Jacinta Nzinga
Dados Biográficos
| ID | 1726632 |
|---|---|
| NOME | Jacinta Nzinga |
| PRENOMES | Jacinta |
| SOBRENOME | Nzinga |
| ASSINATURA | NZINGA J |
| AFILIAÇÕES | Kenya Medical Research Institute |
| ORCID | 0000-0001-8394-8857 |
| VERIFICADO | Sim |
| TOTAL DE OBRAS | 30 |
| TOTAL DE CITAÇÕES | 19 |
| TOTAL COMO AUTOR | 30 |
| TOTAL COMO EDITOR | 0 |
| PRIMEIRO ANO DE PUBLICAÇÃO | 2017 |
| ANO MAIS RECENTE DE PUBLICAÇÃO | 2026 |
| ÍNDICE H | 3 |
Whose crisis is it? Local experiences and health governance in the era of polycrisis
The concept of polycrisis has gained traction to describe the interconnected shocks—pandemics, climate-related disasters, conflict and economic instability—shaping global risk. Yet for many communities in low-income settings, such entanglements are not new but reflect long-standing conditions of permacrisis. We advance a situated perspective that examines how global shocks intersect with pre-existing local vulnerabilities, drawing on examples fro…
Poverty is a social issue, not a mathematical problem”
Background Kenya rolled out a UHC indigent program aimed to expand financial protection and health service access for poor households through subsidized health insurance under the national insurer, National Health Insurance Fund (NHIF). As Kenya transitions to a new social health insurance framework under the Social Health Authority (SHA), understanding the implementation experience of the UHC indigent program is critical for informing the roll o…
Identifying community pharmacists’ preferences for attributes of public health interventions in Kenya
Community pharmacies are increasingly recognized as access points for public health interventions (PHIs) such as vaccination, family planning services, and disease screening. In Kenya, evidence suggests the feasibility of pharmacy-delivered PHIs; however, the uptake remains inconsistent. This is partly attributed to poor programme design without taking pharmacy providers preferences into consideration. We employed a discrete choice experiment (DC…
‘You can sleep hungry just to buy the medicine’
This research applies the Cumulative Complexity model to examine patient experiences of hypertension management following prescription of anti-hypertensive medication in the public health system in Kenya. Set in Kiambu County, central Kenya, it draws on abductive analysis of interviews with patients (n = 24), caregivers (n = 7) and non-participant observation in four purposively selected public facilities conducted between November 2022 and April…
Acceptability of fixed-dose combination treatments for hypertension in Kenya
Fixed-dose combinations (FDCs) – 2-3 anti-hypertensive medications in a single pill - have the potential to improve hypertension treatment and outcomes. Yet, they are not widely implemented. Factors undermining implementation remain unknown, particularly in sub–Saharan Africa, where hypertension is a major cause of disease burden and is poorly controlled. This study explored the acceptability of FDCs among patients, caregivers, and healthcare wor…
Management capacity of primary healthcare facilities in low- and middle-income countries
How health facilities are managed determines their performance and health service delivery. Management capacity of health facilities comprises the competency of managers at the individual level and the management support and work environment in their institutions. Evidence shows this management capacity influences service delivery and performance of the facility. For LMICs, there are evidence gaps as existing evidence is scarce, varied in the ass…
Emotional dimensions of nurses’ daily work in newborn units in Kenya
We draw on our data, the wider literature, and nurses' recommendations to reflect on the interplay between emotional well-being and ethical nursing practice, and to make suggestions for ongoing health system strengthening efforts
Beyond evidence
Efforts to strengthen knowledge translation (KT) for policy-making often call for greater engagement with the policy process and its actors. Yet, existing KT approaches often focus on communication and dissemination of evidence and undertheorise the role and influence of policy actors on KT. As such, this study examines how, why, and to what effect policy actors shape KT. Our findings address a critical gap in the KT literature regarding the rela…
Power, interests, and maternal health care
The maternal and newborn health (MNH) service delivery redesign (SDR) in Kakamega County, Kenya, represents the country's first system-level reorganization of MNH services. The reform aimed to improve care quality and reduce mortality by centralizing delivery services at designated hubs. Using a political economy lens, we examined how ideology, political dynamics, and institutional structures shaped the agenda-setting, adoption, implementation, a…
Lessons learned from Covid-19 modelling efforts for policy decision-making in lower- and middle-income countries
