scholarly journals Uganda’s “EID Systems Strengthening” model produces significant gains in testing, linkage, and retention of HIV-exposed and infected infants: An impact evaluation

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246546
Author(s):  
Charles Kiyaga ◽  
Vijay Narayan ◽  
Ian McConnell ◽  
Peter Elyanu ◽  
Linda Nabitaka Kisaakye ◽  
...  
Keyword(s):  
Health Worker ◽  
Health Workers ◽  
Clinical Care ◽  
Implementation Fidelity ◽  
Facility Management ◽  
Health Facilities ◽  
Qualitative Assessment ◽  
Study Cohort ◽  
Cross Sectional ◽  
Hiv Exposed

Introduction A review of Uganda’s HIV Early Infant Diagnosis (EID) program in 2010 revealed poor retention outcomes for HIV-exposed infants (HEI) after testing. The review informed development of the ‘EID Systems Strengthening’ model: a set of integrated initiatives at health facilities to improve testing, retention, and clinical care of HIV-exposed and infected infants. The program model was piloted at several facilities and later scaled countrywide. This mixed-methods study evaluates the program’s impact and assesses its implementation. Methods We conducted a retrospective cohort study at 12 health facilities in Uganda, comprising all HEI tested by DNA PCR from June 2011 to May 2014 (n = 707). Cohort data were collected manually at the health facilities and analyzed. To assess impact, retention outcomes were statistically compared to the baseline study’s cohort outcomes. We conducted a cross-sectional qualitative assessment of program implementation through 1) structured clinic observation and 2) key informant interviews with health workers, district officials, NGO technical managers, and EID trainers (n = 51). Results The evaluation cohort comprised 707 HEI (67 HIV+). The baseline study cohort contained 1268 HEI (244 HIV+). Among infants testing HIV+, retention in care at an ART clinic increased from 23% (57/244) to 66% (44/67) (p < .0001). Initiation of HIV+ infants on ART increased from 36% (27/75) to 92% (46/50) (p < .0001). HEI receiving 1st PCR results increased from 57% (718/1268) to 73% (518/707) (p < .0001). Among breastfeeding HEI with negative 1st PCR, 55% (192/352) received a confirmatory PCR test, a substantial increase from baseline period. Testing coverage improved significantly: HIV+ pregnant women who brought their infants for testing after birth increased from 18% (67/367) to 52% (175/334) (p < .0001). HEI were tested younger: mean age at DBS test decreased from 6.96 to 4.21 months (p < .0001). Clinical care for HEI was provided more consistently. Implementation fidelity was strong for most program components. The strongest contributory interventions were establishment of ‘EID Care Points’, integration of clinical care, longitudinal patient tracking, and regular health worker mentorship. Gaps included limited follow up of lost infants, inconsistent buy-in/ownership of health facility management, and challenges sustaining health worker motivation. Discussion Uganda’s ‘EID Systems Strengthening’ model has produced significant gains in testing and retention of HEI and HIV+ infants, yet the country still faces major challenges. The 3 core concepts of Uganda’s model are applicable to any country: establish a central service point for HEI, equip it to provide high-quality care and tracking, and develop systems to link HEI to the service point. Uganda’s experience has shown the importance of intensively targeting systemic bottlenecks to HEI retention at facility level, a necessary complement to deploying rapidly scalable technologies and other higher-level initiatives.

scholarly journals A health worker knowledge, attitudes and practices survey of SARS-CoV-2 infection prevention and control in South Africa

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Saiendhra Vasudevan Moodley ◽  
Muzimkhulu Zungu ◽  
Molebogeng Malotle ◽  
Kuku Voyi ◽  
Nico Claassen ◽  
...  
Keyword(s):  
South Africa ◽  
Health Worker ◽  
Prevention And Control ◽  
Infection Prevention ◽  
Health Workers ◽  
Health Facilities ◽  
World Health ◽  
Infection Prevention And Control ◽  
Successful Implementation ◽  
And Control

