TY - JOUR
T1 - Implementation research to support bangladesh ministry of health and family welfare to implement its national guidelines for management of infections in young infants in two rural districts
AU - Ahmed, Salahuddin
AU - Applegate, Jennifer A.
AU - Mitra, Dipak K.
AU - Callaghan, Jennifer
AU - Mousumi, Mahfuza
AU - Khan, Ahad Mahmud
AU - Joarder, Taufique
AU - Harrison, Meagan
AU - Ahmed, Sabbir
AU - Begum, Nazma
AU - Quaiyum, Abdul
AU - George, Joby
AU - Baqui, Abdullah H.
N1 - Funding Information:
This study was supported by United States Agency for International Development (USAID) through the Health Research Challenge for Impact (HRCI) Cooperative Agreement (#GHS-A-00-09-00004-00). The contents are the responsibility of the authors and do not necessarily reflect the views of USAID or the United States Government.
Publisher Copyright:
© 2019 The Author(s).
PY - 2019/12/6
Y1 - 2019/12/6
N2 - Background: World Health Organization revised the global guidelines for management of possible serious bacterial infection (PSBI) in young infants to recommend the use of simplified antibiotic therapy in settings where access to hospital care is not possible. The Bangladesh Ministry of Health and Family Welfare (MoHFW), Government of Bangladesh (GOB) adopted these guidelines, allowing treatment at first-level facilities. During the first year of implementation, the Projahnmo Study Group and USAID/MaMoni Health Systems Strengthening (HSS) Project supported the MoHFW to operationalize the new guidelines and conducted an implementation research study in selected districts to assess challenges and identify solutions to facilitate scale-up across the country. Implementation support: Projahnmo and MaMoni HSS teams supported implementation in three areas: building capacity, strengthening service delivery, and mobilizing communities. Capacity building focused on training paramedics to conduct outpatient management of PSBI cases and developing monitoring and supervision systems. The teams also filled gaps in government supply of essential drugs, equipment, and logistics. Community mobilization strategies to promote care-seeking and referrals to facilities varied across districts; in one district community, health workers made home visits while in another district, the promotion was carried out through community volunteers, village doctors, and through existing community structures. Methods: We followed a plan-do-study-Act (PDSA) cycle to identify and address implementation challenges. Three cycles-1 every 4 months-were conducted. We collected data utilizing quantitative and qualitative methods in both the community and facilities. The total sample size for this study was 13,590. Discussion: This article provides implementation research design details for program managers intending to implement new guidelines on management of young infant infections. Results of this research will be reported in the forthcoming papers. Preliminary findings indicate that the management of PSBI cases at the UH&FWCs is feasible. However, MoHFW, GOB needs to address the implementation challenges before scale-up of this policy to the national level.
AB - Background: World Health Organization revised the global guidelines for management of possible serious bacterial infection (PSBI) in young infants to recommend the use of simplified antibiotic therapy in settings where access to hospital care is not possible. The Bangladesh Ministry of Health and Family Welfare (MoHFW), Government of Bangladesh (GOB) adopted these guidelines, allowing treatment at first-level facilities. During the first year of implementation, the Projahnmo Study Group and USAID/MaMoni Health Systems Strengthening (HSS) Project supported the MoHFW to operationalize the new guidelines and conducted an implementation research study in selected districts to assess challenges and identify solutions to facilitate scale-up across the country. Implementation support: Projahnmo and MaMoni HSS teams supported implementation in three areas: building capacity, strengthening service delivery, and mobilizing communities. Capacity building focused on training paramedics to conduct outpatient management of PSBI cases and developing monitoring and supervision systems. The teams also filled gaps in government supply of essential drugs, equipment, and logistics. Community mobilization strategies to promote care-seeking and referrals to facilities varied across districts; in one district community, health workers made home visits while in another district, the promotion was carried out through community volunteers, village doctors, and through existing community structures. Methods: We followed a plan-do-study-Act (PDSA) cycle to identify and address implementation challenges. Three cycles-1 every 4 months-were conducted. We collected data utilizing quantitative and qualitative methods in both the community and facilities. The total sample size for this study was 13,590. Discussion: This article provides implementation research design details for program managers intending to implement new guidelines on management of young infant infections. Results of this research will be reported in the forthcoming papers. Preliminary findings indicate that the management of PSBI cases at the UH&FWCs is feasible. However, MoHFW, GOB needs to address the implementation challenges before scale-up of this policy to the national level.
KW - Implementation research
KW - Outpatient management; Bangladesh
KW - Possible serious bacterial infection
KW - Young infant infection
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U2 - 10.1186/s41043-019-0200-6
DO - 10.1186/s41043-019-0200-6
M3 - Article
C2 - 31810496
AN - SCOPUS:85076204715
SN - 1606-0997
VL - 38
JO - Journal of Health, Population and Nutrition
JF - Journal of Health, Population and Nutrition
IS - 1
M1 - 41
ER -