scholarly journals Implementing Cancer Care in Rwanda: Capacity Building for Treatment and Scale-Up

2021 ◽  
Vol 13 (13) ◽  
pp. 7216
Author(s):  
Paul H. Park ◽  
Cyprien Shyirambere ◽  
Fred Kateera ◽  
Neil Gupta ◽  
Christian Rusangwa ◽  
...  
Keyword(s):  
Capacity Building ◽  
Scale Up ◽  
Implementation Strategies ◽  
Sub Saharan Africa ◽  
Essential Medicines ◽  
Cancer Center ◽  
Health Coverage ◽  
Cancer Centers ◽  
Implementation Approach ◽  
Single Cancer

Background: The majority of countries in sub-Saharan Africa are ill-prepared to address the rising burden of cancer. While some have been able to establish a single cancer referral center, few have been able to scale-up services nationally towards universal health coverage. The literature lacks a step-wise implementation approach for resource-limited countries to move beyond a single-facility implementation strategy and implement a national cancer strategy to expand effective coverage. Methods: We applied an implementation science framework, which describes a four-phase approach: Exploration, Preparation, Implementation, and Sustainment (EPIS). Through this framework, we describe Rwanda’s approach to establish not just a single cancer center, but a national cancer program. Results: By applying EPIS to Rwanda’s implementation approach, we analyzed and identified the implementation strategies and factors, which informed processes of each phase to establish foundational cancer delivery components, including trained staff, diagnostic technology, essential medicines, and medical informatics. These cancer delivery components allowed for the implementation of Rwanda’s first cancer center, while simultaneously serving as the nidus for capacity building of foundational components for future cancer centers. Conclusion: This “progressive scaling” approach ensured that initial investments in the country’s first cancer center was a step toward establishing future cancer centers in the country.

A protocol for evaluating a multi-level implementation theory to scale up obstetric triage in referral hospitals in Ghana

2020 ◽  
Author(s):  
Caitlin Rain Williams ◽  
Stephanie Bogdewic ◽  
Medge Owen ◽  
Emmanuel K. Srofe ◽  
Rohit Ramaswamy
Keyword(s):  
Mixed Methods ◽  
Scale Up ◽  
Implementation Strategies ◽  
Clinical Intervention ◽  
Interactive Systems ◽  
Interactive Systems Framework ◽  
Implementation Theory ◽  
Care Plans ◽  
Implementation Approach ◽  
Multi Level

Abstract Background: Ghana significantly reduced maternal and newborn mortality between 1990 and 2015, largely through efforts focused on improving access to care. Yet achieving further progress requires improving the quality and timeliness of care. Beginning in 2013, Ghana Health Service and Kybele, a US-based non-governmental organization, developed an innovative obstetric triage system to help midwives assess, diagnosis, and determine appropriate care plans more quickly and accurately. In 2019, efforts began to scale this successful intervention into six additional hospitals. This protocol describes the theory-based implementation approach guiding scale-up and presents the proposed mixed-methods evaluation plan. Methods: An implementation theory was developed to describe how complementary implementation strategies would be bundled into a multi-level implementation approach. Drawing on the Interactive Systems Framework and Evidenced Based System for Implementation Support, the proposed implementation approach is designed to help individual facilities develop implementation capacity and also build a learning network across facilities to support the implementation of evidence-based interventions.A convergent design mixed methods approach will be used to evaluate implementation with relevant data drawn from tailored assessments, routinely collected process and quality monitoring data, textual analysis of relevant documents and WhatsApp group messages, and key informant interviews. Implementation outcomes of interest are acceptability, adoption, and sustainability.Discussion: The past decade has seen a rapid growth in the development of frameworks, models, and theories of implementation, yet there remains little guidance on how to use these to operationalize implementation practice. This study proposes one method for using implementation theory, paired with other kinds of mid-level and program theory, to guide the replication and evaluation of a clinical intervention in a complex, real-world setting. The results of this study should help to provide evidence of how implementation theory can be used to help close the “know-do” gap.