INTRODUCTION: The COVID-19 pandemic had devastating health and socioeconomic effects, partly due to policy decisions to mitigate them. Little evidence exists of approaches that guided decisions in settings with limited pre-pandemic modelling capacity. We thus sought to identify knowledge translation mechanisms, enabling factors and structures needed to effectively translate modelled evidence into policy decisions. METHODS: We used convergent mixe…
The maternal and newborn health eCohort to track longitudinal care quality
The MNH eCohort was developed to fill gaps in maternal and newborn health (MNH) care quality measurement. In this paper, we describe the survey development process, recruitment strategy, data collection procedures, survey content and plans for analysis of the data generated by the study. We also compare the survey content to that of existing multi-country tools on MNH care quality. The eCohort is a longitudinal mixed-mode (in-person and phone) su…
Care seeking during pregnancy
A health systems reform known as Service Delivery Redesign (SDR) for maternal and newborn health seeks to make high-quality delivery care universal in Kakamega County, in western Kenya, by strengthening hospital-level care and making hospital deliveries the default option for pregnant women. Using a large prospective survey of new mothers in Kakamega County, we examine several key assumptions that underpin the SDR policy’s theory of change. We an…
Examining liminality in professional practice, relational identities, and career prospects in resource-constrained health systems
We examine new doctors' and nurses' experiences of transitioning from training to practising as health professionals, drawing on the concept of liminality. Liminality is a stage of 'in-betweenness', involving uncertainty and ambiguity as people leave one social context and reintegrate into a new one. Surprisingly little research has explored new health professionals' experiences of liminality during role and career transitions, particularly in pr…
‘We were treated like we are nobody’
OBJECTIVE: Medical interns are an important workforce providing first-line healthcare services in hospitals. The internship year is important for doctors as they transition from theoretical learning with minimal hands-on work under supervision to clinical practice roles with considerable responsibility. However, this transition is considered stressful and commonly leads to burn-out due to challenging working conditions and an ongoing need for lea…
The hidden emotional labour behind ensuring the social value of research
Health policy and systems research (HPSR) is a multi-disciplinary, largely applied field of research aimed at understanding and strengthening the performance of health systems, often with an emphasis on power, policy and equity. The value of embedded and participatory HPSR specifically in facilitating the collection of rich data that is relevant to addressing real-world challenges is increasingly recognised. However, the potential contributions a…
Improving facility-based care
Attention has turned to improving the quality and safety of healthcare within health facilities to reduce avoidable mortality and morbidity. Interventions should be tested in health system environments that can support their adoption if successful. To be successful, interventions often require changes in multiple behaviours making their consequences unpredictable. Here, we focus on this challenge of change at the mesolevel or microlevel. Drawing …
Investments for effective functionality of health systems towards Universal Health Coverage in Africa
The health challenges in Africa underscore the importance of effectively investing in health systems. Unfortunately, there is no information on systems investments adequate for an effective functional health system. We aimed to address this by conducting a scoping review of existing evidence following the Joanna Briggs Institute Manual for Evidence Synthesis and preregistered with the Open Science Framework ( https://osf.io/bvg4z ). We included a…
High impact health service interventions for attainment of UHC in Africa
African countries have prioritized the attainment of targets relating to Universal Health Coverage (UHC), Health Security (HSE) and Coverage of Health Determinants (CHD)to attain their health goals. Given resource constraints, it is important to prioritize implementation of health service interventions with the highest impact. This is important to be identified across age cohorts and public health functions of health promotion, disease prevention…
Service delivery reform for maternal and newborn health in Kakamega County, Kenya
This protocol describes a hybrid effectiveness/implementation evaluation study with an adaptive design. The impact evaluation ("effectiveness") study focuses on maternal and newborn health outcomes, and will be accompanied by an implementation evaluation focused on program reach, adoption, and fidelity
