Figures & Tables
Figures
- FIGURE.
African Health Initiative Theory of Change to Strengthen Data Quality and Use in Low- and Middle-Income Settings
Abbreviation: HCW, health care worker.
Tables
- TABLE 1
In-Depth Interview and Focus Group Discussion Recruitment Sample, by African Health Initiative Project
In-Depth Interview Focus Group Discussion No. Participants No. Participants Ethiopia 40 Regional and woreda-level health management team members; health center staff (head, deputy head, health information technicians, and maternal/child health care workers) 43 Regional and woreda-level health management team members; health center staff (head, deputy head, health information technicians, and maternal/child health care workers), university staff Ghana 34 District health management team and community health officers, Ghana Health Service 52 Community members, community health volunteers, subdistrict health team Mozambique 7 Chief district medical officers, district maternal child health supervisors 39 Maternal/child health nurses Ethiopia DUP was designed to scaffold onto the government's information revolution roadmap through leadership engagement, mentored and team-based capacity building, financial incentives, and investments in the eHealth architecture Actor Action Action Target and Justification Temporality Dose Implementation Outcome Study staff Leadership engagement Work with MOH leadership at district, province, and national levels to define and bolster governance structures and define standards and responsibilities Baseline and annually thereafter Formal dissemination meetings at each level (1–2 hours) Acceptability, sustainability Mentored supervision Local universities provide individual HIS capacity building to health worker-led PMTs in target regions through the CBMP At a minimum, quarterly mentored supervision Supervision visits of PMTs (2–3 hours) Adoption Investments in data use eHealth architecture Financial support to upgrade technology for HIS as well as related learning platforms linked to the Connected Woreda strategy Investments were made at the start of DUP to upgrade technologies Penetration, sustainability Study staff, facility staff PMTs at health facility level PMTs meet to review data, perform root cause analysis, LQAS, and define tailored action strategies for improvement Monthly Meetings monthly (2–3 hours) Appropriateness, penetration Ghana's CHPS+ project approach provided investments into learning platforms and mentoring partnerships and reinforced data collection modalities (e-Tracker/Data dashboard) Actor Action Action Target and Justification Temporality Dose Implementation Outcome Study staff, university partners Linked systems learning districts and university-based learning process Innovative approach to transfer system strengthening strategies from 4 districts to larger-scale implementation in additional regions (peer learning with financial incentives) Peer learning introduced at baseline and followed up once at 6 months Two trainings at baseline and 6 months for each systems learning district Adoption, appropriateness Study staff Mentoring support Peer learning operations prioritized including decision making and leadership At minimum quarterly Mentoring 4 times per year (1–2 hours) Adoption Technologies to reinforce data collection and use (e-Tracker) Data capture, analysis, and use will be prioritized through the use and expansion of the e-Tracker Start-up and annual refresher trainings plus monthly use on-the-job Training/refresher course (3 hours) Adoption, penetration, sustainability Training to address skill gaps among health care team Training to disseminate simple, low-cost, and rapid turnaround tools for impact monitoring to inform policy and practical decision making Completed at baseline 2–3 hours Acceptability, fidelity Mozambique IDEAs program was designed to adapt and expand a district-based audit and feedback approach and enhance capacity in research and targeted implementation studies linked to MNCH Actor Action Action Target and Justification Temporality Dose Implementation Outcome Mozambique NIH Service provision assessments and data quality audits Periodic service readiness and data quality assessments of a rotating sample of randomly selected facilities in the study area Conducted quarterly 1–2 days for each activity Fidelity, penetration Study staff, MOH managers District performance review and enhancement meetings Adaptation and expansion of the district performance and enhancement meetings into an iterative learning approach Conducted twice annually 4–5 hours Appropriateness, penetration Mentored supervision Build and support implementation research, through mentoring visits that review action plans and use of facility support grants Quarterly at a subsample of sites 2–3 hours Adoption, implementation cost Abbreviations: AHI, African Health Initiative; CBMP, capacity building and mentorship program; DUP, Data Use Partnership; HIS, health information system; IDEAs, Integrated District Evidence-to-Action program to improve maternal, newborn, and child health; LQAS, lot quality assurance sampling; MOH, Ministry of Health; PMT, performance-monitoring team.
