Application of systems thinking: 12‐month postintervention evaluation of a complex health system intervention in <scp>Z</scp>ambia: the case of the <scp>BHOMA</scp>

Mutale, Wilbroad; Ayles, Helen; Bond, Virginia; Chintu, Namwinga; Chilengi, Roma; Mwanamwenge, Margaret Tembo; Taylor, Angela; Spicer, Neil; Balabanova, Dina

doi:10.1111/jep.12354

Cited by 26 publications

(28 citation statements)

References 32 publications

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“…The introduction of externally developed QI mentorship teams was initially met with weak facility-level staff involvement, but intensified engagement with district supervisors (e.g. enlisting them as training and supervision mentors) improved participation of health facility personnel in QI work, including data quality tasks [ 19 ].…”

Section: Resultsmentioning

confidence: 99%

Improving data quality across 3 sub-Saharan African countries using the Consolidated Framework for Implementation Research (CFIR): results from the African Health Initiative

Gimbel

Moses

Nisingizwe³

et al. 2017

BMC Health Serv Res

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BackgroundHigh-quality data are critical to inform, monitor and manage health programs. Over the seven-year African Health Initiative of the Doris Duke Charitable Foundation, three of the five Population Health Implementation and Training (PHIT) partnership projects in Mozambique, Rwanda, and Zambia introduced strategies to improve the quality and evaluation of routinely-collected data at the primary health care level, and stimulate its use in evidence-based decision-making. Using the Consolidated Framework for Implementation Research (CFIR) as a guide, this paper: 1) describes and categorizes data quality assessment and improvement activities of the projects, and 2) identifies core intervention components and implementation strategy adaptations introduced to improve data quality in each setting.MethodsThe CFIR was adapted through a qualitative theme reduction process involving discussions with key informants from each project, who identified two domains and ten constructs most relevant to the study aim of describing and comparing each country’s data quality assessment approach and implementation process. Data were collected on each project’s data quality improvement strategies, activities implemented, and results via a semi-structured questionnaire with closed and open-ended items administered to health management information systems leads in each country, with complementary data abstraction from project reports.ResultsAcross the three projects, intervention components that aligned with user priorities and government systems were perceived to be relatively advantageous, and more readily adapted and adopted. Activities that both assessed and improved data quality (including data quality assessments, mentorship and supportive supervision, establishment and/or strengthening of electronic medical record systems), received higher ranking scores from respondents.ConclusionOur findings suggest that, at a minimum, successful data quality improvement efforts should include routine audits linked to ongoing, on-the-job mentoring at the point of service. This pairing of interventions engages health workers in data collection, cleaning, and analysis of real-world data, and thus provides important skills building with on-site mentoring. The effect of these core components is strengthened by performance review meetings that unify multiple health system levels (provincial, district, facility, and community) to assess data quality, highlight areas of weakness, and plan improvements.

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Section: Resultsmentioning

confidence: 99%

Improving data quality across 3 sub-Saharan African countries using the Consolidated Framework for Implementation Research (CFIR): results from the African Health Initiative

Gimbel

Moses

Nisingizwe³

et al. 2017

BMC Health Serv Res

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“…It is a crucial tool that binds stakeholders, and inculcates a sense of belonging to the community. Processes that involved community members enable effective information dissemination among stakeholders, which in turn promote project sustainability [ 12 ]. However, community participation alone is not enough; community members need to utilize local resources within their disposal as a means of sustaining projects.…”

Section: Discussionmentioning

confidence: 99%

An overview of civil society organizations’ roles in health project sustainability in Bauchi State, Nigeria