Professional identity transitions, violations and reconciliations among new nurses in low- and middle-income countries
We examine how new nurses construct their professional identity in Low- and Middle-Income Countries (LMICs) when they enter clinical practice and encounter practical norms violating procedural standards. We conducted interviews and focus group discussions with 47 Kenyan nurses. We describe new nurses experiencing ‘shock’ entering nursing practice (working and learning alone while responsible for many patients and doing ‘dirty work’), which contra…
An innovative leadership development initiative to support building everyday resilience in health systems
Effective management and leadership are essential for everyday health system resilience, but actors charged with these roles are often underprepared and undersupported to perform them. Particular challenges have been observed in interpersonal and relational aspects of health managers’ work, including communication skills, emotional competence and supportive oversight. Within the Resilient and Responsive Health Systems (RESYST) consortium in Kenya…
Lessons from a Health Policy and Systems Research programme exploring the quality and coverage of newborn care in Kenya
There are global calls for research to support health system strengthening in low-income and middle-income countries (LMICs). To examine the nature and magnitude of gaps in access and quality of inpatient neonatal care provided to a largely poor urban population, we combined multiple epidemiological and health services methodologies. Conducting this work and generating findings was made possible through extensive formal and informal stakeholder e…
Tracking health sector priority setting processes and outcomes for human resources for health, five-years after political devolution
Devolution has significantly increased county level decision-space for HRH priority setting in Kenya. However, HRH management and accountability challenges still exist at the county level. There is need for interventions to strengthen county level HRH management capacity and accountability mechanisms beyond additional resources allocation. This will boost the realization of the country's efforts for promoting service delivery equity as a key goal…
Prolonged health worker strikes in Kenya- perspectives and experiences of frontline health managers and local communities in Kilifi County
Strikes cannot be seen in isolation of the prevailing policy and health systems context. The 2017 prolonged strikes highlight the underlying and longer-term frustration amongst public sector health workers in Kenya. The health system exhibited properties of complex adaptive systems that are interdependent and interactive. Reactive responses within the public system and the use of private healthcare led to limited continued activity through the st…
Shocks, stress and everyday health system resilience
Health systems are faced with a wide variety of challenges. As complex adaptive systems, they respond differently and sometimes in unexpected ways to these challenges. We set out to examine the challenges experienced by the health system at a sub-national level in Kenya, a country that has recently undergone rapid devolution, using an ‘everyday resilience’ lens. We focussed on chronic stressors, rather than acute shocks in examining the responses…
Pastoral practices' for quality improvement in a Kenyan clinical network
We explain social and organisational processes influencing health professionals in a Kenyan clinical network to implement a form of quality improvement (QI) into clinical practice, using the concept of 'pastoral practices'. Our qualitative empirical case study, conducted in 2015-16, shows the way practices constructing and linking local evidence-based guidelines and data collection processes provided a foundation for QI. Participation in these co…
Shocks, stress and everyday health system resilience
Health systems are faced with a wide variety of challenges. As complex adaptive systems, they respond differently and sometimes in unexpected ways to these challenges. We set out to examine the challenges experienced by the health system at a sub-national level in Kenya, a country that has recently undergone rapid devolution, using an ‘everyday resilience’ lens. We focussed on chronic stressors, rather than acute shocks in examining the responses…
Examining liminality in professional practice, relational identities, and career prospects in resource-constrained health systems
We examine new doctors' and nurses' experiences of transitioning from training to practising as health professionals, drawing on the concept of liminality. Liminality is a stage of 'in-betweenness', involving uncertainty and ambiguity as people leave one social context and reintegrate into a new one. Surprisingly little research has explored new health professionals' experiences of liminality during role and career transitions, particularly in pr…
