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Dougherty L, Adediran M, Akinola A, Alabi M, Etim EO, Ohioghame J, Adedimeji A. An evaluation of a multi-partner approach to increase routine immunization coverage in six northern Nigerian States. BMC Health Serv Res 2024; 24:951. [PMID: 39164689 PMCID: PMC11337754 DOI: 10.1186/s12913-024-11403-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 08/05/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Global health partnerships are increasingly being used to improve coordination, strengthen health systems, and incentivize government commitment for public health programs. From 2012 to 2022, the Bill & Melinda Gates Foundation (BMGF) and Aliko Dangote Foundation (ADF) forged Memorandum of Understanding (MoU) partnership agreements with six northern state governments to strengthen routine immunization (RI) systems and sustainably increase immunization coverage. This mixed methods evaluation describes the RI MoUs contribution to improving program performance, strengthening capacity and government financial commitment as well as towards increasing immunization coverage. METHODS Drawing from stakeholder interviews and a desk review, we describe the MoU inputs and processes and adherence to design. We assess the extent to which the program achieved its objectives as well as the benefits and challenges by drawing from a health facility assessment, client exit interview and qualitative interviews with service providers, community leaders and program participants. Finally, we assess the overall impact of the MoU by evaluating trends in immunization coverage rates. RESULTS We found the RI MoUs across the six states to be mostly successful in strengthening health systems, improving accountability and coordination, and increasing the utilization of services and financing for RI. Across all six states, pentavalent 3 vaccine coverage increased from 2011 to 2021 and in some states, the gains were substantial. For example, in Yobe, vaccination coverage increased from 10% in 2011 to nearly 60% in 2021. However, in Sokoto, the change was minimal increasing from only 4% in 2011 to nearly 8% in 2021. However, evaluation findings indicate that issues pertaining to human resources for health, insecurity that inhibits supportive supervision and vaccine logistics as well as harmful socio-cultural norms remain a persistent challenge in the states. There is also a need for a rigorous monitoring and evaluation plan with well-defined measures collected prior to and throughout implementation. CONCLUSION Introducing a multi-partner approach grounded in a MoU agreement provides a promising approach to addressing health system challenges that confront RI programs.
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Affiliation(s)
- Leanne Dougherty
- Population Council, Abuja, Nigeria.
- , 4301 Connecticut Avenue, NW, Suite 280, Washington, DC, 20008, USA.
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Belrhiti Z, Bigdeli M, Lakhal A, Kaoutar D, Zbiri S, Belabbes S. Unravelling collaborative governance dynamics within healthcare networks: a scoping review. Health Policy Plan 2024; 39:412-428. [PMID: 38300250 PMCID: PMC11005841 DOI: 10.1093/heapol/czae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 02/02/2024] Open
Abstract
In many countries, healthcare systems suffer from fragmentation between hospitals and primary care. In response, many governments institutionalized healthcare networks (HN) to facilitate integration and efficient healthcare delivery. Despite potential benefits, the implementation of HN is often challenged by inefficient collaborative dynamics that result in delayed decision-making, lack of strategic alignment and lack of reciprocal trust between network members. Yet, limited attention has been paid to the collective dynamics, challenges and enablers for effective inter-organizational collaborations. To consider these issues, we carried out a scoping review to identify the underlying processes for effective inter-organizational collaboration and the contextual conditions within which these processes are triggered. Following appropriate methodological guidance for scoping reviews, we searched four databases [PubMed (n = 114), Web of Science (n = 171), Google Scholar (n = 153) and Scopus (n = 52)] and used snowballing (n = 22). A total of 37 papers addressing HN including hospitals were included. We used a framework synthesis informed by the collaborative governance framework to guide data extraction and analysis, while being sensitive to emergent themes. Our review showed the prominence of balancing between top-down and bottom-up decision-making (e.g. strategic vs steering committees), formal procedural arrangements and strategic governing bodies in stimulating participative decision-making, collaboration and sense of ownership. In a highly institutionalized context, the inter-organizational partnership is facilitated by pre-existing legal frameworks. HN are suitable for tackling wicked healthcare issues by mutualizing resources, staff pooling and improved coordination. Overall performance depends on the capacity of partners for joint action, principled engagement and a closeness culture, trust relationships, shared commitment, distributed leadership, power sharing and interoperability of information systems To promote the effectiveness of HN, more bottom-up participative decision-making, formalization of governance arrangement and building trust relationships are needed. Yet, there is still inconsistent evidence on the effectiveness of HN in improving health outcomes and quality of care.