Abstract Background Health workers are crucial to the successful implementation of infection prevention and control strategies to limit the transmission of SARS-CoV-2 at healthcare facilities. The aim of our study was to determine SARS-CoV-2 infection prevention and control knowledge and attitudes of frontline health workers in four provinces of South Africa as well as explore some elements of health worker and health facility infection prevention and control practices. Methods A cross-sectional study design was utilised. The study population comprised both clinical and non-clinical staff working in casualty departments, outpatient departments, and entrance points of health facilities. A structured self-administered questionnaire was developed using the World Health Organization guidance as the basis for the knowledge questions. COVID-19 protocols were observed during data collection. Results A total of 286 health workers from 47 health facilities at different levels of care participated in the survey. The mean score on the 10 knowledge items was 6.3 (SD = 1.6). Approximately two-thirds of participants (67.4%) answered six or more questions correctly while less than a quarter of all participants (24.1%) managed to score eight or more. A knowledge score of 8 or more was significantly associated with occupational category (being either a medical doctor or nurse), age (< 40 years) and level of hospital (tertiary level). Only half of participants (50.7%) felt adequately prepared to deal with patients with COVD-19 at the time of the survey. The health workers displaying attitudes that would put themselves or others at risk were in the minority. Only 55.6% of participants had received infection prevention and control training. Some participants indicated they did not have access to medical masks (11.8%) and gloves (9.9%) in their departments. Conclusions The attitudes of participants reflected a willingness to engage in appropriate SARS-CoV-2 infection prevention and control practices as well as a commitment to be involved in COVID-19 patient care. Ensuring adequate infection prevention and control training for all staff and universal access to appropriate PPE were identified as key areas that needed to be addressed. Interim and final reports which identified key shortcomings that needed to be addressed were provided to the relevant provincial departments of health.

scholarly journals THE CHILDBIRTH UTILIZATION IN HEALTH FACILITIES IN THE WORKING AREA OF SUNGAI LOKAN PHC TANJUNG JABUNG TIMUR REGENCY: A CROSS SECTIONAL STUDY

NSC Nursing ◽  
2021 ◽  
pp. 20-33
Author(s):  
Lia Artika Sari ◽  
Yuli Suryanti ◽  
Enny Susilawati
Keyword(s):  
Health Center ◽  
Family Support ◽  
Health Workers ◽  
Community Health Center ◽  
Cross Sectional Study ◽  
Health Facilities ◽  
Service Access ◽  
Cross Sectional ◽  
Family Culture ◽  
Work Area

Introduction: The low number of deliveries assisted by midwives or health workers is an indicator of the low utilization of health facilities by mothers in labor. This study analyzes the factors related to the utilization of childbirth in health facilities in the Sungai Lokan Community Health Center Work Area, Tanjung Jabung Timur Regency. Materials and Methods: This research is an analytic observational using a cross-sectional approach involving 74 participants. The research was conducted from January to July 2019 in the Sungai Lokan Health Center Work Area, Tanjung Jabung Timur Regency. Results: The results showed that the factor of the utilization of childbirth in health facilities was related to family culture (p = 0.0001) and family support (p = 0.003), while the service access factor was not related (p = 0.364). Conclusion: The role of health workers in socializing the importance of utilizing health facilities as a place of delivery is significant in reducing maternal mortality Keywords: Health Facilities; Family Culture; Family Support; Access To Services

Factors Influencing Choice of Delivery Place among Mothers in Rukungiri and Kanungu Districts, South Western Uganda: A Cross Sectional Study

2020 ◽  
Author(s):  
Richard Mugambe ◽  
Habib Yakubu ◽  
Solomon Wafula ◽  
Tonny Ssekamatte ◽  
Simon Kasasa ◽  
...  
Keyword(s):  
Health Facility ◽  
Rural Areas ◽  
Health Workers ◽  
Public Health Facility ◽  
Facility Delivery ◽  
Health Facilities ◽  
Public Facility ◽  
Cross Sectional ◽  
Western Uganda ◽  
Delivery Place