Collective strategies to cope with work related stress among nurses in resource constrained settings
Kenyan neonatal nurses are asked to do the impossible: to bridge the gap between international standards of nursing and the circumstances they face each day. They work long hours with little supervision in ill-designed wards, staffed by far too few nurses given the pressing need. Despite these conditions, a single neonatal nurse can be tasked with looking after forty sick babies for whom very close care is a necessity. Our 18-month ethnography ex…
Maintaining Distance and Staying Immersed
The Health Services that Deliver for Newborns (HSD-N) project is supported by a multidisciplinary team with experience in ethnographic work, epidemiology, and health systems. The project aims to investigate the projected need for neonatal inpatient services; what existing infrastructure and human resource capacity is available supporting access for this population; utilization of these services; and the quality of existing nursing care services. …
Examining clinical leadership in Kenyan public hospitals through the distributed leadership lens
Clinical leadership is recognized as a crucial element in health system strengthening and health policy globally yet it has received relatively little attention in low and middle income countries (LMICs). Moreover, analyses of clinical leadership tend to focus on senior-level individual leaders, overlooking a wider constellation of middle-level leaders delivering health care in practice in a way affected by their health care context. Using the th…
Pastoral practices' for quality improvement in a Kenyan clinical network
We explain social and organisational processes influencing health professionals in a Kenyan clinical network to implement a form of quality improvement (QI) into clinical practice, using the concept of 'pastoral practices'. Our qualitative empirical case study, conducted in 2015-16, shows the way practices constructing and linking local evidence-based guidelines and data collection processes provided a foundation for QI. Participation in these co…
Examining clinical leadership in Kenyan public hospitals through the distributed leadership lens
Clinical leadership is recognized as a crucial element in health system strengthening and health policy globally yet it has received relatively little attention in low and middle income countries (LMICs). Moreover, analyses of clinical leadership tend to focus on senior-level individual leaders, overlooking a wider constellation of middle-level leaders delivering health care in practice in a way affected by their health care context. Using the th…
What do we know about maternal and perinatal mortality and morbidity audits in sub-Saharan Africa? A scoping literature review
Purpose The purpose of this paper is to provide a situational overview of the facility-based maternal and perinatal morbidity and mortality audits (MPMMAs) in SSA, their current efficacy at reducing mortality and morbidity rates related to childbirth. Design/methodology/approach This is a scoping literature review based on the synthesis of secondary literature. Findings Not all countries in SSA conduct MPMMAs. Countries where MPMMAs are conducted…
Maintaining Distance and Staying Immersed
The Health Services that Deliver for Newborns (HSD-N) project is supported by a multidisciplinary team with experience in ethnographic work, epidemiology, and health systems. The project aims to investigate the projected need for neonatal inpatient services; what existing infrastructure and human resource capacity is available supporting access for this population; utilization of these services; and the quality of existing nursing care services. …
Lessons from a Health Policy and Systems Research programme exploring the quality and coverage of newborn care in Kenya
There are global calls for research to support health system strengthening in low-income and middle-income countries (LMICs). To examine the nature and magnitude of gaps in access and quality of inpatient neonatal care provided to a largely poor urban population, we combined multiple epidemiological and health services methodologies. Conducting this work and generating findings was made possible through extensive formal and informal stakeholder e…
Tracking health sector priority setting processes and outcomes for human resources for health, five-years after political devolution
Devolution has significantly increased county level decision-space for HRH priority setting in Kenya. However, HRH management and accountability challenges still exist at the county level. There is need for interventions to strengthen county level HRH management capacity and accountability mechanisms beyond additional resources allocation. This will boost the realization of the country's efforts for promoting service delivery equity as a key goal…
