Article type
Year
Abstract
Background: Health systems in low- and middle-income countries (LMIC) have significantly improved since Alma Ata and the Bamako initiative for Africa. However, with district health service (DHS) as an operational level, they still face challenges implementing evidence, which makes them less effective than they should be. Africa-relevant evidence is available from evidence networks including the Cochrane Africa Network, Campbell Collaboration, and Joanna Briggs Institute (JBI), but getting the evidence into practice is a challenge.
Objective: To strengthen health systems with evidence-informed decision-making by integrating the JBI GRiP (Getting Research into Practice) approach.
Methods: This evidence-implementation project used the JBI Practical Application of Clinical Evidence System (PACES) and GRiP audit and feedback tool. The PACES and GRiP framework involved three phases of activity.
- Phase 1: Stakeholder engagement and baseline audit data collection with identification of barriers to implementation.
- Phase 2: Design and implementation of strategies to improve practice through GRiP.
- Phase 3: Follow-up audit post implementation of change strategy.
In the eBASE JBI adapted approach, we worked with DHS rather than clinical partners. We calculated a cost-effectiveness ratio analysis for integrating the approach in LMIC.
Results: We report on an adapted JBI approach to suit health systems in LMIC by integrating clinical audits and feedback. DHS were able to integrate the approach into monthly supervision tasks with minimal costs. We reached three health facilities in the Bali Health District in 12 months. Cost ratios calculated showed reduced costs of $1577/health facility with evidence implementation compared to $4731/health facility if the single clinical partner approach was used. Compliance rates improved overall by 31% (R: 20 to 42) for all criteria. We identified 19 barriers and stratified into clinician-, community health worker-, patient- and policymaker-related barriers.
Conclusion: This approach exploits the existing health system and significantly strengthens the health system with evidence-based practice which improves the quality of care. The DHS approach facilitates systematization, ownership and sustainability within healthcare systems in LMIC.
Patient or healthcare consumer involvement: Yes, at all stakeholder meetings.
Objective: To strengthen health systems with evidence-informed decision-making by integrating the JBI GRiP (Getting Research into Practice) approach.
Methods: This evidence-implementation project used the JBI Practical Application of Clinical Evidence System (PACES) and GRiP audit and feedback tool. The PACES and GRiP framework involved three phases of activity.
- Phase 1: Stakeholder engagement and baseline audit data collection with identification of barriers to implementation.
- Phase 2: Design and implementation of strategies to improve practice through GRiP.
- Phase 3: Follow-up audit post implementation of change strategy.
In the eBASE JBI adapted approach, we worked with DHS rather than clinical partners. We calculated a cost-effectiveness ratio analysis for integrating the approach in LMIC.
Results: We report on an adapted JBI approach to suit health systems in LMIC by integrating clinical audits and feedback. DHS were able to integrate the approach into monthly supervision tasks with minimal costs. We reached three health facilities in the Bali Health District in 12 months. Cost ratios calculated showed reduced costs of $1577/health facility with evidence implementation compared to $4731/health facility if the single clinical partner approach was used. Compliance rates improved overall by 31% (R: 20 to 42) for all criteria. We identified 19 barriers and stratified into clinician-, community health worker-, patient- and policymaker-related barriers.
Conclusion: This approach exploits the existing health system and significantly strengthens the health system with evidence-based practice which improves the quality of care. The DHS approach facilitates systematization, ownership and sustainability within healthcare systems in LMIC.
Patient or healthcare consumer involvement: Yes, at all stakeholder meetings.