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Implementation of the ‘Optimising the Health Extension Program’ Intervention in Ethiopia: A Process Evaluation Using Mixed Methods

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 pragmati...

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Autores principales: Okwaraji, Yemisrach B., Hill, Zelee, Defar, Atkure, Berhanu, Della, Wolassa, Desta, Persson, Lars Åke, Gonfa, Geremew, Schellenberg, Joanna A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7459764/
https://www.ncbi.nlm.nih.gov/pubmed/32796574
http://dx.doi.org/10.3390/ijerph17165803
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author Okwaraji, Yemisrach B.
Hill, Zelee
Defar, Atkure
Berhanu, Della
Wolassa, Desta
Persson, Lars Åke
Gonfa, Geremew
Schellenberg, Joanna A.
author_facet Okwaraji, Yemisrach B.
Hill, Zelee
Defar, Atkure
Berhanu, Della
Wolassa, Desta
Persson, Lars Åke
Gonfa, Geremew
Schellenberg, Joanna A.
author_sort Okwaraji, Yemisrach B.
collection PubMed
description 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.
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spelling pubmed-74597642020-09-02 Implementation of the ‘Optimising the Health Extension Program’ Intervention in Ethiopia: A Process Evaluation Using Mixed Methods Okwaraji, Yemisrach B. Hill, Zelee Defar, Atkure Berhanu, Della Wolassa, Desta Persson, Lars Åke Gonfa, Geremew Schellenberg, Joanna A. Int J Environ Res Public Health Article 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. MDPI 2020-08-11 2020-08 /pmc/articles/PMC7459764/ /pubmed/32796574 http://dx.doi.org/10.3390/ijerph17165803 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Okwaraji, Yemisrach B.
Hill, Zelee
Defar, Atkure
Berhanu, Della
Wolassa, Desta
Persson, Lars Åke
Gonfa, Geremew
Schellenberg, Joanna A.
Implementation of the ‘Optimising the Health Extension Program’ Intervention in Ethiopia: A Process Evaluation Using Mixed Methods
title Implementation of the ‘Optimising the Health Extension Program’ Intervention in Ethiopia: A Process Evaluation Using Mixed Methods
title_full Implementation of the ‘Optimising the Health Extension Program’ Intervention in Ethiopia: A Process Evaluation Using Mixed Methods
title_fullStr Implementation of the ‘Optimising the Health Extension Program’ Intervention in Ethiopia: A Process Evaluation Using Mixed Methods
title_full_unstemmed Implementation of the ‘Optimising the Health Extension Program’ Intervention in Ethiopia: A Process Evaluation Using Mixed Methods
title_short Implementation of the ‘Optimising the Health Extension Program’ Intervention in Ethiopia: A Process Evaluation Using Mixed Methods
title_sort implementation of the ‘optimising the health extension program’ intervention in ethiopia: a process evaluation using mixed methods
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7459764/
https://www.ncbi.nlm.nih.gov/pubmed/32796574
http://dx.doi.org/10.3390/ijerph17165803
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