HeAlth System StrEngThening in four sub-Saharan African countries (ASSET) to achieve high-quality, evidence-informed surgical, maternal and newborn, and primary care: protocol for pre-implementation phase studies

Nadine Seward; Charlotte Hanlon; Ahmed Abdella; Zulfa Abrahams; Atalay Alem; Ricardo Araya; Max Bachmann; Alemayehu Bekele; Birke Bogale; Nataliya Brima; Dixon Chibanda; Robyn Curran; Justine Davies; Andualem Beyene; Lara Fairall; Lindsay Farrant; Souci Frissa; Jennifer Gallagher; Wei Gao; Liz Gwyther; Richard Harding; Muralikrishnan R Kartha; Andrew Leather; Crick Lund; Maggie Marx; Kennedy Nkhoma; Jamie Murdoch; Inge Petersen; Ruwayda Petrus; André van Rensburg; Jane Sandall; Nick Sevdalis; Andrew Sheenan; Amezene Tadesse; Graham Thornicroft; Ruth Verhey; Chris Willott; Martin Prince

doi:10.1080/16549716.2021.1987044

HeAlth System StrEngThening in four sub-Saharan African countries (ASSET) to achieve high-quality, evidence-informed surgical, maternal and newborn, and primary care: protocol for pre-implementation phase studies

Glob Health Action. 2022 Dec 31;15(1):1987044. doi: 10.1080/16549716.2021.1987044.

Authors

Nadine Seward¹, Charlotte Hanlon^{2

3}, Ahmed Abdella⁴, Zulfa Abrahams⁵, Atalay Alem³, Ricardo Araya², Max Bachmann⁶, Alemayehu Bekele⁴, Birke Bogale^{7

8}, Nataliya Brima⁹, Dixon Chibanda^{10

11}, Robyn Curran¹², Justine Davies^{13

14}, Andualem Beyene¹⁵, Lara Fairall^{12

16}, Lindsay Farrant¹⁷, Souci Frissa¹⁶, Jennifer Gallagher⁷, Wei Gao¹⁸, Liz Gwyther¹⁷, Richard Harding¹⁸, Muralikrishnan R Kartha¹⁹, Andrew Leather⁹, Crick Lund^{2

5}, Maggie Marx⁵, Kennedy Nkhoma¹⁸, Jamie Murdoch²⁰, Inge Petersen²¹, Ruwayda Petrus²², André van Rensburg²¹, Jane Sandall²³, Nick Sevdalis¹, Andrew Sheenan²³, Amezene Tadesse¹⁵, Graham Thornicroft^{1

2}, Ruth Verhey¹⁰, Chris Willott⁹, Martin Prince¹⁶

Affiliations

¹ Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
² Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
³ Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-, Addis Ababa University, Addis Ababa, Ethiopia.
⁴ Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
⁵ Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
⁶ Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK.
⁷ Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London, London, UK.
⁸ Department of Dentistry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
⁹ King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King's College London, London, UK.
¹⁰ University of Zimbabwe, Harare, Zimbabwe.
¹¹ Psychology Department, School of Applied Human Science College of Humanities, University of KwaZulu Natal, London, UK.
¹² Knowledge Translation Unit, University of Cape Town Lung Institute and Department of Medicine, University of Cape Town, Cape Town, South Africa.
¹³ Centre for Applied Health Research, University of Birmingham, Birmingham, UK.
¹⁴ Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa.
¹⁵ Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
¹⁶ King's Global Health Institute, King's College London, London, UK.
¹⁷ Division of Family Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
¹⁸ Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK.
¹⁹ King's Health Economics, Kings College London, London, UK.
²⁰ Department of Population Health Science, Kings College London, London, UK.
²¹ Centre for Rural Health, University of KwaZulu-Natal, Berea, Durban, South Africa.
²² Psychology Department, School of Applied Human Science College of Humanities, University of KwaZulu Natal, Berea, Durban, South Africa.
²³ Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences & Medicine, King's College London, London, UK.

Abstract

To achieve universal health coverage, health system strengthening (HSS) is required to support the of delivery of high-quality care. The aim of the National Institute for Health Research Global Research Unit on HeAlth System StrEngThening in Sub-Saharan Africa (ASSET) is to address this need in a four-year programme, with three healthcare platforms involving eight work-packages. Key to effective health system strengthening (HSS) is the pre-implementation phase of research where efforts focus on applying participatory methods to embed the research programme within the existing health system. To conceptualise the approach, we provide an overview of the key methods applied across work-package to address this important phase of research conducted between 2017 and 2021.Work-packages are being undertaken in publicly funded health systems in rural and urban areas in Ethiopia, Sierra Leone, South Africa, and Zimbabwe. Stakeholders including patients and their caregivers, community representatives, clinicians, managers, administrators, and policymakers are the main research participants.In each work-package, initial activities engage stakeholders and build relationships to ensure co-production and ownership of HSSIs. A mixed-methods approach is then applied to understand and address determinants of high-quality care delivery. Methods such as situation analysis, cross-sectional surveys, interviews and focus group discussions are adopted to each work-package aim and context. At the end of the pre-implementation phase, findings are disseminated using focus group discussions and participatory Theory of Change workshops where stakeholders from each work package use findings to select HSSIs and develop a programme theory.ASSET places a strong emphasis of the pre-implementation phase in order to provide an in-depth and systematic diagnosis of the existing heath system functioning, needs for strengthening and stakeholder engagement. This common approach will inform the design and evaluation of the HSSIs to increase effectiveness across work packages and contexts, to better understand what works, for whom, and how.

Keywords: Implementation research; Sub-Saharan Africa; global health; health systems strengthening; implementation science.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Review

MeSH terms

Cross-Sectional Studies
Delivery of Health Care*
Government Programs*
Humans
Infant, Newborn
Medical Assistance
Primary Health Care

Abstract

Publication types

MeSH terms

Grants and funding