Maryse Kok is a public health specialist and researcher in health systems strengthening. In 2015, Maryse obtained her PhD on performance of community health workers. She focused on optimization of the benefits of community health workers’ unique position between communities and the health sector in low- and middle-income countries. She also has expertise in qualitative and quantitative research on human resources for health, strengthening of (district) health systems and sexual and reproductive health and rights. She is experienced in leading multi-country mixed-methods research, working within multi-stakeholder processes in policy advice and monitoring and evaluation. She also has expertise in (systematic) literature reviews and qualitative evidence syntheses.
Background Community bylaws are commonly accepted mechanisms to influence behaviour change to ach... more Background Community bylaws are commonly accepted mechanisms to influence behaviour change to achieve better health and development outcomes in sub-Saharan Africa. However, the uses, benefits, and potential downsides of community bylaws are largely unclear, especially regarding sexual and reproductive health and rights (SRHR) of young people. The objective of this study was to determine the extent to which community bylaws in Machinga district in southern Malawi are responsive to young people’s realities and SRHR needs. Methods In Phase 1 of this qualitative study, 35 community members were interviewed, including 14 young people (15–24 years), five parents, five traditional leaders, and eleven key informants. Based on findings from Phase 1, eleven members from local youth groups co-created a drama performance that covered issues concerning bylaws and young people’s SRHR (Phase 2). The drama was performed in the community, after which young women (18–24 years), young men (17–24 years...
Aim: Improving community health worker's performance is vital for an effective health system in d... more Aim: Improving community health worker's performance is vital for an effective health system in developing countries. In Malawi, hardly any research has been done on factors that motivate this cadre. This qualitative assessment was undertaken to identify factors that influence motivation and job satisfaction of health surveillance assistants (HSAs) in Mwanza district, Malawi, in order to inform development of strategies to influence staff motivation for better performance. Methods: Seven key informant interviews, six focus group discussions with HSAs and one group discussion with HSAs supervisors were conducted in 2009. The focus was on HSAs motivation and job performance. Data were supplemented with results from a district wide survey involving 410 households, which included views of the community on HSAs performance. Qualitative data were analysed with a coding framework, and quantitative data with the Statistical Package for Social Sciences (SPSS). Results: The main satisfiers identified were team spirit and coordination, the type of work to be performed by an HSA and the fact that an HSA works in the local environment. Dissatisfiers that were found were low salary and position, poor access to training, heavy workload and extensive job description, low recognition, lack of supervision, communication and transport. Managers and had a negative opinion of HSA perfomance, the community was much more positive: 72.9% of all respondents had a positive view on the performance of their HSA. Conclusion: Activities associated with worker appreciation, such as performance management were not optimally implemented. The district level can launch different measures to improve HSAs motivation, including human resource management and other measures relating to coordination of and support to the work of HSAs.
International Journal of Health Planning and Management, Feb 13, 2023
Community Health Committees (CHCs) are mechanisms through which communities participate in the go... more Community Health Committees (CHCs) are mechanisms through which communities participate in the governance and oversight of community health services. While there is renewed interest in strengthening community participation in the governance of community health services, there is limited evidence on how context influences community‐level structures of governance and oversight. The objective of this study was to examine how contextual factors influence the functionality of CHCs in Kajiado, Migori, and Nairobi Counties in Kenya. Using a case study design, we explored the influence of context on CHCs using 18 focus group discussions with 110 community members (clients, CHC members, and community health volunteers [CHVs]) and interviews with 33 health professionals. Essential CHC functions such as ‘leadership’ and ‘management’ were weak, partly because Health professionals did not involve CHCs in developing health plans. Community Health Committees were active in the supervision of CHVs, reviewing their household reports, although they did not utilise these data for making decisions. Resource mobilisation and evaluation of health programs were affected by the lack of administrative and operational support, such as training. Despite having influential membership, CHCs could not provide leadership and management functions. Health system actors perceived the roles of CHCs as service providers rather than structures for governance and oversight. Insufficient awareness of CHC roles among health professionals, lack of training and operational support for community‐based activities constrained CHCs' functionality and thus their role in community participation. While there are efforts to institutionalise community‐level governance structures for health at sub‐national level, there is a need to scale‐up these efforts countrywide. We recommend that community‐level governance structures be empowered, mandated, and provided with resources to take on the responsibility of overseeing community health services and exacting accountability from health providers.
