IDEAS Phase 2 project – Village Health Worker Scheme sustainability study in Gombe State, Nigeria: Protocol and topic guides

The IDEAS project sought to improve the health and survival of mothers and babies by understanding the factors that would contribute to making a Village Health Worker Scheme sustainable at scale across Gombe State, northeastern Nigeria, where survival rates for mothers and babies are low compared with many other low and middle-income countries, in part due to a shortage of trained health care workers and to low levels of community awareness about health care services available. The scheme was initially introduced by the Gombe State Primary Health Care Development Agency with implementation support from a national NGO, Society for Family Health, and external financial support. This collection comprises the protocol and semi-structured topic guides for three rounds of qualitative, in-depth interviews with key stakeholders from the Gombe State Primary Health Care Development Agency, and Society for Family Health in Sept 2017, Jan-Feb 2018 and Nov-Dec 2018. Focus group discussions were also held in Sept 2017 and Nov-Dec 2018 with local government area health service staff who now oversee the day to day running of the scheme, village health workers from two wards in the state, the primary health care staff who supervise them and members of the Ward Development Committees – local leaders responsible for community health. The final round of data collection also included four additional focus group discussions with women who had received support from village health workers and their children’s fathers

Recommendations from the Village Health Worker Scheme Sustainability Study: Based on the third round of data collection (November – December 2018)

These recommendations have emerged from several in-depth qualitative interviews and 13 focus group discussions with stakeholders involved in the Village Health Worker Scheme in Gombe state, Nigeria. Much work has been done to ensure the sustainability of the scheme, yet there are still some areas of uncertainty, which it would be beneficial to consider writes Deepthi Wickremasinghe. The recommendations for sustainability are for those involved in implementing the scheme, and for national and state governments considering setting up a similar scheme

A qualitative study of the scalability and sustainability of the Village Health Worker scheme in Gombe State, Nigeria: Findings about the set-up phase

This exploratory study seeks to understand the factors that will contribute to the sustainability of the A research brief to present the key findings of an exploratory study to understand the factors that will contribute to the stustainability of a Village Health Worker Scheme introduced into half the wards in Gombe State, northeastern Nigeria. The findings are based on a first round of qualitative interviews and focus group discussions with key stakeholders, to gain their views on what has worked well and what has proved challenging in setting up the scheme, to inform any future scale-up of the initiative to the rest of the state and across Nigeria

A qualitative study of the scalability and sustainability of the Village Health Worker scheme in Gombe State, Nigeria: Findings from the consolidation phase

A second round of qualitative data collection, for an exploratory study to understand factors that contribute to or hinder the sustainability of the Village Health Worker (VHW) Scheme, took place in Gombe State in January and February 2018. We conducted in-depth interviews with 13 purposively selected interviewees from the Gombe State Primary Health Care Development Agency (the Agency), which leads the work. Changes being made to the VHW scheme, that are designed to increase its sustainability in the 57 wards where it is being implemented include: • Introduction of Tier Two VHWs, to improve coverage of VHWs in rural communities • Increased involvement of Ward Development Committees in decision-making, VHW selection and supervision • Improved incentives to motivate and retain VHWs • Investigation of alternative sources of funding, beyond the end of 2018 Areas of concern for the sustainability of the VHW scheme are: • Sustaining intensified monitoring and supervision amid transport and funding challenges • Concerns about political sustainability of the scheme after elections in early 201

Protocol for the IDEAS qualitative study of scalability and sustainability of maternal and newborn health innovations in northeast Nigeria, Ethiopia and Uttar Pradesh, India

The aim of this study was to identify the critical steps and conditions required to foster the sustainability of maternal and newborn health (MNH) innovations in Ethiopia, Uttar Pradesh, India and Gombe and Adamawa, Nigeria. It addressed the following objectives: [1] document what happens to case study foundation-funded MNH innovations that are adopted and scaled in the longer-term; [2] identify the attributes of the case study innovations that foster their sustainability, including their effectiveness and relative advantages, observable benefits, acceptability to health workers and communities, and simplicity and costs, as well as potential challenges; [3] assess the most important actions and conditions required to foster sustainability at scale of selected MNH innovations, including ways the foundation and other donors can take steps to foster sustainability relating to the following dimensions: financial, fiscal and political sustainability, institutionalisation, organisational capacity and programmatic sustainability, partner support, routinisation and social sustainability; [4] identify the contextual factors within the broader health system, socioeconomic and geographical settings, that enable and inhibit the scale-up and sustainability of selected MNH innovations and assess how barriers have been overcome

Use of social network analysis methods to study professional advice and performance among healthcare providers: a systematic review.

