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Papers by Ephraim Chiriseri

BMC Nursing

Background Non-communicable diseases (NCDs) contribute significantly to the global disease burden... more Background Non-communicable diseases (NCDs) contribute significantly to the global disease burden, with low-and middle-income (LMICs) countries disproportionately affected. A significant knowledge gap in NCDs exacerbates the high burden, worsened by perennial health system challenges, including human and financial resources constraints. Primary health care workers play a crucial role in offering health care to most people in LMICs, and their views on the barriers to the provision of quality care for NCDs are critical. This study explored perceived barriers to providing NCDs care in primary health care facilities in Zimbabwe. Methods In-depth, individual semi-structured interviews were conducted with general nurses in primary care facilities until data saturation was reached. We focused on diabetes, hypertension, and depression, the three most common conditions in primary care in Zimbabwe. We used thematic content analysis based on an interview guide developed following a situational...

Evidence Based Mental Health, 2021

BackgroundTask-sharing treatment approaches offer a pragmatic approach to treating common mental ... more BackgroundTask-sharing treatment approaches offer a pragmatic approach to treating common mental disorders in low-income and middle-income countries (LMICs). The Friendship Bench (FB), developed in Zimbabwe with increasing adoption in other LMICs, is one example of this type of treatment model using lay health workers (LHWs) to deliver treatment.ObjectiveTo consider the level of treatment coverage required for a recent scale-up of the FB in Zimbabwe to be considered cost-effective.MethodsA modelling-based deterministic threshold analysis conducted within a ‘cost-utility’ framework using a recommended cost-effectiveness threshold.FindingsThe FB would need to treat an additional 3413 service users (10 per active LHW per year) for its scale-up to be considered cost-effective. This assumes a level of treatment effect observed under clinical trial conditions. The associated incremental cost-effectiveness ratio was $191 per year lived with disability avoided, assuming treatment coverage l...

BMJ Open, 2021

IntroductionCommon mental disorders (CMDs) are a leading cause of disability globally. CMDs are h... more IntroductionCommon mental disorders (CMDs) are a leading cause of disability globally. CMDs are highly prevalent in Zimbabwe and have been addressed by an evidence-based, task-shifting psychological intervention called the Friendship Bench (FB). The task-shifted FB programme guides clients through problem-solving therapy. It was scaled up across 36 implementation sites in Zimbabwe in 2016.Methods and analysisThis study will employ a mixed-method framework. It aims to: (1) use quantitative survey methodologies organised around the Reach, Effectiveness, Adoption and Implementation and Maintenance evaluation framework to assess the current scaleup of the FB intervention and classify 36 clinics according to levels of performance; (2) use qualitative focus group discussions and semistructured interviews organised around the Consolidated Framework for Implementation Research to analyse determinants of implementation success, as well as elucidate heterogeneity in implementation strategies ...

BMC Health Services Research, 2021

Background Non-communicable diseases (NCDs) are projected to become the leading cause of disabili... more Background Non-communicable diseases (NCDs) are projected to become the leading cause of disability and mortality in sub-Saharan Africa by 2030; a vast treatment gap exists. There is a dearth of knowledge on developing evidence-based interventions that address comorbid NCDs using a task-shifting approach. The Friendship Bench, a brief psychological intervention for common mental disorders delivered by trained community grandmothers, is a promising intervention for comorbid NCDs. Although task-shifting appears to be a rational approach, evidence suggests that it may bring about tension between existing professionals from whom tasks are shifted. A Theory of Change approach is an effective way of managing the unintended tension by bringing together different stakeholders involved to build consensus on how to task shift appropriately to the parties involved. We aimed to use a theory of change approach to formulating a road map on how to successfully integrate diabetes and hypertension c...

Health Promotion International, 2018

Summary Implementation of the Ebola response was credited with reducing incidence of Ebola virus ... more Summary Implementation of the Ebola response was credited with reducing incidence of Ebola virus disease (EVD) in West Africa; however little is known about the amount and kind of Ebola response activities that were ultimately successful in addressing the 2014 outbreak. We collaboratively monitored Ebola response activities and associated effects in Margibi County, Liberia, a rural county in Liberia deeply affected by the outbreak. We used a participatory monitoring and evaluation system, including key informant interviews and document review, to systematically document activities, code them, characterize their contextual features, and discover and communicate patterns in Ebola response activities to essential stakeholders. We also measured incidence of EVD over time. Results showed a distinct pattern in Ebola response activities and key events, which corresponded with subsequent decreased EVD incidence. These data are suggestive of the role of Ebola response activities played in re...

