Transforming Global Health by Improving the Science of Scale-Up

Kruk, Margaret E; Yamey, Gavin; Angell, Sonia Y.; Beith, Alix; Cotlear, Daniel; Guanais, Frederico C.; Jacobs, Lisa M.; Saxenian, Helen; Victora, Cesar G; Goosby, Eric

doi:10.1371/journal.pbio.1002360

Cited by 53 publications

(50 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The PC101 management tool is correctly seen as a means of overcoming the “silo” approach to individual disease management in which recommendations for different conditions may vary and even conflict and, more importantly, ensures that NCDs and mental health are not overlooked because of prioritisation of communicable diseases. For us, as researchers who look to rigorous research methods to guide health system development, this has been a powerful lesson in understanding that evidence of effectiveness is only one element under consideration by decision-makers [63]. Given clinicians’ strong attraction to the ease of integrating PC101 into clinic practice and the positive system effects of our intervention mentioned above, it might have been more useful to focus our primary analysis on lack of harm.…”

Section: Discussionmentioning

confidence: 99%

Educational Outreach with an Integrated Clinical Tool for Nurse-Led Non-communicable Chronic Disease Management in Primary Care in South Africa: A Pragmatic Cluster Randomised Controlled Trial

et al. 2016

View full text Add to dashboard Cite

BackgroundIn many low-income countries, care for patients with non-communicable diseases (NCDs) and mental health conditions is provided by nurses. The benefits of nurse substitution and supplementation in NCD care in high-income settings are well recognised, but evidence from low- and middle-income countries is limited. Primary Care 101 (PC101) is a programme designed to support and expand nurses’ role in NCD care, comprising educational outreach to nurses and a clinical management tool with enhanced prescribing provisions. We evaluated the effect of the programme on primary care nurses’ capacity to manage NCDs.Methods and FindingsIn a cluster randomised controlled trial design, 38 public sector primary care clinics in the Western Cape Province, South Africa, were randomised. Nurses in the intervention clinics were trained to use the PC101 management tool during educational outreach sessions delivered by health department trainers and were authorised to prescribe an expanded range of drugs for several NCDs. Control clinics continued use of the Practical Approach to Lung Health and HIV/AIDS in South Africa (PALSA PLUS) management tool and usual training. Patients attending these clinics with one or more of hypertension (3,227), diabetes (1,842), chronic respiratory disease (1,157) or who screened positive for depression (2,466), totalling 4,393 patients, were enrolled between 28 March 2011 and 10 November 2011. Primary outcomes were treatment intensification in the hypertension, diabetes, and chronic respiratory disease cohorts, defined as the proportion of patients in whom treatment was escalated during follow-up over 14 mo, and case detection in the depression cohort. Primary outcome data were analysed for 2,110 (97%) intervention and 2,170 (97%) control group patients. Treatment intensification rates in intervention clinics were not superior to those in the control clinics (hypertension: 44% in the intervention group versus 40% in the control group, risk ratio [RR] 1.08 [95% CI 0.94 to 1.24; p = 0.252]; diabetes: 57% versus 50%, RR 1.10 [0.97 to 1.24; p = 0.126]; chronic respiratory disease: 14% versus 12%, RR 1.08 [0.75 to 1.55; p = 0.674]), nor was case detection of depression (18% versus 24%, RR 0.76 [0.53 to 1.10; p = 0.142]). No adverse effects of the nurses’ expanded scope of practice were observed. Limitations of the study include dependence on self-reported diagnoses for inclusion in the patient cohorts, limited data on uptake of PC101 by users, reliance on process outcomes, and insufficient resources to measure important health outcomes, such as HbA1c, at follow-up.ConclusionsEducational outreach to primary care nurses to train them in the use of a management tool involving an expanded role in managing NCDs was feasible and safe but was not associated with treatment intensification or improved case detection for index diseases. This notwithstanding, the intervention, with adjustments to improve its effectiveness, has been adopted for implementation in primary care clinics throughout South Africa.Trial...

show abstract

Section: Discussionmentioning

confidence: 99%

Educational Outreach with an Integrated Clinical Tool for Nurse-Led Non-communicable Chronic Disease Management in Primary Care in South Africa: A Pragmatic Cluster Randomised Controlled Trial

et al. 2016

View full text Add to dashboard Cite

show abstract

“…32 There remains limited evidence understanding how best to do this, particularly in the context of a technical capacity gap in national planning and implementing bodies in many high burden countries. 50 This gap in delivery capacity has been demonstrated in other parallel programs, for example, the IMCI strategy, which was launched by the WHO in 1996. A multicountry evaluation conducted in Bangladesh, Brazil, Peru, Tanzania, and Uganda found that the WHO expected IMCI would be implemented fully regardless of the strength of the health system, and this assumption did not hold true.…”

