scholarly journals Programme theory and linked intervention strategy for large-scale change to improve hospital care in a low and middle-income country - A Study Pre-Protocol

2020 ◽  
Vol 5 ◽  
pp. 265
Author(s):  
Mike English ◽  
Jacinta Nzinga ◽  
Grace Irimu ◽  
David Gathara ◽  
Jalemba Aluvaala ◽  
...  
Keyword(s):  
Hospital Care ◽  
Large Scale ◽  
Intervention Strategy ◽  
Poor Quality ◽  
Programme Theory ◽  
Middle Income ◽  
Care Services ◽  
Scale Change ◽  
Large Scale Change ◽  
Low And Middle Income

In low and middle-income countries (LMIC) general hospitals are important for delivering some key acute care services. Neonatal care is emblematic of these acute services as averting deaths requires skilled care over many days from multiple professionals with at least basic equipment. However, hospital care is often of poor quality and large-scale change is needed to improve outcomes. However, achieving large scale change in health systems remains challenging. To set the scene we first characterise the problems of hospital newborn units (NBU) in Kenya. We then combine our understanding of theory and context with reflection on our own position as an embedded research group with no formal authority to help us propose a feasible intervention strategy linked to in initial programme theory. We explain this programme theory and suggest how within a multi-level clinical professional network leaders at the ward or mid-level of hospital hierarchies are key potential change agents. In support of our programme theory we briefly outline and seek to integrate key ideas drawn from a wider set of theories. We propose how an intervention might be developed and employed in a phased approach to create the ownership, relationships and momentum that will be needed to achieve change at scale. Finally, we discuss the implications of such a strategy for our research design that is based on a prospective, in-depth case study that includes quantitative and qualitative data collection linked to specific sub-studies. We suggest using Realistic Evaluation to integrate our findings and develop an updated programme theory that should inform future large-scale change efforts before briefly discussing some of the challenges of evaluating a network as an intervention

scholarly journals Programme theory and linked intervention strategy for large-scale change to improve hospital care in a low and middle-income country - A Study Pre-Protocol

2020 ◽  
Vol 5 ◽  
pp. 265
Author(s):  
Mike English ◽  
Jacinta Nzinga ◽  
Grace Irimu ◽  
David Gathara ◽  
Jalemba Aluvaala ◽  
...  
Keyword(s):  
Hospital Care ◽  
Large Scale ◽  
Intervention Strategy ◽  
Neonatal Care ◽  
Programme Theory ◽  
Middle Income ◽  
Research Activities ◽  
Scale Change ◽  
Large Scale Change ◽  
Low And Middle Income

In low and middle-income countries (LMIC) general hospitals are important for delivering some key acute care services. Neonatal care is emblematic of these acute services as averting deaths requires skilled care over many days from multiple professionals with at least basic equipment. However, hospital care is often of poor quality and large-scale change is needed to improve outcomes. In this manuscript we aim to show how we have drawn upon our understanding of contexts of care in Kenyan general hospital NBUs, and on social and behavioural theories that offer potential mechanisms of change in these settings, to develop an initial programme theory guiding a large scale change intervention to improve neonatal care and outcomes.  Our programme theory is an expression of our assumptions about what actions will be both useful and feasible.  It incorporates a recognition of our strengths and limitations as a research-practitioner partnership to influence change. The steps we employ represent the initial programme theory development phase commonly undertaken in many Realist Evaluations. However, unlike many Realist Evaluations that develop initial programme theories focused on pre-existing interventions or programmes, our programme theory informs the design of a new intervention that we plan to execute. Within this paper we articulate briefly how we propose to operationalise this new intervention. Finally, we outline the quantitative and qualitative research activities that we will use to address specific questions related to the delivery and effects of this new intervention, discussing some of the challenges of such study designs. We intend that this research on the intervention will inform future efforts to revise the programme theory and yield transferable learning.