Abstract Background: Child birth in health facilities is generally associated with lower risk of maternal and neonatal mortality. However, in Uganda, little is known about factors that influence use of health facilities for delivery especially in rural areas. In this study, we examined the determinants of mothers’ decision of the choice of child delivery place in Western Uganda.Methods: Cross-sectional data was collected from 894 randomly-sampled mothers within the catchment of two private hospitals in Rukungiri and Kanungu districts. Data was collected on the place of delivery for the most recent child, mothers’ sociodemographic characteristics, health facility water, sanitation and hygiene (WASH) status. Modified Poisson regression was used to estimate prevalence ratios (PRs) for the determinants of mothers’ choice of delivery place as well as determinants for the choice of private versus public facility for delivery at 95% confidence intervals. Results: Majority of mothers (90.2%) delivered in health facilities. Non-facility deliveries were attributed to fast progression of labour (77.3%), lack of transport (31.8%) and high cost of hospital delivery (12.5%). Being engaged in business as an occupation [APR = 1.06, 95% CI (1.01 – 1.11)] and belonging to the highest wealth quintile [APR = 1.09, 95% CI (1.02 – 1.17)] favoured facility delivery while higher parity of 3 – 4 [APR = 0.93, 95% CI (0.88 – 0.99)] was inversely associated with facility delivery as compared to parity of 1-2. Choice of private facility over public facility was influenced by how mothers valued factors such as high skilled health workers [APR = 1.15, 95% CI (1.05 – 1.26)], higher quality of WASH services [APR = 1.11, 95% CI (1.04 – 1.17)], cost of the delivery [APR = 0.85, 95% CI (0.78 – 0.92)] and availability of caesarean services [APR = 1.13, 95% CI (1.08 – 1.19)].Conclusion: Utilization of health facility child delivery services was high. Health facility delivery service utilization was influenced by engaging in business, belonging to wealthiest quintile and being multiparous. Choice of private versus public health facility for child delivery was influenced by health facility WASH status, cost of services, and availability of skilled workforce and caesarean services.

scholarly journals Priorities, Barriers, and Facilitators towards International Guidelines for the Delivery of Supportive Clinical Care during an Ebola Outbreak: A Cross-Sectional Survey

Viruses ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. 194 ◽  
Author(s):  
Marie-Claude Battista ◽  
Christine Loignon ◽  
Lynda Benhadj ◽  
Elysee Nouvet ◽  
Srinivas Murthy ◽  
...  
Keyword(s):  
Supportive Care ◽  
Ebola Virus ◽  
Health Workers ◽  
Virus Disease ◽  
Clinical Care ◽  
Barriers And Facilitators ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Treatment Protocols ◽  
Key Stakeholders

During the Ebola outbreak, mortality reduction was attributed to multiple improvements in supportive care delivered in Ebola treatment units (ETUs). We aimed to identify high-priority supportive care measures, as well as perceived barriers and facilitators to their implementation, for patients with Ebola Virus Disease (EVD). We conducted a cross-sectional survey of key stakeholders involved in the response to the 2014–2016 West African EVD outbreak. Out of 57 email invitations, 44 responses were received, and 29 respondents completed the survey. The respondents listed insufficient numbers of health workers (23/29, 79%), improper tools for the documentation of clinical data (n = 22/28, 79%), insufficient material resources (n = 22/29, 76%), and unadapted personal protective equipment (n = 20/28, 71%) as the main barriers to the provision of supportive care in ETUs. Facilitators to the provision of supportive care included team camaraderie (n in agreement = 25/28, 89%), ability to speak the local language (22/28, 79%), and having treatment protocols in place (22/28, 79%). This survey highlights a consensus across various stakeholders involved in the response to the 2014–2016 EVD outbreak on a limited number of high-priority supportive care interventions for clinical practice guidelines. Identified barriers and facilitators further inform the application of guidelines.

scholarly journals Assesssment of Health Facilities for Implementation of Package of Essential Non-communicable Disease in Nepal: Baseline Study in Kailali and Ilam District

2018 ◽  
Vol 16 (2) ◽  
pp. 149-155 ◽  
Author(s):  
Binod Kumar Aryal ◽  
Mohammad Daud ◽  
Ambika Thapa ◽  
Anita Mahotra ◽  
Sudip Ale Magar ◽  
...  
Keyword(s):  
Health Workers ◽  
Communicable Disease ◽  
Action Plan ◽  
Descriptive Analysis ◽  
Health Facilities ◽  
Essential Medicines ◽  
World Health ◽  
Cross Sectional ◽  
Baseline Study ◽  
Non Communicable Disease

