HeAlth System StrEngThening in four sub-Saharan African countries (ASSET) to achieve high-quality, evidence-informed surgical, maternal and newborn, and primary care: protocol for pre-implementation phase studies

Abstract

To achieve universal health coverage, health system strengthening (HSS) is required to support the of delivery of high-quality care. The aim of the National Institute for Health Research Global Research Unit on HeAlth System StrEngThening in Sub-Saharan Africa (ASSET) is to address this need in a four-year programme, with three healthcare platforms involving eight work-packages. Key to effective health system strengthening (HSS) is the pre-implementation phase of research where efforts focus on applying participatory methods to embed the research programme within the existing health system. To conceptualise the approach, we provide an overview of the key methods applied across work-package to address this important phase of research conducted between 2017 and 2021. Work-packages are being undertaken in publicly funded health systems in rural and urban areas in Ethiopia, Sierra Leone, South Africa, and Zimbabwe. Stakeholders including patients and their caregivers, community representatives, clinicians, managers, administrators, and policymakers are the main research participants. In each work-package, initial activities engage stakeholders and build relationships to ensure co-production and ownership of HSSIs. A mixed-methods approach is then applied to understand and address determinants of high-quality care delivery. Methods such as situation analysis, cross-sectional surveys, interviews and focus group discussions are adopted to each work-package aim and context. At the end of the pre-implementation phase, findings are disseminated using focus group discussions and participatory Theory of Change workshops where stakeholders from each work package use findings to select HSSIs and develop a programme theory. ASSET places a strong emphasis of the pre-implementation phase in order to provide an in-depth and systematic diagnosis of the existing heath system functioning, needs for strengthening and stakeholder engagement. This common approach will inform the design and evaluation of the HSSIs to increase effectiveness across work packages and contexts, to better understand what works, for whom, and how.

Improving child health service interventions through a Theory of Change: A scoping review

“…Of the remainder, 9 (24%) were developed post-intervention, 8 (21%) during the intervention, and the timing of the development of two was not clear. Under half of the studies (16/38, 42%) commented on the process of ToC development, with many describing a collaborative approach through workshops, meetings, or discussions ( 5 , 25 , 30 , 31 , 33 – 35 , 37 , 38 , 43 , 44 ). Seven studies (18%) provided a stepwise and more comprehensive explanation for their ToC development ( 5 , 25 , 28 , 33 , 38 , 39 , 42 ).…”

Costs, catastrophic out-of-pocket payments and impoverishment related to accessing surgical care among households in rural Ethiopia

“…This study was conducted as part of the pre-implementation phase of the ASSET programme (Health System Strengthening in sub-Saharan Africa). The goal of ASSET was to identify system bottlenecks to accessing quality surgical, maternal and primary healthcare in Ethiopia, Sierra Leone, South Africa and Zimbabwe [21]. In this paper, we present findings from Ethiopia.…”

“Problems you can live with” versus emergencies: how community members in rural Ethiopia contend with conditions requiring surgery

“…The study design was qualitative, nested within the surgery work package of ASSET, a health systems strengthening research programme working across four sub-Saharan African countries (Ethiopia, Sierra Leone, South Africa, Zimbabwe) and three platforms of care (surgery, integrated primary care and maternal and newborn care) (Seward, Hanlon et al 2022). The overall aim of the surgery work package was to develop a surgical and dental health care plan at a district and hospital quality cluster level which would lead to increased access to quality essential and emergency surgical care.…”