scholarly journals Determinants of adherence to physical cancer rehabilitation guidelines among cancer patients and cancer centers: a cross-sectional observational study

2020 ◽  
Author(s):  
Charlotte IJsbrandy ◽  
Petronella B. Ottevanger ◽  
Winald R. Gerritsen ◽  
Wim H. van Harten ◽  
Rosella P. M. G. Hermens
Keyword(s):  
Cancer Survivors ◽  
Guideline Adherence ◽  
Implementation Strategies ◽  
Information Provision ◽  
Cancer Rehabilitation ◽  
Cancer Center ◽  
Tumor Type ◽  
Cross Sectional ◽  
Cancer Centers ◽  
Patient Level

Abstract Purpose To tailor implementation strategies that maximize adherence to physical cancer rehabilitation (PCR) guidelines, greater knowledge concerning determinants of adherence to those guidelines is needed. To this end, we assessed the determinants of adherence to PCR guidelines in the patient and cancer center. Methods We investigated adherence variation of PCR guideline-based indicators regarding [1] screening with the Distress Thermometer (DT), [2] information provision concerning physical activity (PA) and physical cancer rehabilitation programs (PCRPs), [3] advice to take part in PA and PCRPs, [4] referral to PCRPs, [5] participation in PCRPs, and [6] PA uptake (PAU) in nine cancer centers. Furthermore, we assessed patient and cancer center characteristics as possible determinants of adherence. Regression analyses were used to determine associations between guideline adherence and patient and cancer center characteristics. In these analyses, we assumed the patient (level 1) nested within the cancer center (level 2). Results Nine hundred and ninety-nine patients diagnosed with cancer between January 2014 and June 2015 were included. Of the 999 patients included in the study, 468 (47%) received screening with the DT and 427 (44%) received information provision concerning PA and PCRPs. Subsequently, 550 (56%) patients were advised to take part in PA and PCRPs, which resulted in 174 (18%) official referrals. Ultimately, 280 (29%) patients participated in PCRPs, and 446 (45%) started PAU. Screening with the DT was significantly associated with information provision concerning PA and PCRPs (OR 1.99, 95% CI 1.47–2.71), advice to take part in PA and PCRPs (OR 1.79, 95% CI 1.31–2.45), referral to PCRPs (OR 1.81, 95% CI 1.18–2.78), participation in PCRPs (OR 2.04, 95% CI 1.43–2.91), and PAU (OR 1.69, 95% CI 1.25–2.29). Younger age, male gender, breast cancer as the tumor type, ≥2 cancer treatments, post-cancer treatment weight gain/loss, employment, and fatigue were determinants of guideline adherence. Less variation in scores of the indicators between the different cancer centers was found. This variation between centers was too low to detect any association between center characteristics with the indicators. Conclusions The implementation of PCR guidelines is in need of improvement. We found determinants at the patient level associated with guideline-based PCR care. Implications for Cancer Survivors Implementation strategies that deal with the determinants of adherence to PCR guidelines might improve the implementation of PCR guidelines and the quality of life of cancer survivors.

The Sub-Saharan Africa Regional Partnership (SHARP) for Mental Health Capacity-Building Scale-Up Trial: Study Design and Protocol

2020 ◽  
pp. appi.ps.2020000
Author(s):  
Bradley N. Gaynes ◽  
Christopher F. Akiba ◽  
Mina C. Hosseinipour ◽  
Kazione Kulisewa ◽  
Alemayehu Amberbir ◽  
...  
Keyword(s):  
Mental Health ◽  
Capacity Building ◽  
Study Design ◽  
Scale Up ◽  
Sub Saharan Africa ◽  
Regional Partnership ◽  
Sub Saharan

scholarly journals The Sub-Saharan Africa Regional Partnership (SHARP) for Mental Health Capacity Building: a program protocol for building implementation science and mental health research and policymaking capacity in Malawi and Tanzania

