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.citation.doi10.1002/HPM.2655en_ZA
dc.citation.epage386
dc.citation.spage369
dc.contributor.authorEboreime E
dc.contributor.authorEyles J
dc.contributor.authorNxumalo N
dc.date.accessioned2020-03-10T12:28:47Z
dc.date.available2020-03-10T12:28:47Z
dc.date.issued2018-09-14
dc.description.abstractSummary 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.description.librarianKM2020en_ZA
dc.facultyHealth Sciencesen_ZA
dc.funderNational Research Foundation World Health Organization. Grant Number: B40299en_ZA
dc.identifier.citationISIen_ZA
dc.identifier.issn0749-6753
dc.identifier.urihttps://hdl.handle.net/10539/29086
dc.journal.issue1en_ZA
dc.journal.linkDOI: 10.1002/hpm.2655en_ZA
dc.journal.titleINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENTen_ZA
dc.journal.volume34en_ZA
dc.schoolSchool of Public Healthen_ZA
dc.subjectPrimary Health Careen_ZA
dc.subjectHealth Policyen_ZA
dc.titleImplementation process and quality of a primary health care system improvement initiative in a decentralized context A retrospective appraisal using the quality implementation frameworken_ZA
dc.typeArticleen_ZA
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