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Khisa AM, Wao H, Brizuela V, Compaoré R, Baguiya A, López Gómez A, Bonet M, Kouanda S, Thorson A, Gitau E. Embedding research capacity strengthening in multi-country studies in low-and middle-income countries: learnings from sexual and reproductive health research. Glob Health Action 2024; 17:2338634. [PMID: 38607331 PMCID: PMC11018088 DOI: 10.1080/16549716.2024.2338634] [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: 10/02/2023] [Accepted: 03/31/2024] [Indexed: 04/13/2024] Open
Abstract
Research capacity strengthening (RCS) can empower individuals, institutions, networks, or countries to define and prioritize problems systematically; develop and scientifically evaluate appropriate solutions; and reinforce or improve capacities to translate knowledge into policy and practice. However, how to embed RCS into multi-country studies focusing on sexual and reproductive health and rights (SRHR) is largely undocumented. We used findings from a qualitative study, from a review of the literature, and from a validation exercise from a panel of experts from research institutions that work on SRHR RCS. We provide a framework for embedded RCS; suggest a set of seven concrete actions that research project planners, designers, implementers, and funders can utilise to guide embedded RCS activities in low- and middle-income countries; and present a practical checklist for planning and assessing embedded RCS in research projects.
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Affiliation(s)
- Anne M. Khisa
- Capacity Strengthening and SRHR Research, African Population and Health Research Center, Nairobi, Kenya
| | - Hesborn Wao
- Capacity Strengthening and SRHR Research, African Population and Health Research Center, Nairobi, Kenya
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rachidatou Compaoré
- Department of Biomedical and Public Health, Research Institute for Health Sciences, Ouagadougou, Burkina Faso
| | - Adama Baguiya
- Department of Biomedical and Public Health, Research Institute for Health Sciences, Ouagadougou, Burkina Faso
| | | | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Seni Kouanda
- Department of Biomedical and Public Health, Research Institute for Health Sciences, Ouagadougou, Burkina Faso
- African Institute of Public Health, Ouagadougou, Burkina Faso
| | - Anna Thorson
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Evelyn Gitau
- Capacity Strengthening and SRHR Research, African Population and Health Research Center, Nairobi, Kenya
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Chen-Xu J, Grad DA, Varga O, Viegas S. Burden of disease studies supporting policymaking in the European Union: a systematic review. Eur J Public Health 2024:ckae133. [PMID: 39214868 DOI: 10.1093/eurpub/ckae133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
Burden of disease (BoD) studies quantify the health impact of diseases and risk factors, which can support policymaking, particularly in the European Union (EU). This study aims to systematically analyse BoD studies, which address EU public policies to contribute to the understanding of its policy uptake. A systematic search of six electronic databases and two grey-literature registries was carried out for articles published between 1990 and 2023. The thematic area, type of legislation and the respective policymaking stage were extracted. A textual analysis of the discussion was conducted to assess the inclusion of specific EU policy implications. Overton was used to detect citations in policy documents. Out of the 2054 records screened, 83 were included. Most studies employed secondary data, with 37 utilizing GBD data. Disability-adjusted life year was present in most of the studies (n = 53). The most common type of the EU legislation mentioned was the directive (n = 47), and the most frequent topic was environment (n = 34). Policy implications for EU laws were discussed in most papers (n = 46, 55.4%), with only 8 conducting evaluation of EU policies. Forty-two articles have been cited at the EU-level, in a total of 86 EU policies. Despite increasing efforts in integrating EU legislation impact within BoD studies, these results denote a low consideration of the legal and policy changes. Greater efforts in directing research towards policy effectiveness evaluation might increase their uptake in EU policies.
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Affiliation(s)
- José Chen-Xu
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, REAL, CCAL, NOVA University Lisbon, Lisbon, Portugal
| | | | - Orsolya Varga
- Syreon Research Institute, Budapest, Hungary
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Susana Viegas
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, REAL, CCAL, NOVA University Lisbon, Lisbon, Portugal
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Therrell BL, Padilla CD, Borrajo GJC, Khneisser I, Schielen PCJI, Knight-Madden J, Malherbe HL, Kase M. Current Status of Newborn Bloodspot Screening Worldwide 2024: A Comprehensive Review of Recent Activities (2020-2023). Int J Neonatal Screen 2024; 10:38. [PMID: 38920845 PMCID: PMC11203842 DOI: 10.3390/ijns10020038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/28/2024] [Accepted: 03/28/2024] [Indexed: 06/27/2024] Open
Abstract
Newborn bloodspot screening (NBS) began in the early 1960s based on the work of Dr. Robert "Bob" Guthrie in Buffalo, NY, USA. His development of a screening test for phenylketonuria on blood absorbed onto a special filter paper and transported to a remote testing laboratory began it all. Expansion of NBS to large numbers of asymptomatic congenital conditions flourishes in many settings while it has not yet been realized in others. The need for NBS as an efficient and effective public health prevention strategy that contributes to lowered morbidity and mortality wherever it is sustained is well known in the medical field but not necessarily by political policy makers. Acknowledging the value of national NBS reports published in 2007, the authors collaborated to create a worldwide NBS update in 2015. In a continuing attempt to review the progress of NBS globally, and to move towards a more harmonized and equitable screening system, we have updated our 2015 report with information available at the beginning of 2024. Reports on sub-Saharan Africa and the Caribbean, missing in 2015, have been included. Tables popular in the previous report have been updated with an eye towards harmonized comparisons. To emphasize areas needing attention globally, we have used regional tables containing similar listings of conditions screened, numbers of screening laboratories, and time at which specimen collection is recommended. Discussions are limited to bloodspot screening.
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Affiliation(s)
- Bradford L. Therrell
- Department of Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, TX 78229, USA
- National Newborn Screening and Global Resource Center, Austin, TX 78759, USA
| | - Carmencita D. Padilla
- Department of Pediatrics, College of Medicine, University of the Philippines Manila, Manila 1000, Philippines;
| | - Gustavo J. C. Borrajo
- Detección de Errores Congénitos—Fundación Bioquímica Argentina, La Plata 1908, Argentina;
| | - Issam Khneisser
- Jacques LOISELET Genetic and Genomic Medical Center, Faculty of Medicine, Saint Joseph University, Beirut 1104 2020, Lebanon;
| | - Peter C. J. I. Schielen
- Office of the International Society for Neonatal Screening, Reigerskamp 273, 3607 HP Maarssen, The Netherlands;
| | - Jennifer Knight-Madden
- Caribbean Institute for Health Research—Sickle Cell Unit, The University of the West Indies, Mona, Kingston 7, Jamaica;
| | - Helen L. Malherbe
- Centre for Human Metabolomics, North-West University, Potchefstroom 2531, South Africa;
- Rare Diseases South Africa NPC, The Station Office, Bryanston, Sandton 2021, South Africa
| | - Marika Kase
- Strategic Initiatives Reproductive Health, Revvity, PL10, 10101 Turku, Finland;
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Agudelo-Hernández F, Plata-Casas L, Vélez Botero H, Salazar Vieira LM, Moreno Mayorga B. [Mental Health Gap Action Programme: a theoretical model of barriers to implementation by health personnel in Chocó, ColombiaPrograma de Ação para Reduzir as Lacunas em Saúde Mental: modelo teórico das barreiras de implementação por profissionais de saúde de Chocó, Colômbia]. Rev Panam Salud Publica 2024; 48:e49. [PMID: 38779536 PMCID: PMC11110682 DOI: 10.26633/rpsp.2024.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/19/2024] [Indexed: 05/25/2024] Open
Abstract
Objectives Mental, neurological, and substance use (MNS) disorders have a high prevalence in Colombia and there is a treatment gap. The World Health Organization (WHO) Mental Health Gap Action Programme (mhGAP) has various components. The mhGAP 2.0 Intervention Guide, aimed at improving primary health care, is a guide for the assessment and management of MNS disorders based on clinical decision-making protocols. The objective of this study was to determine the barriers that may hinder the program implementation process. Methods A qualitative study with content analysis was conducted in three phases: i) study preparation, organization, and presentation; ii) open coding, categorization, and abstraction of contents; and iii) information analysis. The study included semi-structured interviews with 21 people involved in the provision of mental health services in Chocó (Colombia): five medical doctors, seven nurses, and three psychologists, as well as six professionals working in the administrative area of the department's health secretariats. The perceptions of these stakeholders were explored. Open-ended questions were asked to explore experiences with the process, as well as the barriers identified in practice. Results Four different thematic categories were identified: intersectoral action, long-standing challenges, opportunities, and suitability of tools. Conclusions A theoretical model of barriers to implementation of the mhGAP program was constructed, based on stakeholder perceptions. Controlling barriers is perceived as a possible way to contribute significantly to population health.