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Christopher Fittipaldi Akiba ◽  
Vivian Go ◽  
Victor Mwapasa ◽  
Mina Hosseinipour ◽  
Bradley Neil Gaynes ◽  
...  
Keyword(s):  
Mental Health ◽  
Capacity Building ◽  
Scale Up ◽  
Sub Saharan Africa ◽  
Evidence Based ◽  
Regional Partnership ◽  
Sub Saharan ◽  
Building Program ◽  
Capacity Building Program ◽  
Research And Policy

Abstract Background Mental health (MH) disorders in low and middle-income countries (LMICs) account for a large proportion of disease burden. While efficacious treatments exist, only 10% of those in need are able to access care. This treatment gap is fueled by structural determinants including inadequate resource allocation and prioritization, both rooted in a lack of research and policy capacity. The goal of the Sub-Saharan Africa Regional Partnership for Mental Health Capacity Building (SHARP), based in Malawi and Tanzania, is to address those research and policy-based determinants. Methods SHARP aims to (1) build implementation science skills and expertise among Malawian and Tanzanian researchers in the area of mental health; (2) ensure that Malawian and Tanzanian policymakers and providers have the knowledge and skills to effectively apply research findings on evidence-based mental health programs to routine practice; and (3) strengthen dialogue between researchers, policymakers, and providers leading to efficient and sustainable scale-up of mental health services in Malawi and Tanzania. SHARP comprises five capacity building components: introductory and advanced short courses, a multifaceted dialogue, on-the-job training, pilot grants, and “mentor the mentors” courses. Discussion Program evaluation includes measuring dose delivered and received, participant knowledge and satisfaction, as well as academic output (e.g., conference posters or presentations, manuscript submissions, grant applications). The SHARP Capacity Building Program aims to make a meaningful contribution in pursuit of a model of capacity building that could be replicated in other LMICs. If impactful, the SHARP Capacity Building Program could increase the knowledge, skills, and mentorship capabilities of researchers, policymakers, and providers regarding effective scale up of evidence-based MH treatment.

scholarly journals A protocol for evaluating a multi-level implementation theory to scale up obstetric triage in referral hospitals in Ghana

2020 ◽  
Author(s):  
Caitlin Rain Williams ◽  
Stephanie Bogdewic ◽  
Medge Owen ◽  
Emmanuel K. Srofe ◽  
Rohit Ramaswamy
Keyword(s):  
Mixed Methods ◽  
Scale Up ◽  
Implementation Strategies ◽  
Clinical Intervention ◽  
Interactive Systems ◽  
Interactive Systems Framework ◽  
Implementation Theory ◽  
Care Plans ◽  
Implementation Approach ◽  
Multi Level

Abstract Background Ghana significantly reduced maternal and newborn mortality between 1990 and 2015, largely through efforts focused on improving access to care. Yet achieving further progress requires improving the quality and timeliness of care. Beginning in 2013, Ghana Health Service and Kybele, a US-based non-governmental organization, developed an innovative obstetric triage system to help midwives assess, diagnosis, and determine appropriate care plans more quickly and accurately. In 2019, efforts began to scale this successful intervention into six additional hospitals. This protocol describes the theory-based implementation approach guiding scale-up and presents the proposed mixed-methods evaluation plan. Methods An implementation theory was developed to describe how complementary implementation strategies would be bundled into a multi-level implementation approach. Drawing on the Interactive Systems Framework and Evidenced Based System for Implementation Support, the proposed implementation approach is designed to help individual facilities develop implementation capacity and also build a learning network across facilities to support the implementation of evidence-based interventions. A convergent design mixed methods approach will be used to evaluate implementation with relevant data drawn from tailored assessments, routinely collected process and quality monitoring data, textual analysis of relevant documents and WhatsApp group messages, and key informant interviews. Implementation outcomes of interest are acceptability, adoption, and sustainability. Discussion The past decade has seen a rapid growth in the development of frameworks, models, and theories of implementation, yet there remains little guidance on how to use these to operationalize implementation practice. This study proposes one method for using implementation theory, paired with other kinds of mid-level and program theory, to guide the replication and evaluation of a clinical intervention in a complex, real-world setting. The results of this study should help to provide evidence of how implementation theory can be used to help close the “know-do” gap.

