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Medina-Jaudes N, Carmone AE, Prust ML, Ngosa L, Aladesanmi O, Zulu M, Storey A, Muntanga B, Chizuni C, Mwiche A, Shakwelele H, Kamanga A. Operational demonstration and process evaluation of non-pneumatic anti-shock garment (NASG) introduction to the public health system of Northern Province, Zambia. BMC Health Serv Res 2023; 23:1321. [PMID: 38031166 PMCID: PMC10687818 DOI: 10.1186/s12913-023-10294-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND A disproportionate burden of maternal deaths occurs in low- and middle-income countries (LMICs), and obstetric hemorrhage (OH) is a leading cause of excess mortality. In Zambia, most of maternal deaths are directly caused by OH. The Non-Pneumatic Anti-Shock Garment (NASG) is a first aid tool that uses compression to the abdomen and lower body to stop and reverse hypovolemic shock secondary to OH. We describe the process and experiences introducing the NASG into the Zambia public health system to encourage the development of national policies, clinical guidelines, and implementation plans that feature the NASG. METHODS We conducted an observational study of NASG introduction to 143 public health facilities in Northern Province, Zambia, organizing observations into the five dimensions of the RE-AIM evaluation framework: reach, effectiveness, adoption, implementation, and maintenance. The NASG was introduced in August 2019, and the introduction was evaluated for 18 months. Data on healthcare worker training and mentorship, cases where NASG was used, and NASG availability and use during the study period were collected and analyzed. RESULTS The NASG was successfully introduced and integrated into the Zambia public health system, and appropriately used by healthcare workers when responding to cases of OH. Sixteen months after NASG introduction, NASGs were available and functional at 99% of study sites and 88% reported ever using a NASG. Of the 68 cases of recorded OH where a NASG was applied, 66 were confirmed as clinically appropriate, and among cases where shock index (SI) could be calculated, 59% had SI ≥ 0.9. Feedback from healthcare providers revealed that 97% thought introducing the NASG was a good decision, and 92% felt confident in their ability to apply the NASG after initial training. The RE-AIM average for this study was 0.65, suggesting a public health impact that is not equivocal, and that NASG introduction had a positive population-based effect. CONCLUSIONS A successful NASG demonstration took place over the course of 18 months in the existing health system of Northern Province, Zambia, suggesting that incorporation of NASG into the standard of care for obstetric emergency in the Zambia public sector is feasible and can be maintained without external support.
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Affiliation(s)
| | | | | | | | | | - Morrison Zulu
- Clinton Health Access Initiative, Inc, Lusaka, Zambia
| | - Andrew Storey
- Clinton Health Access Initiative, Inc, Boston, MA, USA
| | - Beauty Muntanga
- Zambia Ministry of Health, Kasama, Northern Province, Zambia
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Joseph JT, Mpasela F, Dowling S, Banda I, Bobo PM, Carmone AE, Haimbe P, Hasweeka P, Kampekete GS, Mumba F, Mwanza F, Sakulanda C, Simasiku M, Suggu K, Shakwelele H, Munthali G. Optimizing and validating a pediatric screening tool to more efficiently test and identify children living with HIV. AIDS 2023; 37:1451-1458. [PMID: 37115846 DOI: 10.1097/qad.0000000000003583] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To develop and validate a screening tool to improve testing efficiency and increase case finding of children living with HIV. DESIGN Cross-sectional study. METHODS Between November 2020 and September 2021, children 18 months to 14 years presenting at outpatient departments in 30 health facilities in Zambia were administered a 14-question pediatric HIV screening tool and then tested for HIV. Data were analyzed using a randomly extracted 'validation' dataset and multivariable logistic regression to determine the highest performing and optimal number of screening questions. The final tool was then evaluated in the 'test' dataset. Sensitivity and specificity were calculated for both datasets. The final tool was then also implemented in 12 additional facilities to determine operational feasibility and uptake. RESULTS A total of 9902 children were included in the final analysis. HIV prevalence was 1.3%. Six questions were significantly associated with HIV-positivity. The optimal screening cutoff score was to answer 'yes' to one or more of the six questions; using this cutoff sensitivity was 92.5% [95% confidence interval (CI) 85.7-96.7%] and specificity was 62.9% (95% CI 61.9-64%). In the test dataset, the same tool had a sensitivity of 84.6% (95% CI 65.1-95.6%) and specificity of 64.6% (95% CI 62.4-66.7%). Uptake was 89%. CONCLUSION The results of this study show sensitivity and acceptable specificity in a six-question validated HIV screening tool. Implementing this screening tool in settings where universal testing is not feasible should more efficiently accelerate identification of children living with HIV (CLHIV) and their timely initiation onto life-saving drugs.
