Abstract
BackgroundGlobal guidance can help countries strengthen their health systems to deliver effective interventions to their populations. However, to have an impact, guidance needs to be contextualised or adapted to local settings; this process includes consideration of health system arrangements and political system factors. To date, methods to support contextualisation do not exist. In response, a workbook was designed to provide specific methods and strategies to enable the contextualisation of WHO’s ‘Optimizing health worker roles to improve maternal and newborn health’ (OptimizeMNH) guidance at the national or subnational level. The objective of this study was to describe the process of developing the workbook and identify key steps of the development process, barriers that arose and facilitators that helped overcome some of these barriers.MethodsA qualitative single case study design was carried out. Interviews, documents and a reflexive journal were used. Constant comparison and an edit-style of organisation were used during data analysis to develop concepts, themes, subthemes and relationships among them.ResultsThirteen interviews were conducted and 52 documents were reviewed. Three main steps were identified in the process of developing the workbook for health systems guidance contextualisation, namely (1) determining the need for and gaining approval to develop the workbook, (2) developing the workbook (taking on the task, creating the structure of the workbook, operationalising its components, undergoing approval processes and editing it), and (3) implementing the workbook both at the WHO level and at the national/subnational level.Five barriers and/or facilitators emerged relevant to each step, namely (1) having well-placed and credible champions, (2) creating and capitalising on opportunities, (3) finding the right language to engage various actors and obtain buy-in, (4) obtaining and maintaining meaningful buy-in, and (5) ensuring access to resources.ConclusionsUnderstanding the key steps and the critical factors involved in the process of developing the workbook could help in the planning of similar and other tools aimed to support the implementation of WHO guidance. A plan for dissemination and implementation needs to be addressed during the preparation of these tools.
Highlights
Global guidance can help countries strengthen their health systems to deliver effective interventions to their populations
For the purposes of this study, participants are described as belonging to one of three categories, namely members of the Secretariat of the guidance panel on task shifting, staff of WHO not part of the Secretariat of the guidance panel on task shifting (3 participants), or health system and policy analysts (7 participants)
The key steps and critical factors found through this study would help in the planning of other tools at WHO
Summary
Global guidance can help countries strengthen their health systems to deliver effective interventions to their populations. Many low-resource and effective clinical and public health interventions (e.g. immunisations, kangaroo mother care for low birthweight infants) are not reaching people who need them most, especially in low- and middle-income countries (LMICs), because of fragmented and overburdened health systems [1,2,3,4]. This leads to the inability to implement evidence-based guideline recommendations. Bollini et al [7] showed that the content of policies around HIV prevention in prisons in four different settings varied and reflected the thinking and strategies of HIV prevention and care in their respective communities despite the availability of international guidelines on this topic
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