Health system readiness for innovation scale-up: the experience of community-based distribution of injectable contraceptives in Nigeria
Abstract Background Following the successful pilot of the community-based distribution of injectable contraceptives (CBDIC) by community health extension workers (CHEWs) in Gombe, northern Nigeria in 2010, there was a policy decision to scale-up the innovation to other parts of the country. However,...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-12-01
|
| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-019-4786-6 |
| _version_ | 1819173890130182144 |
|---|---|
| author | Oluwaseun Akinyemi Bronwyn Harris Mary Kawonga |
| author_facet | Oluwaseun Akinyemi Bronwyn Harris Mary Kawonga |
| author_sort | Oluwaseun Akinyemi |
| collection | DOAJ |
| description | Abstract Background Following the successful pilot of the community-based distribution of injectable contraceptives (CBDIC) by community health extension workers (CHEWs) in Gombe, northern Nigeria in 2010, there was a policy decision to scale-up the innovation to other parts of the country. However, there is limited understanding of health system factors that may facilitate or impede the successful scale-up of this innovation beyond the pilot site. Thus, this study assessed the health system readiness to deliver CBDIC in Nigeria and how this may influence the scale-up process. Methods This study was conducted in two Local Government Areas in Gombe State in September 2016. Seven key informant interviews were held with purposively sampled senior officials of the ministries of health at the federal and state levels as well as NGO program managers. Also, 10 in-depth interviews were carried out with health workers. All transcripts were analyzed using the thematic framework analysis approach. Result The availability of a policy framework that supports task-shifting and task-sharing, as well as application of evidence from the pilot programme and capacity building programmes for health workers provided a favourable environment for scale-up. Health system challenges for the scale-up process included insufficient community health workers, resistance to the task-shifting policy from professional health groups (who should support the CHEWs), limited funding and poor logistics management which affected commodity distribution and availability. However, there were also a number of health worker innovations which kept the scale-up going. Health workers sometimes used personal resources to make up for logistics failures and poor funding. They often modify the process in order to adapt to the realities on the ground. Conclusion This study shows health system weaknesses that may undermine scale-up of CBDIC. The study also highlights what happens when scale-up is narrowly focused on the intervention without considering system context, capacity and readiness. However, agency and discretionary decision-making among frontline health workers facilitated the process of scaling up, although the sustainability of this is questionable. Benefits observed during the pilot may not be realised on a larger scale if health system challenges are not addressed. |
| first_indexed | 2024-12-22T20:30:16Z |
| format | Article |
| id | doaj.art-a4ee3982b90241aabcc4bb2e6daddd1d |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-22T20:30:16Z |
| publishDate | 2019-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-a4ee3982b90241aabcc4bb2e6daddd1d2022-12-21T18:13:38ZengBMCBMC Health Services Research1472-69632019-12-0119111110.1186/s12913-019-4786-6Health system readiness for innovation scale-up: the experience of community-based distribution of injectable contraceptives in NigeriaOluwaseun Akinyemi0Bronwyn Harris1Mary Kawonga2Department of Health Policy and Management, College of Medicine, University of IbadanCentre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the WitwatersrandDepartment of Community Health, School of Public Health, Faculty of Health Sciences, University of the WitwatersrandAbstract Background Following the successful pilot of the community-based distribution of injectable contraceptives (CBDIC) by community health extension workers (CHEWs) in Gombe, northern Nigeria in 2010, there was a policy decision to scale-up the innovation to other parts of the country. However, there is limited understanding of health system factors that may facilitate or impede the successful scale-up of this innovation beyond the pilot site. Thus, this study assessed the health system readiness to deliver CBDIC in Nigeria and how this may influence the scale-up process. Methods This study was conducted in two Local Government Areas in Gombe State in September 2016. Seven key informant interviews were held with purposively sampled senior officials of the ministries of health at the federal and state levels as well as NGO program managers. Also, 10 in-depth interviews were carried out with health workers. All transcripts were analyzed using the thematic framework analysis approach. Result The availability of a policy framework that supports task-shifting and task-sharing, as well as application of evidence from the pilot programme and capacity building programmes for health workers provided a favourable environment for scale-up. Health system challenges for the scale-up process included insufficient community health workers, resistance to the task-shifting policy from professional health groups (who should support the CHEWs), limited funding and poor logistics management which affected commodity distribution and availability. However, there were also a number of health worker innovations which kept the scale-up going. Health workers sometimes used personal resources to make up for logistics failures and poor funding. They often modify the process in order to adapt to the realities on the ground. Conclusion This study shows health system weaknesses that may undermine scale-up of CBDIC. The study also highlights what happens when scale-up is narrowly focused on the intervention without considering system context, capacity and readiness. However, agency and discretionary decision-making among frontline health workers facilitated the process of scaling up, although the sustainability of this is questionable. Benefits observed during the pilot may not be realised on a larger scale if health system challenges are not addressed.https://doi.org/10.1186/s12913-019-4786-6Scale-upCommunity-based distribution of injectable contraceptivesHealth system readinessStakeholder collaboration |
| spellingShingle | Oluwaseun Akinyemi Bronwyn Harris Mary Kawonga Health system readiness for innovation scale-up: the experience of community-based distribution of injectable contraceptives in Nigeria BMC Health Services Research Scale-up Community-based distribution of injectable contraceptives Health system readiness Stakeholder collaboration |
| title | Health system readiness for innovation scale-up: the experience of community-based distribution of injectable contraceptives in Nigeria |
| title_full | Health system readiness for innovation scale-up: the experience of community-based distribution of injectable contraceptives in Nigeria |
| title_fullStr | Health system readiness for innovation scale-up: the experience of community-based distribution of injectable contraceptives in Nigeria |
| title_full_unstemmed | Health system readiness for innovation scale-up: the experience of community-based distribution of injectable contraceptives in Nigeria |
| title_short | Health system readiness for innovation scale-up: the experience of community-based distribution of injectable contraceptives in Nigeria |
| title_sort | health system readiness for innovation scale up the experience of community based distribution of injectable contraceptives in nigeria |
| topic | Scale-up Community-based distribution of injectable contraceptives Health system readiness Stakeholder collaboration |
| url | https://doi.org/10.1186/s12913-019-4786-6 |
| work_keys_str_mv | AT oluwaseunakinyemi healthsystemreadinessforinnovationscaleuptheexperienceofcommunitybaseddistributionofinjectablecontraceptivesinnigeria AT bronwynharris healthsystemreadinessforinnovationscaleuptheexperienceofcommunitybaseddistributionofinjectablecontraceptivesinnigeria AT marykawonga healthsystemreadinessforinnovationscaleuptheexperienceofcommunitybaseddistributionofinjectablecontraceptivesinnigeria |