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Affiliation(s)
| | | | | | | | | | - Andy E Carmone
- Clinton Health Access Initiative, Boston, Massachusetts, USA
| | | | | | | | | | | | | | | | - Kanchana Suggu
- Clinton Health Access Initiative, Boston, Massachusetts, USA
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Kalaris K, Radovich E, Carmone AE, Smith JM, Hyre A, Baye ML, Vougmo C, Banerjee A, Liljestrand J, Moran AC. Networks of Care: An Approach to Improving Maternal and Newborn Health. Glob Health Sci Pract 2022; 10:GHSP-D-22-00162. [PMID: 36562444 PMCID: PMC9771468 DOI: 10.9745/ghsp-d-22-00162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/16/2022] [Indexed: 12/24/2022]
Abstract
The Networks of Care approach has the potential to harmonize existing strategies and optimize health systems functions for maternal and newborn health, thereby strengthening the quality of care and ultimately improving outcomes.
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Affiliation(s)
| | - Emma Radovich
- London School of Hygiene and Tropical Medicine,London, United Kingdom
| | | | | | | | | | - Clemence Vougmo
- Perinatal Network of Yaoundé, Viallaite Cameroun Association, Yaoundé, Cameroon
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Brady E, Carmone AE, Das S, Hurley R, Martinez Vergara MT, Malata A. Harnessing the Power of Networks of Care for Universal Health Coverage. Health Syst Reform 2020; 6:e1840825. [PMID: 33252995 DOI: 10.1080/23288604.2020.1840825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
On the global health agenda, Universal Health Coverage has been displaced by the COVID-19 pandemic while disparities in COVID-19 outcomes have exposed stark gaps in quality, access, equity, and financial risk protection. These disparities highlight the importance of the core goals of Universal Health Coverage and the need for innovative approaches to working toward them. The newly codified concept of "Networks of Care" offers a promising option for implementation. The articles in this special issue present the Networks of Care lexicon and framework and demonstrate the development of leadership, responsibility, intra- and inter-facility cooperation, and dynamic cycles of quality improvement. These elements are associated with better access to services and better health outcomes, the ultimate goals of Universal Health Coverage. Increases in poverty, food insecurity, and deleterious impact on the status of women secondary to the COVID-19 pandemic add urgency to Universal Health Coverage, while the economic impact of pandemic mitigation may reduce availability of resources for years to come. The need for Universal Health Coverage and efficiency and flexibility in health spending, including the ability to contract directly, has become even more important. Countries where Universal Health Coverage efforts have yet to carry through to provision of good quality, accessible and equitable service delivery could potentially benefit from concurrent Networks of Care implementation. Documentation of Networks of Care in the context of Universal Health Coverage should be prioritized to understand how Networks of Care can be used to help realize the goals of Universal Health Coverage around the world.
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Affiliation(s)
- Eoghan Brady
- Health Financing Department, Clinton Health Access Initiative , Pretoria, South Africa
| | - Andy E Carmone
- Health Financing Department, Clinton Health Access Initiative , Pretoria, South Africa
| | - Sarthak Das
- Harvard TH Chan School of Public Health , Cambridge, Massachusetts, USA
| | - Raphael Hurley
- Health Financing Department, Clinton Health Access Initiative , Pretoria, South Africa
| | | | - Address Malata
- Malawi University of Science and Technology , Limbe, Malawi
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Bhatta S, Rajbhandari S, Kalaris K, Carmone AE. The Logarithmic Spiral of Networks of Care for Expectant Families in Rural Nepal: A Descriptive Case Study. Health Syst Reform 2020; 6:e1824520. [DOI: 10.1080/23288604.2020.1824520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Surya Bhatta
- Executive Leadership, One Heart Worldwide, Kathmandu, Nepal
| | | | - Katherine Kalaris
- Maternal and Neonatal Health, Clinton Health Access Initiative, Boston, Massachusetts, USA
| | - Andy E. Carmone
- Clinical Sciences, Clinton Health Access Initiative, Boston, Massachusetts, USA
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Malata A, Carmone AE. Seeing the Forest for the Trees: A Set of Descriptive Case Studies Presented with the Networks of Care Framework. Health Syst Reform 2020; 6:e1840824. [PMID: 33253010 DOI: 10.1080/23288604.2020.1840824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Durable solutions for daunting problems in global health can be elusive. The global health literature tends to present aggregated data and highlight clinical outcomes but fails to describe the systems that buttress the interventions. The common idiom about "missing the forest for the trees" is apropos: by focusing on individual examples, we may miss the bigger picture. How implementation of policies and innovations plays out on the front lines of service delivery often goes uncommunicated. The Networks of Care scoping study takes a different approach, looking at diverse programs to seek out common patterns. Using the four domains of the Networks of Care framework to structure descriptions of six operational programs reveals commonalities in their designs and shows the utility of the framework's components. The commonalities increase our conviction that the framework can be used as a practical approach to strengthen service-level health systems. The case studies are followed by a commentary about the potential synergy of Networks of Care with Universal Health Coverage efforts, to deliver on the core promises to increase access and quality of care for all, especially the persistently underserved. These case studies help define a practical toolkit to promote enduring positive changes, forging a path for the Networks of Care framework to move anecdotes of individual successes to health policy and broader implementation, enabling global health practitioners at all levels to keep the big picture in focus while working toward ensuring healthy lives and well-being for all.