BACKGROUND: Social network analysis quantifies and visualizes relationships between and among individuals or organizations. Applications in the health sector remain underutilized. This systematic review seeks to analyze what social network methods have been used to study professional communication and performance among healthcare providers. METHODS: Ten databases were searched from 1990 through April 2016, yielding 5970 articles screened for inclusion by two independent reviewers who extracted data and critically appraised each study. Inclusion criteria were study of health care worker professional communication, network methods used, and patient outcomes measured. The search identified 10 systematic reviews. The final set of articles had their citations prospectively and retrospectively screened. We used narrative synthesis to summarize the findings. RESULTS: The six articles meeting our inclusion criteria described unique health sectors: one at primary healthcare level and five at tertiary level; five conducted in the USA, one in Australia. Four studies looked at multidisciplinary healthcare workers, while two focused on nurses. Two studies used mixed methods, four quantitative methods only, and one involved an experimental design. Four administered network surveys, one coded observations, and one used an existing survey to extract network data. Density and centrality were the most common network metrics although one study did not calculate any network properties and only visualized the network. Four studies involved tests of significance, and two used modeling methods. Social network analysis software preferences were evenly split between ORA and UCINET. All articles meeting our criteria were published in the past 5 years, suggesting that this remains in clinical care a nascent but emergent research area. There was marked diversity across all six studies in terms of research questions, health sector area, patient outcomes, and network analysis methods. CONCLUSION: Network methods are underutilized for the purposes of understanding professional communication and performance among healthcare providers. The paucity of articles meeting our search criteria, lack of studies in middle- and low-income contexts, limited number in non-tertiary settings, and few longitudinal, experimental designs, or network interventions present clear research gaps. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015019328

IDEAS project - Scaling-up innovations to improve maternal and newborn health - Uttar Pradesh case study resources

The IDEAS project sought to improve the health and survival of mothers and babies through generating evidence to inform policy and practice in Ethiopia, northeast Nigeria and Uttar Pradesh, India. This data collection contains interview field notes and supporting information produced as part of a case study to document and assess the process by which the State Government of Uttar Pradesh introduced and scaled-up mSehat, a mobile phone application used by community health workers (Accredited Social Health Activists (ASHAs)) to create and maintain electronic health records

District decision-making for health in low-income settings: a systematic literature review.

Health management information systems (HMIS) produce large amounts of data about health service provision and population health, and provide opportunities for data-based decision-making in decentralized health systems. Yet the data are little-used locally. A well-defined approach to district-level decision-making using health data would help better meet the needs of the local population. In this second of four papers on district decision-making for health in low-income settings, our aim was to explore ways in which district administrators and health managers in low- and lower-middle-income countries use health data to make decisions, to describe the decision-making tools they used and identify challenges encountered when using these tools. A systematic literature review, following PRISMA guidelines, was undertaken. Experts were consulted about key sources of information. A search strategy was developed for 14 online databases of peer reviewed and grey literature. The resources were screened independently by two reviewers using pre-defined inclusion criteria. The 14 papers included were assessed for the quality of reported evidence and a descriptive evidence synthesis of the review findings was undertaken. We found 12 examples of tools to assist district-level decision-making, all of which included two key stages-identification of priorities, and development of an action plan to address them. Of those tools with more steps, four included steps to review or monitor the action plan agreed, suggesting the use of HMIS data. In eight papers HMIS data were used for prioritization. Challenges to decision-making processes fell into three main categories: the availability and quality of health and health facility data; human dynamics and financial constraints. Our findings suggest that evidence is available about a limited range of processes that include the use of data for decision-making at district level. Standardization and pre-testing in diverse settings would increase the potential that these tools could be used more widely

"It's About the Idea Hitting the Bull's Eye": How Aid Effectiveness Can Catalyse the Scale-up of Health Innovations.

BACKGROUND: Since the global economic crisis, a harsher economic climate and global commitments to address the problems of global health and poverty have led to increased donor interest to fund effective health innovations that offer value for money. Simultaneously, further aid effectiveness is being sought through encouraging governments in low- and middle-income countries (LMICs) to strengthen their capacity to be self-supporting, rather than donor reliant. In practice, this often means donors fund pilot innovations for three to five years to demonstrate effectiveness and then advocate to the national government to adopt them for scale-up within country-wide health systems. We aim to connect the literature on scaling-up health innovations in LMICs with six key principles of aid effectiveness: country ownership; alignment; harmonisation; transparency and accountability; predictability; and civil society engagement and participation, based on our analysis of interviewees' accounts of scale-up in such settings. METHODS: We analysed 150 semi-structured qualitative interviews, to explore the factors catalysing and inhibiting the scale-up of maternal and newborn health (MNH) innovations in Ethiopia, northeast Nigeria and the State of Uttar Pradesh, India and identified links with the aid effectiveness principles. Our interviewees were purposively selected for their knowledge of scale-up in these settings, and represented a range of constituencies. We conducted a systematic analysis of the expanded field notes, using a framework approach to code a priori themes and identify emerging themes in NVivo 10. RESULTS: Our analysis revealed that actions by donors, implementers and recipient governments to promote the scale-up of innovations strongly reflected many of the aid effectiveness principles embraced by well-known international agreements - including the Paris Declaration of Aid Effectiveness. Our findings show variations in the extent to which these six principles have been adopted in what are three diverse geographical settings, raising important implications for scaling health innovations in low- and middle-income countries. CONCLUSION: Our findings suggest that if donors, implementers and recipient governments were better able to put these principles into practice, the prospects for scaling externally funded health innovations as part of country health policies and programmes would be enhanced

IDEAS project - Scaling-up innovations to improve maternal and newborn health - Nigeria case study resources

The IDEAS project sought to improve the health and survival of mothers and babies through generating evidence to inform policy and practice in Ethiopia, northeast Nigeria and Uttar Pradesh, India. This data collection contains interview field notes and supporting information produced as part of a case study to investigate how an emergency transport scheme for pregnant women and newborn babies introduced in Gombe state had been scaled up to Adamawa state by Transaid and the Society for Family Health, working with National Union of Transport Workers