Domain Short Description I. INTERVENTION CHARACTERISTICS Intervention source Perception of key stakeholders about whether the intervention is externally or internally developed. Evidence strength and quality Stakeholders’ perceptions of the quality and validity of evidence supporting the belief that the intervention will have desired outcomes. Relative advantage Stakeholders’ perception of the advantage of implementing the intervention versus an alternative solution. Adaptability The degree to which an intervention can be adapted, tailored, refined, or reinvented to meet local needs. Trialability The ability to test the intervention on a small scale in the organization and to be able to reverse course (undo implementation) if warranted. Complexity Perceived difficulty of implementation reflected by duration, scope, radicalness, disruptiveness, centrality, intricacy, and number of steps required to implement. Design quality and packaging Perceived excellence in how the intervention is bundled, presented, and assembled. Cost Costs of the intervention and costs associated with implementing the intervention including investment, supply, and opportunity costs. II. OUTER SETTING Patient needs and resources The extent to which patient needs, as well as barriers and facilitators to meet those needs, are accurately known and prioritized by the organization. Cosmopolitanism The degree to which an organization is networked with other external organizations. Peer pressure Mimetic or competitive pressure to implement an intervention; typically, because most other key peer or competing organizations have already implemented or are in a bid for a competitive edge. External policy and incentives A broad construct that includes external strategies to spread interventions, including policy and regulations (governmental or other central entity), external mandates, recommendations and guidelines, pay-for-performance, collaboratives, and public or benchmark reporting. III. INNER SETTING Structural characteristics The social architecture, age, maturity, and size of an organization. Networks and communications The nature and quality of webs of social networks and the nature and quality of formal and informal communications within an organization. Culture Norms, values, and basic assumptions of a given organization. Implementation climate The absorptive capacity for change, shared receptivity of involved individuals to an intervention, and the extent to which use of that intervention will be rewarded, supported, and expected within their organization. Tension for change The degree to which stakeholders perceive the current situation as intolerable or needing change. Compatibility The degree of tangible fit between meaning and values attached to the intervention by involved individuals, how those align with individuals’ norms, values, and perceived risks and needs, and how the intervention fits with existing workflows and systems. Relative priority Individuals’ shared perception of the importance of the implementation within the organization. Organizational incentives and rewards Extrinsic incentives such as goal-sharing awards, performance reviews, promotions, and raises in salary, and less tangible incentives such as increased stature or respect. Goals and feedback The degree to which goals are clearly communicated, acted upon, and fed back to staff, and alignment of that feedback with goals. Learning climate A climate in which: (1) leaders express their own fallibility and need for team members’ assistance and input; (2) team members feel that they are essential, valued, and knowledgeable partners in the change process; (3) individuals feel psychologically safe to try new methods; and d) there is sufficient time and space for reflective thinking and evaluation. Readiness for implementation Tangible and immediate indicators of organizational commitment to its decision to implement an intervention. Leadership engagement Commitment, involvement, and accountability of leaders and managers with the implementation. Available resources The level of resources dedicated for implementation and ongoing operations, including money, training, education, physical space, and time. Access to knowledge and information Ease of access to digestible information and knowledge about the intervention and how to incorporate it into work tasks. IV. CHARACTERISTICS OF INDIVIDUALS Knowledge and beliefs about the intervention Individuals’ attitudes toward and value placed on the intervention as well as familiarity with facts, truths, and principles related to the intervention. Self-efficacy Individual belief in their own capabilities to execute courses of action to achieve implementation goals. Individual stage of change Characterization of the phase an individual is in, as he or she progresses toward skilled, enthusiastic, and sustained use of the intervention. Individual identification with organization A broad construct related to how individuals perceive the organization, and their relationship and degree of commitment with that organization. Other personal attributes A broad construct to include other personal traits such as tolerance of ambiguity, intellectual ability, motivation, values, competence, capacity, and learning style. V. IMPLEMENTATION PROCESS Planning The degree to which a scheme or method of behavior and tasks for implementing an intervention are developed in advance, and the quality of those schemes or methods. Engagement Attracting and involving appropriate individuals in the implementation and use of the intervention through a combined strategy of social marketing, education, role modeling, training, and other similar activities. Opinion Leaders Individuals in an organization who have formal or informal influence on the attitudes and beliefs of their colleagues with respect to implementing the intervention. Formally appointed internal implementation leaders Individuals from within the organization who have been formally appointed with responsibility for implementing an intervention as coordinator, project manager, team leader, or another similar role. Champions Individuals who dedicate themselves to supporting, marketing, and “driving through” an [implementation], overcoming indifference or resistance that the intervention may provoke in an organization. External change agents Individuals who are affiliated with an outside entity who formally influence or facilitate intervention decisions in a desirable direction. Executing Carrying out or accomplishing the implementation according to plan. Reflecting and evaluating Quantitative and qualitative feedback about the progress and quality of implementation accompanied with regular personal and team debriefing about progress and experience.
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