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Affiliation(s)
- Zakaria Belrhiti
- International School Mohammed VI of Public Health, Mohammed VI University of Sciences and Health (UM6SS), UM6SS – Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Knowledge for Health Policies, UM6SS, Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Mohammed VI Center for Research and Innovation (CM6RI), Rue Mohamed Al Jazouli – Madinat Al Irfane Rabat 10 100, Rabat Rue, Mohamed Al Jazouli – 10 100, Morocco
| | - Maryam Bigdeli
- World Health Organization, 3 Av. S.A.R. Sidi Mohamed, Rabat, Geneva 10170, Morocco
| | - Aniss Lakhal
- Knowledge for Health Policies, UM6SS, Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Directorate of Hospitals and Ambulatory Care, Ministry of Health and Social Protection, Route d’El Jadida, Agdal, Rabat 10100, Morocco
| | - Dib Kaoutar
- Knowledge for Health Policies, UM6SS, Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Directorate of Hospitals and Ambulatory Care, Ministry of Health and Social Protection, Route d’El Jadida, Agdal, Rabat 10100, Morocco
| | - Saad Zbiri
- International School Mohammed VI of Public Health, Mohammed VI University of Sciences and Health (UM6SS), UM6SS – Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Knowledge for Health Policies, UM6SS, Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Mohammed VI Center for Research and Innovation (CM6RI), Rue Mohamed Al Jazouli – Madinat Al Irfane Rabat 10 100, Rabat Rue, Mohamed Al Jazouli – 10 100, Morocco
| | - Sanaa Belabbes
- International School Mohammed VI of Public Health, Mohammed VI University of Sciences and Health (UM6SS), UM6SS – Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Knowledge for Health Policies, UM6SS, Anfa City : Bld Mohammed Taïeb Naciri, Commune Hay Hassani 82 403, Casablanca 20230, Morocco
- Mohammed VI Center for Research and Innovation (CM6RI), Rue Mohamed Al Jazouli – Madinat Al Irfane Rabat 10 100, Rabat Rue, Mohamed Al Jazouli – 10 100, Morocco
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Ali N, Amare E, Fekadu A, Awol M, Kayode O, Gebresenbet M, Nasir K, Dresser SA, Schriebmann E, Seife E, Esiashvili N. Establishment of Twinning Partnership to Improve Pediatric Radiotherapy Outcomes Globally. JCO Glob Oncol 2024; 10:e2300345. [PMID: 38359372 PMCID: PMC10881094 DOI: 10.1200/go.23.00345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/05/2023] [Accepted: 12/05/2023] [Indexed: 02/17/2024] Open
Abstract
PURPOSE Pediatric radiotherapy is a necessary and challenging component of oncologic care for children in low- and middle-income countries (LMICs). Collaboration between institutions in LMICs and high-income countries (HICs) has been shown to be effective in improving oncologic treatment outcomes; however, literature regarding pediatric radiotherapy twinning partnerships is limited. METHODS Emory University has a long-standing twinning collaboration with Tikur Anbessa Specialized Hospital (TASH) for certain medical specialties. After securing institutional funding, a faculty member and a resident from the Emory University Department of Radiation Oncology set out to establish a twinning program with TASH for pediatric radiotherapy. RESULTS Emory and TASH faculty and residents established initial communications virtually via email and video correspondence. TASH residents and faculty completed surveys regarding pediatric radiotherapy institutional and educational needs to outline goals of collaboration. Five lectures and case-based practicums were identified focused on Wilms tumor, medulloblastoma, rhabdomyosarcoma, Hodgkin lymphoma, and palliative radiotherapy. The Emory team then conducted a visit to TASH during which lectures and practicums were delivered. The Emory team directly observed and guided simulation and treatment planning procedures. TASH residents practiced decision making, simulation, contouring, and field placement for Wilms tumor cases on the basis of didactics and feedback provided by the Emory team. Additionally, a needs assessment regarding pediatric oncologic resources was completed. Clinical care pathways and standard operating procedures were drafted by collaborators. Virtual peer-review sessions were established to continue collaborations abroad and plan for next in-person visit. CONCLUSION Collaborative efforts by global experts have helped to establish and improve treatment protocols for childhood cancer. The presented twinning experience may serve as a model for other LMIC and HIC centers for establishing similar partnerships.
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Affiliation(s)
- Naba Ali
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Elias Amare
- Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adugna Fekadu
- Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Munir Awol
- Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Molalgn Gebresenbet
- Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Keyru Nasir
- Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Edom Seife
- Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Benski C, Zambruni M, Stancanelli G, Landinarisoa T, Hantavololona A, Rachel Andrianarisoa V, Manjary PR, Capello C, de Tejada BM, Reich MR, Guyer AL. Lessons Learned From Building a Global Health Partnership on Obstetric Care in Madagascar. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200521. [PMID: 37903582 PMCID: PMC10615231 DOI: 10.9745/ghsp-d-22-00521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/30/2023] [Indexed: 11/01/2023]
Abstract
The authors share experiences of a global health partnership that worked to promote equity through a commitment to shared values and goals, engagement and communication, and mutual trust and respect.
