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Factors affecting the performance of maternal health care providers in Armenia
– Reported, January 22, 2013
Over the last five years, international development organizations began to modify and adapt the conventional Performance Improvement Model for use in low-resource settings. This model outlines the five key factors believed to influence performance outcomes: job expectations, performance feedback, environment and tools, motivation and incentives, and knowledge and skills. Each of these factors should be supplied by the organization in which the provider works, and thus, organizational support is considered as an overarching element for analysis. Little research, domestically or internationally, has been conducted on the actual effects of each of the factors on performance outcomes and most PI practitioners assume that all the factors are needed in order for performance to improve. This study presents a unique exploration of how the factors, individually as well as in combination, affect the performance of primary reproductive health providers (nurse-midwives) in two regions of Armenia.
The multivariate analysis showed that (a) training in the use of the clinic tools; and (b) receiving recognition from the employer or the client/community, are factors strongly associated with performance, followed by (c) receiving performance feedback in postpartum care. Other extraneous variables such as the facility type (antenatal care) and whether observation was on simulated vs. real patients (postpartum care) also had a role in observed performance.
Furthermore, there is a perceived loss of complexity within the provider-client interaction when a “hypothetical client” is used in lieu of a normal client, as was used in some of the data collection. Case simulation might not replicate entirely the quality and completeness of the normal exchange occurring during direct observation of a provider with a real client, thus producing lower performance scores and possibly affecting the appearance of performance factors in unknown ways [17]. However, once again, “hypothetical clients” have been widely recognized as a reliable and systematic way to assess technical competency when other alternatives are not viable due to low case load for years [18]. In our case, though unavoidable, differences did appear in our measures of performance for postpartum care between real and hypothetical scenarios.
CREDITS:
http://www.ncbi.nlm.nih.gov/
Alfredo L Fort1 and Lauren Voltero2
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