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Affiliation(s)
- Felipe Agudelo-Hernández
- Facultad de Ciencias de la Salud Universidad de Manizales Caldas Colombia Facultad de Ciencias de la Salud, Universidad de Manizales, Caldas, Colombia
| | - Laura Plata-Casas
- Ministerio de Salud y Protección Social Bogotá Colombia Ministerio de Salud y Protección Social, Bogotá, Colombia
| | - Helena Vélez Botero
- Universidad Nacional de Colombia Bogotá Colombia Universidad Nacional de Colombia, Bogotá, Colombia
| | - Luz María Salazar Vieira
- Universidad Nacional de Colombia Bogotá Colombia Universidad Nacional de Colombia, Bogotá, Colombia
| | - Bibian Moreno Mayorga
- Ministerio de Salud y Protección Social Bogotá Colombia Ministerio de Salud y Protección Social, Bogotá, Colombia
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McGinty EE, Alegria M, Beidas RS, Braithwaite J, Kola L, Leslie DL, Moise N, Mueller B, Pincus HA, Shidhaye R, Simon K, Singer SJ, Stuart EA, Eisenberg MD. The Lancet Psychiatry Commission: transforming mental health implementation research. Lancet Psychiatry 2024; 11:368-396. [PMID: 38552663 DOI: 10.1016/s2215-0366(24)00040-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 04/19/2024]
Affiliation(s)
| | - Margarita Alegria
- Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Rinad S Beidas
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Lola Kola
- College of Medicine, University of Ibadan, Ibadan, Nigeria; Kings College London, London, UK
| | | | | | | | | | - Rahul Shidhaye
- Pravara Institute of Medical Sciences University, Loni, India; Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | | | - Sara J Singer
- Stanford University School of Medicine, Stanford, CA, USA
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Peters MA, Cloete K, Odwe G, Tadele G, Hirschhorn LR, Magge H, Roder-DeWan S. Embedding implementation research to cross the quality of care chasm during the covid-19 pandemic and beyond. BMJ 2023; 383:e076331. [PMID: 38081643 PMCID: PMC10704412 DOI: 10.1136/bmj-2023-076331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
| | - Keith Cloete
- Western Cape Department of Health and Wellness, Cape Town, South Africa
| | | | | | | | - Hema Magge
- Bill and Melinda Gates Foundation, Seattle, USA
- Harvard University, Brigham and Women's Hospital, Division of Global Equity, Boston, USA
| | - Sanam Roder-DeWan
- World Bank Group, Washington DC, USA
- Dartmouth University, Hanover, USA
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Becerril-Montekio V, Torres-Pereda P, García-Bello LA, Alcalde-Rabanal J. Replacement of core team members on embedded implementation research teams: experiences from Latin America and the Caribbean. Rev Panam Salud Publica 2023; 47:e82. [PMID: 37223326 PMCID: PMC10202338 DOI: 10.26633/rpsp.2023.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 02/10/2023] [Indexed: 05/25/2023] Open
Abstract
Objective To understand how replacement of decision-makers (DMs) serving as principal investigators (PI) or co-PIs on research teams may affect the feasibility and value of embedded implementation research (EIR) used to improve health policies, programs, and services in Latin America and the Caribbean. Methods This was a descriptive qualitative study based on 39 semistructured interviews with 13 embedded research teams selected by financing agencies to explore team composition, interaction among members, and research results. Interviews were conducted at three points during the study period from September 2018 to November 2019; data were analyzed from 2020 to 2021. Results Research teams were found to be operating in one of three situations: (i) permanent core team (no change) with either active DM or inactive DM participation; (ii) replacement of DM-PI or co-PI that did not affect EIR research; and (iii) replacement of DM-PI that affected EIR. Conclusions To ensure EIR continuity and stability, research teams should include high-level DMs together with more technical staff performing essential implementation activities. This structure could improve collaboration among professional researchers and ensure greater embeddedness of EIR to strengthen the health system.
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Affiliation(s)
- Victor Becerril-Montekio
- Centro de Investigación en Sistemas de SaludInstituto Nacional de Salud PúblicaCuernavacaMorelosMexicoCentro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico.
| | - Pilar Torres-Pereda
- Centro de Investigación en Sistemas de SaludInstituto Nacional de Salud PúblicaCuernavacaMorelosMexicoCentro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico.
| | - Luis Alberto García-Bello
- Dirección de Salud MentalInstituto de Salud Pública del Estado de GuanajuatoLeónGuanajuatoMexicoDirección de Salud Mental, Instituto de Salud Pública del Estado de Guanajuato, León, Guanajuato, Mexico.
| | - Jacqueline Alcalde-Rabanal
- Centro de Investigación en Sistemas de SaludInstituto Nacional de Salud PúblicaCuernavacaMorelosMexicoCentro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico.
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Becerril-Montekio V, García-Bello LA, Torres-Pereda P, Alcalde-Rabanal J, Reveiz L, Langlois EV. Collaboration between health system decision makers and professional researchers to coproduce knowledge, a scoping review. Int J Health Plann Manage 2022; 37 Suppl 1:45-58. [PMID: 35643849 DOI: 10.1002/hpm.3513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/10/2022] [Accepted: 05/17/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Recent literature uses different terms and approaches to the collaboration between researchers and health system decision-makers in the research process. In 2012, the World Health Organisation proposed to "Embed research within decision-making processes". Yet, important contributions use other terms and perspectives for the same issue. This scoping review aimed to identify these terms, approaches, their application and eventual influence on the utilization of evidence. METHODS We searched papers published between January 2000 and February 2019 in English, Spanish, French and Portuguese in the databases of PubMed, Scielo, Google Scholar and EBSCOhost, thus accessing MedicLatina, MEDLINE Complete and eBook Collection. Our main inclusion criterion was the participation of health personnel in non-clinical research activities. We considered three domains for in depth analysis: Definition, name and description of the participation of decision makers and health staff; Forms of collaboration and actual/effective participation of health staff in research; Eventual influence on the utilization of research results. RESULTS We identified 607 articles and selected 74 for full text analysis. Nineteen different terms are currently used in twelve countries to describe the participation of health decision-makers and staff in research activities. Most publications refer to Integrated Knowledge Translation or Embedded Research, and were published in Canada and the United Kingdom. Forty-five papers discuss the participation of health staff in research activities; 20 leading the whole process and 21 as collaborators. CONCLUSIONS The identification of the different terms and approaches to the close collaboration of health staff and decision-makers with professional researchers is essential to promote its effective application and influence on the utilization of evidence. Yet, it is also necessary to insist in their co-participation throughout the whole investigation process as a relevant way to improve research results uptake, strengthen health systems and advance towards universal health coverage.
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Affiliation(s)
| | | | | | | | - Ludovic Reveiz
- Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, Washington, Columbia, USA
| | - Etienne V Langlois
- Partnership for Maternal, Newborn & Child Health (PMNCH), World Health Organization (WHO), Geneva, Switzerland
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Tangcharoensathien V, Sudhakar M, Birhanu Z, Abraham G, Bawah A, Kyei P, Biney A, Shroff ZC, Witthayapipopsakul W, Panichkriangkrai W. Health Policy and Systems Research Capacities in Ethiopia and Ghana: Findings From a Self-Assessment. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00715. [PMID: 36109057 PMCID: PMC9476481 DOI: 10.9745/ghsp-d-21-00715] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 05/11/2022] [Indexed: 11/23/2022]
Abstract
Government investment in strengthening health policy and systems research capacities is needed to enhance the generation of evidence for effective policy making. Researchers’ engagement in the policy-making process helps shape policy-relevant research and support policy-relevant decisions. Introduction: Health systems are complex. Policies targeted at health system development may be informed by health policy and systems research (HPSR). This study assesses HPSR capacity to generate evidence and inform policy in Ethiopia and Ghana. Methods: We used a mixed-methods approach including a self-administered survey at selected HPSR institutes and in-depth interviews of policy makers. Results: Both countries have limited capacity to generate HPSR evidence, especially in terms of mobilizing adequate funding and retaining a critical number of competent researchers who understand complex policy processes, have the skills to influence policy, and know policy makers’ demands for evidence. Common challenges are limited government research funding, rigidity in executing the research budget, and reliance on donor funding that might not respond to national health priorities. There are no large research programs in either country. The annual number of HPSR projects per research institute in Ethiopia (10 projects) was higher than in Ghana (2.5 projects), Ethiopia has a significantly smaller annual budget for health research. Policy makers in the 2 countries increasingly recognize the importance of evidence-informed policy making, but various challenges remain in building effective interactions with HPSR institutes. Conclusion: We propose 3 synergistic recommendations to strengthen HPSR capacity in Ethiopia and Ghana. First, strengthen researchers’ capacity and enhance their opportunities to know policy actors; engage with the policy community; and identify and work with policy entrepreneurs, who have attributes, skills, and strategies to achieve a successful policy. Second, deliver policy-relevant research findings in a timely way and embed research into key health programs to guide effective implementation. Third, mobilize local and international funding to strengthen HPSR capacities as well as address challenges with recruiting and retaining a critical number of talented researchers. These recommendations may be applied to other low- and middle-income countries to strengthen HPSR capacities.
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Affiliation(s)
| | | | - Zewdie Birhanu
- Jimma Institute of Health, Jimma University, Jimma, Ethiopia
| | - Gelila Abraham
- Jimma Institute of Health, Jimma University, Jimma, Ethiopia
| | - Ayaga Bawah
- Regional Institute of Population Studies, Accra, Ghana
| | - Pearl Kyei
- Regional Institute of Population Studies, Accra, Ghana
| | - Adriana Biney
- Regional Institute of Population Studies, Accra, Ghana
| | - Zubin Cyrus Shroff
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
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Ghaffar A, Zennaro LD, Tran N. The African Health Initiative's Role in Advancing the Use of Embedded Implementation Research for Health Systems Strengthening. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2200318. [PMID: 36109064 PMCID: PMC9476485 DOI: 10.9745/ghsp-d-22-00318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/25/2022] [Indexed: 12/03/2022]
Abstract
The African Health Initiative has demonstrated the feasibility of changing the traditional knowledge generation paradigm by using an embedded implementation research approach to improve health systems’ performance and strengthen capacity for knowledge generation and use.
