Wilbroad Mutale1,2, Helen Ayles2,3, Virginia Bond3, Namwinga Chintu4, Roma Chilengi4, Margaret Tembo Mwanamwenge3, Angela Taylor4, Neil Spicer5, Dina Balabanova5. 1. Department of Community Medicine, University of Zambia School of Medicine, Lusaka, Zambia. 2. Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK. 3. ZAMBART Project, Ridgeway Campus, University of Zambia, Lusaka, Zambia. 4. Centre for Infectious Disease Control in Zambia, Northmead Lusaka, Zambia. 5. Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Abstract
RATIONALE, AIMS AND OBJECTIVES: Strong health systems are said to be paramount to achieving effective and equitable health care. The World Health Organization has been advocating for using system-wide approaches such as 'systems thinking' to guide intervention design and evaluation. In this paper we report the system-wide effects of a complex health system intervention in Zambia known as Better Health Outcome through Mentorship and Assessment (BHOMA) that aimed to improve service quality. METHODS: We conducted a qualitative study in three target districts. We used a systems thinking conceptual framework to guide the analysis focusing on intended and unintended consequences of the intervention. NVivo version 10 was used for data analysis. RESULTS: The addressed community responded positively to the BHOMA intervention. The indications were that in the short term there was increased demand for services but the health worker capacity was not severely affected. This means that the prediction that service demand would increase with implementation of BHOMA was correct and the workload also increased, but the help of clinic lay supporters meant that some of the work of clinicians was transferred to these lay workers. However, from a systems perspective, unintended consequences also occurred during the implementation of the BHOMA. CONCLUSIONS: We applied an innovative approach to evaluate a complex intervention in low-income settings, exploring empirically how systems thinking can be applied in the context of health system strengthening. Although the intervention had some positive outcomes by employing system-wide approaches, we also noted unintended consequences.
RCT Entities:
RATIONALE, AIMS AND OBJECTIVES: Strong health systems are said to be paramount to achieving effective and equitable health care. The World Health Organization has been advocating for using system-wide approaches such as 'systems thinking' to guide intervention design and evaluation. In this paper we report the system-wide effects of a complex health system intervention in Zambia known as Better Health Outcome through Mentorship and Assessment (BHOMA) that aimed to improve service quality. METHODS: We conducted a qualitative study in three target districts. We used a systems thinking conceptual framework to guide the analysis focusing on intended and unintended consequences of the intervention. NVivo version 10 was used for data analysis. RESULTS: The addressed community responded positively to the BHOMA intervention. The indications were that in the short term there was increased demand for services but the health worker capacity was not severely affected. This means that the prediction that service demand would increase with implementation of BHOMA was correct and the workload also increased, but the help of clinic lay supporters meant that some of the work of clinicians was transferred to these lay workers. However, from a systems perspective, unintended consequences also occurred during the implementation of the BHOMA. CONCLUSIONS: We applied an innovative approach to evaluate a complex intervention in low-income settings, exploring empirically how systems thinking can be applied in the context of health system strengthening. Although the intervention had some positive outcomes by employing system-wide approaches, we also noted unintended consequences.
Authors: Sarah Gimbel; Moses Mwanza; Marie Paul Nisingizwe; Cathy Michel; Lisa Hirschhorn Journal: BMC Health Serv Res Date: 2017-12-21 Impact factor: 2.655
Authors: Anatole Manzi; Lisa R Hirschhorn; Kenneth Sherr; Cindy Chirwa; Colin Baynes; John Koku Awoonor-Williams Journal: BMC Health Serv Res Date: 2017-12-21 Impact factor: 2.655
Authors: Joan T Price; Benjamin H Chi; Winifreda M Phiri; Helen Ayles; Namwinga Chintu; Roma Chilengi; Jeffrey S A Stringer; Wilbroad Mutale Journal: PLoS One Date: 2018-09-07 Impact factor: 3.240
Authors: Wilbroad Mutale; Samuel Bosomprah; Perfect Shankalala; Oliver Mweemba; Roma Chilengi; Sharon Kapambwe; Charles Chishimba; Mulenga Mukanu; Daniel Chibutu; Douglas Heimburger Journal: PLoS One Date: 2018-08-23 Impact factor: 3.240