Embedding implementation research to cross the quality of care chasm during the covid-19 pandemic and beyond

Peters, Michael A; Cloete, Keith; Odwe, George; Tadele, Gizachew; Hirschhorn, Lisa R; Magge, Hema; Roder-DeWan, Sanam

doi:10.1136/bmj-2023-076331

Cited by 3 publications

(1 citation statement)

References 34 publications

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“…We employed a pragmatic embedded implementation research (eIR) to explore contextual challenges, and design and implement strategies to optimize the integration of PSBI management into the health system during the COVID-19 pandemic. Embedded implementation research is a systematic method of translating evidence-based interventions into routine health system functions through meaningful engagement of program managers and researchers in the co-production and use of knowledge for continuous program improvement [ 26 , 27 ]. The success of integration is dependent on the well-thought-out design, implementation, and performance monitoring system.…”

Section: Methodsmentioning

confidence: 99%

Optimizing integration of community-based management of possible serious bacterial infection (PSBI) in young infants into primary healthcare systems in Ethiopia and Kenya: successes and challenges

Tiruneh,

Odwe,

Kamberos

et al. 2024

BMC Health Serv Res

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Background Ethiopia and Kenya have adopted the community-based integrated community case management (iCCM) of common childhood illnesses and newborn care strategy to improve access to treatment of infections in newborns and young infants since 2012 and 2018, respectively. However, the iCCM strategy implementation has not been fully integrated into the health system in both countries. This paper describes the extent of integration of iCCM program at the district/county health system level, related barriers to optimal integration and implementation of strategies. Methods From November 2020 to August 2021, Ethiopia and Kenya implemented the community-based treatment of possible serious bacterial infection (PSBI) when referral to a higher facility is not possible using embedded implementation research (eIR) to mitigate the impact of COVID-19 on the delivery of this life-saving intervention. Both projects conducted mixed methods research from April-May 2021 to identify barriers and facilitators and inform strategies and summative evaluations from June-July 2022 to monitor the effectiveness of implementation outcomes including integration of strategies. Results Strategies identified as needed for successful implementation and sustainability of the management of PSBI integrated at the primary care level included continued coaching and support systems for frontline health workers, technical oversight from the district/county health system, and ensuring adequate supply of commodities. As a result, support and technical oversight capacity and collaborative learning were strengthened between primary care facilities and community health workers, resulting in improved bidirectional linkages. Improvement of PSBI treatment was seen with over 85% and 81% of estimated sick young infants identified and treated in Ethiopia and Kenya, respectively. However, perceived low quality of service, lack of community trust, and shortage of supplies remained barriers impeding optimal PSBI services access and delivery. Conclusion Pragmatic eIR identified shared and unique contextual challenges between and across the two countries which informed the design and implementation of strategies to optimize the integration of PSBI management into the health system during the COVID-19 pandemic. The eIR participatory design also strengthened ownership to operationalize the implementation of identified strategies needed to improve the health system’s capacity for PSBI treatment.

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Section: Methodsmentioning

confidence: 99%

Optimizing integration of community-based management of possible serious bacterial infection (PSBI) in young infants into primary healthcare systems in Ethiopia and Kenya: successes and challenges

Tiruneh,

Odwe,

Kamberos

et al. 2024

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

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Improving possible serious bacterial infection (PSBI) management in young infants when referral is not feasible: lessons from embedded implementation research in Ethiopia and Kenya

Tiruneh,

Odwe,

K’Oduol

et al. 2024

BMC Pediatr

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Lessons from polio eradication: a synthesis of implementation strategies for global health services delivery from a scoping review

Neel,

Olateju,

Peters

et al. 2024

Front. Health Serv.

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IntroductionThere is limited guidance on strategies for delivering complex global health programs. We synthesized available evidence on implementation strategies and outcomes utilized in the global polio eradication initiative (GPEI) across low and middle-income country (LMIC) settings.MethodsWe nested our scoping review into a literature review conducted as part of a parent study, STRIPE. This review systematically searched PubMed for articles between 1 January 1988 and 25 April 2018 using polio search terms. Strategies from included studies were organized according to the Expert Recommendations for Implementing Change (ERIC) framework, specified using Proctor's framework, and linked to various outcomes (implementation, services delivery, impact).Results152 unique articles fulfilled our inclusion criteria (from 1,885 articles included in the parent study). Only 43 out of the 152 articles described a suitable quantitative study design for evaluating outcomes. We extracted 66 outcomes from the 43 unique studies. Study publication dates ranged from 1989 to 2018 and represented diverse country settings. The most common implementation strategies were developing mechanisms for feedback, monitoring, and evaluation (n = 69); increasing awareness among the population (n = 58); involving stakeholders, workers, and consumers in the implementation efforts (n = 46); conducting workshops (n = 33); using mass media (n = 31); and building robust record systems to capture outcomes (n = 31). Coverage (n = 13) and morbidity (n = 12) were the most frequently identified outcomes, followed by effectiveness (n = 9) and fidelity (n = 6). Feasibility and sustainability were rarely evaluated.ConclusionsThis review provides a catalogue of implementation strategies and outcomes relevant for advancing global health services delivery in LMICs drawing from the GPEI. Implementation strategies reviewed were poorly described and not adequately linked to outcomes. It calls for additional implementation research to unravel the mechanisms of implementation strategies and their effectiveness, and adaptation of the ERIC framework in LMICs.

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Embedding implementation research to cross the quality of care chasm during the covid-19 pandemic and beyond

Abstract: Michael Peters and colleagues argue that concerted efforts to embed implementation research can improve health services, even in the most challenging operating environments

Cited by 3 publications

References 34 publications

Optimizing integration of community-based management of possible serious bacterial infection (PSBI) in young infants into primary healthcare systems in Ethiopia and Kenya: successes and challenges

Optimizing integration of community-based management of possible serious bacterial infection (PSBI) in young infants into primary healthcare systems in Ethiopia and Kenya: successes and challenges

Improving possible serious bacterial infection (PSBI) management in young infants when referral is not feasible: lessons from embedded implementation research in Ethiopia and Kenya

Lessons from polio eradication: a synthesis of implementation strategies for global health services delivery from a scoping review

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