Implementation process and quality of a primary health care system improvement initiative in a decentralized context A retrospective appraisal using the quality implementation framework

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dc.contributor.author Eboreime E
dc.contributor.author Eyles J
dc.contributor.author Nxumalo N
dc.date.accessioned 2020-03-10T12:28:47Z
dc.date.available 2020-03-10T12:28:47Z
dc.date.issued 2018-09-14
dc.identifier.citation ISI en_ZA
dc.identifier.issn 0749-6753
dc.identifier.uri https://hdl.handle.net/10539/29086
dc.description.abstract Summary Background Effective implementation processes are essential in achieving desired outcomes of health initiatives. Whereas many approaches to implementation may seem straightforward, careful advanced planning, multiple stakeholder involvements, and addressing other contextual constraints needed for quality implementation are complex. Consequently, there have been recent calls for more theory‐informed implementation science in health systems strengthening. This study applies the quality implementation framework (QIF) developed by Meyers, Durlak, and Wandersman to identify and explain observed implementation gaps in a primary health care system improvement intervention in Nigeria. Methods We conducted a retrospective process appraisal by analyzing contents of 39 policy document and 15 key informant interviews. Using the QIF, we assessed challenges in the implementation processes and quality of an improvement model across the tiers of Nigeria's decentralized health system. Results Significant process gaps were identified that may have affected subnational implementation quality. Key challenges observed include inadequate stakeholder engagements and poor fidelity to planned implementation processes. Although needs and fit assessments, organizational capacity building, and development of implementation plans at national level were relatively well carried out, these were not effective in ensuring quality and sustainability at the subnational level. Conclusions Implementing initiatives between levels of governance is more complex than within a tier. Adequate preintervention planning, understanding, and engaging the various interests across the governance spectrum are key to improving quality. en_ZA
dc.subject Primary Health Care en_ZA
dc.subject Health Policy en_ZA
dc.title Implementation process and quality of a primary health care system improvement initiative in a decentralized context A retrospective appraisal using the quality implementation framework en_ZA
dc.type Article en_ZA
dc.journal.volume 34 en_ZA
dc.journal.title INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT en_ZA
dc.description.librarian KM2020 en_ZA
dc.citation.doi 10.1002/HPM.2655 en_ZA
dc.citation.epage 386
dc.citation.spage 369
dc.funder National Research Foundation World Health Organization. Grant Number: B40299 en_ZA
dc.journal.link DOI: 10.1002/hpm.2655 en_ZA
dc.journal.issue 1 en_ZA
dc.faculty Health Sciences en_ZA
dc.school School of Public Health en_ZA


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