Daka Dawit Wolde, Wordofa Muluemebet Abera, Woldie Mirkuzie
Faculty of Public Health, Department of Health Policy and Management, Jimma University, Jimma, Ethiopia.
Faculty of Public Health, Department of Population and Family Health, Jimma University, Jimma, Ethiopia.
BMC Health Serv Res. 2025 May 16;25(1):710. doi: 10.1186/s12913-025-12863-x.
Improving quality of sick child care is the primary aim of Integrated Community Case Management services and implementation fidelity is critical to translating an evidence-based intervention to practice. A community-based complex intervention was implemented at the health posts of four agrarian regions of Ethiopia from 2017 to 2018 to improve the coverage and utilization of quality child health services. This study aimed to examine the implementation status of child health care quality improvement interventions in program areas of Oromia region, Ethiopia.
A case study design using quantitative and qualitative research methods was conducted from September to October 2018. Implementation data were collected using observations, document reviews, and program staff interviews. Program staffs including health extension workers and their supervisors were included in surveys, and purposefully selected key informants from health posts to zonal health office level were included in the qualitative component of the research. The analysis framework was focused on the fidelity of the interventions' content, frequency, duration, and coverage, as well as the potential moderating factors of implementation using the model proposed by Carroll et al. conceptual framework for implementation fidelity.
Performance Review Clinical Mentoring was implemented according to the plan (every 6 months) in all of the districts and around nine in ten (88%) of the core contents were implemented. Though mentoring was provided by trained mentors, the duration of mentoring was less than the plan to fully implement all of the core activities. Overall, the mentoring program has reached 88% of health extension workers. Slightly greater than three-fourths of health extension workers have been supervised (76%) according to the plan and 80% of health posts were supplied with required iCCM medicines regularly. Staff turnover, topographical challenges, lack of transportation, competing priorities, weak support and feedback from the District health office, and security problems were frequently mentioned challenges to implementation. Whereas, the existence of continual partner support, the presence of integration and coordination of activities, and changes observed were the facilitators of implementation.
The implementation status of the Performance Review Clinical Mentoring Meeting was sufficient, while moderate adherence was observed in supportive supervision and supply of medicines. All of the providers were reached with sick children management training. Therefore, the implementation of community-based interventions should be aware of operational challenges in order to improve and sustain the program's performance.
提高患病儿童护理质量是综合社区病例管理服务的主要目标，实施保真度对于将循证干预措施转化为实践至关重要。2017年至2018年期间，在埃塞俄比亚四个农业地区的卫生站实施了一项基于社区的综合干预措施，以提高优质儿童保健服务的覆盖率和利用率。本研究旨在调查埃塞俄比亚奥罗米亚地区项目区儿童保健质量改进干预措施的实施状况。
2018年9月至10月采用定量和定性研究方法进行了案例研究设计。通过观察、文件审查和项目工作人员访谈收集实施数据。调查对象包括卫生推广工作者及其主管等项目工作人员，定性研究部分有目的地选取了从卫生站到地区卫生局各级的关键信息提供者。分析框架聚焦于干预措施的内容、频率、持续时间和覆盖范围的保真度，以及使用卡罗尔等人提出的模型的实施潜在调节因素，即实施保真度概念框架。
绩效评估临床指导按计划（每6个月一次）在所有地区实施，约十分之八（88%）的核心内容得到实施。虽然指导由经过培训的指导者提供，但指导持续时间少于全面实施所有核心活动的计划。总体而言，指导计划覆盖了88%的卫生推广工作者。略超过四分之三的卫生推广工作者按计划得到了监督（76%），80%的卫生站定期获得所需的综合社区病例管理药物。工作人员流动、地形挑战、交通不便、优先事项相互竞争、地区卫生局的支持和反馈薄弱以及安全问题是实施过程中经常提到的挑战。而持续的伙伴支持、活动的整合与协调以及观察到的变化是实施的促进因素。
绩效评估临床指导会议的实施状况良好，而在支持性监督和药物供应方面观察到适度的依从性。所有提供者都接受了患病儿童管理培训。因此，基于社区的干预措施的实施应意识到运营挑战，以提高和维持项目绩效。
