Metronidazole intravenous formulation use in in-patients in Kapkatet District Hospital, Kenya: a best practice implementation project

Barriers and Facilitators to Implementing Evidence in African Health Care: A Content Analysis With Implications for Action

“…Eleven published (55%) and nine unpublished reports (45%) of implementation projects undertaken in Africa were reviewed. The majority of projects were conducted in Kenya (Amdamy & McMillan, ; Kaguongo & McArthur, ; Karua, ; Kebaya et al, ; Mirigo, ; Mwita et al, ; Nyakiba et al, ; Panga et al, ), Ghana (Amoah et al, ; Bayuo et al, ; Oduro, ; Tinkorang et al, ), Ethiopia (Admassu et al, ; Feyissa et al, ; Kerie et al, ), and Uganda (Ayiasi et al, ; Muhumuza et al, ), with one project each from Malawi (Chibwana & Gomersall, ), Tanzania (Jelly & Peters, ), and Cameroon (Okwen et al, ). A third of the projects were undertaken in a teaching hospital ( n = 6/20, 30%), another third were conducted in a regional, rural, district or public hospital ( n = 7, 35%), a few were carried out in a paediatric hospital ( n = 3, 15%), and one project each was implemented in a health centre ( n = 1, 5%), infectious disease hospital ( n = 1, 5%), health district ( n = 1, 5%) and a university‐based dental clinic ( n = 1, 5%).…”

“…Only one project described barriers at the government and consumer levels (Okwen, Ngem, Chia, Cheabum, & Moola, ); this was undertaken in Cameroon. Seven of the 20 implementation projects reported facilitators, of which the majority were related to either health practitioners’ attitude or motivation to change practice or support from influential individuals (Amdamy & McMillan, ; Ayiasi, Kirungi, Namatovu, & Kuhinira, ; Bayuo, Munn, & Campbell, ; Chibwana & Gomersall, ; Kaguongo & McArthur, ; Panga, Ngwiri, Nganga, Nguu, & Ndinda, ; Tinkorang, Abebrese, & Yeboah, ). Table presents a summary of barriers and facilitators described in the implementation reports.…”

“…The most frequently identified barrier that traversed countries and clinical settings was lack of material resources ( n = 16/20; 80%), including hospital equipment (e.g., endoscope, safety devices for sharp objects, ultrasound machine), supplies (e.g., hand hygiene products, water supply, sterile packs, medications), assessment tools (e.g., cardiovascular risk screening tool, pain assessment, thermometers) and reporting or documentation forms (Admassu, Abdulahi, Fogi, & Egziabher, ; Amdamy & McMillan, ; Amoah, Moola, & Newman‐Nartey, ; Bayuo et al., ; Chibwana & Gomersall, ; Feyissa, Gomersall, & Robertson‐Malt, ; Kaguongo & McArthur, ; Karua, ; Mirigo, ; Muhumuza et al., ; Mwita, Ogoti, Abila, Mbogo, & Sisenda, ; Nyakiba, McMillan, & Kenyatta, ; Oduro, ; Okwen et al., ; Panga et al., ; Tinkorang et al., ). An implementation project undertaken in a paediatric hospital in Kenya, which aimed to improve pain assessment in children postsurgery, identified the lack of an acute pain service (including a team of skilled practitioners and a dedicated facilitator to lead the service) as a key barrier to the implementation of best practice in acute postoperative pain assessment and management in children (Panga et al., ).…”

“…Another commonly reported organizational barrier was related to human resources ( n = 9/20; 45%). Heavy workload or inadequate staffing was identified in projects conducted in Uganda, Kenya, Ghana and Ethiopia across various clinical areas and was frequently described in rural‐ or regional‐based settings (Admassu et al., ; Amdamy & McMillan, ; Ayiasi et al., ; Feyissa et al., ; Karua, ; Mirigo, ; Muhumuza et al., ; Mwita et al., ; Oduro, ). Lack of or inadequate supervision and oversight of services provided to patients (i.e., postnatal women and patients postpulpotomy) was identified by two projects undertaken in Uganda and Ghana, respectively (Amoah et al., ; Ayiasi et al., ).…”

“…Lack of access to best practice guidelines, up‐to‐date information, educational resources or regular training for healthcare practitioners was also a key barrier in many countries such as Kenya, Ethiopia, Malawi, Ghana and Cameroon and across different clinical settings including paediatrics, surgery and maternal health (Amdamy & McMillan, ; Chibwana & Gomersall, ; Kebaya et al., ; Kerie, Haile, & Eseye, ; Oduro, ; Okwen et al., ; Tinkorang et al., ). Absence of resources for patient education was reported in two implementation projects (one on burns care and another on newborn care) conducted in Uganda and Ghana, respectively (Ayiasi et al., ; Bayuo et al., ).…”