Assessing the Integrated Community-Based Health Systems Strengthening initiative in northern Togo: a pragmatic effectiveness-implementation study protocol.

Autor: Lauria ME; Community Health Systems Lab, Integrate Health/Santé Intégrée, Kara, Togo. mlauria@integratehealth.org., Fiori KP; Community Health Systems Lab, Integrate Health/Santé Intégrée, Kara, Togo.; Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA.; Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA., Jones HE; CUNY Graduate School of Public Health & Health Policy, New York, USA., Gbeleou S; Integrate Health/Santé Intégrée, Kara, Togo., Kenkou K; Integrate Health/Santé Intégrée, Kara, Togo., Agoro S; Kara Regional Health Department, Ministry of Health and Public Hygiene, Kara, Togo., Agbèrè AD; Department of Pediatrics, Health Sciences Faculty, University of Lomé, Lomé, Togo.; Department of Pediatrics, Regional Hospital, Lomé-Commune, Lomé, Togo., Lue KD; Community Health Systems Lab, Integrate Health/Santé Intégrée, Kara, Togo., Hirschhorn LR; Community Health Systems Lab, Integrate Health/Santé Intégrée, Kara, Togo.; Northwestern University Feinberg School of Medicine, Chicago, USA.
Jazyk: angličtina
Zdroj: Implementation science : IS [Implement Sci] 2019 Oct 16; Vol. 14 (1), pp. 92. Date of Electronic Publication: 2019 Oct 16.
DOI: 10.1186/s13012-019-0921-3
Abstrakt: Background: Over the past decade, prevalence of maternal and child morbidity and mortality in Togo, particularly in the northern regions, has remained high despite global progress. The causes of under-five child mortality in Togo are diseases with effective and low-cost prevention and/or treatment strategies, including malaria, acute lower respiratory infections, and diarrheal diseases. While Togo has a national strategy for implementing the integrated management of childhood illness (IMCI) guidelines, including a policy on integrated community case management (iCCM), challenges in implementation and low public sector health service utilization persist. There are critical gaps to access and quality of community health systems throughout the country. An integrated facility- and community-based initiative, the Integrated Community-Based Health Systems Strengthening (ICBHSS) initiative, seeks to address these gaps while strengthening the public sector health system in northern Togo. This study aims to evaluate the effect and implementation strategy of the ICBHSS initiative over 48 months in the catchment areas of 21 public sector health facilities.
Methods: The ICBHSS model comprises a bundle of evidence-based interventions targeting children under five, women of reproductive age, and people living with HIV through (1) community engagement and feedback; (2) elimination of point-of-care costs; (3) proactive community-based IMCI using community health workers (CHWs) with additional services including family planning, HIV testing, and referrals; (4) clinical mentoring and enhanced supervision; and (5) improved supply chain management and facility structures. Using a pragmatic type II hybrid effectiveness-implementation study, we will evaluate the ICBHSS initiative with two primary aims: (1) determine effectiveness through changes in under-five mortality rates and (2) assess the implementation strategy through measures of reach, adoption, implementation, and maintenance. We will conduct a mixed-methods assessment using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. This assessment consists of four components: (1) a stepped-wedge cluster randomized control trial using a community-based household survey, (2) annual health facility assessments, (3) key informant interviews, and (4) costing and return-on-investment assessments for each randomized cluster.
Discussion: Our research is expected to contribute to continuous quality improvement initiatives, optimize implementation factors, provide knowledge regarding health service delivery, and accelerate health systems improvements in Togo and more broadly.
Trial Registration: ClinicalTrials.gov , NCT03694366 , registered 3 October 2018.
Databáze: MEDLINE
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