Background: Non-communicable Diseases are an alarming public health emergency in Nepal. Owing to the risk of NCD’s in Nepal, Government of Nepal has developed a Multisectoral Action Plan for Non-communicable Disease 2014-2020 and has adopted the World Health Organization Package of Essential Non-communicable Disease protocol. Prior for its implementation in Nepal, baseline study has been carried out to assess the status of health facilities in Nepal.Methods: A descriptive cross-sectional study was carried out in Kailali and Ilam district encompassing a total of 92 health facilities. A set of structured questionnaire and interview guideline was used to obtain the data. Collected data was transferred to Microsoft Excel, cleaned and analyzed in SPSS 16.0. Descriptive analysis was performed to express the frequencies and relative frequencies Results: Of the total health facilities, 49 and 43 health facilities of Ilam and Kailali were interviewed. The hospital of Ilam consisted all the procedure, equipment and medicine for the management of NCDs whilst, health posts lacked Oxygen services. Only 592 posts were fulfilled out of 704 sanctioned post in both the districts of which only 161 were trained in management of NCDs. Atotal of 231 patients were diagnosed with NCDs before the day of study in all the health facilities of both districts. Conclusions: Study reveals the gaps in capacity of health institution and system in terms of training, supply, equipments, and diagnostics. However, training of health workers, supply of essential medicines and improvising the service delivery would supplement the effective implementation of PEN in Nepal.

scholarly journals Assessment of Public Health Units’ Capacity to Manage Under-Five Malnutrition: A Case Study of Kamuli District, Uganda

2018 ◽  
Vol 3 (3) ◽  
pp. 100
Author(s):  
Benon Musasizi ◽  
Elizabeth Ekirapa Kiracho ◽  
Saul Kamukama ◽  
Geoffrey Babughirana
Keyword(s):  
Public Health ◽  
Human Resource Development ◽  
Quantitative Methods ◽  
Health Workers ◽  
Public Health Problem ◽  
Building Blocks ◽  
Health Facilities ◽  
Major Public Health Problem ◽  
Cross Sectional ◽  
Under Five

Malnutrition is a major public-health problem throughout the developing world and is an underlying factor in over 50% of the 10-11 million children under 5 years of age who die each year of preventable causes. Uganda loses US$310 million worth of productivity per year due to the high levels of stunting, iodine-deficiency disorders, iron deficiency, low birth weight, and malnutrition contributes to a loss of about 4.1% of the gross domestic product per year. This paper provides the findings of an assessment conducted in Kamuli district to determine the capacity of public health units to manage under-five malnutrition focusing on the six building blocks of the health system. This was a descriptive cross sectional study that employed both qualitative and quantitative methods of data collection, analysis and presentation. This involved interviewing health workers using a semi structured questionnaire and checklist for health facilities. Supplement qualitative data was collected using key informant interviews (KIIs). Results indicate that the capacity of health facilities to manage under-five malnutrition in Kamuli district was found to be low at 36.6% only. Capacity of health facilities was based on; Nutrition leadership and human resource development, health worker knowledge, availability of equipment and supplies, physical infrastructure, availability of infant and young child nutrition policy guidelines and planning and budgeting at health facility level.

scholarly journals Organizational factors associated with health worker protection during the COVID-19 pandemic in four provinces of South Africa

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Muzimkhulu Zungu ◽  
Kuku Voyi ◽  
Nosimilo Mlangeni ◽  
Saiendhra Vasudevan Moodley ◽  
Jonathan Ramodike ◽  
...  
Keyword(s):  
South Africa ◽  
Occupational Health ◽  
Health Worker ◽  
Personal Protective Equipment ◽  
Health Workers ◽  
Health Facilities ◽  
Protective Equipment ◽  
Middle Income ◽  
Factors Associated ◽  
Middle Income Countries