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Affiliation(s)
- Address Malata
- Office of the Chancellor, Vice-Chancellor, Malawi University of Science and Technology , Limbe, Malawi
| | - Andy E Carmone
- Global Health Sciences, Clinical Sciences, Clinton Health Access Initiative , Boston, Massachusetts, USA
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Carmone AE, Kalaris K, Leydon N, Sirivansanti N, Smith JM, Storey A, Malata A. Developing a Common Understanding of Networks of Care through a Scoping Study. Health Syst Reform 2020; 6:e1810921. [PMID: 33021881 DOI: 10.1080/23288604.2020.1810921] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The phrase "Networks of Care" seems familiar but remains poorly defined. A health system that exemplifies effective Networks of Care (NOC) purposefully and effectively interconnects service delivery touch points within a catchment area to fill critical service gaps and create continuity in patient care. To more fully elaborate the concept of Networks of Care, we conducted a multi-method scoping study that included a literature review, stakeholder interviews, and descriptive case studies from five low- and middle-income countries. Our extended definition of a Network of Care features four overlapping and interdependent domains of activity at multiple levels of health systems, characterized by: 1) Agreement and Enabling Environment, 2) Operational Standards, 3) Quality, Efficiency and Responsibility, and 4) Learning and Adaptation. There are a series of key interrelated themes within each domain. Creating a common understanding of what characterizes and fosters an effective Network of Care can drive the evolution and strengthening of national health programs, especially those incorporating universal health coverage and promoting comprehensive care and integrated services. An understanding of the Networks of Care model can help guide efforts to move health service delivery toward goals that can benefit a diversity of stakeholders, including a variety of health system actors, such as health care workers, users of health systems, and the wider community at large. It can also contribute to improving poor health outcomes and reducing waste originating from fragmented services and lack of access.
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Affiliation(s)
- Andy E Carmone
- Clinical Sciences, Clinton Health Access Initiative , Boston, Massachusetts, USA
| | - Katherine Kalaris
- Maternal and Neonatal Health, Clinton Health Access Initiative , Boston, Massachusetts, USA
| | - Nicholas Leydon
- Global Delivery Programs, Bill & Melinda Gates Foundation , Seattle, Washington, USA
| | - Nicole Sirivansanti
- Maternal, Newborn & Child Health, Bill & Melinda Gates Foundation , Seattle, Washington, USA
| | - Jeffrey M Smith
- Maternal, Newborn & Child Health, Bill & Melinda Gates Foundation , Seattle, Washington, USA
| | - Andrew Storey
- Maternal and Neonatal Health, Clinton Health Access Initiative , Boston, Massachusetts, USA
| | - Address Malata
- Office of the Chancellor, Vice Chancellor, Malawi University of Science and Technology , Limbe, Malawi
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Martinez Vergara MT, Angulo de Vera E, Carmone AE. Building Trust to Save Lives in a Metro Manila Public-Private Network of Care: A Descriptive Case Study of Quirino Recognized Partners in Quezon City, Philippines. Health Syst Reform 2020; 6:e1815473. [DOI: 10.1080/23288604.2020.1815473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
| | - Eleanor Angulo de Vera
- Department of Obstetrics and Gynecology, Quirino Memorial Medical Center, Quezon City, Philippines
| | - Andy E. Carmone
- Clinical Sciences, Clinton Health Access Initiative, Boston, Massachusetts, USA
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Fasawe O, Adekeye O, Carmone AE, Dahunsi O, Kalaris K, Storey A, Ubani O, Wiwa O. Applying a Client-centered Approach to Maternal and Neonatal Networks of Care: Case Studies from Urban and Rural Nigeria. Health Syst Reform 2020; 6:e1841450. [PMID: 33270477 DOI: 10.1080/23288604.2020.1841450] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
In Nigeria, two maternal and neonatal health Networks of Care (NOC) focus on extending the reach and quality of routine and emergency maternal and neonatal health services tailored to the different contexts. This paper uses the four domains of the NOC framework-Agreements and Enabling Environment, Operational Standards, Quality, Efficiency and Responsibility, and Learning and Adaptation-to describe the NOC, highlighting how each developed to address specific local needs. In Northern Nigeria, the NOC were established in collaboration among Clinton Health Access Initiative and the government to reduce maternal and neonatal morbidity and mortality. Health centers and communities in the network were supported to be better prepared to provide maternal and neonatal care, while birth attendants at all levels were empowered and equipped to stabilize and treat complications. The approach brought services closer to the community and facilitated rapid referrals. The NOC in Lagos State extended the reach of routine and emergency maternal and neonatal health services through organically developed linkages among registered traditional birth attendant clinics, private and public sector facilities, the Primary Healthcare Board, and the Traditional Medicine Board. Traditional birth attendants are registered, trained, and monitored by Apex Community Health Officers, whose responsibilities include collection and review of data and ensuring linkages to postpartum services, such as family planning and immunizations. While differing in their approaches, both NOC provide locally appropriate, pragmatic approaches to supporting women birthing in the community and encouraging institutional delivery to ensure that women and their babies have access to timely, appropriate, and safe services.