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Affiliation(s)
- Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland.
| | - Livia Dal Zennaro
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Nhan Tran
- Department of the Social Determinants of Health, World Health Organization, Geneva, Switzerland
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Awoonor-Williams JK, Apanga S, Bawah AA, Phillips JF, Kachur PS. Using Health Systems and Policy Research to Achieve Universal Health Coverage in Ghana. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2100763. [PMID: 36109062 PMCID: PMC9476492 DOI: 10.9745/ghsp-d-21-00763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/31/2022] [Indexed: 11/15/2022]
Abstract
Ghana is positioned to become the first country in sub-Saharan Africa to implement universal health coverage based on nationwide expansion of geographic access through the Community-based Health Planning and Services initiative. This achievement is the outcome of 3 decades of implementation research that health authorities have used for guiding the development of its primary health care program. This implementation research process has comprised Ghana's official endorsement of the 1978 Alma Ata Declaration, leading to the institutionalization of evidence relevant to the strategic design of primary health care and national health insurance policies and services. Rather than relying solely upon the dissemination of project results, Ghana has embraced a continuous and systemic process of knowledge capture, curation, and utilization of evidence in expanding geographic access by a massive expansion in the number of community health service points that has taken decades. A multisectoral approach has been pursued that has involved the creation of systematic partnerships that included all levels of the political system, local development officials, community groups and social networks, multiple university-based disciplines, external development partners, and donors. However, efforts to achieve high levels of financial access through the roll-out of the National Health Insurance Scheme have proceeded at a less consistent pace and been fraught with many challenges. As a result, financial access has been less comprehensive than geographical access despite sequential reforms having been made to both programs. The legacy of activities and current research on primary health care and national health insurance are reviewed together with unaddressed priorities that merit attention in the future. Factors that have facilitated or impeded progress with research utilization are reviewed and implications for health systems strengthening in Ghana and elsewhere in Africa and globally are discussed.
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Affiliation(s)
| | | | - Ayaga A Bawah
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | - James F Phillips
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Patrick S Kachur
- Mailman School of Public Health, Columbia University, New York, NY, USA
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Varallyay NI, Kennedy C, Bennett SC, Peters DH. Strategies to promote evidence use for health programme improvement: learning from the experiences of embedded implementation research teams in Latin America and the Caribbean. Health Res Policy Syst 2022; 20:38. [PMID: 35392931 PMCID: PMC8991468 DOI: 10.1186/s12961-022-00834-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background To achieve global health targets, innovative approaches are needed to strengthen the implementation of efficacious interventions. New approaches in implementation research that bring together health system decision-makers alongside researchers to collaboratively design, produce and apply research evidence are gaining traction. Embedded implementation research (EIR) approaches led by decision-maker principal investigators (DM PIs) appear promising in this regard. Our aim is to describe the strategies study teams employ in the post-research phase of EIR to promote evidence-informed programme or policy improvement. Methods We conducted a prospective, comparative case study of an EIR initiative in Bolivia, Colombia and Dominican Republic. Guided by a conceptual framework on EIR, we used semi-structured key informant interviews (n = 51) and document reviews (n = 20) to examine three decision-maker-led study teams (“cases”). Focusing on three processes (communication/dissemination, stakeholder engagement with evidence, integrating evidence in decision-making) and the main outcome (enacting improvements), we used thematic analysis to identify associated strategies and enabling or hindering factors. Results Across cases, we observed diverse strategies, shaped substantially by whether the DM PI was positioned to lead the response to study findings within their sphere of work. We found two primary change pathways: (1) DM PIs implement remedial measures directly, and (2) DM PIs seek to influence other stakeholders to respond to study findings. Throughout the post-research phase, EIR teams adapted research use strategies based on the evolving context. Conclusions EIR led by well-positioned DM PIs can facilitate impactful research translation efforts. We draw lessons around the importance of (1) understanding DM PI positionality, (2) ongoing assessment of the evolving context and stakeholders and (3) iterative adaptation to dynamic, uncertain circumstances. Findings may guide EIR practitioners in planning and conducting fit-for-purpose and context-sensitive strategies to advance the use of evidence for programme improvement. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-022-00834-1.
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Affiliation(s)
- N Ilona Varallyay
- Health Systems Program, Department of International Health, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States of America.
| | - Caitlin Kennedy
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States of America
| | - Sara C Bennett
- Health Systems Program, Department of International Health, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States of America
| | - David H Peters
- Department of International Health, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States of America
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Awoonor‐Williams JK, Phillips JF. Developing organizational learning for scaling-up community-based primary health care in Ghana. Learn Health Syst 2022; 6:e10282. [PMID: 35036554 PMCID: PMC8753302 DOI: 10.1002/lrh2.10282] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Achieving effective community-based primary health care requires evidence for guiding strategic decisions that must be made. However, research processes often limit data collection to particular organizational levels or disseminate results to specific audiences. Decision-making that emerges can fail to account for the contrasting perspectives and needs of managers at each organizational level. The Ghana Health Service (GHS) addressed this problem with a multilevel and sequential research and action approach that has provided two decades of implementation learning for guiding community-based primary health care development. METHOD The GHS implementation research initiatives progressed from (i) a participatory pilot investigation to (ii) an experimental trial of strategies that emerged to (iii) replication research for testing scale-up, culminating in (iv) evidence-based scale-up of a national community-based primary health care program. A reform process subsequently repeated this sequence in a manner that involved stakeholders at the community, sub-district, district, and regional levels of the system. The conduct, interpretation, and dissemination of results that emerged comprised a strategy for achieving systems learning by conducting investigations in phases in conjunction with bottom-up knowledge capture, lateral exchanges for fostering peer learning at each system level, and top-down processes for communicating results as policy. Continuous accumulation of qualitative data on stakeholder reactions to operations at each organizational level was conducted in conjunction with quantitative monitoring of field operations. RESULTS Implementation policies were enhanced by results associated with each phase. A quasi-experiment for testing the reform process showed that scale-up of community-based primary health care was accelerated, leading to improvements in childhood survival and reduced fertility. CONCLUSION Challenges to system learning were overcome despite severe resource constraints. The integration of knowledge generation with ongoing management processes institutionalized learning for achieving evidence-driven program action.
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Affiliation(s)
| | - James F. Phillips
- Heilbrunn Department of Population and Family Health, Mailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
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Sáenz V, Patino CM, Ferreira JC. Implementation research and its role in public health and health policies. J Bras Pneumol 2021; 47:e20210443. [PMID: 34878060 PMCID: PMC9013525 DOI: 10.36416/1806-3756/e20210443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Victoria Sáenz
- . Methods in Epidemiologic, Clinical, and Operations Research (MECOR) program, American Thoracic Society/Asociación Latinoamericana del Tórax, Montevideo, Uruguay.,. Roche Argentina, Buenos Aires, Argentina
| | - Cecilia María Patino
- . Methods in Epidemiologic, Clinical, and Operations Research (MECOR) program, American Thoracic Society/Asociación Latinoamericana del Tórax, Montevideo, Uruguay.,. Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles (CA) USA
| | - Juliana Carvalho Ferreira
- . Methods in Epidemiologic, Clinical, and Operations Research (MECOR) program, American Thoracic Society/Asociación Latinoamericana del Tórax, Montevideo, Uruguay.,. Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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15
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What informs oral health and chronic disease policy development in Australia: a citation analysis. J Public Health Policy 2021; 42:635-646. [PMID: 34782735 DOI: 10.1057/s41271-021-00313-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2021] [Indexed: 01/12/2023]
Abstract
Improvement of health services and patient outcomes depends on the translation of health research into health policy. Oral health research can inform policies to manage chronic diseases and improve quality of life of affected individuals. To determine if translation of this research into policy is occurring, we identify where policymakers obtain evidence to inform the development of Australian health policy. We conducted a citation analysis of oral health, cardiovascular disease, diabetes and cognitive impairment National policies to determine if current oral health research has informed oral health and chronic disease policy. We analysed five National policies with 268 individual references to policy or organizational documents (n = 179), peer-reviewed research (n = 74), grey literature (n = 12), or unidentifiable (n = 3). Although we found oral health references listed in the National policies (92), we did not find this information to have been translated into the oral health and chronic disease policies we analysed.
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Jackson D, Shahabuddin ASM, Sharkey AB, Källander K, Muñiz M, Mwamba R, Nyankesha E, Scherpbier RW, Hasman A, Balarajan Y, Albright K, Idele P, Peterson SS. Closing the know-do gap for child health: UNICEF's experiences from embedding implementation research in child health and nutrition programming. Implement Sci Commun 2021; 2:112. [PMID: 34588002 PMCID: PMC8479889 DOI: 10.1186/s43058-021-00207-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 08/25/2021] [Indexed: 11/16/2022] Open
Abstract
UNICEF operates in 190 countries and territories, where it advocates for the protection of children’s rights and helps meet children’s basic needs to reach their full potential. Embedded implementation research (IR) is an approach to health systems strengthening in which (a) generation and use of research is led by decision-makers and implementers; (b) local context, priorities, and system complexity are taken into account; and (c) research is an integrated and systematic part of decision-making and implementation. By addressing research questions of direct relevance to programs, embedded IR increases the likelihood of evidence-informed policies and programs, with the ultimate goal of improving child health and nutrition. This paper presents UNICEF’s embedded IR approach, describes its application to challenges and lessons learned, and considers implications for future work. From 2015, UNICEF has collaborated with global development partners (e.g. WHO, USAID), governments and research institutions to conduct embedded IR studies in over 25 high burden countries. These studies focused on a variety of programs, including immunization, prevention of mother-to-child transmission of HIV, birth registration, nutrition, and newborn and child health services in emergency settings. The studies also used a variety of methods, including quantitative, qualitative and mixed-methods. UNICEF has found that this systematically embedding research in programs to identify implementation barriers can address concerns of implementers in country programs and support action to improve implementation. In addition, it can be used to test innovations, in particular applicability of approaches for introduction and scaling of programs across different contexts (e.g., geographic, political, physical environment, social, economic, etc.). UNICEF aims to generate evidence as to what implementation strategies will lead to more effective programs and better outcomes for children, accounting for local context and complexity, and as prioritized by local service providers. The adaptation of implementation research theory and practice within a large, multi-sectoral program has shown positive results in UNICEF-supported programs for children and taking them to scale.