Prolonged health worker strikes in Kenya- perspectives and experiences of frontline health managers and local communities in Kilifi County
Strikes cannot be seen in isolation of the prevailing policy and health systems context. The 2017 prolonged strikes highlight the underlying and longer-term frustration amongst public sector health workers in Kenya. The health system exhibited properties of complex adaptive systems that are interdependent and interactive. Reactive responses within the public system and the use of private healthcare led to limited continued activity through the st…
Shocks, stress and everyday health system resilience
Health systems are faced with a wide variety of challenges. As complex adaptive systems, they respond differently and sometimes in unexpected ways to these challenges. We set out to examine the challenges experienced by the health system at a sub-national level in Kenya, a country that has recently undergone rapid devolution, using an ‘everyday resilience’ lens. We focussed on chronic stressors, rather than acute shocks in examining the responses…
Collective strategies to cope with work related stress among nurses in resource constrained settings
Kenyan neonatal nurses are asked to do the impossible: to bridge the gap between international standards of nursing and the circumstances they face each day. They work long hours with little supervision in ill-designed wards, staffed by far too few nurses given the pressing need. Despite these conditions, a single neonatal nurse can be tasked with looking after forty sick babies for whom very close care is a necessity. Our 18-month ethnography ex…
Professional identity transitions, violations and reconciliations among new nurses in low- and middle-income countries
We examine how new nurses construct their professional identity in Low- and Middle-Income Countries (LMICs) when they enter clinical practice and encounter practical norms violating procedural standards. We conducted interviews and focus group discussions with 47 Kenyan nurses. We describe new nurses experiencing ‘shock’ entering nursing practice (working and learning alone while responsible for many patients and doing ‘dirty work’), which contra…
An innovative leadership development initiative to support building everyday resilience in health systems
Effective management and leadership are essential for everyday health system resilience, but actors charged with these roles are often underprepared and undersupported to perform them. Particular challenges have been observed in interpersonal and relational aspects of health managers’ work, including communication skills, emotional competence and supportive oversight. Within the Resilient and Responsive Health Systems (RESYST) consortium in Kenya…
Improving facility-based care
Attention has turned to improving the quality and safety of healthcare within health facilities to reduce avoidable mortality and morbidity. Interventions should be tested in health system environments that can support their adoption if successful. To be successful, interventions often require changes in multiple behaviours making their consequences unpredictable. Here, we focus on this challenge of change at the mesolevel or microlevel. Drawing …
Investments for effective functionality of health systems towards Universal Health Coverage in Africa
The health challenges in Africa underscore the importance of effectively investing in health systems. Unfortunately, there is no information on systems investments adequate for an effective functional health system. We aimed to address this by conducting a scoping review of existing evidence following the Joanna Briggs Institute Manual for Evidence Synthesis and preregistered with the Open Science Framework ( https://osf.io/bvg4z ). We included a…
High impact health service interventions for attainment of UHC in Africa
African countries have prioritized the attainment of targets relating to Universal Health Coverage (UHC), Health Security (HSE) and Coverage of Health Determinants (CHD)to attain their health goals. Given resource constraints, it is important to prioritize implementation of health service interventions with the highest impact. This is important to be identified across age cohorts and public health functions of health promotion, disease prevention…
Service delivery reform for maternal and newborn health in Kakamega County, Kenya
This protocol describes a hybrid effectiveness/implementation evaluation study with an adaptive design. The impact evaluation ("effectiveness") study focuses on maternal and newborn health outcomes, and will be accompanied by an implementation evaluation focused on program reach, adoption, and fidelity
‘We were treated like we are nobody’
OBJECTIVE: Medical interns are an important workforce providing first-line healthcare services in hospitals. The internship year is important for doctors as they transition from theoretical learning with minimal hands-on work under supervision to clinical practice roles with considerable responsibility. However, this transition is considered stressful and commonly leads to burn-out due to challenging working conditions and an ongoing need for lea…
