Neil thank you for sharing this study. [https://human-resources-health.biomedcentral.com/articles/10.1186/s12960...
In our centre we read it with interest having just begone activities to reactivate the 12-Pillar Clinical Governance programme in states where we had implemented it with great success during the last 16 years. We are finding that chronic inadequacies (fragility of systems especially the Human resource) make sustainability of health improvement programmes herculean tasks, whether you are looking at CHWs (and in Nigeria as we stated before CHWs are mostly skilled with criteria of selection, curriculum of training and certification, career path to retirement, pension, etc), or other cadres who are traditionally described as skilled (doctors, nurses, midwives, pharmacists, etc). Or whether you are looking at facility readiness (equipment, tests, utilities like water and electricity, sanitation etc). Chronic shortages, poor pay and general disillusion in society affects performance of all cadres including CHWs.
We look forward to sharing our experience in future with members, even as we are appreciative of the Governments that realised that the system had gone back to harmful failures like in the past and trusted us by re-inviting us to re-jig the system again.
HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: www.hriwestafrica.com Joseph is a member of the HIFA Steering Group and the HIFA working group on Community Health Workers.
Email: jneana AT yahoo.co.uk