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Affiliation(s)
- Caroline Benski
- Département de la femme, l'enfant et l'adolescent, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
| | - Monica Zambruni
- Département de la femme, l'enfant et l'adolescent, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | | | | | - Abéline Hantavololona
- Service Maternité Sans Risque, Direction de la Santé Familiale, Ministère de la Santé Publique, Antananarivo, Madagascar
| | | | | | | | - Begona Martinez de Tejada
- Département de la femme, l'enfant et l'adolescent, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Michael R Reich
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Leresche E, Hossain M, Rossi R, Truppa C, Barth CA, Mactaggart I, Leaning J, Singh N. Do we really want to know? The journey to implement empirical research recommendations in the ICRC's responses in Myanmar and Lebanon. DISASTERS 2023; 47:437-463. [PMID: 35617255 DOI: 10.1111/disa.12549] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Efforts to reduce the gap between the research evidence base and humanitarian responses have focused on producing quality evidence and ensuring its use in decision-making. Yet, how evidence translates into field-level implementation is not well understood in humanitarian contexts. This study analysed how recommendations produced through academic research partnerships were implemented by the International Committee of the Red Cross (ICRC) in Lebanon and Myanmar. The methodology included: social network analysis to represent collective dynamics; document reviews to assess implementation; qualitative interviews to comprehend why actors engaged; and a critical appraisal of these combined results. The application of Extended Normalization Process Theory provided information on 'anticipation of constraints' (access to information, staff turnover, context specificity, and the need to engage as a cohesive group). Future research efforts should concentrate explicitly on identifying and tackling implementation barriers such as power imbalances and ethical dilemmas related to service delivery by humanitarian actors.
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Affiliation(s)
- Enrica Leresche
- MPH is a Doctorate of Public Health Candidate in the Department of Global Health and Development, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Mazeda Hossain
- MSc, PhD is an Associate Professorial Research Fellow at the Centre for Women, Peace and Security, London School of Economics and Political Science, United Kingdom
- Honorary Associate Professor in the Department of Global Health and Development, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Rodolfo Rossi
- MSc, MPH is an Epidemiologist in the Health Unit at the International Committee of the Red Cross, Switzerland
| | - Claudia Truppa
- MD, MSc was a Health Coordinator at the International Committee of the Red Cross, Lebanon at the time of the study
- Now a PhD Candidate at CRIMEDIM - Centre for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Novara, Italy
| | - Cornelia Anne Barth
- MSc was a Physical Rehabilitation Specialist at the International Committee of the Red Cross, Switzerland at the time of the study
- Now a PhD Candidate at University College, Dublin, Ireland
| | - Islay Mactaggart
- MA, PhD is an Assistant Professor in Disability and Global Health in the Department of Global Health and Development, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Jennifer Leaning
- MD SMH is a Senior Research Fellow at the FXB Center for Health and Human Rights, Harvard University, United States
- Retired Professor of the Practice, Harvard Chan School of Public Health, United States
| | - Neha Singh
- MPH, PhD is an Associate Professor in the Department of Global Health and Development, London School of Hygiene and Tropical Medicine, United Kingdom
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Rajabzadeh V, McGrath M, Van Loggerenberg F, Bird VJ, Priebe S. What are the expectations and experiences of a GMH research programme delivered in Bosnia-Herzegovina, Colombia and Uganda? A prospective longitudinal qualitative study. BMJ Open 2022; 12:e059590. [PMID: 36691243 PMCID: PMC9171268 DOI: 10.1136/bmjopen-2021-059590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 05/09/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES Global health research collaborations between partners in high-income countries and low-income and middle-income countries (LMICs) aim to generate new evidence, strengthen research capacity, tackle health inequalities and improve outcomes. Previous evaluations of such programmes have identified areas for improvement but consisted only of retrospective experiences. We conducted the first prospective study to assess the initial expectations as well as the final experiences of participants of a global health research programme. DESIGN, SETTINGS AND PARTICIPANTS This study adopted a prospective longitudinal qualitative study, 38 participants of a global mental health research programme with partners in Bosnia-Herzegovina, Colombia, Uganda and the (UK). The interviewees included senior investigators, coordinators and researchers. Framework analysis was used to analyse the data. OUTCOME MEASURES Participants were interviewed about their initial expectations at the inception of the research programme and their final experiences at the end. RESULTS Many of the original expectations were later reported as met or even exceeded. They included experiences of communication, relationships, developed research expertise, further research opportunities and extending networks. However, other expectations were not met or only partially met, mainly on developing local leadership, strengthening institutional research capacity and opportunities for innovation and for mutual learning. Around equity of partnership and ownership of research the views of participants in the UK tended to be more critical than those of partners in LMICs. CONCLUSIONS The findings suggest that global health research programmes can achieve several of their aims, and that partners in LMICs feel equity has been established in the partnership despite the imbalance of the funding arrangement. Aims of global health research projects should have a realistic focus and be proportionate to the parameters of the funding arrangement. More resources and longer time scales may be required to address sustainable structural capacity and long-standing local leadership sufficiently.
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Affiliation(s)
- Vian Rajabzadeh
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Michael McGrath
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Francois Van Loggerenberg
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Victoria Jane Bird
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
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International collaboration for the development of clinical guidelines in low and middle-income countries: case study on the development of a national framework and clinical guidelines for diabetic retinopathy in Ghana. Eye (Lond) 2022; 36:12-16. [PMID: 35590050 PMCID: PMC9159026 DOI: 10.1038/s41433-022-02002-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Diabetic retinopathy is a leading cause of blindness in many countries across the world. Ghana has seen a rise in diabetic retinopathy and is working on various strategies to prevent blindness. Clinical guidelines are seen as a promising strategy for improving quality and reducing cost of care. Little is known about the processes of collaborative guideline development in the African context. Methods This case study discusses the process of developing clinical guidelines for diabetic retinopathy in Ghana via a collaboration with the Kenya team that had previously developed guidelines for Kenya. Results The main lesson learnt was the ability to overcome challenges. The main output achieved was the draft national framework, guidelines and training slides on the guidelines. Conclusion Horizontal international collaboration can aid development of clinical guidelines.
