Strengthening the quality of paediatric primary care: Protocol for the process evaluation of a health systems intervention in South Africa

Jamie Murdoch; Robyn Curran; Max Bachmann; Eric Bateman; Ruth Vania Cornick; Tanya Doherty; Sandra Claire Picken; Makhosazana Lungile Simelane; Lara Fairall

doi:10.1136/bmjgh-2018-000945

Strengthening the quality of paediatric primary care: Protocol for the process evaluation of a health systems intervention in South Africa

Jamie Murdoch^*, Robyn Curran, Max Bachmann, Eric Bateman, Ruth Vania Cornick, Tanya Doherty, Sandra Claire Picken, Makhosazana Lungile Simelane, Lara Fairall

^*Corresponding author for this work

Population Health Sciences

Research output: Contribution to journal › Article › peer-review

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Abstract

Background Despite significant reductions in mortality, preventable and treatable conditions remain the leading causes of death in children under five within South Africa. The WHO's Integrated Management of Childhood Illness (IMCI) programme has been widely implemented to address the most common causes of mortality in children under five. Although effective, limitations in IMCI scope and adherence have emerged. The Practical Approach to Care Kit (PACK) Child guide has been developed to expand on IMCI and address these limitations. It is intended as a clinical decision support tool for health workers with additional systems strengthening components, including active implementation and training strategy to address contextual and organisational factors hindering quality of care for children. Implementation is complex, requiring comprehensive pilot and process evaluation. The PACK Child pilot and feasibility study will sample 10 primary care facilities in the Western Cape Province. Staff will be trained to integrate the PACK Child guide into routine practice. The process evaluation will investigate implementation and health systems components to establish how to optimise delivery, strengthen IMCI principles and factors required to support effective and sustained uptake into everyday practice. Methods Mixed method process evaluation. Qualitative data include interviews with managers, staff, caregivers and policymakers; observations of training, consultations and clinic flow. Quantitative data include training logs and staff questionnaires. Quantitative and qualitative analysis will be integrated to describe study sites and develop explanations for implementation variation. Discussion The process evaluation will provide the opportunity to document implementation and refine the programme prior to a larger pragmatic trial or scale-up.

Original language	English
Article number	e000945
Journal	BMJ Global Health
Volume	3
DOIs	https://doi.org/10.1136/bmjgh-2018-000945
Publication status	Published - Oct 2018

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title = "Strengthening the quality of paediatric primary care: Protocol for the process evaluation of a health systems intervention in South Africa",

abstract = "Background Despite significant reductions in mortality, preventable and treatable conditions remain the leading causes of death in children under five within South Africa. The WHO's Integrated Management of Childhood Illness (IMCI) programme has been widely implemented to address the most common causes of mortality in children under five. Although effective, limitations in IMCI scope and adherence have emerged. The Practical Approach to Care Kit (PACK) Child guide has been developed to expand on IMCI and address these limitations. It is intended as a clinical decision support tool for health workers with additional systems strengthening components, including active implementation and training strategy to address contextual and organisational factors hindering quality of care for children. Implementation is complex, requiring comprehensive pilot and process evaluation. The PACK Child pilot and feasibility study will sample 10 primary care facilities in the Western Cape Province. Staff will be trained to integrate the PACK Child guide into routine practice. The process evaluation will investigate implementation and health systems components to establish how to optimise delivery, strengthen IMCI principles and factors required to support effective and sustained uptake into everyday practice. Methods Mixed method process evaluation. Qualitative data include interviews with managers, staff, caregivers and policymakers; observations of training, consultations and clinic flow. Quantitative data include training logs and staff questionnaires. Quantitative and qualitative analysis will be integrated to describe study sites and develop explanations for implementation variation. Discussion The process evaluation will provide the opportunity to document implementation and refine the programme prior to a larger pragmatic trial or scale-up.",

author = "Jamie Murdoch and Robyn Curran and Max Bachmann and Eric Bateman and Cornick, {Ruth Vania} and Tanya Doherty and Picken, {Sandra Claire} and Simelane, {Makhosazana Lungile} and Lara Fairall",

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AU - Bachmann, Max

AU - Bateman, Eric

AU - Cornick, Ruth Vania

AU - Doherty, Tanya

AU - Picken, Sandra Claire

AU - Simelane, Makhosazana Lungile

AU - Fairall, Lara

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AB - Background Despite significant reductions in mortality, preventable and treatable conditions remain the leading causes of death in children under five within South Africa. The WHO's Integrated Management of Childhood Illness (IMCI) programme has been widely implemented to address the most common causes of mortality in children under five. Although effective, limitations in IMCI scope and adherence have emerged. The Practical Approach to Care Kit (PACK) Child guide has been developed to expand on IMCI and address these limitations. It is intended as a clinical decision support tool for health workers with additional systems strengthening components, including active implementation and training strategy to address contextual and organisational factors hindering quality of care for children. Implementation is complex, requiring comprehensive pilot and process evaluation. The PACK Child pilot and feasibility study will sample 10 primary care facilities in the Western Cape Province. Staff will be trained to integrate the PACK Child guide into routine practice. The process evaluation will investigate implementation and health systems components to establish how to optimise delivery, strengthen IMCI principles and factors required to support effective and sustained uptake into everyday practice. Methods Mixed method process evaluation. Qualitative data include interviews with managers, staff, caregivers and policymakers; observations of training, consultations and clinic flow. Quantitative data include training logs and staff questionnaires. Quantitative and qualitative analysis will be integrated to describe study sites and develop explanations for implementation variation. Discussion The process evaluation will provide the opportunity to document implementation and refine the programme prior to a larger pragmatic trial or scale-up.

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Strengthening the quality of paediatric primary care: Protocol for the process evaluation of a health systems intervention in South Africa

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