Journal of Community Health, 2017

Journal of Humanities and Social Sciences

In the context of an evolving domain and the complexity globalization adds to the situation, heal... more In the context of an evolving domain and the complexity globalization adds to the situation, health promotion practice in Southeast Asia face challenges posed by the growing gaps between practice needs, human resource development needs, and educational program development needs. One of the challenges is how to foster a much needed paradigm shift among those responsible for workforce production in health promotion. In this paper, we provide practical proposals for action that provide leverage in thinking differently about health promotion practice. These proposals reflect the authors’ perspectives and experiences in competencies relevant to health promotion key action areas: empowerment, health services, partnerships and alliances, environments, and health and policy. We first describe the developments in the health promotion domain; summarize competency frameworks for health promotion; to arrive at a comparison of Southeast Asia education programs for health promotion with programs ...

International Quarterly of Community Health Education, 2019

To address the Ebola outbreak in West Africa, the World Health Organization and the United Nation... more To address the Ebola outbreak in West Africa, the World Health Organization and the United Nations Children’s Fund led a multilevel and multisectoral intervention known as the Ebola response effort. Although surveillance systems were able to detect reduction in Ebola incidence, there was little understanding of the implemented activities within affected areas. To address this gap, this empirical case study examined (a) implementation of Ebola response activities and associated bending the curve of incidence of Ebola virus disease and (b) candidate factors associated with fuller implementation of the Ebola response effort. A mix of qualitative and quantitative methods were used to address these questions. A participatory monitoring and evaluation system was used to capture, code, characterize, and communicate nearly a hundred Ebola response activities implemented in Lofa County, a highly affected area in Liberia. The Ebola response effort was enabled by community engagement and colla...

Research on Humanities and Social Sciences, 2012

In the context of an evolving domain and the complexity globalization adds to the situation, heal... more In the context of an evolving domain and the complexity globalization adds to the situation, health promotion practice in Southeast Asia face challenges posed by the growing gaps between practice needs, human resource development needs, and educational program development needs. One of the challenges is how to foster a much needed paradigm shift among those responsible for workforce production in health promotion. In this paper, we provide practical proposals for action that provide leverage in thinking differently about health promotion practice. These proposals reflect the authors' perspectives and experiences in competencies relevant to health promotion key action areas: empowerment, health services, partnerships and alliances, environments, and health and policy. We first describe the developments in the health promotion domain; summarize competency frameworks for health promotion; to arrive at a comparison of Southeast Asia education programs for health promotion with programs in socio-economic advanced regions. We suggest proposals on the way forward aimed at fueling the required paradigm shift in capacity building for health promotion in Southeast Asia; and conclude by considering the role national and international alliances can play in implementing these proposals and improving workforce production for health promotion in Southeast Asia.

BMC Nursing

Background Non-communicable diseases (NCDs) contribute significantly to the global disease burden... more Background Non-communicable diseases (NCDs) contribute significantly to the global disease burden, with low-and middle-income (LMICs) countries disproportionately affected. A significant knowledge gap in NCDs exacerbates the high burden, worsened by perennial health system challenges, including human and financial resources constraints. Primary health care workers play a crucial role in offering health care to most people in LMICs, and their views on the barriers to the provision of quality care for NCDs are critical. This study explored perceived barriers to providing NCDs care in primary health care facilities in Zimbabwe. Methods In-depth, individual semi-structured interviews were conducted with general nurses in primary care facilities until data saturation was reached. We focused on diabetes, hypertension, and depression, the three most common conditions in primary care in Zimbabwe. We used thematic content analysis based on an interview guide developed following a situational...

Evidence Based Mental Health, 2021

BackgroundTask-sharing treatment approaches offer a pragmatic approach to treating common mental ... more BackgroundTask-sharing treatment approaches offer a pragmatic approach to treating common mental disorders in low-income and middle-income countries (LMICs). The Friendship Bench (FB), developed in Zimbabwe with increasing adoption in other LMICs, is one example of this type of treatment model using lay health workers (LHWs) to deliver treatment.ObjectiveTo consider the level of treatment coverage required for a recent scale-up of the FB in Zimbabwe to be considered cost-effective.MethodsA modelling-based deterministic threshold analysis conducted within a ‘cost-utility’ framework using a recommended cost-effectiveness threshold.FindingsThe FB would need to treat an additional 3413 service users (10 per active LHW per year) for its scale-up to be considered cost-effective. This assumes a level of treatment effect observed under clinical trial conditions. The associated incremental cost-effectiveness ratio was $191 per year lived with disability avoided, assuming treatment coverage l...

BMJ Open, 2021

IntroductionCommon mental disorders (CMDs) are a leading cause of disability globally. CMDs are h... more IntroductionCommon mental disorders (CMDs) are a leading cause of disability globally. CMDs are highly prevalent in Zimbabwe and have been addressed by an evidence-based, task-shifting psychological intervention called the Friendship Bench (FB). The task-shifted FB programme guides clients through problem-solving therapy. It was scaled up across 36 implementation sites in Zimbabwe in 2016.Methods and analysisThis study will employ a mixed-method framework. It aims to: (1) use quantitative survey methodologies organised around the Reach, Effectiveness, Adoption and Implementation and Maintenance evaluation framework to assess the current scaleup of the FB intervention and classify 36 clinics according to levels of performance; (2) use qualitative focus group discussions and semistructured interviews organised around the Consolidated Framework for Implementation Research to analyse determinants of implementation success, as well as elucidate heterogeneity in implementation strategies ...

