The RE-AIM framework-based evaluation of the implementation of the Maternal and Child Health Handbook program in Angola: a mixed methods study

Abstract

Background The World Health Organization recommends the Maternal and Child Health Handbook (MCH-HB) to promote health service utilization from pregnancy to early childhood. Although many countries have adopted it as a national health policy, there is a paucity of research in MCH-HB’s implementation. Thus, this study aimed to evaluate the MCH-HB’s implementation status based on the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance), and identify facilitators of, and barriers to its implementation in Angola to understand effective implementation strategies. Methods A cross-sectional survey was conducted targeting all health facilities which implemented MCH-HB, subsamples of health workers, and officers responsible for the MCH-HB at the municipality health office. Using the 14 indicators based on the RE-AIM framework, health facilities’ overall implementation statuses were assessed. This categorized health facilities into optimal-implementation and suboptimal-implementation groups. To identify barriers to and facilitators of MCH-HB implementation, semi-structured interviews were conducted among health workers and municipality health officers responsible for MCH-HB. The data were analyzed via content analysis. Results A total of 88 health facilities and 216 health workers were surveyed to evaluate the implementation status, and 155 interviews were conducted among health workers to assess the barriers to and facilitators of the implementation. The overall implementation target was achieved in 50 health facilities (56.8%). The target was achieved by more health facilities in urban than rural areas (urban 68.4%, rural 53.6%) and by more health facilities of higher facility types (hospital 83.3%, health center 59.3%, health post 52.7%). Through the interview data’s analysis, facilitators of and barriers to MCH-HB were comprehensively demonstrated. MCH-HB’s content advantage was the most widely recognized facilitator and inadequate training for health workers was the most widely recognized barrier. Conclusions Strengthening education for health workers, supervision by municipality health officers, and community sensitization were potential implementation strategies. These strategies must be intensified in rural and lower-level health facilities.

Effectiveness of the maternal and child health handbook for improving continuum of care and other maternal and child health indicators: A cluster randomized controlled trial in Angola

“…Thus, inadequate supply of health care services and inputs, especially in rural areas are likely to be important constraints to the attainment of the continuum of care for maternal and child health in this study. To further elucidate barriers and facilitators to the intervention delivery, we did a mixed-methods implementation study which demonstrated the need for strengthening education for health care providers [ 27 ]. Our study also highlights the importance of health care provider training.…”

“…Pre- and post-training assessments and direct observation revealed improvements in health care provider knowledge and competence in service delivery using the MCH handbook. However, urban/rural and facility level disparities in basic skills and competencies required for providing maternity services remain evident [ 27 ]. Evidence shows that health care provider training may further enhance availability and quality of maternity services when adapted to country needs [ 28 ].…”

Development and implementation of the maternal and child health Handbook in Angola

“…The phases I and II projects formed the basis for the nationwide expansion of the MCH Handbook programme. We did an impact evaluation study from June 2019 to September 2020 to assess the programme impact on service use and MCH outcomes,17 while an implementation study that assessed the barriers and facilitators to the programme delivery done between October and November 2020 showed need to strengthen monitoring and supervision at healthcare facilities and training for healthcare providers 18…”

Applying RE-AIM to evaluations of Veterans Health Administration Enterprise-Wide Initiatives: lessons learned

“…While there are many papers and reports of individual evaluations that used RE-AIM as an evaluation framework (7)(8)(9)(10)(11)(12)(13), and papers that use RE-AIM to synthesize information across multiple evaluations (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24), fewer authors have addressed the utility of RE-AIM as an evaluation framework (25). The purpose of this manuscript is to capture one evaluation center's experience of using RE-AIM as an evaluation framework across a series of Enterprise-Wide Initiative evaluations.…”