Factors that influence the scale up of new interventions in low-income settings
A qualitative case study of the introduction of chlorhexidine cleansing of the umbilical cord in Bangladesh
Datos Bibliográficos
There is a well-recognized need for empirical study of processes and factors that influence scale up of evidence-based interventions in low-income countries to address the ‘know-do’ gap. We undertook a qualitative case study of the scale up of chlorhexidine cleansing of the umbilical cord (CHX) in Bangladesh to identify and compare facilitators and barriers for the institutionalization and expansion stages of scale up. Data collection and analysis for this case study were informed by the Consolidated Framework for Implementation Research (CFIR) and the WHO/ExpandNet model of scale up. At the national level, we interviewed 20 stakeholders involved in CHX policy or implementation. At the district level, we conducted interviews with 31 facility-based healthcare providers in five districts and focus group discussions (FGDs) with eight community-based providers and eight programme managers. At the community level, we conducted 7 FGDs with 53 mothers who had a baby within the past year. Expanded interview notes were thematically coded and analysed following an adapted Framework approach. National stakeholders identified external policy and incentives, and the engagement of stakeholders in policy development through the National Technical Working Committee for Newborn Health, as key facilitators for policy and health systems changes. Stakeholders, providers and families perceived the intervention to be simple, safe and effective, and more consistent with family preferences than the prior policy of dry cord care. The major barriers that delayed or decreased the public health impact of the scale up of CHX in Bangladesh’s public health system related to commodity production, procurement and distribution. Bangladesh’s experience scaling up CHX suggests that scale up should involve early needs assessments and planning for institutionalizing new drugs and commodities into the supply chain. While the five CFIR domains were useful for categorizing barriers and facilitators, additional constructs are needed for common health systems barriers in low-income settings
Business · Economic growth · Economics · Environmental health · Focus group · Health care · Implementation research · Incentive · Institutionalisation · Psychological intervention · Public health · Qualitative research · Scale (ratio) · Sociology · Child Nutrition and Water Access · Global Maternal and Child Health · Health Policy Implementation Science · Marketing · Medicine · Nursing
Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities
A systematic review of the use of the Consolidated Framework for Implementation Research
Making sense of implementation theories, models and frameworks
Medicine prices, availability, and affordability in 36 developing and middle-income countries
Is verbatim transcription of interview data always necessary?
Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?
Countdown to 2030
Global health 2035
Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015
“Scaling-out” evidence-based interventions to new populations or new health care delivery systems
Systematic debriefing after qualitative encounters
Narrative review of models and success factors for scaling up public health interventions
Dynamic adaptation process to implement an evidence-based child maltreatment intervention
Fostering implementation of health services research findings into practice
Scaling up antiretroviral therapy in Uganda
Institutionalizing community-focused maternal, newborn, and child health strategies to strengthen health systems
The Adaptome
Scaling up in international health
Critical interactions between Global Fund-supported programmes and health systems
Understanding pathways for scaling up health services through the lens of complex adaptive systems
Benchmarks to measure readiness to integrate and scale up newborn survival interventions
How complexity science can inform scale-up and spread in health care
Applying ExpandNet's Systematic Approach to Scaling Up in an Integrated Population, Health and Environment Project in East Africa
Utilization of HIV-related services from the private health sector
Rapid ethnographic assessment
Scaling-up a public health innovation
| Obras citantes distintas | 1 |
|---|---|
| Citas por año | 0,25 |
| Intervalo de citas | 2022 - 2022 (1) |
| Velocidad de citación | historical |
| Altamente citado | No |
| Tipos de cita | Neutras: 1 |