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Larson CP, Plamondon KM, Dubent L, Bicaba F, Bicaba A, Minh TH, Nguyen A, Girard JE, Ramdé J, Gyorkos TW. The Equity Tool for Valuing Global Health Partnerships. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00316. [PMID: 35487557 PMCID: PMC9053142 DOI: 10.9745/ghsp-d-21-00316] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/15/2022] [Indexed: 11/15/2022]
Abstract
There is a need to more comprehensively identify and respond to equity in global health partnerships. The Equity Tool can support dialogue at any stage of a partnership, by individuals at any level. This assists partnerships to embrace ways of recognizing, understanding, and advancing equity in all their processes. Global health partnerships (GHPs) involve complex relationships between individuals and organizations, often joining partners from high-income and low- or middle-income countries around work that is carried out in the latter. Therefore, GHPs are situated in the context of global inequities and their underlying sociopolitical and historical causes, such as colonization. Equity is a core principle that should guide GHPs from start to end. How equity is embedded and nurtured throughout a partnership has remained a constant challenge. We have developed a user-friendly tool for valuing a GHP throughout its lifespan using an equity lens. The development of the EQT was informed by 5 distinct elements: a scoping review of scientific published peer-reviewed literature; an online survey and follow-up telephone interviews; workshops in Canada, Burkina Faso, and Vietnam; a critical interpretive synthesis; and a content validation exercise. Findings suggest GHPs generate experiences of equity or inequity yet provide little guidance on how to identify and respond to these experiences. The EQT can guide people involved in partnering to consider the equity implications of all their actions, from inception, through implementation and completion of a partnership. When used to guide reflective dialogue with a clear intention to advance equity in and through partnering, this tool offers a new approach to valuing global health partnerships. Global health practitioners, among others, can apply the EQT in their partnerships to learning together about how to cultivate equity in their unique contexts within what is becoming an increasingly diverse, vibrant, and responsive global health community.
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Affiliation(s)
- Charles P Larson
- Canadian Association for Global Health (formerly Canadian Coalition for Global Health Research), Ottawa, Canada.
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | - Katrina M Plamondon
- Canadian Association for Global Health (formerly Canadian Coalition for Global Health Research), Ottawa, Canada
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, Okanagan, Canada
| | - Leslie Dubent
- Canadian Association for Global Health (formerly Canadian Coalition for Global Health Research), Ottawa, Canada
| | - Frank Bicaba
- Société d'Études et de Recherche en Santé Publique, Ouagadougou, Burkina Faso
| | - Abel Bicaba
- Société d'Études et de Recherche en Santé Publique, Ouagadougou, Burkina Faso
| | - Tran Hung Minh
- Center for Creative Initiatives in Health and Population, Hanoi, Vietnam
| | - An Nguyen
- HealthBridge Vietnam, Hanoi, Vietnam
| | - Jacques E Girard
- Canadian Association for Global Health (formerly Canadian Coalition for Global Health Research), Ottawa, Canada
- Direction en Santé Mondiale, Faculté de Médecine, Université Laval, Québec, Canada
| | - Jean Ramdé
- Canadian Association for Global Health (formerly Canadian Coalition for Global Health Research), Ottawa, Canada
- HealthBridge Vietnam, Hanoi, Vietnam
| | - Theresa W Gyorkos
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
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International cooperation in developing countries health systems: in-depth analyses from Gaslini Children Hospital. INTERNATIONAL JOURNAL OF ORGANIZATIONAL ANALYSIS 2021. [DOI: 10.1108/ijoa-07-2021-2885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this study is to provide a framework useful for identifying the elements that aim for success in the construction of collaborative governance and to investigate how international governance systems have characterized the international collaborative projects developed by the International Division of Gaslini Children Hospital in Genoa (Italy). Critical and successful factors in developing partnerships in the healthcare sector have been identified.
Design/methodology/approach
A total of 15 projects implemented by the Gaslini Hospital in collaboration with a global network of low and middle-income countries were examined using a content analysis of the project reports. Later, a conceptual framework proposed by Emerson and colleagues was used to design a theoretical map for investigating elements of international governance systems.
Findings
A matrix developed in two categories (health cooperation and training, and exchange of best practices) and three branches of medicine (oncology, paediatrics and cardiology) made it possible to cluster the research projects. However, details of the collaborative process often overlooked by research on public-private partnerships emerged from the framework.
Originality/value
The growing demand for higher quality health services in low- and middle-income countries has led to an increasing number of partnerships with industrialized countries to enable access to wider resources and technologies and develop useful skills to adapt to changes in society. Through the application of collaborative governance’s framework to healthcare collaboration, different elements of the collaborative process emerged which have been previously neglected.
