourse toward more accountability made room to test new mechanisms. A group of policy entrepreneurs from the World Bank, through numerous forms of influence (financial, ideational, network and knowledge-based) and building on several ongoing reforms, collaborated with senior government officials to place the PBF program on the agenda. The policy changes occurred as the result of two open policy windows (i.e. national and international), and in both instances, policy entrepreneurs were able to couple the policy streams to effect change.ConclusionThe policy agenda of PBF in Cameroon underlined the importance of a perceived crisis in the policy reform process and the advantage of building a team to carry forward the policy process. It also highlighted the role of other sources of information alongside scientific evidence (eg.: workshop and study tour), as well as the role of previous policies and experiences, in shaping or influencing respectively the way issues are framed and reformers’ actions and choices.

Performance-based Financing in Africa: Time to Test Measures for Equity:

Over the past 15 years, hundreds of millions of dollars have been invested in reforms founded on performance-based financing (PBF) in low- and middle-income countries. While evidence on its effectiveness and efficiency is still controversial, there appears to be an emerging consensus that equity has not been adequately considered. In this article, we show how PBF-type interventions in Africa have not sufficiently taken into account equity of access to care for the worst-off and their financial protection. In reviewing the history of health reforms in Africa, we show that this omission is nothing new. We suggest that strategic purchasing and PBF-type actions would benefit from being implemented in ways that promote equity and the financial protection of populations in Africa. Without such a reorientation of reforms, it will be impossible to achieve universal health coverage by 2030.

Deconstructing the notion of “global health research partnerships” across Northern and African contexts

BackgroundGlobal health conceives the notion of partnership between North and South as central to the foundations of this academic field. Indeed, global health aspires to an equal positioning of Northern and Southern actors. While the notion of partnership may be used to position the field of global health morally, this politicization may mask persisting inequalities in global health. In this paper, we reflect on global health partnerships by revisiting the origins of global health and deconstructing the notion of partnership. We also review promising initiatives that may help to rebalance the relationship.Results and DiscussionHistorical accounts are helpful in unpacking the genesis of collaborative research between Northerners and Southerners – particularly those coming from the African continent. In the 1980s, the creation of a scientific hub of working relationships based on material differences created a context that was bound to create tensions between the alleged “partners”. Today, partnerships provide assistance to underfunded African research institutions, but this assistance is often tied with hypotheses about program priorities that Northern funders require from their Southern collaborators. African researchers are often unable to lead or contribute substantially to publications for lack of scientific writing skills, for instance. Conversely, academics from African countries report frustrations at not being consulted when the main conceptual issues of a research project are discussed. However, in the name of political correctness, these frustrations are not spoken aloud. Fortunately, initiatives that shift paternalistic programs to formally incorporate a mutually beneficial design at their inception with equal input from all stakeholders are becoming increasingly prominent, especially initiatives involving young researchers.ConclusionSeveral concrete steps can be undertaken to rethink partnerships. This goes hand in hand with reconceptualizing global health as an academic discipline, mainly through being explicit about past and present inequalities between Northern and Southern universities that this discipline has thus far eluded. Authentic and transformative partnerships are vital to overcome the one-sided nature of many partnerships that can provide a breeding-ground for inequality.

Burden of human scabies in sub-Saharan African prisons: Evidence from the west region of Cameroon

There is little data on the profile and magnitude of scabies in sub‐Saharan African prisons. The present study aimed to assess the prevalence and determinants of scabies in prisons of the west region of Cameroon.

Prevalence, Drivers and Clinical Features of Human Scabies at the Mfou Principal Prison, Centre Region of Cameroon

Background and aim: Researches assessing the prevalence and magnitude of human scabies (HS) in Cameroonian penitentiaries are direly rare. The present study aimed to determine the prevalence, drivers and clinical features of HS in a Cameroonian prison. Methods: We conducted a cross-sectional study from February to April 2014 at the Mfou Principal Prison (MPP), Cameroon, including all prisoners who voluntarily consulted the research team at the prison infirmary. The diagnosis was based on clinical findings, the examination being independently performed by two experienced dermatologists. Results: Overall, 217 prisoners were enrolled, of whom 201 (92.6%) were males. Ages ranged from 14 to 60 years with a mean of 32.4 ± 9.5 years. The prevalence of HS was 41.0% (95% confidence interval (CI): 34.5-47.5%). Eighty one (91.0%) infected prisoners presented classical scabies while 8 prisoners (9.0%) presented crusted scabies. Excoriations (85.4%) and crusts (83.1%) were the prevailing lesions while the infra-gluteal (92.1%) and the inter-gluteal (88.8%) regions were the leading lesion sites. After multivariable logistic regression analysis, a number of baths less than once daily (adjusted odds ratio (aOR) 11.23, 95% CI: 2.10-60.06; p=0.005) and a number of laundries less than once weekly (aOR 16.27, 95% CI: 4.21-62.84; p<0.0001) were the independent factors impacting scabies occurrence. Conclusion: HS is highly prevalent at the MPP, driven by poor personal hygiene alongside a probable lack of health care. Prisoners should be counselled on healthy (personal) hygiene rules, and encouraged to adopt such habits; all necessary means should be made available accordingly.

