Ligia Paina
Biographic Data
| ID | 6076013 |
|---|---|
| NAME | Ligia Paina |
| GIVEN NAMES | Ligia |
| FAMILY NAME | Paina |
| SIGNATURE | PAINA L |
| AFFILIATIONS | Johns Hopkins University |
| ORCID | 0000-0002-8403-7825 |
| VERIFIED | Yes |
| TOTAL WORKS | 30 |
| TOTAL CITATIONS | 40 |
| AUTHOR COUNT | 30 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 2011 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 2 |
Managing Public-Private Partnerships for Health Diagnostics
This paper draws upon a process evaluation of a public-private partnership (PPP) for diagnostics in three Sub-Saharan African countries, Ethiopia, Ghana and Kenya. The study sought to identify challenges in managing health PPP projects and potential solutions. We used an extensive document review and 72 recent key informant interviews (KIIs), building on 63 KIIs previously conducted to analyze the African Health Diagnostics Platform (AHDP) projec…
Barriers to raising taxes on tobacco products in Uganda
Raising taxes on tobacco is considered the most effective measure for reducing tobacco consumption. Although Uganda ratified WHO’s Framework Convention on Tobacco control which recommends levying taxes on tobacco products by up to 75% of their retail price, in Uganda taxes on tobacco stagnated at 35% between 2017 and 2024. There is little in-depth research interrogating the political economy underpinning tobacco tax policy in Uganda. The aim of t…
What slows the progress of health systems strengthening at subnational level? A political economy analysis of three districts in Uganda
There is increasing recognition that without stronger health systems, efforts to improve global health and Universal Health Coverage cannot be achieved. Over the last three decades, initiatives to strengthen health systems in low-income countries have attracted huge investments in the context of achieving the Millennium Development Goals, the Sustainable Development Goals, as well as Universal Health Coverage. Yet, health system inadequacies pers…
Prospective policy analysis—a critical interpretive synthesis review
Most policy analysis methods and approaches are applied retrospectively. As a result, there have been calls for more documentation of the political-economy factors central to health care reforms in real-time. We sought to highlight the methods and previous applications of prospective policy analysis (PPA) in the literature to document purposeful use of PPA and reflect on opportunities and drawbacks. We used a critical interpretive synthesis (CIS)…
The impact of shifts in Pepfar funding policy on HIV services in Eastern Uganda (2015–21)
Although donor transitions from HIV programmes are increasingly common in low-and middle-income countries, there are limited analyses of long-term impacts on HIV services. We examined the impact of changes in President’s Emergency Plan for AIDS Relief (PEPFAR) funding policy on HIV services in Eastern Uganda between 2015 and 2021.We conducted a qualitative case study of two districts in Eastern Uganda (Luuka and Bulambuli), which were affected by…
SDG5 “Gender Equality” and the Covid-19 pandemic
Introduction: The COVID-19 pandemic disrupted healthcare and societies, exacerbating existing inequalities for women and girls across every sphere. Our study explores health system responses to gender equality goals during the COVID-19 pandemic and inclusion in future policies. Methods: We apply a qualitative comparative approach, drawing on secondary sources and expert information; the data was collected from March-July 2022. Australia, Brazil, …
Geographic prioritisation in Kenya and Uganda
Introduction Donor transition for HIV/AIDS programmes remains sensitive, marking a significant shift away from the traditional investment model of large-scale, vertical investments to control the epidemic and achieve rapid scaling-up of services. In late 2015, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) headquarters instructed their country missions to implement ‘geographic prioritisation’ (GP), whereby PEPFAR investment…
‘All my co-workers are good people, but…’
Multisectoral collaboration has been identified as a critical component in a wide variety of health and development initiatives. For India’s Integrated Child Development Services (ICDS) scheme, which serves >100 million people annually across more than one million villages, a key point of multisectoral collaboration—or ‘convergence’, as it is often called in India—is between the three frontline worker cadres jointly responsible for delivering ess…
Political economy analysis of subnational health management in Kenya, Malawi and Uganda
The need to bolster primary health care (PHC) to achieve the Sustainable Development Goal (SDG) targets for health is well recognized. In Eastern and Southern Africa, where governments have progressively decentralized health decision-making, health management is critical to PHC performance. While investments in health management capacity are important, so is improving the environment in which managers operate. Governance arrangements, management …
From ‘no problem’ to ‘a lot of difficulties’
Migration is increasingly common in Africa, especially for employment. Migrants may face additional barriers to accessing health care, including human immunodeficiency virus (HIV) prevention and treatment, compared with long-term residents. Exploring migrants’ experiences with health services can provide insights to inform the design of health programmes. In this study, we used qualitative methods to understand migrants’ barriers to health servic…