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Orozalieva G, Loutan L, Azimova A, Baroffio A, Heller O, Lab B, Mambetova A, Mambetalieva D, Muratalieva E, Nendaz M, Savoldelli G, Vu NV, Beran D. Reforms in medical education: lessons learnt from Kyrgyzstan. Glob Health Action 2021; 14:1944480. [PMID: 34330184 PMCID: PMC8330711 DOI: 10.1080/16549716.2021.1944480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Human resources are one of the six building blocks of a health system. In order to ensure that these resources are adequately trained to meet the evolving needs of populations, medical education reforms are needed. In Kyrgyzstan, like in many other low- and middle-income countries, human resources for health are a key challenge for the health system in both the quantity and having their training aligned with the health system priorities. Here we present the experience of the Medical Education Reform Project, a project aimed at improving the quality of health professionals through reforming medical education, funded by the Swiss Agency for Development and Cooperation, as a collaborative effort between partners in Kyrgyzstan and Switzerland since 2013. We used a qualitative study taking a cooperative inquiry approach with an experiential perspective in order to present the implementation of the Medical Education Reform Project in Kyrgyzstan. In order to look at the different components impacting the reform process, a framework comprising: Setting the direction; Building a consensus; Engaging stakeholders; Pilot projects and evaluation; Capacity building; Timing, and Key partners was used to disentangle the lessons learnt. Champions and partnering with key institutions were essential in building consensus, as was the catalytic and facilitating role the project played. This enabled active engagement of a variety of stakeholders in the reform process using different means of interaction ranging from large roundtable discussions, workshops, trainings and even study tours. Pilot projects and research provided tangible actions that could be used to further the reforms. For capacity building, the project offered a wide range of activities that improved clinical competencies, empowered stakeholders, and strengthened organizational capacity. The timing of this reform process in medical education was facilitated by the overall reforms and policies in the health system.
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Affiliation(s)
| | - Louis Loutan
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Aigul Azimova
- Foundation Initiatives in Medical Education, Bishkek, Kyrgyzstan
| | - Anne Baroffio
- Unit of Development and Research in Medical Education (UDREM), University Faculty of Medicine, Faculty of Medicine, Geneva, Switzerland
| | - Olivia Heller
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Bruno Lab
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | | | | | - Mathieu Nendaz
- Unit of Development and Research in Medical Education (UDREM), University Faculty of Medicine, Faculty of Medicine, Geneva, Switzerland
| | - Georges Savoldelli
- Unit of Development and Research in Medical Education (UDREM), University Faculty of Medicine, Faculty of Medicine, Geneva, Switzerland
| | - Nu V Vu
- Unit of Development and Research in Medical Education (UDREM), University Faculty of Medicine, Faculty of Medicine, Geneva, Switzerland
| | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva, Faculty of Medicine and Geneva University Hospitals, Geneva, Switzerland
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Plamondon KM, Brisbois B, Dubent L, Larson CP. Assessing how global health partnerships function: an equity-informed critical interpretive synthesis. Global Health 2021; 17:73. [PMID: 34215301 PMCID: PMC8254362 DOI: 10.1186/s12992-021-00726-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background Global health partnerships (GHPs) are situated in complex political and economic relationships and involve partners with different needs and interests (e.g., government agencies, non-governmental organizations, corporations, universities, professional associations, philanthropic organizations and communities). As part of a mixed methods study designed to develop an equity-sensitive tool to support more equity-centred North-South GHPs, this critical interpretive synthesis examined reported assessments of GHPs. Results We examined 30 peer-reviewed articles for power dynamics, equity and inequities, and contradictions or challenges encountered in North-South partnerships. Among articles reviewed, authors most often situated GHPs around a topical focus on research, capacity-building, clinical, or health services issues, with the ‘work’ of the partnership aiming to foster skills or respond to community needs. The specific features of GHPs that were assessed varied widely, with consistently-reported elements including the early phases of partnering; governance issues; the day-to-day work of partnerships; the performance, impacts and benefits of GHPs; and issues of inclusion. Articles shared a general interest in partnering processes and often touched briefly on issues of equity; but they rarely accounted for the complexity of sociopolitical and historical contexts shaping issues of equity in GHPs. Further, assessments of GHPs were often reported without inclusion of voices from all partners or named beneficiaries. GHPs were frequently portrayed as inherently beneficial for Southern partners, without attention to power dynamics and inequities (North-South, South-South). Though historical and political dynamics of the Global North and South were inconsistently examined as influential forces in GHPs, such dynamics were frequently portrayed as complex and characterized by asymmetries in power and resources. Generally, assessments of GHPs paid little attention to the macroeconomic forces in the power and resource dynamics of GHPs highlights the importance of considering the broader political. Our findings suggest that GHPs can serve to entrench both inequitable relationships and unfair distributions of power, resources, and wealth within and between countries (and partners) if inequitable power relationships are left unmitigated. Conclusions We argue that specific practices could enhance GHPs’ contributions to equity, both in their processes and outcomes. Enhancing partnering practices to focus on inclusion, responsiveness to North-South and South-South inequities, and recognition of GHPs as situated in a broader (and inequitable) political economy. A relational and equity-centred approach to assessing GHPs would place social justice, humility and mutual benefits as central practices—that is, regular, routine things that partners involved in partnering do intentionally to make GHPs function well. Practicing equity in GHPs requires continuous efforts to explicitly acknowledge and examine the equity implications of all aspects of partnering. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-021-00726-z.