BMC Health Services Research, 2021

Background Non-communicable diseases (NCDs) are projected to become the leading cause of disabili... more Background Non-communicable diseases (NCDs) are projected to become the leading cause of disability and mortality in sub-Saharan Africa by 2030; a vast treatment gap exists. There is a dearth of knowledge on developing evidence-based interventions that address comorbid NCDs using a task-shifting approach. The Friendship Bench, a brief psychological intervention for common mental disorders delivered by trained community grandmothers, is a promising intervention for comorbid NCDs. Although task-shifting appears to be a rational approach, evidence suggests that it may bring about tension between existing professionals from whom tasks are shifted. A Theory of Change approach is an effective way of managing the unintended tension by bringing together different stakeholders involved to build consensus on how to task shift appropriately to the parties involved. We aimed to use a theory of change approach to formulating a road map on how to successfully integrate diabetes and hypertension c...

Health Promotion International, 2018

Summary Implementation of the Ebola response was credited with reducing incidence of Ebola virus ... more Summary Implementation of the Ebola response was credited with reducing incidence of Ebola virus disease (EVD) in West Africa; however little is known about the amount and kind of Ebola response activities that were ultimately successful in addressing the 2014 outbreak. We collaboratively monitored Ebola response activities and associated effects in Margibi County, Liberia, a rural county in Liberia deeply affected by the outbreak. We used a participatory monitoring and evaluation system, including key informant interviews and document review, to systematically document activities, code them, characterize their contextual features, and discover and communicate patterns in Ebola response activities to essential stakeholders. We also measured incidence of EVD over time. Results showed a distinct pattern in Ebola response activities and key events, which corresponded with subsequent decreased EVD incidence. These data are suggestive of the role of Ebola response activities played in re...

Journal of Community Health, 2017

Journal of Humanities and Social Sciences

In the context of an evolving domain and the complexity globalization adds to the situation, heal... more In the context of an evolving domain and the complexity globalization adds to the situation, health promotion practice in Southeast Asia face challenges posed by the growing gaps between practice needs, human resource development needs, and educational program development needs. One of the challenges is how to foster a much needed paradigm shift among those responsible for workforce production in health promotion. In this paper, we provide practical proposals for action that provide leverage in thinking differently about health promotion practice. These proposals reflect the authors’ perspectives and experiences in competencies relevant to health promotion key action areas: empowerment, health services, partnerships and alliances, environments, and health and policy. We first describe the developments in the health promotion domain; summarize competency frameworks for health promotion; to arrive at a comparison of Southeast Asia education programs for health promotion with programs ...

International Quarterly of Community Health Education, 2019

To address the Ebola outbreak in West Africa, the World Health Organization and the United Nation... more To address the Ebola outbreak in West Africa, the World Health Organization and the United Nations Children’s Fund led a multilevel and multisectoral intervention known as the Ebola response effort. Although surveillance systems were able to detect reduction in Ebola incidence, there was little understanding of the implemented activities within affected areas. To address this gap, this empirical case study examined (a) implementation of Ebola response activities and associated bending the curve of incidence of Ebola virus disease and (b) candidate factors associated with fuller implementation of the Ebola response effort. A mix of qualitative and quantitative methods were used to address these questions. A participatory monitoring and evaluation system was used to capture, code, characterize, and communicate nearly a hundred Ebola response activities implemented in Lofa County, a highly affected area in Liberia. The Ebola response effort was enabled by community engagement and colla...

Research on Humanities and Social Sciences, 2012

In the context of an evolving domain and the complexity globalization adds to the situation, heal... more In the context of an evolving domain and the complexity globalization adds to the situation, health promotion practice in Southeast Asia face challenges posed by the growing gaps between practice needs, human resource development needs, and educational program development needs. One of the challenges is how to foster a much needed paradigm shift among those responsible for workforce production in health promotion. In this paper, we provide practical proposals for action that provide leverage in thinking differently about health promotion practice. These proposals reflect the authors' perspectives and experiences in competencies relevant to health promotion key action areas: empowerment, health services, partnerships and alliances, environments, and health and policy. We first describe the developments in the health promotion domain; summarize competency frameworks for health promotion; to arrive at a comparison of Southeast Asia education programs for health promotion with programs in socio-economic advanced regions. We suggest proposals on the way forward aimed at fueling the required paradigm shift in capacity building for health promotion in Southeast Asia; and conclude by considering the role national and international alliances can play in implementing these proposals and improving workforce production for health promotion in Southeast Asia.