Teaching Systems Thinking as a Foundational Public Health Competency Can Be Improved
P ublic health decision-making often deals with problems that do not have a single perfect solution; the solutions' effectiveness depends highly on the context in which they are applied, and they often unfold in uncertain, complex environments.The recent COVID-19 pandemic response provides a perfect example of a "wicked problem." 1-3At the height of the pandemic, public health professionals had to make decisions without perfect information or suf…
Reflections on benefits and challenges of longitudinal organisational network analysis as a tool for health systems research and practice
As health systems practitioners and researchers increasingly turn towards systems thinking approaches and work on building interorganisational networks, they have demonstrated increasing interest in network analysis for investigating relationships and interactions between system actors, both at the individual and organisational levels. Despite the potential of network-based approaches to improve health system efficiency, effectiveness and respons…
Exploring perceived effects from loss of Pepfar support for outreach in Kenya and Uganda
INTRODUCTION: In 2015, the President's Emergency Plan for AIDS Relief undertook policy shifts to increase efficiencies in its programming, including transitioning HIV/AIDS funding away from low burden areas. We examine the impact of these changes on HIV outreach in Kenya and Uganda. METHODS: Qualitative data collection was conducted as a part of a broader mixed-methods evaluation. Two rounds of facility-level case studies and national-level inter…
South African physician emigration and return migration, 1991–2017
Although critical for understanding health labour market trends in low- and middle-income countries (LMICs), longitudinal LMIC health worker emigration and return migration trends are not routinely documented. This article seeks to better understand SA’s trends in physician emigration and return migration and whether economic growth and related policies affect migration patterns. This study used physician registry data to analyse patterns of emig…
Designing for Scale and taking scale to account
Governments seeking to scale up CSCs and to take scale to account should keenly adapt existing models to the local implementation context with strategic and meaningful involvement of key legitimate local and sub national leaders in decision making during the design and implementation process. However, they should watch out for elite capture and develop mitigating strategies. Social accountability practitioners should document their planning and a…
Influence of community scorecards on maternal and newborn health service delivery and utilization
The community score cards created opportunities for community leaders and communities to work together to identify innovative ways of dealing with the health service delivery and utilization challenges that they face. Local leaders should encourage the availability of safe spaces for dialogue between communities, health workers and leaders where performance and utilization challenges can be identified and solutions proposed and implemented jointl…
The differential impacts of Pepfar transition on private for-profit, private not-for-profit and publicly owned health facilities in Uganda
While transition of donor programs to national control is increasingly common, there is a lack of evidence about the consequences of transition for private health care providers. In 2015, President’s Emergency Plan for AIDS Relief (PEPFAR) identified 734 facilities in Uganda for transition from PEPFAR support, including 137 private not-for-profits (PNFP) and 140 private for-profits (PFPs). We sought to understand the differential impacts of trans…
Applying the model of diffusion of innovations to understand facilitators for the implementation of maternal and neonatal health programmes in rural Uganda
In Uganda, more than 336 out of every 100,000 women die annually during childbirth. Pregnant women, particularly in rural areas, often lack the financial resources and means to access health facilities in a timely manner for quality antenatal, delivery, and post-natal services. For nearly the past decade, the Makerere University School of Public Health researchers, through various projects, have been spearheading innovative interventions, embedde…
Contracting non-state providers for universal health coverage
For countries with a sizeable NSP sector, making full use of the available human and other resources by contracting NSPs and appropriately managing them, offers an important way for expanding coverage of publicly financed health services and moving towards universal health coverage
Characteristics of community savings groups in rural Eastern Uganda
BACKGROUND: Rural populations in Uganda have limited access to formal financial Institutions, but a growing majority belong to saving groups. These saving groups could have the potential to improve household income and access to health services. OBJECTIVE: To understand organizational characteristics, benefits and challenges, of savings groups in rural Uganda. METHODS: This was a cross-sectional descriptive study that employed both quantitative a…
Effect of a participatory multisectoral maternal and newborn intervention on maternal health service utilization and newborn care practices