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Affiliation(s)
- Debra Jackson
- Implementation Research and Delivery Science Unit, Health Section, Programme Division, UNICEF, New York, New York, USA. .,Takeda Chair in Global Child Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK. .,School of Public Health, University of the Western Cape, Cape Town, South Africa.
| | - A S M Shahabuddin
- Implementation Research and Delivery Science Unit, Health Section, Programme Division, UNICEF, New York, New York, USA
| | - Alyssa B Sharkey
- Implementation Research and Delivery Science Unit, Health Section, Programme Division, UNICEF, New York, New York, USA
| | - Karin Källander
- Implementation Research and Delivery Science Unit, Health Section, Programme Division, UNICEF, New York, New York, USA
| | - Maria Muñiz
- Health Section, East and Southern Africa Regional Office, UNICEF, Nairobi, Nairobi, Kenya
| | - Remy Mwamba
- Implementation Research and Delivery Science Unit, Health Section, Programme Division, UNICEF, New York, New York, USA
| | - Elevanie Nyankesha
- Implementation Research and Delivery Science Unit, Health Section, Programme Division, UNICEF, New York, New York, USA
| | - Robert W Scherpbier
- Implementation Research and Delivery Science Unit, Health Section, Programme Division, UNICEF, New York, New York, USA
| | - Andreas Hasman
- Nutrition Section, Programme Division, UNICEF, New York, New York, USA
| | - Yarlini Balarajan
- Nutrition Section, Programme Division, UNICEF, New York, New York, USA
| | - Kerry Albright
- Office of Research Innocenti, UNICEF, Florence, Florence, Italy
| | - Priscilla Idele
- Office of Research Innocenti, UNICEF, Florence, Florence, Italy
| | - Stefan Swartling Peterson
- Office of the Associate Director for Health, Programme Division, UNICEF, New York, New York, USA.,Uppsala University, Women's and Children's Health (IMCH) and Karolinska Institutet, Uppsala, Sweden.,Makerere University School of Public Health, Kampala, Uganda
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17
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Mancuso A, Ahmed Malm S, Sharkey A, Shahabuddin ASM, Shroff ZC. Cross-cutting lessons from the Decision-Maker Led Implementation Research initiative. Health Res Policy Syst 2021; 19:83. [PMID: 34380519 PMCID: PMC8356374 DOI: 10.1186/s12961-021-00706-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Almost 20 million children under one year of age did not receive basic vaccines in 2019, and most of these children lived in low- and middle-income countries. Implementation research has been recognized as an emerging area that is critical to strengthen the implementation of interventions proven to be effective. As a component of strengthening implementation, WHO has called for greater embedding of research within decision-making processes. One strategy to facilitate the embedding of research is to engage decision-makers as Principal Investigators of the research. Since 2015, the Alliance for Health Policy and Systems Research within the WHO and the United Nations Children's Fund have supported decision-maker led research by partnering with Gavi, the Vaccine Alliance, in an initiative called "Decision-Maker Led Implementation Research". This synthesis paper describes the cross-cutting lessons from the initiative to further understand and develop future use of the decision-maker led strategy. METHODS This study used qualitative methods of data collection, including a document review and in-depth interviews with decision-makers and researchers engaged in the initiative. Document extraction and thematic content analysis were applied. The individual project was the unit of analysis and the results were summarized across projects. RESULTS Research teams from 11 of the 14 projects participated in this study, for an overall response rate of 78.6%. Most projects were carried out in countries in Africa and conducted at the sub-state or sub-district level. Seven enablers and five barriers to the process of conducting the studies or bringing about changes were identified. Key enablers were the relevance, acceptability, and integration of the research, while key barriers included unclear results, limited planning and support, and the limited role of a single study in informing changes to strengthen implementation. CONCLUSIONS Decision-maker led research is a promising strategy to facilitate the embedding of research into decision-making processes and contribute to greater use of research to strengthen implementation of proven-effective interventions, such as immunization. We identified several lessons for consideration in the future design and use of the decision-maker led strategy.
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Affiliation(s)
- Arielle Mancuso
- Alliance for Health Policy and Systems Research, WHO headquarters, Avenue Appia 20, 1211, Geneva, Switzerland.
| | - Shahira Ahmed Malm
- Nutrition Section, United Nations Children's Fund, UNICEF headquarters, New York, NY, 10017, United States of America
| | - Alyssa Sharkey
- Implementation Research and Delivery Science Unit, Health Section, United Nations Children's Fund, UNICEF headquarters, New York, NY, 10017, United States of America
| | - A S M Shahabuddin
- Implementation Research and Delivery Science Unit, Health Section, United Nations Children's Fund, UNICEF headquarters, New York, NY, 10017, United States of America
| | - Zubin Cyrus Shroff
- Alliance for Health Policy and Systems Research, WHO headquarters, Avenue Appia 20, 1211, Geneva, Switzerland
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18
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Varallyay NI, Bennett SC, Kennedy C, Ghaffar A, Peters DH. How does embedded implementation research work? Examining core features through qualitative case studies in Latin America and the Caribbean. Health Policy Plan 2021; 35:ii98-ii111. [PMID: 33156937 PMCID: PMC7646734 DOI: 10.1093/heapol/czaa126] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 01/04/2023] Open
Abstract
Innovative strategies are needed to improve the delivery of evidence-informed health interventions. Embedded implementation research (EIR) seeks to enhance the generation and use of evidence for programme improvement through four core features: (1) central involvement of programme/policy decision-makers in the research cycle; (2) collaborative research partnerships; (3) positioning research within programme processes and (4) research focused on implementation. This paper examines how these features influence evidence-to-action processes and explores how they are operationalized, their effects and supporting conditions needed. We used a qualitative, comparative case study approach, drawing on document analysis and semi-structured interviews across multiple informant groups, to examine three EIR projects in Bolivia, Colombia and the Dominican Republic. Our findings are presented according to the four core EIR features. The central involvement of decision-makers in EIR was enhanced by decision-maker authority over the programme studied, professional networks and critical reflection. Strong research-practice partnerships were facilitated by commitment, a clear and shared purpose and representation of diverse perspectives. Evidence around positioning research within programme processes was less conclusive; however, as all three cases made significant advances in research use and programme improvement, this feature of EIR may be less critical than others, depending on specific circumstances. Finally, a research focus on implementation demanded proactive engagement by decision-makers in conceptualizing the research and identifying opportunities for direct action by decision-makers. As the EIR approach is a novel approach in these low-resource settings, key supports are needed to build capacity of health sector stakeholders and create an enabling environment through system-level strategies. Key implications for such supports include: promoting EIR and creating incentives for decision-makers to engage in it, establishing structures or mechanisms to facilitate decision-maker involvement, allocating funds for EIR, and developing guidance for EIR practitioners.
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Affiliation(s)
- N Ilona Varallyay
- Department of International Health, Johns Hopkins School
of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States
- Corresponding author. Malabia 1970, Buenos Aires CABA 1414,
Argentina. E-mail:
| | - Sara C Bennett
- Department of International Health, Johns Hopkins School
of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States
| | - Caitlin Kennedy
- Social and Behavioral Interventions Program, Department of
International Health, Johns Hopkins School of Public Health, 615 N Wolfe St,
Baltimore, MD 21205, United States
| | - Abdul Ghaffar
- The Alliance for Health Policy and Systems Research at the
World Health Organization, 20 avenue Appia, 1211 Geneva, Switzerland
| | - David H Peters
- Department of International Health, Johns Hopkins School
of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States
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Pulido-Salgado M, Castaneda Mena FA. Bringing Policymakers to Science Through Communication: A Perspective From Latin America. Front Res Metr Anal 2021; 6:654191. [PMID: 33981947 PMCID: PMC8107434 DOI: 10.3389/frma.2021.654191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/19/2021] [Indexed: 11/13/2022] Open
Abstract
Scientific knowledge should be shared beyond academic circles in order to promote science in policymaking. Science communication increases the understanding of how the natural world works and the capacity to make informed decisions. However, not every researcher has the ability to master the art of communicating, and even less in a clear, concise, and easy to understand language that society representatives appreciate. Within the huge and extraordinarily diverse Latin American region, science communication has been going on for at least 200 years, when the first science stories appeared in the newspapers, as well as the first science museums and botanical gardens were founded. Nevertheless, resources are limited, and notably time, which researchers spend mostly in mentoring, ensuring funding, publication of their results and laboratory work, while science journalists are an endangered species. This perspective article aims at providing some recommendations to build bridges between science and decision-making parties through communication, by exploring how Latin American diplomats and policymakers engage with scientific knowledge.