Background Despite the coordinated efforts Ethiopia has exerted against child marriage, the pract... more Background Despite the coordinated efforts Ethiopia has exerted against child marriage, the practice continues to negatively affect rural girls. Child marriage is embedded in the social structures (social norms and values) of rural communities. In this research, we investigated social structure factors that enable child marriage and intend to give insights into emergent agency of young people in actively taking actions against child marriage.Methods A mixed research approach combining quantitative and qualitative research methods was used to generate data from young people (15–24 years) residing in Kewet and Bahir Dar Zuria woredas, Amhara region. The quantitative sample consisted of 1.602 respondents while 23 qualitative interviews were conducted with young people, parents, community and religious leaders, teachers, health extension workers, women and children affairs’ officers and NGO staff.Results We found that child marriage was present among 37% of the respondent girls, aged 18...
Background The scale-up of successfully tested public health interventions is critical to achievi... more Background The scale-up of successfully tested public health interventions is critical to achieving universal health coverage. To ensure optimal use of resources, assessment of the scalability of an intervention is recognized as a crucial step in the scale-up process. This study assessed the scalability of a tested health management-strengthening intervention (MSI) at the district level in Ghana, Malawi and Uganda. Methods Qualitative interviews were conducted with intervention users (district health management teams, DHMTs) and implementers of the scale-up of the intervention (national-level actors) in Ghana, Malawi and Uganda, before and 1 year after the scale-up had started. To assess the scalability of the intervention, the CORRECT criteria from WHO/ExpandNet were used during analysis. Results The MSI was seen as credible, as regional- and national-level Ministry of Health officials were championing the intervention. While documented evidence on intervention effectiveness was li...
Background: Community health committees (CHCs) are a mechanism for communities to voluntarily par... more Background: Community health committees (CHCs) are a mechanism for communities to voluntarily participate in making decisions and providing oversight of the delivery of community health services. For CHCs to succeed, governments need to implement policies that promote community participation. Our research aimed to analyze factors influencing the implementation of CHC-related policies in Kenya. Methods: Using a qualitative study design, we extracted data from policy documents and conducted 12 key informant interviews with health workers and health managers in two counties (rural and urban) and the national Ministry of Health. We applied content analysis for both the policy documents and interview transcripts and summarized the factors that influenced the implementation of CHC-related policies. Findings: Since the inception of the community health strategy, the roles of CHCs in community participation have been consistently vague. Primary health workers found the policy content relate...
Background Community health committees (CHCs) are mechanisms for community participation in decis... more Background Community health committees (CHCs) are mechanisms for community participation in decision-making and overseeing health services in several low-and middle-income countries (LMICs). There is little research that examines teamwork and internal team relationships between members of these committees in LMICs. We aimed to assess teamwork and factors that affected teamwork of CHCs in an urban slum setting in Nairobi, Kenya.Methods Using a qualitative case-study design, we explored teamwork of two CHCs based in two urban informal settlements in Nairobi. We used semi-structured interviews (n = 16) to explore the factors that influenced teamwork and triangulated responses using three group discussions (n = 14). We assessed the interpersonal and contextual factors that influenced teamwork using a framework for assessing teamwork of teams involved in delivering community health services.Results Committee members perceived the relationships with each other as trusting and respectful. ...
BackgroundChild marriage persists in many countries and has severe impacts on health, education, ... more BackgroundChild marriage persists in many countries and has severe impacts on health, education, economic and social status of girls. Child marriage has many interlinked causes. This study aimed to explore the drivers of child marriage in specific contexts in Ethiopia, Indonesia, Kenya, Malawi, Mozambique and Zambia.MethodsThe study combined a household survey among youth (15-24 years) with focus group discussions and interviews conducted with youth (15-24 years) and parents. A variety of community stakeholders were interviewed as well. Logistic regression was done to explore associations between individual and family-level characteristics of young women and the occurrence of child marriage. Transcripts were analysed using an inductive approach. Narratives on the main drivers of child marriage across study contexts were written and inspired by the theory of normative spectrum.ResultsA lack of education was associated with the occurrence of child marriage in Ethiopia, Kenya and Zambi...