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Affiliation(s)
- Katrina M Plamondon
- Michael Smith Foundation for Health Research Scholar, School of Nursing, Faculty of Health & Social Development, University of British Columbia, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada.
| | - Ben Brisbois
- School of Health Sciences, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Leslie Dubent
- Canadian Coalition for Global Health Research, 46 Cremona Crescent, Nepean, ON, K2G 1A1, Canada
| | - Charles P Larson
- Faculty of Medicine and Health Sciences, School of Population and Global Health, McGill University, 772 Sherbrooke Street West, Montreal, QC, H3A 1G1, Canada
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12
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Oni T, Assah F, Erzse A, Foley L, Govia I, Hofman KJ, Lambert EV, Micklesfield LK, Shung-King M, Smith J, Turner-Moss E, Unwin N, Wadende P, Woodcock J, Mbanya JC, Norris SA, Obonyo CO, Tulloch-Reid M, Wareham NJ. The global diet and activity research (GDAR) network: a global public health partnership to address upstream NCD risk factors in urban low and middle-income contexts. Global Health 2020; 16:100. [PMID: 33076935 PMCID: PMC7570103 DOI: 10.1186/s12992-020-00630-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 10/07/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are the leading cause of death globally. While upstream approaches to tackle NCD risk factors of poor quality diets and physical inactivity have been trialled in high income countries (HICs), there is little evidence from low and middle-income countries (LMICs) that bear a disproportionate NCD burden. Sub-Saharan Africa and the Caribbean are therefore the focus regions for a novel global health partnership to address upstream determinants of NCDs. PARTNERSHIP The Global Diet and Activity research Network (GDAR Network) was formed in July 2017 with funding from the UK National Institute for Health Research (NIHR) Global Health Research Units and Groups Programme. We describe the GDAR Network as a case example and a potential model for research generation and capacity strengthening for others committed to addressing the upstream determinants of NCDs in LMICs. We highlight the dual equity targets of research generation and capacity strengthening in the description of the four work packages. The work packages focus on learning from the past through identifying evidence and policy gaps and priorities, understanding the present through adolescent lived experiences of healthy eating and physical activity, and co-designing future interventions with non-academic stakeholders. CONCLUSION We present five lessons learned to date from the GDAR Network activities that can benefit other global health research partnerships. We close with a summary of the GDAR Network contribution to cultivating sustainable capacity strengthening and cutting-edge policy-relevant research as a beacon to exemplify the need for such collaborative groups.
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Affiliation(s)
- Tolu Oni
- MRC Epidemiology Unit, Institute of Metabolic Sciences Building, Addenbrookes Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK.
- Research Initiative for Cities Health and Equity (RICHE), School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Felix Assah
- Health of Populations in Transition (HoPiT), Research Group, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
| | - Agnes Erzse
- SA MRC Centre for Health Economics and Decision Science (PRICELESS SA), Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Louise Foley
- MRC Epidemiology Unit, Institute of Metabolic Sciences Building, Addenbrookes Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Ishtar Govia
- Caribbean Institute for Health Research, The University of West Indies, Kingston, Jamaica
| | - Karen J Hofman
- SA MRC Centre for Health Economics and Decision Science (PRICELESS SA), Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Estelle Victoria Lambert
- Health through Physical Activity Lifestyle and Sport Research Centre, University of Cape Town, Cape Town, South Africa
| | - Lisa K Micklesfield
- MRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of Witwatersrand, Johannesburg, South Africa
| | - Maylene Shung-King
- Research Initiative for Cities Health and Equity (RICHE), School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Joanne Smith
- Caribbean Institute for Health Research, The University of West Indies, Kingston, Jamaica
| | - Eleanor Turner-Moss
- MRC Epidemiology Unit, Institute of Metabolic Sciences Building, Addenbrookes Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Nigel Unwin
- MRC Epidemiology Unit, Institute of Metabolic Sciences Building, Addenbrookes Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Pamela Wadende
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - James Woodcock
- MRC Epidemiology Unit, Institute of Metabolic Sciences Building, Addenbrookes Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Jean Claude Mbanya
- Health of Populations in Transition (HoPiT), Research Group, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
| | - Shane A Norris
- MRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of Witwatersrand, Johannesburg, South Africa
| | - Charles O Obonyo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Marshall Tulloch-Reid
- Caribbean Institute for Health Research, The University of West Indies, Kingston, Jamaica
| | - Nicholas J Wareham
- MRC Epidemiology Unit, Institute of Metabolic Sciences Building, Addenbrookes Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
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13
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Soi C, Shearer J, Chilundo B, Muchanga V, Matsinhe L, Gimbel S, Sherr K. Global health systems partnerships: a mixed methods analysis of Mozambique's HPV vaccine delivery network actors. BMC Public Health 2020; 20:862. [PMID: 32503479 PMCID: PMC7275554 DOI: 10.1186/s12889-020-08958-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/19/2020] [Indexed: 02/03/2023] Open
