Marjolein Dieleman

• Research article

In 1993, WHO declared tuberculosis (TB) as a global health emergency considering 10 million people are battling TB, of which 30% are undiagnosed annually. In 2020 the COVID-19 pandemic took an unprecedented toll on health systems in every country. Public health staff already engaged in TB control and numerous other departments were additionally tasked with […]

• Research article

Conflict has devastating effects on health systems, especially on healthcare workers (HCWs) working in under-resourced and hostile environments. However, little evidence is available on how policy-makers, often together with development partners, can optimize the organization of the health workforce and support HCWs to deliver accessible and trustworthy health services in conflict-affected settings (CAS). A scoping […]

• Research article

a case study of community health committees in Kenya. Community Health Committees (CHCs) are mechanisms through which communities participate in the governance and oversight of community health services. While there is renewed interest in strengthening community participation in the governance of community health services, there is limited evidence on how context influences community-level structures of […]

• Research article

The need to scale up public health interventions in low- and middle-income countries to ensure equitable and sustainable impact is widely acknowledged. However, there has been little understanding of how projects have sought to address the importance of scale-up in the design and implementation of their initiatives. This paper aims to gain insight into the […]

• Research article

Since 2017, PERFORM2Scale, a research consortium with partners from seven countries in Africa and Europe, has steered the implementation and scale-up of a district-level health management strengthening intervention in Ghana, Malawi and Uganda. This article presents PERFORM2Scale’s theory of change (ToC) and reflections upon and adaptations of the ToC over time. The article aims to […]

• Research article

The scale-up of successfully tested public health interventions is critical to achieving universal health coverage. To ensure optimal use of resources, assessment of the scalability of an intervention is recognized as a crucial step in the scale-up process. This study assessed the scalability of a tested health management-strengthening intervention (MSI) at the district level in […]

The evaluation of the PERFORM project demonstrated that a management strengthening intervention was effective in enabling district-level, health management teams to improve health district management based on local evidence, solve workforce performance problems and improve service delivery. The Perform2Scale programme scaled-up this intervention in Malawi, Ghana and Uganda. This final synthesis report: Brings together the […]

• Research article

Health committees are key mechanisms for enabling participation of community members in decision-making on matters related to their health. This paper aims to establish an in-depth understanding of how community members participate in primary health care through health committees in sub-Saharan Africa

This study explores how district-level health system decision-making is shaped by power dynamics in different decentralised contexts in Ghana, Malawi and Uganda.

Promoting mental health and well-being and treating mental, neurologic and substance use conditions has a positive impact on individuals and societies and is essential to ensure good health and well-being and to contribute towards sustainable development. This brief elaborates upon key concepts in relation to mental health and psychosocial support, the global priorities on mental […]

Promoting mental health and well-being and treating mental, neurologic and substance use conditions has a positive impact on individuals and societies and is essential to ensure good health and well-being and contribute to sustainable development. This report elaborates upon key concepts in relation to mental health and psychosocial support, the global priorities on mental health, […]

To achieve universal health coverage, the scale-up of high impact public health interventions is essential. However, scale-up is challenging and often not successful. Therefore, a systematic review was conducted to provide insights into the factors influencing the scale-up of public health interventions in low- and middle-income countries (LMICs). Two databases were searched for studies with […]

Le Ministère de la Santé de Burkina Faso et ses partenaires techniques et financiers se sont engagés à mettre en œuvre le Plan National de Développement Sanitaire (PNDS) 2011-2020 avec le but de contribuer à l’amélioration de la performance du système de santé et à la prestation de soins de santé de qualité. Les objectifs […]

How Health Worker Motivation and Performance in Results-Based Financing Arrangements Hinges on Strong and Adaptive Health Systems This paper presents findings from a study which sought to understand why health workers working under the results-based financing (RBF) arrangements in Zimbabwe reported being satisfied with the improvements in working conditions and compensation, but paradoxically reported lower […]

We developed and piloted a methodology to establish TB related work load at primary care level for clinical and laboratory staff. Workload is influenced by activities to be implemented, time to perform them, their frequency and patient load. Of particular importance is the patient pathway for diagnosis and treatment and the frequency of clinic visits. […]

Policy-makers in every country are faced with the significant challenge of meeting the health needs of their populations, including the especially vulnerable communities in remote and rural areas. In order to ensure the equitable delivery of health services in these areas, skilled and motivated health workers need to be in the right place at the […]

South Sudan has one of the worst health and maternal health situations in the world. Across South Sudan, while maternal health services at the primary care level are not well developed, even where they exist, many women do not use them. Developing location specific understanding of what hinders women from using services is key to […]

“At the health centres, you are asked many questions like: ‘Have you given birth, what is your age, whom do you live with, are you in your menses…?” a respondent said. “But in the chemist, you are injected without questions,” another said. And yet another respondent said: “In chemists it is business.” “You only say […]

Community health workers (CHWs) are increasingly recognized as an integral component of the health workforce needed to achieve public health goals in lowand middle-income countries (LMICs). Many factors influence CHW performance. A systematic review was conducted to identify intervention design related factors influencing performance of CHWs. We systematically searched six databases for quantitative and qualitative […]

Community health workers (CHWs) are increasingly recognized as an integral component of the health workforce needed to achieve public health goals in low- and middle-income countries (LMICs). Many factors intersect to influence CHW performance. A systematic review with a narrative analysis was conducted to identify contextual factors influencing performance of CHWs.

