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| Content Provider | Springer Nature : BioMed Central |
|---|---|
| Author | Zulu, Joseph Mumba Maritim, Patricia Halwiindi, Hikabasa Chavula, Malizgani Paul Munakampe, Margarate Matenga, Tulani Francis L. Mweemba, Chris Sinyangwe, Ntazana N. Habib, Batuli Musukuma, Mwiche Silumbwe, Adam Wang, Bo Kaonga, Patrick Chewe, Mwimba Fisa, Ronald Banda, Jeremiah Mubanga, Angel Phiri, Henry |
| Abstract | Background Decentralized management approaches for multi-drug-resistant tuberculosis (MDR TB) have shown improved treatment outcomes in patients. However, challenges remain in the delivery of decentralized MDR TB services. Further, implementation strategies for effectively delivering the services in community health systems (CHSs) in low-resource settings have not been fully described, as most strategies are known and effective in high-income settings. Our research aimed to delineate the specific implementation strategies employed in managing MDR TB in Zambia. Methods Our qualitative case study involved 112 in-depth interviews with a diverse group of participants, including healthcare workers, community health workers, patients, caregivers, and health managers in nine districts. We categorized implementation strategies using the Expert Recommendations for Implementing Change (ERIC) compilation and later grouped them into three CHS lenses: programmatic, relational, and collective action. Results The programmatic lens comprised four implementation strategies: (1) changing infrastructure through refurbishing and expanding health facilities to accommodate management of MDR TB, (2) adapting and tailoring clinical and diagnostic services to the context through implementing tailored strategies, (3) training and educating health providers through ongoing training, and (4) using evaluative and iterative strategies to review program performance, which involved development and organization of quality monitoring systems, as well as audits. Relational lens strategies were (1) providing interactive assistance through offering local technical assistance in clinical expert committees and (2) providing support to clinicians through developing health worker and community health worker outreach teams. Finally, the main collective action lens strategy was engaging consumers; the discrete strategies were increasing demand using community networks and events and involving patients and family members. Conclusion This study builds on the ERIC implementation strategies by stressing the need to fully consider interrelations or embeddedness of CHS strategies during implementation processes. For example, to work effectively, the programmatic lens strategies need to be supported by strategies that promote meaningful community engagement (the relational lens) and should be attuned to strategies that promote community mobilization (collective action lens). |
| Related Links | https://archpublichealth.biomedcentral.com/counter/pdf/10.1186/s13690-024-01384-4.pdf |
| Ending Page | 14 |
| Page Count | 14 |
| Starting Page | 1 |
| File Format | HTM / HTML |
| ISSN | 20493258 |
| DOI | 10.1186/s13690-024-01384-4 |
| Journal | Archives of Public Health |
| Issue Number | 1 |
| Volume Number | 82 |
| Language | English |
| Publisher | BioMed Central |
| Publisher Date | 2024-09-14 |
| Access Restriction | Open |
| Subject Keyword | Public Health Medicine Health Policy Health Services Research Health Informatics Implementation strategies Community health systems Zambia Medicine/Public Health |
| Content Type | Text |
| Resource Type | Article |
| Subject | Public Health, Environmental and Occupational Health |
| Journal Impact Factor | 3.2/2023 |
| 5-Year Journal Impact Factor | 3.3/2023 |
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