Implementation of the ‘Optimising the Health Extension Program’ Intervention in Ethiopia
A Process Evaluation Using Mixed Methods
Bibliographic Data
| ID | 15464168 |
|---|---|
| Authors | Yemisrach B Okwaraji (0000-0002-4541-2856, Ethiopian Public Health Institute, corresponding author), Zelee Hill (0000-0002-5949-6448, University College London), Atkure Defar (0000-0001-9435-2135, Ethiopian Public Health Institute), Della Berhanu (0000-0002-4984-893X, Ethiopian Public Health Institute), Desta Wolassa (Ethiopian Public Health Institute), Lars Ake Persson (0000-0003-0710-7954, Ethiopian Public Health Institute), Geremew Gonfa (0000-0001-5937-120X, Ethiopian Public Health Institute), J Schellenberg (0000-0002-0708-3676), Joanna A Schellenberg (London School of Hygiene & Tropical Medicine) |
| Year | 2020 |
| Volume | 17 |
| Issue | 16 |
| Pages | 5803-5803 |
| Publication date | 2020-08-11 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | International Journal of Environmental Research and Public Health (JOURNAL) |
| Journal identifiers | ISSN: 1661-7827 • E-ISSN: 1660-4601 |
| Publisher | Multidisciplinary Digital Publishing Institute (PUBLISHER • CH) |
| DOI | 10.3390/ijerph17165803 |
| PMID | 32796574 |
| OpenAlex | W3048401913 |
| Language | EN |
| Citations received | 4 |
| References cited | 32 |
An intervention called 'Optimising the Health Extension Program', aiming to increase care-seeking for childhood illnesses in four regions of Ethiopia, was implemented between 2016 and 2018, and it included community engagement, capacity building, and district ownership and accountability. A pragmatic trial comparing 26 districts that received the intervention with 26 districts that did not found no evidence to suggest that the intervention increased utilisation of services. Here we used mixed methods to explore how the intervention was implemented. A fidelity analysis of each 31 intervention activities was performed, separately for the first phase and for the entire implementation period, to assess the extent to which what was planned was carried out. Qualitative interviews were undertaken with 39 implementers, to explore the successes and challenges of the implementation, and were analysed by using thematic analysis. Our findings show that the implementation was delayed, with only 19% ( n = 6/31) activities having high fidelity in the first phase. Key challenges that presented barriers to timely implementation included the following: complexity both of the intervention itself and of administrative systems; inconsistent support from district health offices, partly due to competing priorities, such as the management of disease outbreaks; and infrequent supervision of health extension workers at the grassroots level. We conclude that, for sustainability, evidence-based interventions must be aligned with national health priorities and delivered within an existing health system. Strategies to overcome the resulting complexity include a realistic time frame and investment in district health teams, to support implementation at grassroots level
Environmental health · Extension (predicate logic · Intervention (counseling · Process (computing · Program evaluation · Statistics · Child Nutrition and Water Access · Computer Science · Global Maternal and Child Health · Healthcare Systems and Reforms · Mathematics · Medicine · Nursing
Insights to optimizing health extension workers’ time use and efficiency in Ethiopia
Caregivers’ and Health Extension Workers’ Perceptions and Experiences of Outreach Management of Childhood Illnesses in Ethiopia
Perception and Experience of Health Extension Workers on Facilitators and Barriers to Maternal and Newborn Health Service Utilization in Ethiopia
Barriers to the utilization of community-based child and newborn health services in Ethiopia
Lessons from Complex Interventions to Improve Health
Countdown to 2030
A conceptual framework for implementation fidelity
Better reporting of interventions
Process evaluation of complex interventions
Saturation in qualitative research
Geographic differences in maternal and child health care utilization in four Ethiopian regions; a cross-sectional study
Wealth-based equity in maternal, neonatal, and child health services utilization
Assessing implementation fidelity of a community-based infant and young child feeding intervention in Ethiopia identifies delivery challenges that limit reach to communities
Knowledge and practice of health extension workers on drug provision for childhood illness in west Gojjam, Amhara, Northwest Ethiopia
Implementation Matters
Community Health Workers in Low- and Middle-Income Countries
Three Approaches to Qualitative Content Analysis
| Unique citing works | 4 |
|---|---|
| Citations per year | 0.8 |
| Citation span | 2021 - 2025 (5) |
| Citation velocity | recent |
| Highly cited | No |
| Citation types | Neutral: 4 |