Cross-country analysis of contextual factors and implementation strategies in under-5 mortality reduction in six low- and middle-income countries 2000–2015
Abstract Background The Exemplars in Under-5 Mortality (U5M) was a multiple cases study of how six low- and middle-income countries (LMICs), Bangladesh, Ethiopia, Nepal, Peru, Rwanda, and Senegal, implemented health system-delivered evidence-based interventions (EBIs) to reduce U5M between 2000 and...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-02-01
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| Series: | BMC Pediatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12887-023-03906-5 |
| _version_ | 1797273150783750144 |
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| author | Agnes Binagwaho Amelia VanderZanden Patricia J. Garcia Fauzia Akhter Huda Mahesh Maskey Mohamadou Sall Felix Sayinzoga Raj Kumar Subedi Alula M. Teklu Kateri Donahoe Miriam Frisch Jovial Thomas Ntawukuriryayo Kelechi Udoh Lisa R. Hirschhorn |
| author_facet | Agnes Binagwaho Amelia VanderZanden Patricia J. Garcia Fauzia Akhter Huda Mahesh Maskey Mohamadou Sall Felix Sayinzoga Raj Kumar Subedi Alula M. Teklu Kateri Donahoe Miriam Frisch Jovial Thomas Ntawukuriryayo Kelechi Udoh Lisa R. Hirschhorn |
| author_sort | Agnes Binagwaho |
| collection | DOAJ |
| description | Abstract Background The Exemplars in Under-5 Mortality (U5M) was a multiple cases study of how six low- and middle-income countries (LMICs), Bangladesh, Ethiopia, Nepal, Peru, Rwanda, and Senegal, implemented health system-delivered evidence-based interventions (EBIs) to reduce U5M between 2000 and 2015 more effectively than others in their regions or with similar economic growth. Using implementation research, we conducted a cross-country analysis to compare decision-making pathways for how these countries chose, implemented, and adapted strategies for health system-delivered EBIs that mitigated or leveraged contextual factors to improve implementation outcomes in reducing amenable U5M. Methods The cross-country analysis was based on the hybrid mixed methods implementation research framework used to inform the country case studies. The framework included a common pathway of Exploration, Preparation, Implementation, Adaptation, and Sustainment (EPIAS). From the existing case studies, we extracted contextual factors which were barriers, facilitators, or determinants of strategic decisions; strategies to implement EBIs; and implementation outcomes including acceptability and coverage. We identified common factors and strategies shared by countries, and individual approaches used by countries reflecting differences in contextual factors and goals. Results We found the six countries implemented many of the same EBIs, often using similar strategies with adaptations to local context and disease burden. Common implementation strategies included use of data by decision-makers to identify problems and prioritize EBIs, determine implementation strategies and their adaptation, and measure outcomes; leveraging existing primary healthcare systems; and community and stakeholder engagement. We also found common facilitators included culture of donor and partner coordination and culture and capacity of data use, while common barriers included geography and culture and beliefs. We found evidence for achieving implementation outcomes in many countries and EBIs including acceptability, coverage, equity, and sustainability. Discussion We found all six countries used a common pathway to implementation with a number of strategies common across EBIs and countries which contributed to progress, either despite contextual barriers or by leveraging facilitators. The transferable knowledge from this cross-country study can be used by other countries to more effectively implement EBIs known to reduce amenable U5M and contribute to strengthening health system delivery now and in the future. |
| first_indexed | 2024-03-07T14:40:30Z |
| format | Article |
| id | doaj.art-20fe93d4a4bd49ab9693004c630d3dd5 |
| institution | Directory Open Access Journal |
| issn | 1471-2431 |
| language | English |
| last_indexed | 2024-03-07T14:40:30Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pediatrics |