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Affiliation(s)
| | | | - Andy E Carmone
- Clinton Health Access Initiative , Boston, Massachusetts, USA
| | | | | | - Andrew Storey
- Clinton Health Access Initiative , Boston, Massachusetts, USA
| | - Osy Ubani
- Lagos Mainland Local Government Area (LGA), Lagos State Ministry of Health , Lagos, Nigeria
| | - Owens Wiwa
- Clinton Health Access Initiative , Abuja, Nigeria
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Sequeira D'Mello B, Bwile P, Carmone AE, Kalaris K, Magembe G, Masweko M, Mtumbuka E, Mushi T, Sellah Z, Gichanga B. Averting Maternal Death and Disability in an Urban Network of Care in Dar es Salaam, Tanzania: A Descriptive Case Study. Health Syst Reform 2020; 6:e1834303. [PMID: 33252994 DOI: 10.1080/23288604.2020.1834303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/02/2020] [Accepted: 10/06/2020] [Indexed: 10/22/2022] Open
Abstract
The non-governmental organization Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) developed a multi-facility maternal and neonatal Network of Care (NOC) among 22 government hospitals and catchment facilities operating across Dar es Salaam. While facility delivery rates were above 90% in the Dar es Salaam region, the quality of services was substandard, leading to an excess of preventable maternal and neonatal morbidity and mortality. In partnership with the Dar es Salaam regional health authorities CCBRT developed a plan to improve the quality of service delivery at childbirth by through a system strengthening approach, capacitating lower-level facilities to provide routine care during pregnancy and uncomplicated deliveries, as well as improving care at secondary level referral hospitals and developing an inter-connected strengthened referral system. The Regional-CCBRT partnership implemented interventions across the continuum of care that included clinical training in basic and comprehensive emergency obstetric care, investments in infrastructure, and a rigorous maternal and perinatal death audit and follow-up program. Routine data generated were reflected upon at quarterly quality improvement meetings to follow up on problems identified. The government has initiated the replication of the model. This descriptive case study uses the four domains of the Networks of Care framework to document the wide-ranging efforts made to build and maintain the CCBRT Network of Care in order to solve for specific challenges in maternal and neonatal health service delivery in the urban context of the Dar es Salaam region.
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Affiliation(s)
- Brenda Sequeira D'Mello
- Maternal and Newborn Healthcare, Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) , Dar Es Salaam, Tanzania
| | - Paschal Bwile
- Vaccines, Clinton Health Access Initiative , Boston, Massachusetts, USA
| | - Andy E Carmone
- Clinical Sciences, Clinton Health Access Initiative , Boston, Massachusetts, USA
| | - Katherine Kalaris
- Maternal and Neonatal Health, Clinton Health Access Initiative , Boston, Massachusetts, USA
| | - Grace Magembe
- Curative Services, Tanzania - Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) , Dar Es Salaam, Tanzania
| | - Mangalu Masweko
- Information and Business Analysis, Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) , Dar Es Salaam, Tanzania
| | - Esther Mtumbuka
- Executive Leadership, Clinton Health Access Initiative , Boston, Massachusetts, USA
| | - Timothy Mushi
- Maternal and Newborn, Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) , Dar Es Salaam, Tanzania
| | - Zaida Sellah
- Nursing and Midwifery Services, Tanzania - Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) , Dar Es Salaam, Tanzania
| | - Bedan Gichanga
- Hospital Executive Leadership, Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) , Dar Es Salaam, Tanzania
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