Background Community bylaws are commonly accepted mechanisms to influence behaviour change to ach... more Background Community bylaws are commonly accepted mechanisms to influence behaviour change to achieve better health and development outcomes in sub-Saharan Africa. However, the uses, benefits, and potential downsides of community bylaws are largely unclear, especially regarding sexual and reproductive health and rights (SRHR) of young people. The objective of this study was to determine the extent to which community bylaws in Machinga district in southern Malawi are responsive to young people’s realities and SRHR needs. Methods In Phase 1 of this qualitative study, 35 community members were interviewed, including 14 young people (15–24 years), five parents, five traditional leaders, and eleven key informants. Based on findings from Phase 1, eleven members from local youth groups co-created a drama performance that covered issues concerning bylaws and young people’s SRHR (Phase 2). The drama was performed in the community, after which young women (18–24 years), young men (17–24 years...
Aim: Improving community health worker's performance is vital for an effective health system in d... more Aim: Improving community health worker's performance is vital for an effective health system in developing countries. In Malawi, hardly any research has been done on factors that motivate this cadre. This qualitative assessment was undertaken to identify factors that influence motivation and job satisfaction of health surveillance assistants (HSAs) in Mwanza district, Malawi, in order to inform development of strategies to influence staff motivation for better performance. Methods: Seven key informant interviews, six focus group discussions with HSAs and one group discussion with HSAs supervisors were conducted in 2009. The focus was on HSAs motivation and job performance. Data were supplemented with results from a district wide survey involving 410 households, which included views of the community on HSAs performance. Qualitative data were analysed with a coding framework, and quantitative data with the Statistical Package for Social Sciences (SPSS). Results: The main satisfiers identified were team spirit and coordination, the type of work to be performed by an HSA and the fact that an HSA works in the local environment. Dissatisfiers that were found were low salary and position, poor access to training, heavy workload and extensive job description, low recognition, lack of supervision, communication and transport. Managers and had a negative opinion of HSA perfomance, the community was much more positive: 72.9% of all respondents had a positive view on the performance of their HSA. Conclusion: Activities associated with worker appreciation, such as performance management were not optimally implemented. The district level can launch different measures to improve HSAs motivation, including human resource management and other measures relating to coordination of and support to the work of HSAs.
International Journal of Health Planning and Management, Feb 13, 2023
Community Health Committees (CHCs) are mechanisms through which communities participate in the go... more Community Health Committees (CHCs) are mechanisms through which communities participate in the governance and oversight of community health services. While there is renewed interest in strengthening community participation in the governance of community health services, there is limited evidence on how context influences community‐level structures of governance and oversight. The objective of this study was to examine how contextual factors influence the functionality of CHCs in Kajiado, Migori, and Nairobi Counties in Kenya. Using a case study design, we explored the influence of context on CHCs using 18 focus group discussions with 110 community members (clients, CHC members, and community health volunteers [CHVs]) and interviews with 33 health professionals. Essential CHC functions such as ‘leadership’ and ‘management’ were weak, partly because Health professionals did not involve CHCs in developing health plans. Community Health Committees were active in the supervision of CHVs, reviewing their household reports, although they did not utilise these data for making decisions. Resource mobilisation and evaluation of health programs were affected by the lack of administrative and operational support, such as training. Despite having influential membership, CHCs could not provide leadership and management functions. Health system actors perceived the roles of CHCs as service providers rather than structures for governance and oversight. Insufficient awareness of CHC roles among health professionals, lack of training and operational support for community‐based activities constrained CHCs' functionality and thus their role in community participation. While there are efforts to institutionalise community‐level governance structures for health at sub‐national level, there is a need to scale‐up these efforts countrywide. We recommend that community‐level governance structures be empowered, mandated, and provided with resources to take on the responsibility of overseeing community health services and exacting accountability from health providers.