Section: Lessons Learned For Dimension 2: Taking Interventions To Scalementioning

confidence: 99%

What implementation evidence matters: scaling‐up nurturing interventions that promote early childhood development

Britto

Singh

Dua

et al. 2018

Annals of the New York Academy of Sciences

View full text Add to dashboard Cite

Research in early childhood development (ECD) has established the need for scaling-up multisectoral interventions for nurturing care to promote ECD, for improved socioeconomic outcomes for sustainable societies. However, key elements and processes for implementation and scale-up of such interventions are not well understood. This special series on implementation research and practice for ECD brings together evidence to inform effectiveness, quality, and scale in nurturing care programs; identifies knowledge gaps; and proposes further directions for research and practice. This paper frames the dimensions and components fundamental to the understanding of implementation processes for nurturing care interventions, factors for improving implementation of interventions, and strategies to scale by embedding interventions in delivery systems. We discuss emerging issues in implementation research for ECD, including (1) the role of context in adaptation and implementation, (2) standardized reporting of implementation research, (3) the importance of feasibility studies to inform scale-up and capacity building, (4) fidelity and program quality improvement, and (5) intervention integration into existing systems. Effective implementation of nurturing care interventions is at the heart of achieving positive developmental outcomes for young children. It is pivotal to adapt and implement these interventions based on evidence for high impact, especially in low-resource settings.

show abstract

“…Similar to many low income countries, health care often fails at the point of deliverydespite laudable policy commitments [53]. The right to health is enshrined in the many national laws and regional and international treaties which Mozambique is party.…”

Section: Discussionmentioning

confidence: 99%

Misoprostol for the prevention of post-partum haemorrhage in Mozambique: an analysis of the interface between human rights, maternal health and development

Hobday

Zwi

Homer

et al. 2020

BMC Int Health Hum Rights

View full text Add to dashboard Cite

Background: Mozambique has high maternal mortality which is compounded by limited human resources for health, weak access to health services, and poor development indicators. In 2011, the Mozambique Ministry of Health (MoH) approved the distribution of misoprostol for the prevention of post-partum haemorrhage (PPH) at home births where oxytocin is not available. Misoprostol can be administered by a traditional birth attendant or self-administered. The objective of this paper is to examine, through applying a human rights lens, the broader contextual, policy and institutional issues that have influenced and impacted the early implementation of misoprostol for the prevention of PPH. We explore the utility of rights-based framework to inform this particular program, with implications for sexual and reproductive health programs more broadly.Methods: A human rights, health and development framework was used to analyse the early expansion phase of the scale-up of Mozambique's misoprostol program in two provinces. A policy document review was undertaken to contextualize the human rights, health and development setting in Mozambique. Qualitative primary data from a program evaluation of misoprostol for the prevention of PPH was then analysed using a human rights lens; these results are presented alongside three examples where rights are constrained. Results: Structural and institutional challenges exacerbated gaps in the misoprostol program, and sexual and reproductive health more generally. While enshrined in the constitution and within health policy documents, human rights were not fully met and many individuals in the study were unaware of their rights. Lack of information about the purpose of misoprostol and how to access the medication contributed to power imbalances between the state, health care workers and beneficiaries. The accessibility of misoprostol was further limited due to dynamics of power and control.(Continued on next page)

show abstract

Transforming Global Health by Improving the Science of Scale-Up

Cited by 53 publications

References 31 publications

Educational Outreach with an Integrated Clinical Tool for Nurse-Led Non-communicable Chronic Disease Management in Primary Care in South Africa: A Pragmatic Cluster Randomised Controlled Trial

Educational Outreach with an Integrated Clinical Tool for Nurse-Led Non-communicable Chronic Disease Management in Primary Care in South Africa: A Pragmatic Cluster Randomised Controlled Trial

What implementation evidence matters: scaling‐up nurturing interventions that promote early childhood development

Misoprostol for the prevention of post-partum haemorrhage in Mozambique: an analysis of the interface between human rights, maternal health and development

Contact Info

Product

Resources

About