Partnerships Generate Co-Benefits in Agricultural Stream Restoration (Canterbury, New Zealand)

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Catherine M. Febria ◽  
Maggie Bayfield ◽  
Kathryn E. Collins ◽  
Hayley S. Devlin ◽  
Brandon C. Goeller ◽  
...  
Keyword(s):  
New Zealand ◽  
Large Scale ◽  
Agricultural Land ◽  
Indigenous Rights ◽  
Freshwater Ecosystem ◽  
Reduced Pressure ◽  
Ecosystem Integrity ◽  
Riparian Management ◽  
Scale Change ◽  
Large Scale Change

In Aotearoa New Zealand, agricultural land-use intensification and decline in freshwater ecosystem integrity pose complex challenges for science and society. Despite riparian management programmes across the country, there is frustration over a lack in widespread uptake, upfront financial costs, possible loss in income, obstructive legislation and delays in ecological recovery. Thus, social, economic and institutional barriers exist when implementing and assessing agricultural freshwater restoration. Partnerships are essential to overcome such barriers by identifying and promoting co-benefits that result in amplifying individual efforts among stakeholder groups into coordinated, large-scale change. Here, we describe how initial progress by a sole farming family at the Silverstream in the Canterbury region, South Island, New Zealand, was used as a catalyst for change by the Canterbury Waterway Rehabilitation Experiment, a university-led restoration research project. Partners included farmers, researchers, government, industry, treaty partners (Indigenous rights-holders) and practitioners. Local capacity and capability was strengthened with practitioner groups, schools and the wider community. With partnerships in place, co-benefits included lowered costs involved with large-scale actions (e.g., earth moving), reduced pressure on individual farmers to undertake large-scale change (e.g., increased participation and engagement), while also legitimising the social contracts for farmers, scientists, government and industry to engage in farming and freshwater management. We describe contributions and benefits generated from the project and describe iterative actions that together built trust, leveraged and aligned opportunities. These actions were scaled from a single farm to multiple catchments nationally.

scholarly journals Large-Scale Food Fortification and Biofortification in Low- and Middle-Income Countries: A Review of Programs, Trends, Challenges, and Evidence Gaps

2018 ◽  
Vol 39 (2) ◽  
pp. 315-331 ◽  
Author(s):  
Saskia J. M. Osendarp ◽  
Homero Martinez ◽  
Greg S. Garrett ◽  
Lynnette M. Neufeld ◽  
Luz Maria De-Regil ◽  
...  
Keyword(s):  
Large Scale ◽  
Food System ◽  
Food Fortification ◽  
Micronutrient Deficiencies ◽  
Middle Income ◽  
Middle Income Countries ◽  
Essential Components ◽  
Quality Of Delivery ◽  
And Control ◽  
Low And Middle Income

Background: Food fortification and biofortification are well-established strategies to address micronutrient deficiencies in vulnerable populations. However, the effectiveness of fortification programs is not only determined by the biological efficacy of the fortified foods but also by effective and sustainable implementation, which requires continual monitoring, quality assurance and control, and corrective measures to ensure high compliance. Objective: To provide an overview of efficacy, effectiveness, economics of food fortification and biofortification, and status of and challenges faced by large-scale food fortification programs in low- and middle-income countries (LMIC). Methods: A literature review of PubMed publications in English from 2000 to 2017, as well as gray literature, targeting nongovernmental organizations whose work focuses on this topic, complemented by national reports and a “snowball” process of citation searching. The article describes remaining technical challenges, barriers, and evidence gap and prioritizes recommendations and next steps to further accelerate progress and potential of impact. Results: The review identifies and highlights essential components of successful programs. It also points out issues that determine poor program performance, including lack of adequate monitoring and enforcement and poor compliance with standards by industry. Conclusions: In the last 17 years, large-scale food fortification initiatives have been reaching increasingly larger segments of populations in LMIC. Large-scale food fortification and biofortification should be part of other nutrition-specific and nutrition-sensitive efforts to prevent and control micronutrient deficiencies. There are remaining technical and food system challenges, especially in relation to improving coverage and quality of delivery and measuring progress of national programs.

The ten essentials of large-scale change

2009 ◽  
Vol 15 (12) ◽  
pp. 580-585 ◽  
Author(s):  
Ruth Kennedy ◽  
Melanie Lawless ◽  
Beverley Slater
Keyword(s):  
Large Scale ◽  
Scale Change ◽  
Large Scale Change
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