Abstract
Background Global health partnerships have expanded exponentially in the last two decades with Gavi, the Vaccine Alliance considered the model’s pioneer and leader because of its vaccination programs’ implementation mechanism. Gavi, relies on diverse domestic and international partners to carry out the programs in low- and middle-income countries under a partnership engagement framework (PEF). In this study, we utilized mixed methods to examine Mozambique’s Gavi driven partnership network which delivered human papillomavirus (HPV) vaccine during the demonstration phase. Methods Qualitative tools gauged contextual factors, prerequisites, partner performance and practices while a social network analysis (SNA) survey measured the partnership structure and perceived added value in terms of effectiveness, efficiency and country ownership. Forty key informants who were interviewed included frontline Ministry of Health workers, Ministry of Education staff and supporting partner organization members, of whom 34 participated in the social network analysis survey. Results Partnership structure SNA connectivity measurement scores of reachability (100%) and average distance (2.5), were high, revealing a network of very well-connected HPV vaccination implementation collaborators. Such high scores reflect a network structure favorable for rapid and widespread diffusion of information, features necessary for engaging and handling multiple implementation scales. High SNA effectiveness and efficiency measures for structural holes (85%) and low redundancy (30%) coupled with high mean perceived effectiveness (97.6%) and efficiency (79.5%) network outcome scores were observed. Additionally, the tie strength average score of 4.1 on a scale of 5 denoted high professional trust. These are all markers of a collaborative partnership environment in which disparate institutions and organizations leveraged each entity’s comparative advantage. Lower perceived outcome scores for country ownership (24%) were found, with participants citing the prominent role of several out-of-country partner organizations as a major obstacle. Conclusions While there is room for improvement on the country ownership aspects of the partnership, the expanded, diverse and inclusive collaboration of institutions and organizations that implemented the Mozambique HPV vaccine demonstration project was effective and efficient. We recommend that the country adapt a similar model during national scale up of HPV vaccination.
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Affiliation(s)
- Caroline Soi
- Department of Global Health, University of Washington, Harris Hydraulics Laboratory, 1510 San Juan Road, Seattle, WA, 98195, USA. .,Health Alliance International, 1107 NE 45TH St #350, Seattle, WA, 98105, USA.
| | | | - Baltazar Chilundo
- Universidade Eduardo Mondlane, Av. Salvador Allende no. 702, Maputo, Mozambique
| | - Vasco Muchanga
- Universidade Eduardo Mondlane, Av. Salvador Allende no. 702, Maputo, Mozambique
| | - Luisa Matsinhe
- Health Alliance International, Rua Caetano Viegas no. 67, Maputo, Mozambique
| | - Sarah Gimbel
- Department of Global Health, University of Washington, Harris Hydraulics Laboratory, 1510 San Juan Road, Seattle, WA, 98195, USA.,Health Alliance International, 1107 NE 45TH St #350, Seattle, WA, 98105, USA.,Department of Family and Child Nursing, University of Washington, Magnuson Health Sciences Building, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Harris Hydraulics Laboratory, 1510 San Juan Road, Seattle, WA, 98195, USA.,Health Alliance International, 1107 NE 45TH St #350, Seattle, WA, 98105, USA
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Hossain MM. Current status of global research on novel coronavirus disease (COVID-19): a bibliometric analysis and knowledge mapping. F1000Res 2020. [DOI: 10.12688/f1000research.23690.1] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Novel coronavirus disease (COVID-19) is a major global health concern due to its pathogenicity and widespread distribution around the world. Despite a growing interest, little is known about the current state of research on COVID-19. This bibliometric study evaluated the contemporary scientific literature to assess the evolution of knowledge on COVID-19, identify the leading research stakeholders, and analyze the conceptual areas of knowledge development in this domain. Methods: Bibliometric data on COVID-19 related studies published until April 1, 2020, were retrieved from Web of Science core collection. Further, a quantitative evaluation and visualizations of knowledge areas in COVID-19 research were created by statistical and text-mining approaches using bibliometric tools and R software. Results: A total of 422 citations were retained in this study, including journal articles, reviews, letters, and other publications. The mean number of authors and citations per document was 3.91 and 2.47, respectively. Also, the top ten articles, authors, and journals were identified based on the frequencies of citations and publications. Networks of contributing authors, institutions, and countries were visualized in maps, which highlight discrete developments in research collaborations. Major areas identified through evaluating keywords and text data included genetic, epidemiological, zoonotic, and other biological topics associated with COVID-19. Conclusions: Current status of COVID-19 research shows early development in different areas of knowledge. More research should be conducted in less-explored areas, including socioeconomic determinants and impacts of COVID-19. Also, global research collaboration should be encouraged for strengthening evidence-based decision-making preventing and addressing the COVID-19 pandemic and aftermath.
