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Seward N, Hanlon C, Abdella A, Abrahams Z, Alem A, Araya R, Bachmann M, Bekele A, Bogale B, Brima N, Chibanda D, Curran R, Davies J, Beyene A, Fairall L, Farrant L, Frissa S, Gallagher J, Gao W, Gwyther L, Harding R, Kartha MR, Leather A, Lund C, Marx M, Nkhoma K, Murdoch J, Petersen I, Petrus R, van Rensburg A, Sandall J, Sevdalis N, Sheenan A, Tadesse A, Thornicroft G, Verhey R, Willott C, Prince M. 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. Glob Health Action 2022; 15:1987044. [PMID: 35037844 PMCID: PMC8765245 DOI: 10.1080/16549716.2021.1987044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 09/25/2021] [Indexed: 12/03/2022] Open
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.
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Affiliation(s)
- Nadine Seward
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmed Abdella
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zulfa Abrahams
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Atalay Alem
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ricardo Araya
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Max Bachmann
- Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Alemayehu Bekele
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Birke Bogale
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King’s College London, London, UK
- Department of Dentistry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nataliya Brima
- King’s Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Dixon Chibanda
- University of Zimbabwe, Harare, Zimbabwe
- Psychology Department, School of Applied Human Science College of Humanities, University of KwaZulu Natal, London, UK
| | - Robyn Curran
- Knowledge Translation Unit, University of Cape Town Lung Institute and Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Justine Davies
- Centre for Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Andualem Beyene
- Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lara Fairall
- Knowledge Translation Unit, University of Cape Town Lung Institute and Department of Medicine, University of Cape Town, Cape Town, South Africa
- King’s Global Health Institute, King’s College London, London, UK
| | - Lindsay Farrant
- Division of Family Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Souci Frissa
- King’s Global Health Institute, King’s College London, London, UK
| | - Jennifer Gallagher
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King’s College London, London, UK
| | - Wei Gao
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, UK
| | - Liz Gwyther
- Division of Family Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Richard Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, UK
| | | | - Andrew Leather
- King’s Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Crick Lund
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Maggie Marx
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kennedy Nkhoma
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, UK
| | - Jamie Murdoch
- Department of Population Health Science, Kings College London, London, UK
| | - Inge Petersen
- Centre for Rural Health, University of KwaZulu-Natal, Berea, Durban, South Africa
| | - Ruwayda Petrus
- Psychology Department, School of Applied Human Science College of Humanities, University of KwaZulu Natal, Berea, Durban, South Africa
| | - André van Rensburg
- Centre for Rural Health, University of KwaZulu-Natal, Berea, Durban, South Africa
| | - Jane Sandall
- Department of Women and Children’s Health, School of Life Course Science, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Andrew Sheenan
- Department of Women and Children’s Health, School of Life Course Science, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Amezene Tadesse
- Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Graham Thornicroft
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | - Chris Willott
- King’s Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Martin Prince
- King’s Global Health Institute, King’s College London, London, UK
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Bari S, Incorvia J, Iverson KR, Bekele A, Garringer K, Ahearn O, Drown L, Emiru AA, Burssa D, Workineh S, Sheferaw ED, Meara JG, Beyene A. Surgical data strengthening in Ethiopia: results of a Kirkpatrick framework evaluation of a data quality intervention. Glob Health Action 2021; 14:1855808. [PMID: 33357164 PMCID: PMC7782003 DOI: 10.1080/16549716.2020.1855808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background: One key challenge in improving surgical care in resource-limited settings is the lack of high-quality and informative data. In Ethiopia, the Safe Surgery 2020 (SS2020) project developed surgical key performance indicators (KPIs) to evaluate surgical care within the country. New data collection methods were developed and piloted in 10 SS2020 intervention hospitals in the Amhara and Tigray regions of Ethiopia. Objective: To assess the feasibility of collecting and reporting new surgical indicators and measure the impact of a surgical Data Quality Intervention (DQI) in rural Ethiopian hospitals. Methods: An 8-week DQI was implemented to roll-out new data collection tools in SS2020 hospitals. The Kirkpatrick Method, a widely used mixed-method evaluation framework for training programs, was used to assess the impact of the DQI. Feedback surveys and focus groups at various timepoints evaluated the impact of the intervention on surgical data quality, the feasibility of a new data collection system, and the potential for national scale-up. Results: Results of the evaluation are largely positive and promising. DQI participants reported knowledge gain, behavior change, and improved surgical data quality, as well as greater teamwork, communication, leadership, and accountability among surgical staff. Barriers remained in collection of high-quality data, such as lack of adequate human resources and electronic data reporting infrastructure. Conclusions: Study results are largely positive and make evident that surgical data capture is feasible in low-resource settings and warrants more investment in global surgery efforts. This type of training and mentorship model can be successful in changing individual behavior and institutional culture regarding surgical data collection and reporting. Use of the Kirkpatrick Framework for evaluation of a surgical DQI is an innovative contribution to literature and can be easily adapted and expanded for use within global surgery.
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Affiliation(s)
- Sehrish Bari
- Program in Global Surgery and Social Change, Harvard Medical School , Boston, MA, USA
| | - Joseph Incorvia
- Program in Global Surgery and Social Change, Harvard Medical School , Boston, MA, USA
| | - Katherine R Iverson
- Program in Global Surgery and Social Change, Harvard Medical School , Boston, MA, USA.,University of California, Davis Medical Center , Sacramento, CA, USA
| | - Abebe Bekele
- University of Global Health Equity, School of Medicine , Kigali, Rwanda
| | - Kaya Garringer
- Program in Global Surgery and Social Change, Harvard Medical School , Boston, MA, USA
| | - Olivia Ahearn
- Program in Global Surgery and Social Change, Harvard Medical School , Boston, MA, USA
| | - Laura Drown
- Program in Global Surgery and Social Change, Harvard Medical School , Boston, MA, USA
| | - Amanu Aragaw Emiru
- College of Medicine and Health Sciences, School of Public Health, Department of Reproductive Health and Population Studies, Bahir Dar University , Bahir Dar, Ethiopia
| | - Daniel Burssa
- Ethiopian Federal Ministry of Health, State Minister's Office , Addis Ababa, Ethiopia
| | | | | | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School , Boston, MA, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital , Boston, MA, USA
| | - Andualem Beyene
- Department of Surgery, Addis Ababa University School of Medicine , Addis Ababa, Ethiopia
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