BACKGROUND: The MANIFEST study in eastern Uganda employed a participatory multisectoral approach to reduce barriers to access to maternal and newborn care services. OBJECTIVES: This study analyses the effect of the intervention on the utilization of maternal and newborn services and care practices. METHODS: The quasi-experimental pre- and post-comparison design had two main components: community mobilization and empowerment, and health provider c…
Maternal and neonatal implementation for equitable systems. A study design paper
BACKGROUND: Evidence on effective ways of improving maternal and neonatal health outcomes is widely available. The challenge that most low-income countries grapple with is implementation at scale and sustainability. OBJECTIVES: The study aimed at improving access to quality maternal and neonatal health services in a sustainable manner by using a participatory action research approach. METHODS: The study consisted of a quasi-experimental design, w…
‘Nurture the sprouting bud; do not uproot it’ . Using saving groups to save for maternal and newborn health
BACKGROUND: Saving groups are increasingly being used to save in many developing countries. However, there is limited literature about how they can be exploited to improve maternal and newborn health. OBJECTIVES: This paper describes saving practices, factors that encourage and constrain saving with saving groups, and lessons learnt while supporting communities to save through saving groups. METHODS: This qualitative study was done in three distr…
Best resources for community engagement in implementation research
Implementation research (IR) focuses on understanding how and why interventions produce their effects in a given context. This often requires engaging a broad array of stakeholders at multiple levels of the health system. Whereas a variety of tools and approaches exist to facilitate stakeholder engagement at the national or institutional level, there is a substantial gap in the IR literature about how best to do this at the local or community lev…
Fair publication of qualitative research in health systems
10.1186/s12939-016-0368-y
Understanding pathways for scaling up health services through the lens of complex adaptive systems
Despite increased prominence and funding of global health initiatives, efforts to scale up health services in developing countries are falling short of the expectations of the Millennium Development Goals. Arguing that the dominant assumptions for scaling up are inadequate, we propose that interpreting change in health systems through the lens of complex adaptive systems (CAS) provides better models of pathways for scaling up. Based on an underst…
Sector-wide approaches (SWAps) in health
Sector-wide approaches (SWAps) in health were developed in the early 1990s in response to widespread dissatisfaction with fragmented donor-sponsored projects and prescriptive adjustment lending. SWAps were intended to provide a more coherent way to articulate and manage government-led sectoral policies and expenditure frameworks and build local institutional capacity as well as offer a means to more effective relationships between governments and…
Best resources for community engagement in implementation research
Implementation research (IR) focuses on understanding how and why interventions produce their effects in a given context. This often requires engaging a broad array of stakeholders at multiple levels of the health system. Whereas a variety of tools and approaches exist to facilitate stakeholder engagement at the national or institutional level, there is a substantial gap in the IR literature about how best to do this at the local or community lev…
Situational analysis of teaching and learning of medicine and nursing students at Makerere University College of Health Sciences
BACKGROUND: Makerere University College of Health Sciences (MakCHS) in Uganda is undergoing a major reform to become a more influential force in society. It is important that its medicine and nursing graduates are equipped to best address the priority health needs of the Ugandan population, as outlined in the government's Health Sector Strategic Plan (HSSP). The assessment identifies critical gaps in the core competencies of the MakCHS medicine a…
Expecting the unexpected
Although health interventions start with good intentions to develop services for disadvantaged populations, they often distort the health market, making the delivery or financing of services difficult once the intervention is over: a condition called the 'Develop-Distort Dilemma' (DDD). In this paper, we describe how to examine whether a proposed intervention may develop or distort the health market. Our goal is to produce a tool that facilitates…
Understanding pathways for scaling up health services through the lens of complex adaptive systems
Despite increased prominence and funding of global health initiatives, efforts to scale up health services in developing countries are falling short of the expectations of the Millennium Development Goals. Arguing that the dominant assumptions for scaling up are inadequate, we propose that interpreting change in health systems through the lens of complex adaptive systems (CAS) provides better models of pathways for scaling up. Based on an underst…
The impact of Fogarty International Center research training programs on public health policy and program development in Kenya and Uganda