Health extension workers (HEWs) in Ethiopia have a unique position, connecting communities to the health sector. This intermediary position requires strong interpersonal relationships with actors in both the community and health sector, in order to enhance HEW performance. This study aimed to understand how relationships between HEWs, the community and health sector were shaped, in […]

This study sought to synthesize and critically review evidence on costs and cost-effectiveness of community health worker (CHW) programmes in low- and middle-income countries (LMICs) to inform policy dialogue around their role in health systems.

There is increasing global interest in how best to support the role of community health workers (CHWs) in building bridges between communities and the health sector. CHWs’ intermediary position means that interpersonal relationships are an important factor shaping CHW performance. This study aimed to obtain in-depth insight into the facilitators of and barriers to interpersonal […]

With a maternal mortality ratio of 789 per 100,000 live births, and a contraceptive prevalence rate of 4.7%, South Sudan has one of the worst reproductive health situations in the world. Understanding the social norms around sexuality and reproduction, across different ethnic groups, is key to developing and implementing locally appropriate public health responses.

In South Sudan, women disproportionately bear the burden of morbidity and mortality related to sexual and reproductive health, with a maternal mortality ratio of 789 deaths per 100,000 live births. A qualitative study was conducted to analyze how gendered social relations among the Fertit people affect women’s ability to exercise control over their reproductive lives […]

• Report

Health systems are social institutions, in which health worker performance is shaped by transactional processes between different actors. This analytical assessment unravels the complex web of factors that influence the performance of community health workers (CHWs) in low- and middle-income countries. It examines their unique intermediary position between the communities they serve and actors in […]

Through the WHO European Region’s Health 2020 policy framework, countries agreed to work together on policy priorities for public health such as strengthening people-centred public health systems and public health capacity. Alongside the Health 2020 strategy, the seventh of the 10 essential public health operations devised by the WHO Regional Office for Europe focuses on […]

• Research article

With a maternal mortality ratio of 789 per 100,000 live births, and a contraceptive prevalence rate of 4.7%, South Sudan has one of the worst reproductive health situations in the world. Understanding the social norms around sexuality and reproduction, across different ethnic groups, is key to developing and implementing locally appropriate public health responses.

In South Sudan, women disproportionately bear the burden of morbidity and mortality related to sexual and reproductive health, with a maternal mortality ratio of 789 deaths per 100,000 live births

A key constraint to saturating coverage of interventions for reducing the burden of childhood illnesses in Low and Middle Income Countries (LMIC) is the lack of human resources. Community health workers (CHW) are potentially important actors in bridging this gap. Evidence exists on effectiveness of CHW in management of some childhood illnesses (IMCI). However, we […]

This study sought to synthesize and critically review evidence on costs and cost-effectiveness of community health worker (CHW) programmes in low- and middle-income countries (LMICs) to inform policy dialogue around their role in health systems.

Health extension workers (HEWs) in Ethiopia have a unique position, connecting communities to the health sector. This intermediary position requires strong interpersonal relationships with actors in both the community and health sector, in order to enhance HEW performance. This study aimed to understand how relationships between HEWs, the community and health sector were shaped, in […]

The Democratic Republic of the Congo is one of the countries in Sub-Saharan Africa with the highest maternal mortality ratio estimated at 846 deaths per 100,000 live births. Innovative strategies such as social accountability are needed to improve both health service delivery and utilization. Indeed, social accountability is a form of citizen engagement defined as […]

• Research article

Community health workers (CHWs) are increasingly recognized as an integral component of the health workforce needed to achieve public health goals in lowand middle-income countries (LMICs). Many factors influence CHW performance. A systematic review was conducted to identify intervention design related factors influencing performance of CHWs. We systematically searched six databases for quantitative and qualitative […]

• Research article

Community health workers (CHWs) are increasingly recognized as an integral component of the health workforce needed to achieve public health goals in low- and middle-income countries (LMICs). Many factors intersect to influence CHW performance. A systematic review with a narrative analysis was conducted to identify contextual factors influencing performance of CHWs.

• Research article

Many European countries are faced with health workforce shortages and the need to develop effective recruitment and retention (R&R) strategies. Yet comparative studies on R&R in Europe are scarce. This paper provides an overview of the measures in place to improve the R&R of health professionals across Europe and offers further insight into the evidence […]

• Research article

The aim of the present study is to assess the cost–effectiveness of community-based practitioner programmes with different design features across three countries – Ethiopia, Indonesia and Kenya – in which these initiatives have been implemented to scale.

• Research article

A motivated and qualified workforce is crucial to increase the productivity and quality of health services in order to contribute to achieving health services targets. Priority programmes have a stake in a skilled and motivated workforce, as they are implemented primarily by a health facility’s existing health staff. Motivation in the work context is defined […]

Disease- or health-determinant specific programmes are important components of any health agenda. Such programmes respond to specific health threats, whether perceived or real. They are set up because the control of these threats requires a focused approach and interventions. In Low-Income Countries (LICs), however, most of these programmes fall short of their ambition because, for […]

• Research article

Many Ministries of Health are trying to improve the functioning of their health care system by introducing changes in resource allocation, better management and changes in the role of the government, such as more responsibility at lower levels through decentralisation. A prerequisite of a well-functioning system is a well-motivated workforce. The Ministry of Health in […]

• Research article

A comparative analysis of factors shaping relationships in four countries Community health workers (CHWs) have a unique position between communities and the health sector. The strength of CHWs’ relationships with both sides influences their motivation and performance. This qualitative comparative study aimed at understanding similarities and differences in how relationships between CHWs, communities and the […]