Abstract Background Health workers, in short supply in many low-and-middle-income countries, are at increased risk of SARS-CoV-2 infection. This study aimed to assess how South Africa, prepared to protect its health workers from SARS-CoV-2 infection. Methods This was a cross-sectional study design applying participatory action research in four provinces of South Africa. A semi-structured questionnaire and a qualitative observational HealthWISE walkthrough risk assessment was carried out to collect data on occupational safety and health (OSH) systems in 45 hospitals across four provinces to identify factors associated with health worker protection. Adapting the International Labour Organization (ILO) and World Health Organization (WHO) HealthWISE tool, we compiled compliance scores through walkthrough surveys. We used logistic regression to analyze the relationship between readiness indicators and the actual implementation of protective measures. Results We found that health facilities in all four provinces had SARS-CoV-2 plans for the general population but no comprehensive OHS plan for health workers. Provincial Departments of Health (PDoH) varied in how they were organized to respond: Provinces A and D had an OSH SARS-CoV-2 provincial coordinating team and a dedicated budget for occupational health; Province A had an occupational health doctor and nurse; while Province B had an occupational health nurse; Province A and D PDoHs had functional OSH committees; and Province D had conducted some health risk assessments specific to SARS-CoV-2. However, none of the assessed health facilities had an acceptable HealthWISE compliance score (≥ 75%) due to poor ventilation and inadequate administrative control measures. While the supply of personal protective equipment was adequate, it was often not worn properly. Our study found that having an OSH SARS-CoV-2 policy was significantly associated with higher personal protective equipment and ventilation scores. In addition, our analysis showed that hospitals with higher compliance scores had significantly lower infection rates (IRR 0.98; 95% CI: 0.97, 0.98). Conclusions Despite some initial preparedness, greater effort to protect health workers is still warranted. Low-and-middle-income countries may need to pay more attention to OSH systems and consider using tools, such as ILO/WHO HealthWISE tool, to protect health workers’ health.

scholarly journals Health literacy and preparedness of health workers in the private health sector towards the COVID-19 pandemic: Need for integration into the nationwide response

2021 ◽  
Vol 3 (2) ◽  
Author(s):  
Ekaete Tobin ◽  
Vivian Ajekweneh ◽  
Andrew Obi ◽  
Eshan Henshaw
Keyword(s):  
Health Literacy ◽  
Health Workers ◽  
Health Sector ◽  
Health Facilities ◽  
Infection Prevention And Control ◽  
Suspected Case ◽  
Willingness To Participate ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Private Health Sector

The private health sector has the potential to participate in the COVID-19 pandemic response. The study aimed to assess the health literacy, perceptions, practices, willingness to participate and opportunities for engagement of the private health sector in the COVID-19 response. A cross-sectional survey was carried out among health workers in private health facilities in Edo Central and Edo North Senatorial districts of Edo state between May and June 2020. Data were collected using pre-tested questionnaires and analysis carried out using Statistical Package for Social Science (SPSS). Chi-square test of significance and logistic regression were applied at 5% cut off. A total of 153 health workers participated giving a response rate of 75.0%. Eighty-eight (57.5%) respondents had good knowledge of COVID-19 and 80 (52.3%) held negative perceptions towards COVID-19. Ninety-five (62.1%) respondents believed private health facilities had a role to play in the response particularly in the area of suspected case screening (85.4%). Thirty-one (20.3%) respondents indicated their willingness to participate in the COVID-19 response if their facilities were invited to. Sixty-one (39.9%) and 92 (60.1%) respondents respectively held poor and good practices towards COVID- 19 prevention, with practice significantly associated with educational level (χ2 = 14.10, P < 0.01), profession (χ2 = 15.28, P = 0.01). and previous training in infection prevention and control (IPC) (χ2 = 18.16, P < 0.01). The resources available from the private sector to support the response can be harnessed through engagements with medical directors and health workers in the sector to identify areas of collaboration, address identified gaps in knowledge, improve perception and participation.

scholarly journals Missed opportunities for vaccination among children aged 0–23 months visiting health facilities in a southwest State of Nigeria, December 2019

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0252798
Author(s):  
Akinola Ayoola Fatiregun ◽  
Laura Nic Lochlainn ◽  
Lassané Kaboré ◽  
Modupeola Dosumu ◽  
Elvis Isere ◽  
...  
Keyword(s):  
Health Service ◽  
Health Workers ◽  
Immunization Coverage ◽  
Cross Sectional Study ◽  
Health Facilities ◽  
Service Encounter ◽  
Childhood Immunization ◽  
Cross Sectional ◽  
Missed Opportunities ◽  
Attitudes And Practices