While FIC has not focused its programs on the goal of policy and program influence, its investments have affected global and national public health policies and practice. These influences have occurred primarily through strengthening research skills of scientists and developing strong in-country networks. Further success of FIC and similar initiatives could be stimulated by investing more in the training of policy-makers, seeking to better align …
Sector-wide approaches (SWAps) in health
Sector-wide approaches (SWAps) in health were developed in the early 1990s in response to widespread dissatisfaction with fragmented donor-sponsored projects and prescriptive adjustment lending. SWAps were intended to provide a more coherent way to articulate and manage government-led sectoral policies and expenditure frameworks and build local institutional capacity as well as offer a means to more effective relationships between governments and…
Fair publication of qualitative research in health systems
10.1186/s12939-016-0368-y
Characteristics of community savings groups in rural Eastern Uganda
BACKGROUND: Rural populations in Uganda have limited access to formal financial Institutions, but a growing majority belong to saving groups. These saving groups could have the potential to improve household income and access to health services. OBJECTIVE: To understand organizational characteristics, benefits and challenges, of savings groups in rural Uganda. METHODS: This was a cross-sectional descriptive study that employed both quantitative a…
Effect of a participatory multisectoral maternal and newborn intervention on maternal health service utilization and newborn care practices
BACKGROUND: The MANIFEST study in eastern Uganda employed a participatory multisectoral approach to reduce barriers to access to maternal and newborn care services. OBJECTIVES: This study analyses the effect of the intervention on the utilization of maternal and newborn services and care practices. METHODS: The quasi-experimental pre- and post-comparison design had two main components: community mobilization and empowerment, and health provider c…
Maternal and neonatal implementation for equitable systems. A study design paper
BACKGROUND: Evidence on effective ways of improving maternal and neonatal health outcomes is widely available. The challenge that most low-income countries grapple with is implementation at scale and sustainability. OBJECTIVES: The study aimed at improving access to quality maternal and neonatal health services in a sustainable manner by using a participatory action research approach. METHODS: The study consisted of a quasi-experimental design, w…
‘Nurture the sprouting bud; do not uproot it’ . Using saving groups to save for maternal and newborn health
BACKGROUND: Saving groups are increasingly being used to save in many developing countries. However, there is limited literature about how they can be exploited to improve maternal and newborn health. OBJECTIVES: This paper describes saving practices, factors that encourage and constrain saving with saving groups, and lessons learnt while supporting communities to save through saving groups. METHODS: This qualitative study was done in three distr…
Best resources for community engagement in implementation research
Implementation research (IR) focuses on understanding how and why interventions produce their effects in a given context. This often requires engaging a broad array of stakeholders at multiple levels of the health system. Whereas a variety of tools and approaches exist to facilitate stakeholder engagement at the national or institutional level, there is a substantial gap in the IR literature about how best to do this at the local or community lev…
Contracting non-state providers for universal health coverage
For countries with a sizeable NSP sector, making full use of the available human and other resources by contracting NSPs and appropriately managing them, offers an important way for expanding coverage of publicly financed health services and moving towards universal health coverage
Applying the model of diffusion of innovations to understand facilitators for the implementation of maternal and neonatal health programmes in rural Uganda
In Uganda, more than 336 out of every 100,000 women die annually during childbirth. Pregnant women, particularly in rural areas, often lack the financial resources and means to access health facilities in a timely manner for quality antenatal, delivery, and post-natal services. For nearly the past decade, the Makerere University School of Public Health researchers, through various projects, have been spearheading innovative interventions, embedde…
Influence of community scorecards on maternal and newborn health service delivery and utilization
The community score cards created opportunities for community leaders and communities to work together to identify innovative ways of dealing with the health service delivery and utilization challenges that they face. Local leaders should encourage the availability of safe spaces for dialogue between communities, health workers and leaders where performance and utilization challenges can be identified and solutions proposed and implemented jointl…
The differential impacts of Pepfar transition on private for-profit, private not-for-profit and publicly owned health facilities in Uganda
While transition of donor programs to national control is increasingly common, there is a lack of evidence about the consequences of transition for private health care providers. In 2015, President’s Emergency Plan for AIDS Relief (PEPFAR) identified 734 facilities in Uganda for transition from PEPFAR support, including 137 private not-for-profits (PNFP) and 140 private for-profits (PFPs). We sought to understand the differential impacts of trans…
