Health Staff's knowledge attitude and practice of the health reforms: a comparative study
Date
2012-08-10
Authors
Sakungo, Kutemba Beatrice
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Abstract
Objective: The objective was to determine whether the health staff understand what the health reforms are all about and whether they have accepted them and are practising in line with which has been stipulated in the guidelines.Design: This was a descriptive comparative study which compared the urban and rural provinces to ascertain the relationships between staffs" knowledge, attitude and practice of th health reforms.
Setting: The study was earned out in the Northwestern and Copper belt Provinces of Zambia: A total of ten Health Institutions were studied and these comprised of Government hospitals. Mission Hospitals and Health centres.Subjects: A total of 238 health workers were studied and these comprised 15 Doctors, 147 Nurses, 41 Paramedical and 35 Clerks and Cashiers.
Sampling Method: A stratified sampling method was used for the Provinces and Districts as well as Health Institutions where pieces of paper with names written and randomly picked were used. Health staff were sampled randomly using a sampling frame. Proportions of the various cadres were got by using the sampling fraction of f= n/N.
Results: The study reveals that there is poor dissemination of infomation from top to the bottom line and is concentrated more in the rural areas than urban. This has also affected all staff cadres with at least 32% and 28% of the 238 rating it as being very poor and poor respectively. This poor dissemination of infomation has been attributed to the use of ineffective channels of communication namely radio, TV., news papers/bulletins, poor road networks and poor postal services. The supervisor, seminar/workshop and circular channels proved to be effective with the majority of those who used them supporting the reforms. Unfortunately, these channels are underutilised.The attitude of staff varied with circumstances, like things that affect their work directly e.g. fear of added responsibility (52%) and being answerable to patients (39%) brought about a bad attitude towards the reforms and lack of support for the reforms.The introduction of user fees however was associated with improved supply of drugs, working environment, implementation of programmes and not salaries and bonuses, showing a positive
attitude in this area. Majority(76%) did not have guidelines hence felt insecure about their practice. Nevertheless, majority did seem to understand the exemption policy with for example only 16 out of 148 saying they charged underlives.Even though there is poor dissemination of infomation, most of the staff know that the reforms are about decentralisation of power to the Distiicts, Community/Private sector participation in the provision of health care and that the introduction of fees is to improve health services.Conclusion: Even though the staff feel that dissemination of information is poor, they do understand some areas of the reforms quite well. Their attitude did vary and the practice is good for the majority. But it is evident that guidelines and supervisor ,seminar/workshop communication is very important in improving the understanding of staff. However more educational work is needed to cover those who still lack knowledge and whose attitude and practice is still bad especially in the rural province which seem to be marginalized in all areas of reform infomation.
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Keywords
Medical Personnel -- Zambia , Public Health Personnel -- Zambia , Health Care Reform -- Zambia