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Affiliation(s)
- Marta Pulido-Salgado
- Investigación y Ciencia (Spanish Edition of Scientific American, Springer Nature), Barcelona, Spain
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Shahabuddin A, Sharkey A, Khalid F, Rasanathan K, Hasman A, Tran N, Durrani A, Ongwae K, Duncan R, Ahmed KA, Farrukh S, Rutter P, Jackson D, Hafeez A, Peterson SS, Ghaffar A. An embedded implementation research initiative to tackle service delivery bottlenecks in the expanded programme on immunisation in Pakistan: Overview and reflections. J Glob Health 2021; 11:06003. [PMID: 34026053 PMCID: PMC8109843 DOI: 10.7189/jogh.11.06003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Embedded implementation research (IR) can play a critical role in health systems strengthening by tackling systems and implementation bottlenecks of a program. To achieve this aim, with the financial support of GAVI, the Vaccine Alliance, in 2016, the Government of Pakistan, UNICEF and the Alliance for Health Policy and Systems Research (AHPSR) launched an Embedded IR for Immunisation Initiative (the Initiative) to explore health systems and implementation bottlenecks, and potential strategies to tackle such bottlenecks in the Expanded Programme on Immunisation (EPI) in Pakistan. In total, 10 research teams were involved in the Initiative, which was the first of its kind in the country. In this paper, we provided a brief overview of the Initiative's approach as well as the key learnings including challenges and successes of the research teams which could inform future embedded IR Initiatives. Methods Data were collected from members of the IR teams through an online survey. In addition, in-depth interviews were conducted via phone and in-person from IR team members to explore further the challenges they faced while conducting IR in Pakistan and recommendations for future IR initiatives. The qualitative information obtained from these sources was collated and categorized into themes reflecting some of the challenges, successes, and lessons learned, as well as teams' recommendations for future initiatives. Results The embedded IR Initiative in Pakistan followed several steps starting with a desk review to compile information on key implementation challenges of EPI and ended with a dissemination workshop where all the research teams shared their IR results with policymakers and implementers. Key factors that facilitated the successful and timely completion of the studies included appreciation by and leadership of implementers in generation and use of local knowledge, identification of research priorities jointly by EPI managers and researchers and provision of continuous and high-quality support from in-country research partners. Participants in the Initiative indicated that challenges included a lack of clarity on the role and responsibilities of each partner involved and need for further support to facilitate use and dissemination of research findings. Conclusions The Initiative established that an immunisation programme in a lower middle-income country can use small and time-bound embedded IR, based on partnerships between programme managers and local researchers, to generate information and evidence that can inform decision-making. Future embedded IR initiatives should strive to ensure effective coordination and active participation of all key stakeholders, a clear research utilisation plan from the outset, and efforts to strengthen research teams' capacity to foster utilisation of research findings.
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Affiliation(s)
- Asm Shahabuddin
- Implementation Research and Delivery Science Unit, Health Section, Programme Division, UNICEF, New York, USA
| | - Alyssa Sharkey
- Implementation Research and Delivery Science Unit, Health Section, Programme Division, UNICEF, New York, USA
| | - Faraz Khalid
- Universal Health Coverage/Health Systems Department, WHO Regional Office for Eastern Mediterranean
| | | | - Andreas Hasman
- Regional Office for South Asia, UNICEF, Kathmandu, Nepal
| | - Nhan Tran
- Alliance for Health Policy and Systems Research, World Health Organisation, Geneva, Switzerland
| | | | | | - Richard Duncan
- Immunisation Unit, Health Section, Programme Division, UNICEF, New York, USA
| | | | - Saadia Farrukh
- Regional Office for South Asia, UNICEF, Kathmandu, Nepal
| | - Paul Rutter
- Regional Office for South Asia, UNICEF, Kathmandu, Nepal
| | - Debra Jackson
- Implementation Research and Delivery Science Unit, Health Section, Programme Division, UNICEF, New York, USA.,London School of Hygiene and Tropical Medicine, London, UK
| | - Assad Hafeez
- Ministry of National Health Services, Regulations & Coordination, Islamabad, Pakistan
| | | | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organisation, Geneva, Switzerland
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García-Cerde R, Becerril-Montekio V, Langlois É, Reveiz L, Alcalde-Rabanal J, Torres-Pereda P. Embedded implementation research determinants in Latin American health systems. Rev Saude Publica 2021; 55:16. [PMID: 33909870 PMCID: PMC8032325 DOI: 10.11606/s1518-8787.2021055003027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE: To assess the determinants of embedded implementation research (EIR) conduct in seven Latin American and Caribbean countries. METHODS: This qualitative interpretative study conducted and analyzed 14 semi-structured interviews based on a grounded theory approach using Atlas-ti© 7.5.7. We grouped the conditions appointed by interviewees as determinants of EIR conduct into six domains. RESULTS: The participation of high-level engaged decision makers as research co-producers is an important EIR determinant that fosters research use. Nevertheless, EIR faces challenges such as dealing with key personnel changes and fluctuating political contexts. CONCLUSIONS: Despite its limitations, EIR is effective in creating a sense of ownership of research results among implementers, which helps bridge the gap between research and decision-making in health systems.
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Affiliation(s)
- Rodrigo García-Cerde
- Centro de Investigación en Sistemas de Salud. Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
| | - Victor Becerril-Montekio
- Centro de Investigación en Sistemas de Salud. Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
| | - Étienne Langlois
- Partnership for Maternal Newborn and Child Health. World Health Organization. Geneva, Switzerland
| | - Ludovic Reveiz
- Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, Washington, D.C, USA
| | - Jacqueline Alcalde-Rabanal
- Centro de Investigación en Sistemas de Salud. Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
| | - Pilar Torres-Pereda
- Centro de Investigación en Sistemas de Salud. Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
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van der Merwe M, D'Ambruoso L, Witter S, Twine R, Mabetha D, Hove J, Byass P, Tollman S, Kahn K. Collective reflections on the first cycle of a collaborative learning platform to strengthen rural primary healthcare in Mpumalanga, South Africa. Health Res Policy Syst 2021; 19:66. [PMID: 33874951 PMCID: PMC8054125 DOI: 10.1186/s12961-021-00716-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Frontline managers and health service providers are constrained in many contexts from responding to community priorities due to organizational cultures focused on centrally defined outputs and targets. This paper presents an evaluation of the Verbal Autopsy with Participatory Action Research (VAPAR) programme-a collaborative learning platform embedded in the local health system in Mpumalanga, South Africa-for strengthening of rural primary healthcare (PHC) systems. The programme aims to address exclusion from access to health services by generating and acting on research evidence of practical, local relevance. METHODS Drawing on existing links in the provincial and national health systems and applying rapid, participatory evaluation techniques, we evaluated the first action-learning cycle of the VAPAR programme (2017-19). We collected data in three phases: (1) 10 individual interviews with programme stakeholders, including from government departments and parastatals, nongovernmental organizations and local communities; (2) an evaluative/exploratory workshop with provincial and district Department of Health managers; and (3) feedback and discussion of findings during an interactive workshop with national child health experts. RESULTS Individual programme stakeholders described early outcomes relating to effective research and stakeholder engagement, and organization and delivery of services, with potential further contributions to the establishment of an evidence base for local policy and planning, and improved health outcomes. These outcomes were verified with provincial managers. Provincial and national stakeholders identified the potential for VAPAR to support engagement between communities and health authorities for collective planning and implementation of services. Provincial stakeholders proposed that this could be achieved through a two-way integration, with VAPAR stakeholders participating in routine health planning and review activities and frontline health officials being involved in the VAPAR process. Findings were collated into a revised theory of change. CONCLUSIONS The VAPAR learning platform was regarded as a feasible, acceptable and relevant approach to facilitate cooperative learning and community participation in health systems. The evaluation provides support for a collaborative learning platform within routine health system processes and contributes to the limited evaluative evidence base on embedded health systems research.
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Affiliation(s)
- Maria van der Merwe
- , White River, South Africa.
- Centre for Global Development, School of Education, University of Aberdeen, Aberdeen, Scotland.
| | - Lucia D'Ambruoso
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- National Health Service (NHS) Grampian, Aberdeen, Scotland
| | - Sophie Witter
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Denny Mabetha
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Jennifer Hove
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Peter Byass
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Tollman
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | - Kathleen Kahn
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
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De la Rosa A, Mordan J, Barinas I, Toribio M, Mancebo D, Rodríguez A, Pacheco-Herrero M. Acceptability and adoption of clinical practice guidelines and treatment protocols on preeclampsia/eclampsia in the Dominican Republic. Rev Panam Salud Publica 2021; 45:e8. [PMID: 33643395 PMCID: PMC7898364 DOI: 10.26633/rpsp.2021.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/06/2020] [Indexed: 11/24/2022] Open
Abstract
Objective Estimate the acceptability and adoption by health care workers of clinical practice guidelines and treatment protocols for women with preeclampsia/eclampsia and identify the facilitating factors and barriers to their implementation. Methods A qualitative study was conducted, using semi-structured interviews and focus groups in five maternity hospitals. Interviews were compiled for analysis, and barriers and facilitators were characterized. Results Seventy health professionals (52 female and 18 male) participated, representing different levels of the health system. The majority of workers and managers were aware of the existence and content of clinical practice guidelines (CPGs) for preeclampsia/eclampsia, especially the participants with more time in the health service. With respect to facilitating factors, both medical and nursing staff were positive about continued development and implementation of high-quality CPGs. There was consensus that limitations exist, especially with respect to a lack of the necessary medicines, supplies, and equipment to meet and implement the established recommendations. Discussion The results of the study show the need to strengthen strategies that help close the gap between research and public policy. Studies suggest that research should focus on users, policymakers, and decisionmakers in the health system. The actors in the Dominican health system recognize the GRADE methodology as an appropriate instrument for the development and implementation of CPGs. Implementation barriers require systemic and comprehensive approaches.