Reflections on benefits and challenges of longitudinal organisational network analysis as a tool for health systems research and practice
As health systems practitioners and researchers increasingly turn towards systems thinking approaches and work on building interorganisational networks, they have demonstrated increasing interest in network analysis for investigating relationships and interactions between system actors, both at the individual and organisational levels. Despite the potential of network-based approaches to improve health system efficiency, effectiveness and respons…
Exploring perceived effects from loss of Pepfar support for outreach in Kenya and Uganda
INTRODUCTION: In 2015, the President's Emergency Plan for AIDS Relief undertook policy shifts to increase efficiencies in its programming, including transitioning HIV/AIDS funding away from low burden areas. We examine the impact of these changes on HIV outreach in Kenya and Uganda. METHODS: Qualitative data collection was conducted as a part of a broader mixed-methods evaluation. Two rounds of facility-level case studies and national-level inter…
South African physician emigration and return migration, 1991–2017
Although critical for understanding health labour market trends in low- and middle-income countries (LMICs), longitudinal LMIC health worker emigration and return migration trends are not routinely documented. This article seeks to better understand SA’s trends in physician emigration and return migration and whether economic growth and related policies affect migration patterns. This study used physician registry data to analyse patterns of emig…
Designing for Scale and taking scale to account
Governments seeking to scale up CSCs and to take scale to account should keenly adapt existing models to the local implementation context with strategic and meaningful involvement of key legitimate local and sub national leaders in decision making during the design and implementation process. However, they should watch out for elite capture and develop mitigating strategies. Social accountability practitioners should document their planning and a…
SDG5 “Gender Equality” and the Covid-19 pandemic
Introduction: The COVID-19 pandemic disrupted healthcare and societies, exacerbating existing inequalities for women and girls across every sphere. Our study explores health system responses to gender equality goals during the COVID-19 pandemic and inclusion in future policies. Methods: We apply a qualitative comparative approach, drawing on secondary sources and expert information; the data was collected from March-July 2022. Australia, Brazil, …
Geographic prioritisation in Kenya and Uganda
Introduction Donor transition for HIV/AIDS programmes remains sensitive, marking a significant shift away from the traditional investment model of large-scale, vertical investments to control the epidemic and achieve rapid scaling-up of services. In late 2015, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) headquarters instructed their country missions to implement ‘geographic prioritisation’ (GP), whereby PEPFAR investment…
‘All my co-workers are good people, but…’
Multisectoral collaboration has been identified as a critical component in a wide variety of health and development initiatives. For India’s Integrated Child Development Services (ICDS) scheme, which serves >100 million people annually across more than one million villages, a key point of multisectoral collaboration—or ‘convergence’, as it is often called in India—is between the three frontline worker cadres jointly responsible for delivering ess…
Political economy analysis of subnational health management in Kenya, Malawi and Uganda
The need to bolster primary health care (PHC) to achieve the Sustainable Development Goal (SDG) targets for health is well recognized. In Eastern and Southern Africa, where governments have progressively decentralized health decision-making, health management is critical to PHC performance. While investments in health management capacity are important, so is improving the environment in which managers operate. Governance arrangements, management …
From ‘no problem’ to ‘a lot of difficulties’
Migration is increasingly common in Africa, especially for employment. Migrants may face additional barriers to accessing health care, including human immunodeficiency virus (HIV) prevention and treatment, compared with long-term residents. Exploring migrants’ experiences with health services can provide insights to inform the design of health programmes. In this study, we used qualitative methods to understand migrants’ barriers to health servic…
Teaching Systems Thinking as a Foundational Public Health Competency Can Be Improved
P ublic health decision-making often deals with problems that do not have a single perfect solution; the solutions' effectiveness depends highly on the context in which they are applied, and they often unfold in uncertain, complex environments.The recent COVID-19 pandemic response provides a perfect example of a "wicked problem." 1-3At the height of the pandemic, public health professionals had to make decisions without perfect information or suf…
Medicine (23 works) · Global Maternal and Child Health (22 works) · Political science (19 works) · Economic growth (17 works) · Nursing (16 works) · Business (15 works) · Economics (15 works) · Public health (12 works) · Environmental health (11 works) · Health care (10 works)