scholarly journals Implementation Strategies to Enhance Youth-Friendly Sexual and Reproductive Health Services in Sub-Saharan Africa: A Systematic Review

2021 ◽  
Vol 3 ◽  
Author(s):  
Chisom Obiezu-Umeh ◽  
Ucheoma Nwaozuru ◽  
Stacey Mason ◽  
Titilola Gbaja-Biamila ◽  
David Oladele ◽  
...  
Keyword(s):  
Young People ◽  
Health Services ◽  
Scale Up ◽  
Implementation Strategies ◽  
Evidence Base ◽  
Sub Saharan Africa ◽  
Reproductive Health Services ◽  
Implementation Outcomes ◽  
Sub Saharan ◽  
Youth Friendly

Introduction: Youth-friendly health service (YFHS) interventions are a promising, cost-effective approaches to delivering sexual and reproductive services that cater to the developmental needs of young people. Despite a growing evidence-base, implementation of such interventions into practice have proven to be challenging in sub-Saharan Africa (SSA). Thus, the purpose of this review is to synthesize existing evidence on YFHS implementation in SSA and understand which implementation strategies were used, in what context, how they were used, and leading to which implementation outcomes.Methods: A comprehensive literature search in PubMed, Embase, Scopus, and CINAHL, was conducted to identify peer-reviewed research articles published from database inception up until August 2020. Eligible studies were required to include young people (ages 10–24 years) in sub-Saharan Africa. Studies that described implementation strategies, as conceptualized by the Expert Recommendations for Implementing Change (ERIC) project, used to enhance the implementation of YFHS were included. Implementation outcomes were extracted using Proctor and colleagues' 8 taxonomy of implementation outcomes.Results: We identified 18 unique interventions (reported in 23 articles) from an initial search of 630 articles, including seven from East Africa, seven from South Africa, and four from West Africa. In most studies (n = 15), youth-friendly health services were delivered within the context of a health facility or clinic setting. The most frequently reported categories of implementation strategies were to train and educate stakeholders (n = 16) followed by infrastructure change (n = 10), to engage consumers (n = 9), the use of evaluative and iterative strategies (n = 8), support clinicians (n = 8), and providing interactive assistance (n = 6). The effectiveness of the strategies to enhance YFHS implementation was commonly measured using adoption (n = 15), fidelity (n = 7), acceptability (n = 5), and penetration (n = 5). Few studies reported on sustainability (n = 2), appropriateness (n = 1), implementation cost (n = 1) and feasibility (n = 0).Conclusion: Results of the review emphasize the need for further research to evaluate and optimize implementation strategies for promoting the scale-up and sustainability of evidence-based, YFHS interventions in resource-constrained settings. This review also highlights the need to design robust studies to better understand which, in what combination, and in what context, can implementation strategies be used to effectively enhance the implementation of YFHS interventions.

How Central Support Built Capacity to Deliver a Health Promoting Intervention for Older Adults

2020 ◽  
Author(s):  
Joanie Sims Gould ◽  
Heather McKay ◽  
Thea Franke
Keyword(s):  
Older Adults ◽  
Capacity Building ◽  
Support System ◽  
Technical Assistance ◽  
Scale Up ◽  
Implementation Strategies ◽  
Essential Elements ◽  
Community Based ◽  
Health Promoting ◽  
Central Support