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15
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Leresche E, Truppa C, Martin C, Marnicio A, Rossi R, Zmeter C, Harb H, Hamadeh RS, Leaning J. Conducting operational research in humanitarian settings: is there a shared path for humanitarians, national public health authorities and academics? Confl Health 2020; 14:25. [PMID: 32435274 PMCID: PMC7222467 DOI: 10.1186/s13031-020-00280-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 05/05/2020] [Indexed: 11/10/2022] Open
Abstract
In humanitarian contexts, it is a difficult and multi-faceted task to enlist academics, humanitarian actors and health authorities in a collaborative research effort. The lack of research in such settings has been widely described in the past decade, but few have analysed the challenges in building strong and balanced research partnerships. The major issues include considering operational priorities, ethical imperatives and power differentials. This paper analyses in two steps a collaborative empirical endeavour to assess health service utilization by Syrian refugee and Lebanese women undertaken by the International Committee of the Red Cross (ICRC), the Lebanese Ministry of Public Health (MoPH) and the Harvard François-Xavier Bagnoud (FXB) Center. First, based on challenges documented in the literature, we shed light on how we negotiated appropriate research questions, methodologies, bias analyses, resource availability, population specificities, security, logistics, funding, ethical issues and organizational cultures throughout the partnership. Second, we describe how the negotiations required each partner to go outside their comfort zones. For the academics, the drivers to engage included the intellectual value of the collaboration, the readiness of the operational partners to conduct an empirical investigation and the possibility that such work might lead to a better understanding in public health terms of how the response met population needs. For actors responding to the humanitarian crisis (the ICRC and the MOPH), participating in a technical collaboration permitted methodological issues to be worked through in the context of deliberations within the wider epistemic community. We find that when they collaborate, academics, humanitarian actors and health authorities deploy their respective complementarities to build a more comprehensive approach. Barriers such as the lack of uptake of research results or weak links to the existing literature were overcome by giving space to define research questions and develop a longer-term collaboration involving individual and institutional learning. There is the need ahead of time to create balanced decision-making mechanisms, allow for relative financial autonomy, and define organizational responsibilities. Ultimately, mutual respect, trust and the recognition of each other's expertise formed the basis of an initiative that served to better understand populations affected by conflict and meet their needs.
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Affiliation(s)
- Enrica Leresche
- International Committee of the Red Cross Delegation, Beirut, Lebanon
| | - Claudia Truppa
- International Committee of the Red Cross Delegation, Beirut, Lebanon
| | - Christophe Martin
- International Committee of the Red Cross Delegation, Beirut, Lebanon
| | | | - Rodolfo Rossi
- International Committee of the Red Cross, Geneva, Switzerland
| | - Carla Zmeter
- International Committee of the Red Cross Delegation, Beirut, Lebanon
| | - Hilda Harb
- Lebanese Ministry of Public Health, Beirut, Lebanon
| | | | - Jennifer Leaning
- Harvard François Xavier Bagnoud Center for Health and Human Rights, Boston, USA
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Lim SH, Ayre TC, Tan AP, Ang SY, Aloweni F. To teach is to learn: The impact of training and capacity building. PROCEEDINGS OF SINGAPORE HEALTHCARE 2018. [DOI: 10.1177/2010105818781379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Swee Hia Lim
- Department of Nursing, Singapore General Hospital, Singapore
| | | | - Ah Pang Tan
- Department of Nursing, Singapore General Hospital, Singapore
| | - Shin Yuh Ang
- Department of Nursing, Singapore General Hospital, Singapore
| | - Fazila Aloweni
- Department of Nursing, Singapore General Hospital, Singapore
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Smythe T, Le G, Owen R, Ayana B, Hansen L, Lavy C. The development of a training course for clubfoot treatment in Africa: learning points for course development. BMC MEDICAL EDUCATION 2018; 18:163. [PMID: 30005662 PMCID: PMC6044045 DOI: 10.1186/s12909-018-1269-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 06/26/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Clubfoot is a common congenital musculoskeletal disorder that causes mobility impairment. There is a lack of trained mid-level personnel to provide clubfoot treatment in Africa and there is no standard training course. This prospective study describes the collaborative and participatory approach to the development of a training course for the treatment of clubfoot in children in resource constrained settings. METHODS We used a systems approach to evaluate the development of the training course. Inputs: The research strategy included a review of context and available training materials, and the collection of data on current training practices. Semi-structured interviews were conducted with seven expert clubfoot trainers. A survey of 32 international and regional trainers was undertaken to inform practical issues. The data were used to develop a framework for training with advice from two technical groups, consisting of regional and international stakeholders and experts. PROCESS A consensus approach was undertaken during workshops, meetings and the sharing of documents. The design process for the training materials took twenty-four months and was iterative. The training materials were piloted nine times between September 2015 and February 2017. Processes and materials were reviewed and adapted according to feedback after each pilot. RESULTS Fifty-one regional trainers from Africa (18 countries), 21 international experts (11 countries), 113 local providers of clubfoot treatment (Ethiopia, Rwanda and Kenya) and local organising teams were involved in developing the curriculum and pilot testing. The diversity of the two technical advisory groups allowed a wide range of contributions to the collaboration. Output: The resulting curriculum and content comprised a two day basic training and a two day advanced course. The basic course utilised adult learning techniques for training novice providers in the treatment of idiopathic clubfoot in children under two years old. The advanced course builds on these principles. CONCLUSION Formative research that included mixed methods (both qualitative and quantitative) was important in the development of an appropriate training course. The process documentation from this study provides useful information to assist planning of medical training programmes and may serve as a model for the development of other courses.
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Affiliation(s)
- Tracey Smythe
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E7HT UK
| | - Grace Le
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | | | - Linda Hansen
- CURE International, Beit CURE Hospital, Lusaka, Zambia
| | - Christopher Lavy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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