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Affiliation(s)
- Andelys De la Rosa
- Ministry of Public Health and Social Welfare Dominican Republic Ministry of Public Health and Social Welfare, Dominican Republic
| | - José Mordan
- Independent consultants Independent consultants
| | - Indiana Barinas
- Ministry of Public Health and Social Welfare Dominican Republic Ministry of Public Health and Social Welfare, Dominican Republic
| | | | - Diana Mancebo
- Ministry of Public Health and Social Welfare Dominican Republic Ministry of Public Health and Social Welfare, Dominican Republic
| | - Alexandra Rodríguez
- Pan American Health Organization Dominican Republic Pan American Health Organization, Dominican Republic
| | - Mar Pacheco-Herrero
- Pontífica Universidad Católica Madre y Maestra Santiago de los Caballeros Dominican Republic Pontífica Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
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Sacoto F, Torres I, López-Cevallos DF. Sustainability in chronic disease prevention: lessons from the Salud al Paso program in Ecuador. Rev Panam Salud Publica 2021; 45:e30. [PMID: 33643405 PMCID: PMC7901044 DOI: 10.26633/rpsp.2021.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/10/2020] [Indexed: 12/31/2022] Open
Abstract
This study analyzes the conditions and possibilities of sustainability of the Salud al Paso program of the Metropolitan Health Secretariat of the Municipality of Quito, Ecuador, as an example for similar initiatives, in the context of the changes made by the new administration in May 2019. The analysis of the implementation of this initiative, focused on the prevention of noncommunicable diseases (NCDs), was based on the program’s user database, the information gathered on the perspectives of operational staff, knowledge of the program, and the opinion of local leaders and opinion leaders of the Quito Metropolitan District, as well as official information. Based on this data, the study identified factors that could have facilitated or hindered its sustainability and documented the rationale to suspend the on-demand activities included in the program and limit activities to the care of populations under municipal responsibility (day-care centers, schools and colleges, markets, elder care programs, and employees) and patients with identified cardiometabolic risk. The insufficient institutionalization of the program, conceived as a project with an insufficient vision of its sustainability in time, was mentioned as a possible obstacle by leaders and operational staff. The growing prevalence of NCDs requires initiatives for their prevention, which must be institutionalized to ensure their continuity and overcome eventual changes of government. In addition, future interventions similar to Salud al Paso should establish better sectoral coordination articulation, especially with the Ministry of Public Health and other service networks.
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Affiliation(s)
- Fernando Sacoto
- Ecuadorian Society of Public Health Quito Ecuador Ecuadorian Society of Public Health, Quito, Ecuador
| | - Irene Torres
- Octaedro Foundation Quito Ecuador Octaedro Foundation, Quito, Ecuador
| | - Daniel F López-Cevallos
- Oregon State University Oregon United States of America Oregon State University, Oregon, United States of America
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Barreto JOM, Bortoli MC, Luquine CD, Oliveira CF, Toma TS, Ribeiro AAV, Tesser TR, Rattner D, Vidal A, Mendes Y, Carvalho V, Neri MA, Chapman E. Implementation of national childbirth guidelines in Brazil: barriers and strategies. Rev Panam Salud Publica 2020; 44:e170. [PMID: 33417646 PMCID: PMC7778467 DOI: 10.26633/rpsp.2020.170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/03/2020] [Indexed: 02/07/2023] Open
Abstract
The present report describes the process and results obtained with a knowledge translation project developed in three stages to identify barriers to the Implementation of the National Guidelines for Normal Childbirth in Brazil, as well strategies for effective implementation. The Improving Programme Implementation through Embedded Research (iPIER) model and the Supporting Policy Relevant Reviews and Trials (SUPPORT) tools provided the methodological framework for the project. In the first stage, the quality of the Guidelines was evaluated and the barriers preventing implementation of the recommendations were identified through review of the global evidence and analysis of contributions obtained in a public consultation process. In the second stage, an evidence synthesis was used as the basis for a deliberative dialogue aimed at prioritizing the barriers identified. Finally, a second evidence synthesis was presented in a new deliberative dialogue to discuss six options to address the prioritized barriers: 1) promote the use of multifaceted interventions; 2) promote educational interventions for the adoption of guidelines; 3) perform audits and provide feedback to adjust professional practice; 4) use reminders to mediate the interaction between workers and service users; 5) enable patient-mediated interventions; and 6) engage opinion leaders to promote use of the Guidelines. The processes and results associated with each stage were documented and formulated to inform a review and update of the Guidelines and the development of an implementation plan for the recommendations. Effective implementation of the Guidelines is important for improving the care provided during labor and childbirth in Brazil.
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Affiliation(s)
- Jorge Otávio Maia Barreto
- Fundação Oswaldo Cruz (Fiocruz)Brasília, DFBrazilFundação Oswaldo Cruz (Fiocruz), Brasília, DF, Brazil.
| | - Maritsa C. Bortoli
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrazilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brazil.
| | - Cézar D. Luquine
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrazilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brazil.
| | - Cintia F. Oliveira
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrazilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brazil.
| | - Tereza S. Toma
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrazilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brazil.
| | - Aline A. V. Ribeiro
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrazilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brazil.
| | - Taís R. Tesser
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrazilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brazil.
| | - Daphne Rattner
- Universidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde ColetivaBrasília (DF)BrazilUniversidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde Coletiva, Brasília (DF), Brazil.
| | - Avila Vidal
- Universidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde ColetivaBrasília (DF)BrazilUniversidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde Coletiva, Brasília (DF), Brazil.
| | - Yluska Mendes
- Universidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde ColetivaBrasília (DF)BrazilUniversidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde Coletiva, Brasília (DF), Brazil.
| | - Viviane Carvalho
- Universidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde ColetivaBrasília (DF)BrazilUniversidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde Coletiva, Brasília (DF), Brazil.
| | - Mônica Almeida Neri
- Universidade Federal da Bahia (UFBa), Instituto de Saúde ColetivaSalvador (BA)BrazilUniversidade Federal da Bahia (UFBa), Instituto de Saúde Coletiva, Salvador (BA), Brazil.
| | - Evelina Chapman
- Fundação Oswaldo Cruz (Fiocruz)Brasília, DFBrazilFundação Oswaldo Cruz (Fiocruz), Brasília, DF, Brazil.
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Diez-Canseco F, Rojas-Vargas J, Toyama M, Mendoza M, Cavero V, Maldonado H, Caballero J, Cutipé Y. Qualitative study of the implementation of the Continuity of Care and Rehabilitation Program for people with severe mental disorders in Peru. Rev Panam Salud Publica 2020; 44:e169. [PMID: 33417655 PMCID: PMC7778464 DOI: 10.26633/rpsp.2020.169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023] Open
Abstract
Objective. Describe the implementation of the Continuity of Care and Rehabilitation Program (PCC-R) in community mental health centers (CSMCs, Spanish acronym) in Peru. Methods. Qualitative study of the implementation of the PCC-R in four CSMCs in Lima and La Libertad, Peru. Forty-two individual semi-structured interviews were conducted, as well as a focus group with five participants, for a total of 47 informants, including users, family members, and professionals involved in the design, implementation, and monitoring of the program. Results. The PCC-R is a key program for community mental health services in Peru and it enjoys broad acceptability. Providers and users report satisfaction with its results; however, the program lacks a policy document specifying its objectives, organization, and activities. This would explain the variability in its implementation. The PCC-R has limitations in terms of management of financial and human resources, and it is necessary to improve training and supervision. There is consensus on the need, usefulness, and viability of developing a system to monitor the PCC-R. Good practices and suggestions are presented with a view to addressing these challenges. Conclusions. The PCC-R is a flagship program for the CSMCs and for mental health reform in Peru. It has achieved broad acceptability among providers and users. Its implementation combines successes and difficulties, with pending tasks that include developing a policy document, improving resource management, strengthening training and supervision, and implementing a monitoring system for continuous improvement of the program.