Abstract Background: A number of conceptual frameworks guide implementation and scale-up of evidence based (health promoting) interventions (EBIs). However, few studies delve into these frameworks to describe aspects of the delivery system--such as capacity building--that support successful scale-up. A standardized approach to capacity building is needed to develop new strategies and transfer successful strategies to new settings. Therefore, our objectives were to describe: (1) implementation strategies adopted by the central support system to build practitioners’ capacity to implement and scale-up a health promoting intervention (Choose to Move (CTM)), and (2) elements within capacity building strategies deemed essential to effectively implement CTM in diverse community contexts.Methods: CTM is a flexible, scalable, community-based health promoting physical activity (PA) and social connectedness intervention for older adults. In 2018-2020, eight health and social service societies, rural or remote municipalities, or community based organizations delivered CTM programs (n=22) that served older adults (n=322). We conducted in depth interviews with delivery partners (n=23), and a focus group with the central support system (n= 4) to assess key elements within capacity building strategies.Results: Capacity building strategies that delivery partners adopted were site selection/marketing, training, tools, technical assistance, peer networking, assessment and feedback. Essential elements that emerged within capacity building strategies were: a support system champion, activity coach skills, self efficacy and confidence; interactive assistance to answer questions and clarify materials. Key elements of central support that emerged were helping organizations-- adapt and tailor the EBI, leverage resources and strategies, maintain fidelity to the EBI, develop partnerships, train and monitor, learn from peers, increase awareness of older adult needs, increase PA programs for older adults and inform future organizational practices and processes. Central support provided a sounding board to organizations and were more successful if they were familiar with delivery partner resources and values, created buy-in and planned ahead.Conclusion: There is a key role for capacity building under the stewardship of central support units to promote implementation success. More clearly described capacity-building strategies that are designed and delivered to support implementation and scale-up would serve to advance the field, in future.

scholarly journals Agenda setting for essential medicines policy in sub-Saharan Africa: a retrospective policy analysis using Kingdon’s multiple streams model

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Alison T. Mhazo ◽  
Charles C. Maponga
Keyword(s):  
Agenda Setting ◽  
Drug Expenditure ◽  
Sub Saharan Africa ◽  
Essential Medicines ◽  
Health Coverage ◽  
Policy Documents ◽  
Essential Drugs ◽  
Sub Saharan ◽  
Future Policy ◽  
Essential Medicines Policy

Abstract Background Lack of access to essential medicines presents a significant threat to achieving universal health coverage (UHC) in sub-Saharan Africa. Although it is acknowledged that essential medicines policies do not rise and stay on the policy agenda solely through rational deliberation and consideration of technical merits, policy theory is rarely used to direct and guide analysis to inform future policy implementation. We used Kingdon’s model to analyse agenda setting for essential medicines policy in sub-Saharan Africa during the formative phase of the primary healthcare (PHC) concept. Methods We retrospectively analysed 49 published articles and 11 policy documents. We used selected search terms in EMBASE and MEDLINE electronic databases to identify relevant published studies. Policy documents were obtained through hand searching of selected websites. We also reviewed the timeline of essential medicines policy milestones contained in the Flagship Report, Medicines in Health Systems: Advancing access, affordability and appropriate use, released by WHO in 2014. Kingdon’s model was used as a lens to interpret the findings. Results We found that unsustainable rise in drug expenditure, inequitable access to drugs and irrational use of drugs were considered as problems in the mid-1970s. As a policy response, the essential drugs concept was introduced. A window of opportunity presented when provision of essential drugs was identified as one of the eight components of PHC. During implementation, policy contradictions emerged as political and policy actors framed the problems and perceived the effectiveness of policy responses in a manner that was amenable to their own interests and objectives. Conclusion We found that effective implementation of an essential medicines policy under PHC was constrained by prioritization of trade over public health in the politics stream, inadequate systems thinking in the policy stream and promotion of economic-oriented reforms in both the politics and policy streams. These lessons from the PHC era could prove useful in improving the approach to contemporary UHC policies.

scholarly journals Implementation strategies in emergency management of children: A scoping review

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248826
Author(s):  
Alex Aregbesola ◽  
Ahmed M. Abou-Setta ◽  
George N. Okoli ◽  
Maya M. Jeyaraman ◽  
Otto Lam ◽  
...  
Keyword(s):  
Emergency Management ◽  
Randomized Controlled Trials ◽  
Capacity Building ◽  
Scoping Review ◽  
Research Evidence ◽  
Scale Up ◽  
Healthcare Delivery ◽  
Implementation Strategies ◽  
Controlled Trials ◽  
Randomized Controlled