The hidden emotional labour behind ensuring the social value of research
Health policy and systems research (HPSR) is a multi-disciplinary, largely applied field of research aimed at understanding and strengthening the performance of health systems, often with an emphasis on power, policy and equity. The value of embedded and participatory HPSR specifically in facilitating the collection of rich data that is relevant to addressing real-world challenges is increasingly recognised. However, the potential contributions a…
Lessons learned from Covid-19 modelling efforts for policy decision-making in lower- and middle-income countries
INTRODUCTION: The COVID-19 pandemic had devastating health and socioeconomic effects, partly due to policy decisions to mitigate them. Little evidence exists of approaches that guided decisions in settings with limited pre-pandemic modelling capacity. We thus sought to identify knowledge translation mechanisms, enabling factors and structures needed to effectively translate modelled evidence into policy decisions. METHODS: We used convergent mixe…
The maternal and newborn health eCohort to track longitudinal care quality
The MNH eCohort was developed to fill gaps in maternal and newborn health (MNH) care quality measurement. In this paper, we describe the survey development process, recruitment strategy, data collection procedures, survey content and plans for analysis of the data generated by the study. We also compare the survey content to that of existing multi-country tools on MNH care quality. The eCohort is a longitudinal mixed-mode (in-person and phone) su…
Care seeking during pregnancy
A health systems reform known as Service Delivery Redesign (SDR) for maternal and newborn health seeks to make high-quality delivery care universal in Kakamega County, in western Kenya, by strengthening hospital-level care and making hospital deliveries the default option for pregnant women. Using a large prospective survey of new mothers in Kakamega County, we examine several key assumptions that underpin the SDR policy’s theory of change. We an…
Examining liminality in professional practice, relational identities, and career prospects in resource-constrained health systems
We examine new doctors' and nurses' experiences of transitioning from training to practising as health professionals, drawing on the concept of liminality. Liminality is a stage of 'in-betweenness', involving uncertainty and ambiguity as people leave one social context and reintegrate into a new one. Surprisingly little research has explored new health professionals' experiences of liminality during role and career transitions, particularly in pr…
‘You can sleep hungry just to buy the medicine’
This research applies the Cumulative Complexity model to examine patient experiences of hypertension management following prescription of anti-hypertensive medication in the public health system in Kenya. Set in Kiambu County, central Kenya, it draws on abductive analysis of interviews with patients (n = 24), caregivers (n = 7) and non-participant observation in four purposively selected public facilities conducted between November 2022 and April…
Acceptability of fixed-dose combination treatments for hypertension in Kenya
Fixed-dose combinations (FDCs) – 2-3 anti-hypertensive medications in a single pill - have the potential to improve hypertension treatment and outcomes. Yet, they are not widely implemented. Factors undermining implementation remain unknown, particularly in sub–Saharan Africa, where hypertension is a major cause of disease burden and is poorly controlled. This study explored the acceptability of FDCs among patients, caregivers, and healthcare wor…
Management capacity of primary healthcare facilities in low- and middle-income countries
How health facilities are managed determines their performance and health service delivery. Management capacity of health facilities comprises the competency of managers at the individual level and the management support and work environment in their institutions. Evidence shows this management capacity influences service delivery and performance of the facility. For LMICs, there are evidence gaps as existing evidence is scarce, varied in the ass…
Emotional dimensions of nurses’ daily work in newborn units in Kenya
We draw on our data, the wider literature, and nurses' recommendations to reflect on the interplay between emotional well-being and ethical nursing practice, and to make suggestions for ongoing health system strengthening efforts
Medicine (23 obras) · Global Maternal and Child Health (19 obras) · Nursing (19 obras) · Political science (18 obras) · Sociology (13 obras) · Health care (12 obras) · Business (11 obras) · Public relations (10 obras) · Psychology (9 obras) · Public health (9 obras)