Background Despite efforts to improve childhood immunization coverage in Nigeria, coverage has remained below the national acceptable level. In December 2019, we conducted an assessment of Missed Opportunities for Vaccination (MOV) in Ondo State, in Southwest Nigeria. The objectives were to determine the magnitude of, explore the reasons for, as well as possible solutions for reducing MOV in the State. Methods This was a cross-sectional study using a mixed-methods approach. We purposively selected 66 health facilities in three local government authorities, with a non-probabilistic sampling of caregivers of children 0–23 months for exit interviews, and health workers for knowledge, attitudes, and practices (KAP) surveys. Data collection was complemented with focus group discussions and in-depth interviews with caregivers and health workers. The proportion of MOV among children with documented vaccination histories were determined and thematic analysis of the qualitative data was carried out. Results 984 caregivers with children aged 0–23 months were interviewed, of which 869 were eligible for inclusion in our analysis. The prevalence of MOV was 32.8%. MOV occurred among 90.8% of children during non-vaccination visits, and 7.3% during vaccination visits. Vaccine doses recommended later in the immunization series were given in a less timely manner. Among 41.0% of health workers, they reported their vaccination knowledge was insufficient. Additionally, 57.5% were concerned about and feared adverse events following immunization. Caregivers were found to have a low awareness about vaccination, and issues related to the organization of the health system were found to contribute towards MOV. Conclusions One in three children experienced a MOV during a health service encounter. Potential interventions to reduce MOV include training of health workers about immunization policies and practices, improving caregivers’ engagement and screening of vaccination documentation by health workers during every health service encounter.

scholarly journals Antiretroviral Adverse Drug Reactions Pharmacovigilance in Harare City, Zimbabwe, 2017

2018 ◽  
Author(s):  
Hamufare Mugauri ◽  
Owen Mugurungi ◽  
Tsitsi Juru ◽  
Notion Gombe ◽  
Gerald Shambira ◽  
...  
Keyword(s):  
Health Worker ◽  
Adverse Drug Reactions ◽  
Health Workers ◽  
Likert Scale ◽  
Pharmacovigilance System ◽  
Drug Reactions ◽  
Cross Sectional ◽  
Therapeutic Decisions ◽  
Clinical Records ◽  
Harare City

AbstractIntroductionKey to pharmacovigilance is spontaneously reporting all Adverse Drug Reactions (ADR) during post-market surveillance. This facilitates identification and evaluation of previously unreported ADR’s, acknowledging the trade-off between benefits and potential harm of medications. Only 41% ADR’s documented in Harare city clinical records for January to December 2016 were reported to Medicines Control Authority of Zimbabwe (MCAZ). We investigated reasons contributing to underreporting of ADR’s in Harare city.MethodsA descriptive cross-sectional study and the updated Centers for Disease Control (CDC) guided surveillance evaluation was conducted. Two hospitals were purposively included. Seventeen health facilities and 52 health workers were randomly selected. Interviewer-administered questionnaires, key informant interviews and WHO pharmacovigilance checklists were used to collect data. Likert scales were applied to draw inferences and Epi info 7 used to generate frequencies and proportions.ResultsOf the 52 participants, 32 (61.5%) distinguished the ADR defining criteria. Twenty-nine (55.8%) knew system’s purpose whilst 28 (53.8%) knew the reporting process. Knowledge scored average on the 5-point-Likert scale. Thirty-eight (73.1%) participants identified ADR’s following client complaints and nine (1.3%) enquired clients’ medication response. Forty-six (88.5%) cited non-feedback from MCAZ for underreporting. Inadequate ADR identification skills were cited by 21 (40.4%) participants. Reporting forms were available in five (26.3%) facilities and reports were generated from hospitals only. Forty-two (90.6%) clinicians made therapeutic decisions from ADR’s. Averaged usefulness score was 4, on the 5-point-Likert scale. All 642 generated signals were committed to Vigiflow by MCAZ, reflecting a case detection rate of 4/ 100 000. Data quality was 0.75–1.0 (WHO) and all reports were causally assessed.ConclusionThe pharmacovigilance system was useful, simple, and acceptable despite being unstable, not representative and not sensitive. It was threatened by suboptimal health worker knowledge, weak detection strategies and referral policy preventing ADR identification by person place and time. Revisiting local policy, advocacy, communication and health worker orientation might improve pharmacovigilance performance in Harare city.

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