Background Implementation strategies are vital for the uptake of evidence to improve health, healthcare delivery, and decision-making. Medical or mental emergencies may be life-threatening, especially in children, due to their unique physiological needs when presenting in the emergency departments (EDs). Thus, practice change in EDs attending to children requires evidence-informed considerations regarding the best approaches to implementing research evidence. We aimed to identify and map the characteristics of implementation strategies used in the emergency management of children. Methods We conducted a scoping review using Arksey and O’Malley’s framework. We searched four databases [Medline (Ovid), Embase (Ovid), Cochrane Central (Wiley) and CINAHL (Ebsco)] from inception to May 2019, for implementation studies in children (≤21 years) in emergency settings. Two pairs of reviewers independently selected studies for inclusion and extracted the data. We performed a descriptive analysis of the included studies. Results We included 87 studies from a total of 9,607 retrieved citations. Most of the studies were before and after study design (n = 68, 61%) conducted in North America (n = 63, 70%); less than one-tenth of the included studies (n = 7, 8%) were randomized controlled trials (RCTs). About one-third of the included studies used a single strategy to improve the uptake of research evidence. Dissemination strategies were more commonly utilized (n = 77, 89%) compared to other implementation strategies; process (n = 47, 54%), integration (n = 49, 56%), and capacity building and scale-up strategies (n = 13, 15%). Studies that adopted capacity building and scale-up as part of the strategies were most effective (100%) compared to dissemination (90%), process (88%) and integration (85%). Conclusions Studies on implementation strategies in emergency management of children have mostly been non-randomized studies. This review suggests that ‘dissemination’ is the most common strategy used, and ‘capacity building and scale-up’ are the most effective strategies. Higher-quality evidence from randomized-controlled trials is needed to accurately assess the effectiveness of implementation strategies in emergency management of children.

scholarly journals Positioning for success: building capacity in academic competencies for early-career researchers in sub-Saharan Africa

2019 ◽  
Vol 6 ◽  
Author(s):  
C. Merritt ◽  
H. Jack ◽  
W. Mangezi ◽  
D. Chibanda ◽  
M. Abas
Keyword(s):  
Mental Health ◽  
Capacity Building ◽  
Low Cost ◽  
Early Career ◽  
Sub Saharan Africa ◽  
Training Experience ◽  
African Countries ◽  
Early Career Researchers ◽  
Academic Competencies ◽  
Sub Saharan

Background. Capacity building is essential in low- and middle-income countries (LMICs) to address the gap in skills to conduct and implement research. Capacity building must not only include scientific and technical knowledge, but also broader competencies, such as writing, disseminating research and achieving work–life balance. These skills are thought to promote long-term career success for researchers in high-income countries (HICs) but the availability of such training is limited in LMICs. Methods. This paper presents the contextualisation and implementation of the Academic Competencies Series (ACES). ACES is an early-career researcher development programme adapted from a UK university. Through consultation between HIC and LMIC partners, an innovative series of 10 workshops was designed covering themes of self-development, engagement and writing skills. ACES formed part of the African Mental Health Research Initiative (AMARI), a multi-national LMIC-led consortium to recruit, train, support and network early-career mental health researchers from four sub-Saharan African countries. Results. Of the 10 ACES modules, three were HIC-LMIC co-led, four led by HIC facilitators with LMIC training experience and three led by external consultants from HICs. Six workshops were delivered face to face and four by webinar. Course attendance was over 90% and the delivery cost was approximately US$4500 per researcher trained. Challenges of adaptation, attendance and technical issues are described for the first round of workshops. Conclusions. This paper indicates that a skills development series for early-career researchers can be contextualised and implemented in LMIC settings, and is feasible for co-delivery with local partners at relatively low cost.

Sign in / Sign up

Export Citation Format

Share Document