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Affiliation(s)
- Francisco Diez-Canseco
- CRONICAS Centro de Excelencia en Enfermedades Crónicas [Center of Excellence in Chronic Diseases], Universidad Peruana Cayetano Heredia Lima Peru CRONICAS Centro de Excelencia en Enfermedades Crónicas [Center of Excellence in Chronic Diseases], Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jefferson Rojas-Vargas
- CRONICAS Centro de Excelencia en Enfermedades Crónicas [Center of Excellence in Chronic Diseases], Universidad Peruana Cayetano Heredia Lima Peru CRONICAS Centro de Excelencia en Enfermedades Crónicas [Center of Excellence in Chronic Diseases], Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Mauricio Toyama
- CRONICAS Centro de Excelencia en Enfermedades Crónicas [Center of Excellence in Chronic Diseases], Universidad Peruana Cayetano Heredia Lima Peru CRONICAS Centro de Excelencia en Enfermedades Crónicas [Center of Excellence in Chronic Diseases], Universidad Peruana Cayetano Heredia, Lima, Peru
| | - María Mendoza
- Mental Health Department, Ministry of Health of Peru Mental Health Department, Ministry of Health of Peru
| | - Victoria Cavero
- CRONICAS Centro de Excelencia en Enfermedades Crónicas [Center of Excellence in Chronic Diseases], Universidad Peruana Cayetano Heredia Lima Peru CRONICAS Centro de Excelencia en Enfermedades Crónicas [Center of Excellence in Chronic Diseases], Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Humberto Maldonado
- Mental Health Department, Ministry of Health of Peru Mental Health Department, Ministry of Health of Peru
| | - July Caballero
- Mental Health Department, Ministry of Health of Peru Mental Health Department, Ministry of Health of Peru
| | - Yuri Cutipé
- Mental Health Department, Ministry of Health of Peru Mental Health Department, Ministry of Health of Peru
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De La Rosa A, Mordan J, Barinas I, Toribio M, Mancebo D, Rodríguez A, Pacheco-Herrero M. [Acceptability and adoption of clinical practice guidelines and treatment protocols on preeclampsia/eclampsia in the Dominican RepublicAceitabilidade e adoção de diretrizes de prática clínica e protocolos de atenção para pré-eclâmpsia e eclâmpsia na República Dominicana]. Rev Panam Salud Publica 2020; 44:e163. [PMID: 33337447 PMCID: PMC7737642 DOI: 10.26633/rpsp.2020.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/06/2020] [Indexed: 11/26/2022] Open
Abstract
Objetivo. Estimar la aceptabilidad y adopción de las guías de prática clínica (GPC) y protocolos de atención a la mujer con preeclampsia-eclampsia por parte del personal prestador de los servicios de salud, e identificar los factores facilitadores y las barreras para su implementación. Métodos. Se desarrolló un estudio cualitativo por medio de entrevistas semiestructuradas y grupos focales en cinco maternidades. Se recopilaron las entrevistas para su análisis y se caracterizaron las barreras y facilitadores. Resultados. Participaron 70 profesionales de la salud (52 de sexo femenino y 18 de sexo masculino) que se desempeñan en distintos niveles del sistema de salud, participaron. La mayoría de los prestadores y gerentes conocen la existencia de las GPC de eclampsia-preeclampsia y su contenido, sobre todo los participantes con más tiempo en el servicio. Para los facilitadores, se estableció una valoración positiva entre el personal médico y de enfermería ante el proceso de continuar con la elaboración e implementación de GPC de alta calidad. Hubo consenso en cuanto a la existencia de limitaciones, sobre todo, por la falta de medicamentos, insumos y equipos requeridos, para cumplir y aplicar las recomendaciones formuladas. Discusión. Los resultados del estudio exponen la necesidad de fortalecer estrategias que ayuden a cerrar la brecha entre la investigación y la política pública. Estudios fundamentan la investigación en priorizar la atención a los usuarios, y los encargados de formular políticas y los tomadores de decisiones en el sistema de salud. Los actores del sistema de salud dominicano reconocen la metodología GRADE como un instrumento apropiado para la formulación e implementación de GPC. Las barreras de implementación requieren de abordajes sistémicos e integrales.
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Affiliation(s)
- Andelys De La Rosa
- Ministerio de Salud Pública y Asistencia Social República Dominicana Ministerio de Salud Pública y Asistencia Social, República Dominicana
| | - José Mordan
- Consultores independientes Consultores independientes
| | - Indiana Barinas
- Ministerio de Salud Pública y Asistencia Social República Dominicana Ministerio de Salud Pública y Asistencia Social, República Dominicana
| | - Mayra Toribio
- Consultores independientes Consultores independientes
| | - Diana Mancebo
- Ministerio de Salud Pública y Asistencia Social República Dominicana Ministerio de Salud Pública y Asistencia Social, República Dominicana
| | - Alexandra Rodríguez
- Organización Panamericana de la Salud República Dominicana Organización Panamericana de la Salud, República Dominicana
| | - Mar Pacheco-Herrero
- Pontificia Universidad Católica Madre y Maestra Santiago de los Caballeros República Dominicana Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana
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Diez-Canseco F, Rojas-Vargas J, Toyama M, Mendoza M, Cavero V, Maldonado H, Caballero J, Cutipé Y. [Qualitative study of the implementation of the Continuity of Care and Rehabilitation Program for people with severe mental disorders in PeruEstudo qualitativo sobre a implementação do Programa de Continuidade de Cuidados e Rehabilitação para pessoas com transtornos mentais graves no Peru]. Rev Panam Salud Publica 2020; 44:e134. [PMID: 33337443 PMCID: PMC7737645 DOI: 10.26633/rpsp.2020.134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/14/2020] [Indexed: 11/24/2022] Open
Abstract
Objetivo. Describir la implementación del Programa de continuidad de cuidados y rehabilitación (PCC-R) en centros de salud mental comunitaria (CSMC) del Perú. Métodos. Estudio cualitativo sobre la implementación del PCC-R en cuatro CSMC de Lima y La Libertad, Perú. Se realizaron 42 entrevistas semiestructuradas individuales y un grupo focal con cinco participantes, para un total de 47 informantes entre usuarios, familiares y profesionales vinculados al diseño, la implementación y el monitoreo del PCC-R. Resultados. El PCC-R es un programa central de los servicios de salud mental comunitaria en Perú, goza de amplia aceptación y los prestadores y usuarios refieren estar satisfechos con sus resultados. Sin embargo, el programa carece de un documento normativo que detalle sus objetivos, organización y actividades, lo que explicaría la variabilidad en su aplicación. Existen limitaciones en la gestión de recursos financieros y humanos del PCC-R y necesidades de capacitación y supervisión, que deben ser mejoradas. Existe consenso sobre la necesidad, la utilidad y la viabilidad de desarrollar un sistema de monitoreo del PCC-R. Se recogen buenas prácticas y sugerencias para enfrentar estos retos. Conclusiones. El PCC-R es un programa insignia de los CSMC y de la reforma de la salud mental en Perú, y ha logrado amplia aceptación entre los prestadores y usuarios. Su implementación combina aciertos y dificultades, y revela tareas pendientes como desarrollar un documento normativo, mejorar la gestión de recursos, fortalecer la capacitación y acompañamiento, y aplicar un sistema de monitoreo para favorecer la mejora continua del programa.
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Affiliation(s)
- Francisco Diez-Canseco
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia Lima Perú CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Jefferson Rojas-Vargas
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia Lima Perú CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Mauricio Toyama
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia Lima Perú CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - María Mendoza
- Dirección de Salud Mental Ministerio de Salud del Perú Dirección de Salud Mental, Ministerio de Salud del Perú
| | - Victoria Cavero
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia Lima Perú CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Humberto Maldonado
- Dirección de Salud Mental Ministerio de Salud del Perú Dirección de Salud Mental, Ministerio de Salud del Perú
| | - July Caballero
- Dirección de Salud Mental Ministerio de Salud del Perú Dirección de Salud Mental, Ministerio de Salud del Perú
| | - Yuri Cutipé
- Dirección de Salud Mental Ministerio de Salud del Perú Dirección de Salud Mental, Ministerio de Salud del Perú
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Sacoto F, Torres I, López-Cevallos DF. Sostenibilidad en la prevención de enfermedades crónicas: lecciones del programa Salud al Paso en Ecuador. Rev Panam Salud Publica 2020; 44:e113. [PMID: 33337449 PMCID: PMC7737644 DOI: 10.26633/rpsp.2020.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/10/2020] [Indexed: 11/24/2022] Open
Abstract
El presente estudio analiza las condiciones y posibilidades de permanencia del programa “Salud al Paso” de la Secretaría Metropolitana de Salud del Municipio de Quito, Ecuador, como ejemplo para iniciativas similares, en el contexto de los cambios efectuados por la nueva administración en mayo del 2019. El análisis de esta implementación enfocada en la prevención de enfermedades no transmisibles se centró en la base de datos de usuarios del programa, la información recabada desde las perspectivas del personal operativo, el conocimiento del programa y el posicionamiento de líderes locales y de opinión del Distrito Metropolitano de Quito, así como información oficial. Con base en estos datos, el estudio identificó factores que podrían haber facilitado u obstaculizado su permanencia y documentó la fundamentación de las nuevas autoridades para suspender las actividades de libre demanda propias del programa y limitar la atención a las poblaciones bajo responsabilidad municipal (guarderías, escuelas y colegios, mercados, programas de atención a la tercera edad y empleados) y de pacientes con riesgo cardiometabólico identificado. La institucionalización insuficiente del programa, concebido más como proyecto y con una también insuficiente visión de permanencia en el tiempo, fue mencionada como un posible obstáculo por líderes y personal operativo. La prevalencia creciente de enfermedades no transmisibles demanda iniciativas para su prevención, que deben institucionalizarse para asegurar su continuidad y superar eventuales cambios de gobierno. Además, intervenciones futuras semejantes a Salud al Paso deberán establecer una mejor articulación sectorial, en especial con el Ministerio de Salud Pública y otras redes de servicios.