Ibrahim¹,

Wan-Puteh²

2018

Pan Afr Med J

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IntroductionThis study sets out to assess the roles of Civil Society Organizations (CSOs) in post donor health project sustainability in Low and Middle Income Countries (LMICs), the case of the Bauchi State, Nigeria. This study equally investigated the CSOs strategies and roles in health project sustainability.MethodsFor quantitative data collection, the random, purposive, and convenient sampling techniques were used and 156 respondents selected from relevant organizations operating in Bauchi state, Nigeria, and 15 respondents for Key Informant Interviews (KIIs). A Semi-structured questionnaire was the study instrument, and consent from the participants as well as ethical clearances were duly obtained.ResultsThe study revealed that 87.8% of the respondents indicate un-friendly operational policies, while 88.9% of them identified lack of resources (human, money and machineries) as impediments to project sustainability. Also, 74.3% of the respondents said partnership among key stakeholders and 86.6% of them affirmed that community participation and use of available (local) resources ensure health project sustainability. The study further revealed that CSOs fund health projects, support government efforts and encourage development of project sustainability road map in the state.ConclusionHence, health project sustainability plan should form part of a project right from inception through the donor period and thereafter. In addition to the above, internal income framework, community involvement, enabling policies and partnership among stakeholders, especially with the host government, should always guide project implementation, because without these in place, project sustainability will remain a mirage.

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“…We graded the capacity of health facilities using a balanced scorecard approach previously adapted and validated by our study team[ 16 , 21 , 22 ]. This instrument is a mixed method evaluative tool that employs interviewer- and self-administered quantitative and qualitative assessments among a representative sample of observations at each facility.…”

Section: Discussionmentioning

confidence: 99%

Associations between health systems capacity and mother-to-child HIV prevention program outcomes in Zambia

et al. 2018

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IntroductionZambia has made substantial investments in health systems capacity, yet it remains unclear whether improved service quality improves outcomes. We investigated the association between health system capacity and use of prevention of mother-to-child HIV transmission (PMTCT) services in Zambia.Materials and methodsWe analyzed data from two studies conducted in rural and semi-urban Lusaka Province in 2014–2015. Health system capacity, our primary exposure, was measured with a validated balanced scorecard approach. Based on WHO building blocks for health systems strengthening, we derived overall and domain-specific facility scores (range: 0–100), with higher scores indicating greater capacity. Our outcome, community-level maternal antiretroviral drug use at 12 months postpartum, was measured via self-report in a large cohort study evaluating PMTCT program impact. Associations between health systems capacity and our outcome were analyzed via linear regression.ResultsAmong 29 facilities, median overall facility score was 72 (IQR:67–74). Median domain scores were: patient satisfaction 75 (IQR 71–78); human resources 85 (IQR:63–87); finance 50 (IQR:50–67); governance 82 (IQR:74–91); service capacity 77 (IQR:68–79); service provision 60 (IQR:52–76). Our programmatic outcome was measured from 804 HIV-infected mothers. Median community-level antiretroviral use at 12 months was 81% (IQR:69–89%). Patient satisfaction was the only domain score significantly associated with 12-month maternal antiretroviral use (β:0.22; p = 0.02). When we excluded the human resources and finance domains, we found a positive association between composite 4-domain facility score and 12-month maternal antiretroviral use in peri-urban but not rural facilities.ConclusionsIn these Zambian health facilities, patient satisfaction was positively associated with maternal antiretroviral 12 months postpartum. The association between overall health system capacity and maternal antiretroviral drug use was stronger in peri-urban versus rural facilities. Additional work is needed to guide strategic investments for improved outcomes in HIV and broader maternal-child health region-wide.

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Application of systems thinking: 12‐month postintervention evaluation of a complex health system intervention in Zambia: the case of the BHOMA

Cited by 26 publications

References 32 publications

Improving data quality across 3 sub-Saharan African countries using the Consolidated Framework for Implementation Research (CFIR): results from the African Health Initiative

Improving data quality across 3 sub-Saharan African countries using the Consolidated Framework for Implementation Research (CFIR): results from the African Health Initiative

An overview of civil society organizations’ roles in health project sustainability in Bauchi State, Nigeria

Associations between health systems capacity and mother-to-child HIV prevention program outcomes in Zambia

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