Erratum to: ‘Setting performance-based financing in the health sector agenda: a case study in Cameroon’

1. We should note that apart from Rwanda, many other countries in Sub-Saharan Africa like Burundi, Democratic Republic of the Congo, Tanzania and Zambia were implementing or adopting PBF approach, and were seen as “flagship countries” [2] or innovators in such reforms. 2. In other words, transnational advocates positioned the PBF policy as a “South-South learning” [3] process open to all countries willing to embark on it. 3. Our findings show that this global player generated the interest of national health officials and shaped the degree to which performance-based financing emerged on the national policy agenda through numerous forms of influence, each identified in previous research on agenda setting [4–9] and have been conceptualized by Gautier [2]. 4. The first form of influence was financial [2]. 5. The second form of influence refers to ideation [2]. 6. Finally, the officials from theWorld Bank relied on “network-” [2] and “knowledge-based” [2] forms of influence [9].

Atopic Dermatitis in Cameroon: Quality of Life and Psychiatric Comorbidities among Affected Children and Adolescents Running Head: Atopic Dermatitis and Psychiatric Impairments

Background: The dearth of Cameroonian data on the quality of life (QoL) of patients with atopic dermatitis (AD) prompted this study which aimed to assess the impact of AD on QoL of affected children and adolescents as well as their families, and seek existence of psychiatric comorbidity (depression and anxiety). Methods: We conducted a cross-sectional study from February to May 2015 in Yaounde, Cameroon. Patients aged 0-16 years, diagnosed with AD by a dermatologist, and whose parents/guardians had given consent were included. Standardized scores and scales were used to assess the severity of the disease, the QoL of patients and families, as well as the presence of depression or anxiety. Results: A total of 53 children were recruited. The median age was 60 months. There were 23 cases of severe AD, 21 of moderate AD and 9 of mild AD. QoL was impaired in 94.3% of cases, moderate in 20 subjects, high in 8 patients and extreme in 2 patients. QoL of the family was impaired in 88.7% of cases, moderate in 16 and high in 7 families. The higher the severity of AD, the more QoL of patients was impaired (r=0,475; p<0.0001), as well as that of families (r=0,365; p=0.007). Alteration in patients’ QoL was linked with that of families (r=0.527; p<0.0001). There were 5 teenagers with mild depression, 2 with mild anxiety, and 1 with moderate anxiety. Conclusion: AD alters the QoL of children and their families.

Profil épidémio-clinique des atteintes dermatologiques chez le noir africain en hémodialyse chronique

INTRODUCTION Dermatologic manifestations are common among patients on chronic hemodialysis and may represent systemic involvement. Our study aims to determine the epidemiological and clinical profile of skin damages in black patients living in Yaounde, Cameroon. METHODS We conducted a cross sectional study including all patients receiving chronic haemodialysis treatment for at least 3 months in two hemodialysis centers in Yaounde from February to May 2014. Patients underwent an interview and a dermatological examination. Chi-squared tests and Students t-test (or equivalents) were used for statistical analysis, with significance level at p <0.05. RESULTS A total of 112 patients (78 (69.9%) men) with an average age of 48.6 ± 13 years and a mean duration of dialysis of 46,3 ± 37 months were included in the study. Skin lesions were present in 94 (83.9%) patients. Xerosis (63.3%), pruritus (37.5%), melanoderma (34.8%), acne (12.5%) and half and half nails (10.7%) were the most common dermatologic manifestations. Xerosis was associated with anuria (p = 0.0001) and advanced age (p = 0.032); melanoderma was associated with anuria (p = 0.042) and time spent on dialysis (p = 0.027) while half and half nails were associated with young age (p = 0.018) and biweekly dialysis (p = 0.01 ). CONCLUSION Skin damages are frequent and dominated by xerosis, pruritus and melanoderma in patients on chronic hemodialysis living in Yaounde. Biweekly dialysis, advanced age, anuria and time spent on dialysis were associated factors.Introduction Les manifestations dermatologiques sont fréquentes chez les hémodialysés chroniques et traduiraient une atteinte systémique. Notre objectif était de déterminer le profil épidémio-clinique sur peau noire à Yaoundé au Cameroun. Méthodes Il s’agissait d’une étude transversale, menée de Février à Mai 2014 dans les deux centres d’hémodialyse de Yaoundé, incluant tout hémodialysé chronique depuis au moins 3 mois, et chez qui étaient conduits un interrogatoire et un examen dermatologique. Les tests de Chi carré et t de Student (ou équivalents) ont été utilisés pour l’analyse statistique, avec le seuil de signification fixé à p<0,05. Résultats Au total, 112 patients (dont 78 (69,9%) hommes) d’un âge moyen de 48,6 ± 13 ans et une durée moyenne en dialyse de 46,3 ± 37 mois étaient recrutés. Les lésions dermatologiques étaient présentes chez 94 (83,9%) patients. La xérose cutanée (63,3%), le prurit (37,5%), la mélanodermie (34,8%), l’acné (12,5%) et les ongles équi-segmentés (10,7%) étaient les principales manifestations dermatologiques. La xérose était associée à l’anurie (p=0,0001) et à l’âge avancé (p=0,032) ; la mélanodermie à l’anurie (p=0,042) et à l’ancienneté en dialyse (p=0,027) alors que les ongles équi-segmentés étaient associés au jeune âge (p=0,018) et aux dialyses bihebdomadaires (p=0,01). Conclusion Les atteintes dermatologiques sont fréquentes et dominées par la xérose, le prurit et la mélanodermie chez l’hémodialysé chronique à Yaoundé. La sous dialyse, l’âge avancé, l’anurie et l’ancienneté en dialyse étaient les facteurs associés.