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Affiliation(s)
| | - Irene Torres
- Fundación Octaedro, Quito, Ecuador
- irene.torres@octaedro
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30
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Barreto JOM, Bortoli MC, Luquine Jr CD, Oliveira CF, Toma TS, Ribeiro AAV, Tesser TR, Rattner D, Vidal A, Mendes Y, Carvalho V, Neri MA, Chapman E. [Implementation of the National Childbirth Guidelines in Brazil: barriers and trategiesObstáculos y estrategias para la aplicación de las Directrices Nacionales para el Parto Normal en el Brasil]. Rev Panam Salud Publica 2020; 44:e120. [PMID: 33346245 PMCID: PMC7745726 DOI: 10.26633/rpsp.2020.120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/03/2020] [Indexed: 01/05/2023] Open
Abstract
The present report describes the process and results obtained with a knowledge translation project developed in three stages to identify barriers to the National Childbirth Guidelines in Brazil as well strategies for effective implementation. The Improving Programme Implementation through Embedded Research (iPIER) model and the Supporting Policy Relevant Reviews and Trials (SUPPORT) tools provided the methodological framework for the project. In the first stage, the quality of the Guidelines was evaluated and the barriers preventing implementation of the recommendations were identified through review of the global evidence and analysis of contributions obtained in a public consultation process. In the second stage, an evidence synthesis was used as basis for a deliberative dialogue aimed at prioritizing the barriers identified. Finally, a second evidence synthesis was presented in a new deliberative dialogue to discuss six options to address the prioritized barriers: 1) promote the use of multifaceted interventions; 2) promote educational interventions for the adoption of guidelines; 3) perform audits and provide feedback to adjust professional practice; 4) use reminders to mediate the interaction between workers and service users; 5) enable patient-mediated interventions; and 6) engage opinion leaders to promote the use of guidelines. The processes and results associated with each stage were documented and formulated to inform a review and update of the Guidelines and the development of an implementation plan for the recommendations. An effective implementation of the Guidelines is relevant to improve the care provided during labor and childbirth in Brazil.
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Affiliation(s)
- Jorge Otávio Maia Barreto
- Fundação Oswaldo Cruz (Fiocruz), BrasíliaDFBrasilFundação Oswaldo Cruz (Fiocruz), Brasília, DF, Brasil.
| | - Maritsa C. Bortoli
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrasilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brasil.
| | - Cézar D. Luquine Jr
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrasilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brasil.
| | - Cintia F. Oliveira
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrasilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brasil.
| | - Tereza S. Toma
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrasilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brasil.
| | - Aline A. V. Ribeiro
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrasilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brasil.
| | - Taís R. Tesser
- Secretaria de Estado da Saúde de São Paulo, Instituto de SaúdeSão Paulo (SP)BrasilSecretaria de Estado da Saúde de São Paulo, Instituto de Saúde, São Paulo (SP), Brasil.
| | - Daphne Rattner
- Universidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde ColetivaBrasília (DF)BrasilUniversidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde Coletiva, Brasília (DF), Brasil.
| | - Avila Vidal
- Universidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde ColetivaBrasília (DF)BrasilUniversidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde Coletiva, Brasília (DF), Brasil.
| | - Yluska Mendes
- Universidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde ColetivaBrasília (DF)BrasilUniversidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde Coletiva, Brasília (DF), Brasil.
| | - Viviane Carvalho
- Universidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde ColetivaBrasília (DF)BrasilUniversidade de Brasília (UnB), Faculdade de Saúde, Departamento de Saúde Coletiva, Brasília (DF), Brasil.
| | - Mônica Almeida Neri
- Universidade Federal da Bahia (UFBa), Instituto de Saúde ColetivaSalvador (BA)BrasilUniversidade Federal da Bahia (UFBa), Instituto de Saúde Coletiva, Salvador (BA), Brasil.
| | - Evelina Chapman
- Fundação Oswaldo Cruz (Fiocruz), BrasíliaDFBrasilFundação Oswaldo Cruz (Fiocruz), Brasília, DF, Brasil.
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Ghaffar A, Swaminathan S, Sheikh K, Al-Mandhari A, Jhalani M, Sambo B, Jakab Z. Implementation research is crucial to countries' efforts to strengthen learning health systems. Health Policy Plan 2020; 35:ii4-ii6. [PMID: 33156930 PMCID: PMC7646721 DOI: 10.1093/heapol/czaa119] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organization, 20 Avenue Appia, 1217 Geneva, Switzerland
| | | | - Kabir Sheikh
- Alliance for Health Policy and Systems Research, World Health Organization, 20 Avenue Appia, 1217 Geneva, Switzerland
| | - Ahmed Al-Mandhari
- Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
| | - Manoj Jhalani
- Regional Office for South East Asia, World Health Organization, New Delhi, India
| | - Boureima Sambo
- Country Office for Ethiopia, World Health Organization, Addis Ababa, Ethiopia
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Varallyay NI, Langlois EV, Tran N, Elias V, Reveiz L. Health system decision-makers at the helm of implementation research: development of a framework to evaluate the processes and effectiveness of embedded approaches. Health Res Policy Syst 2020; 18:64. [PMID: 32522238 PMCID: PMC7288439 DOI: 10.1186/s12961-020-00579-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 05/21/2020] [Indexed: 02/07/2023] Open
Abstract
Background Embedded approaches to implementation research (IR), whereby health system decision-makers participate actively in the research process, are gaining traction as effective approaches to optimise the delivery of health programmes and policies. However, the evidence base on the processes and effectiveness of such collaborative research remains inchoate. Standardised approaches to evaluate these initiatives are needed to identify core elements of ‘embeddedness’, unveil the underlying pathways of change, and assess contribution to evidence uptake in decision-making and overall outcomes of effect. The framework presented in this paper responds to this need, designed to guide the systematic evaluation of embedded IR. Methods This evaluation framework for embedded IR approaches is based on the experience of a joint initiative by the Pan American Health Organization/Alliance for Health Policy and Systems Research, which has supported 19 IR grants in 10 Latin American and Caribbean countries from 2014 to 2017. The conceptualisation of this framework drew on various sources of information, including empirical evidence and conceptual insights from the literature, interviews with content experts, and a prospective evaluation of the 2016 cohort that included semi-structured key informant interviews, document analysis, and a research team survey to examine key aspects of embedded research. Results We developed a widely applicable conceptual framework to guide the evaluation of embedded IR in various contexts. Focused on uncovering how this collaborative research approach influences programme improvement, it outlines expected processes and intermediate outcomes. It also highlights constructs with which to assess ‘embeddedness’ as well as critical contextual factors. The framework is intended to provide a structure by which to systematically examine such embedded research initiatives, proposing three key stages of evidence-informed decision-making – co-production of evidence, engagement with research, and enactment of programme changes. Conclusion Rigorous evaluation of embedded IR is needed to build the evidence on its processes and effectiveness in influencing decision-making. The evaluation framework presented here addresses this gap with consideration of the complexity of such efforts. Its applicability to similar initiatives is bolstered by virtue of being founded on real-world experience; its potential to contribute to a nuanced understanding of embedded IR is significant.
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Affiliation(s)
- N Ilona Varallyay
- Department of International Health of the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - Etienne V Langlois
- Alliance for Health Policy and Systems Research, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Nhan Tran
- Unintentional Injury Prevention Department for the Management of Non-communicable Diseases, Disability, Violence, and Injury Prevention (NVI), World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Vanesa Elias
- Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, 525 Twenty-third Street, N.W, Washington, D.C, USA
| | - Ludovic Reveiz
- Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, 525 Twenty-third Street, N.W, Washington, D.C, USA
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Accoe K, Marchal B, Gnokane Y, Abdellahi D, Bossyns P, Criel B. Action research and health system strengthening: the case of the health sector support programme in Mauritania, West Africa. Health Res Policy Syst 2020; 18:25. [PMID: 32075648 PMCID: PMC7031916 DOI: 10.1186/s12961-020-0531-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 02/04/2020] [Indexed: 05/05/2023] Open
Abstract
Background Access to qualitative and equitable healthcare is a major challenge in Mauritania. In order to support the country’s efforts, a health sector strengthening programme was set up with participatory action research at its core. Reinforcing a health system requires a customised and comprehensive approach to face the complexity inherent to health systems. Yet, limited knowledge is available on how policies could enhance the performance of the system and how multi-stakeholder efforts could give rise to changes in health policy. We aimed to analyse the ongoing participatory action research and, more specifically, see in how far action research as an embedded research approach could contribute to strengthening health systems. Methods We adopted a single-case study design, based on two subunits of analysis, i.e., two selected districts. Qualitative data were collected by analysing country and programme documents, conducting 12 semi-structured interviews and performing participatory observations. Interviewees were selected based on their current position and participation in the programme. The data analysis was designed to address the objectives of the study, but evolved according to emerging insights and through triangulation and identification of emergent and/or recurrent themes along the process. Results An evaluation of the progress made in the two districts indicates that continuous capacity-building and empowerment efforts through a participative approach have been key elements to enhance dialogue between, and ownership of, the actors at the local health system level. However, the strong hierarchical structure of the Mauritanian health system and its low level of decentralisation constituted substantial barriers to innovation. Other constraints were sociocultural and organisational in nature. Poor work ethics due to a weak environmental support system played an important role. While aiming for an alignment between the flexible iterative approach of action research and the prevailing national linear planning process is quite challenging, effects on policy formulation and implementation were not observed. An adequate time frame, the engagement of proactive leaders, maintenance of a sustained dialogue and a pragmatic, flexible approach could further facilitate the process of change. Conclusion Our study showcases that the action research approach used in Mauritania can usher local and national actors towards change within the health system strengthening programme when certain conditions are met. An inclusive, participatory approach generates dynamics of engagement that can facilitate ownership and strengthen capacity. Continuous evaluation is needed to measure how these processes can further develop and presume a possible effect at policy level.
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Affiliation(s)
- Kirsten Accoe
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.
| | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Yahya Gnokane
- AI-PASS Programme (Institutional Support for Health Sector Strengthening), Enabel - Belgian Development Agency, Nouakchott, Mauritania
| | - Dieng Abdellahi
- AI-PASS Programme (Institutional Support for Health Sector Strengthening), Enabel - Belgian Development Agency, Nouakchott, Mauritania
| | - Paul Bossyns
- Department of Health, Enabel - Belgian Development Agency, Rue Haute 147, 1000, Brussels, Belgium
| | - Bart Criel
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
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