| spelling | doaj.art-20fe93d4a4bd49ab9693004c630d3dd52024-03-05T20:23:25ZengBMCBMC Pediatrics1471-24312024-02-0123S112010.1186/s12887-023-03906-5Cross-country analysis of contextual factors and implementation strategies in under-5 mortality reduction in six low- and middle-income countries 2000–2015Agnes Binagwaho0Amelia VanderZanden1Patricia J. Garcia2Fauzia Akhter Huda3Mahesh Maskey4Mohamadou Sall5Felix Sayinzoga6Raj Kumar Subedi7Alula M. Teklu8Kateri Donahoe9Miriam Frisch10Jovial Thomas Ntawukuriryayo11Kelechi Udoh12Lisa R. Hirschhorn13University of Global Health EquityUniversity of Global Health EquitySchool of Public Health at Cayetano Heredia Universityicddr,bNepal Public Health FoundationThe Cheikh Anta Diop UniversityRwanda Biomedical CenterNepal Public Health FoundationMERQ Consultancy PLCUniversity of Global Health EquityUniversity of Global Health EquityUniversity of Global Health EquityUniversity of Global Health EquityUniversity of Global Health EquityAbstract Background The Exemplars in Under-5 Mortality (U5M) was a multiple cases study of how six low- and middle-income countries (LMICs), Bangladesh, Ethiopia, Nepal, Peru, Rwanda, and Senegal, implemented health system-delivered evidence-based interventions (EBIs) to reduce U5M between 2000 and 2015 more effectively than others in their regions or with similar economic growth. Using implementation research, we conducted a cross-country analysis to compare decision-making pathways for how these countries chose, implemented, and adapted strategies for health system-delivered EBIs that mitigated or leveraged contextual factors to improve implementation outcomes in reducing amenable U5M. Methods The cross-country analysis was based on the hybrid mixed methods implementation research framework used to inform the country case studies. The framework included a common pathway of Exploration, Preparation, Implementation, Adaptation, and Sustainment (EPIAS). From the existing case studies, we extracted contextual factors which were barriers, facilitators, or determinants of strategic decisions; strategies to implement EBIs; and implementation outcomes including acceptability and coverage. We identified common factors and strategies shared by countries, and individual approaches used by countries reflecting differences in contextual factors and goals. Results We found the six countries implemented many of the same EBIs, often using similar strategies with adaptations to local context and disease burden. Common implementation strategies included use of data by decision-makers to identify problems and prioritize EBIs, determine implementation strategies and their adaptation, and measure outcomes; leveraging existing primary healthcare systems; and community and stakeholder engagement. We also found common facilitators included culture of donor and partner coordination and culture and capacity of data use, while common barriers included geography and culture and beliefs. We found evidence for achieving implementation outcomes in many countries and EBIs including acceptability, coverage, equity, and sustainability. Discussion We found all six countries used a common pathway to implementation with a number of strategies common across EBIs and countries which contributed to progress, either despite contextual barriers or by leveraging facilitators. The transferable knowledge from this cross-country study can be used by other countries to more effectively implement EBIs known to reduce amenable U5M and contribute to strengthening health system delivery now and in the future.https://doi.org/10.1186/s12887-023-03906-5Under-5 mortalityImplementation researchEvidence-based interventionsAmenable mortalityLow- and middle-income countriesImplementation strategies |
| spellingShingle | Agnes Binagwaho Amelia VanderZanden Patricia J. Garcia Fauzia Akhter Huda Mahesh Maskey Mohamadou Sall Felix Sayinzoga Raj Kumar Subedi Alula M. Teklu Kateri Donahoe Miriam Frisch Jovial Thomas Ntawukuriryayo Kelechi Udoh Lisa R. Hirschhorn Cross-country analysis of contextual factors and implementation strategies in under-5 mortality reduction in six low- and middle-income countries 2000–2015 BMC Pediatrics Under-5 mortality Implementation research Evidence-based interventions Amenable mortality Low- and middle-income countries Implementation strategies |
| title | Cross-country analysis of contextual factors and implementation strategies in under-5 mortality reduction in six low- and middle-income countries 2000–2015 |
| title_full | Cross-country analysis of contextual factors and implementation strategies in under-5 mortality reduction in six low- and middle-income countries 2000–2015 |
| title_fullStr | Cross-country analysis of contextual factors and implementation strategies in under-5 mortality reduction in six low- and middle-income countries 2000–2015 |
| title_full_unstemmed | Cross-country analysis of contextual factors and implementation strategies in under-5 mortality reduction in six low- and middle-income countries 2000–2015 |
| title_short | Cross-country analysis of contextual factors and implementation strategies in under-5 mortality reduction in six low- and middle-income countries 2000–2015 |
| title_sort | cross country analysis of contextual factors and implementation strategies in under 5 mortality reduction in six low and middle income countries 2000 2015 |
| topic | Under-5 mortality Implementation research Evidence-based interventions Amenable mortality Low- and middle-income countries Implementation strategies |
| url | https://doi.org/10.1186/s12887-023-03906-5 |
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