Background Despite the coordinated efforts Ethiopia has exerted against child marriage, the pract... more Background Despite the coordinated efforts Ethiopia has exerted against child marriage, the practice continues to negatively affect rural girls. Child marriage is embedded in the social structures (social norms and values) of rural communities. In this research, we investigated social structure factors that enable child marriage and intend to give insights into emergent agency of young people in actively taking actions against child marriage.Methods A mixed research approach combining quantitative and qualitative research methods was used to generate data from young people (15–24 years) residing in Kewet and Bahir Dar Zuria woredas, Amhara region. The quantitative sample consisted of 1.602 respondents while 23 qualitative interviews were conducted with young people, parents, community and religious leaders, teachers, health extension workers, women and children affairs’ officers and NGO staff.Results We found that child marriage was present among 37% of the respondent girls, aged 18...
Background The scale-up of successfully tested public health interventions is critical to achievi... more Background The scale-up of successfully tested public health interventions is critical to achieving universal health coverage. To ensure optimal use of resources, assessment of the scalability of an intervention is recognized as a crucial step in the scale-up process. This study assessed the scalability of a tested health management-strengthening intervention (MSI) at the district level in Ghana, Malawi and Uganda. Methods Qualitative interviews were conducted with intervention users (district health management teams, DHMTs) and implementers of the scale-up of the intervention (national-level actors) in Ghana, Malawi and Uganda, before and 1 year after the scale-up had started. To assess the scalability of the intervention, the CORRECT criteria from WHO/ExpandNet were used during analysis. Results The MSI was seen as credible, as regional- and national-level Ministry of Health officials were championing the intervention. While documented evidence on intervention effectiveness was li...
Background: Community health committees (CHCs) are a mechanism for communities to voluntarily par... more Background: Community health committees (CHCs) are a mechanism for communities to voluntarily participate in making decisions and providing oversight of the delivery of community health services. For CHCs to succeed, governments need to implement policies that promote community participation. Our research aimed to analyze factors influencing the implementation of CHC-related policies in Kenya. Methods: Using a qualitative study design, we extracted data from policy documents and conducted 12 key informant interviews with health workers and health managers in two counties (rural and urban) and the national Ministry of Health. We applied content analysis for both the policy documents and interview transcripts and summarized the factors that influenced the implementation of CHC-related policies. Findings: Since the inception of the community health strategy, the roles of CHCs in community participation have been consistently vague. Primary health workers found the policy content relate...
Background Community health committees (CHCs) are mechanisms for community participation in decis... more Background Community health committees (CHCs) are mechanisms for community participation in decision-making and overseeing health services in several low-and middle-income countries (LMICs). There is little research that examines teamwork and internal team relationships between members of these committees in LMICs. We aimed to assess teamwork and factors that affected teamwork of CHCs in an urban slum setting in Nairobi, Kenya.Methods Using a qualitative case-study design, we explored teamwork of two CHCs based in two urban informal settlements in Nairobi. We used semi-structured interviews (n = 16) to explore the factors that influenced teamwork and triangulated responses using three group discussions (n = 14). We assessed the interpersonal and contextual factors that influenced teamwork using a framework for assessing teamwork of teams involved in delivering community health services.Results Committee members perceived the relationships with each other as trusting and respectful. ...
BackgroundChild marriage persists in many countries and has severe impacts on health, education, ... more BackgroundChild marriage persists in many countries and has severe impacts on health, education, economic and social status of girls. Child marriage has many interlinked causes. This study aimed to explore the drivers of child marriage in specific contexts in Ethiopia, Indonesia, Kenya, Malawi, Mozambique and Zambia.MethodsThe study combined a household survey among youth (15-24 years) with focus group discussions and interviews conducted with youth (15-24 years) and parents. A variety of community stakeholders were interviewed as well. Logistic regression was done to explore associations between individual and family-level characteristics of young women and the occurrence of child marriage. Transcripts were analysed using an inductive approach. Narratives on the main drivers of child marriage across study contexts were written and inspired by the theory of normative spectrum.ResultsA lack of education was associated with the occurrence of child marriage in Ethiopia, Kenya and Zambi...
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Papers by Maryse Kok