'How to know what you need to do': a cross-country comparison of maternal health guidelines in Burkina Faso, Ghana and Tanzania

Implementation Science

Jaran Eriksen⁹  Lars L Gustafsson⁷  Antje Blank³  Siriel Massawe⁴  Rose Mpembeni⁵  John Williams⁶  Bocar Kouyaté¹  Mathias Somé¹  Göran Tomson²  Ulrika Baker⁸ 

[1] Centre de Recherche en Santé de Nouna (CRSN), BP 02, Nouna, Burkina Faso;Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Centre (MMC), Karolinska Institutet, Berzelius väg 3, SE-17177 Stockholm, Sweden;Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik (Krehl Klinik), University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany;Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, School of Medicine, P.O. Box 65001, Dar-Es-Salaam, Tanzania;Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences (MUHAS), School of Public Health and Social Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania;Navrongo Health Research Centre, P.O. Box 114, Navrongo, Ghana;Department of Laboratory Medicine (LABMED)Division of Clinical PharmacologyKarolinska Institutet, Karolinska University Hospital, F58, 141 86, Stockholm, Sweden;Department of Public Health Sciences, Division of Global Health (IHCAR), Karolinska Institutet, Nobels väg 9, SE-17177 Stockholm, Sweden;London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London WC1E 7HT, UK

关键词: WHO;    Sub Saharan Africa;    Quality improvement;    Maternal health;    Information and communication technology (ICT);    Implementation;    Health service delivery;    CPGs;   

Others  :  828809
DOI  :  10.1186/1748-5908-7-31

 received in 2011-06-25, accepted in 2012-04-13,  发布年份 2012

【 摘 要 】

Background

Initiatives to raise the quality of care provided to mothers need to be given priority in Sub Saharan Africa (SSA). The promotion of clinical practice guidelines (CPGs) is a common strategy, but their implementation is often challenging, limiting their potential impact. Through a cross-country perspective, this study explored CPGs for maternal health in Burkina Faso, Ghana, and Tanzania. The objectives were to compare factors related to CPG use including their content compared with World Health Organization (WHO) guidelines, their format, and their development processes. Perceptions of their availability and use in practice were also explored. The overall purpose was to further the understanding of how to increase CPGs' potential to improve quality of care for mothers in SSA.

Methods

The study was a multiple case study design consisting of cross-country comparisons using document review and key informant interviews. A conceptual framework to aid analysis and discussion of results was developed, including selected domains related to guidelines' implementability and use by health workers in practice in terms of usability, applicability, and adaptability.

Results

The study revealed few significant differences in content between the national guidelines for maternal health and WHO recommendations. There were, however, marked variations in the format of CPGs between the three countries. Apart from the Ghanaian and one of the Tanzanian CPGs, the levels of both usability and applicability were assessed as low or medium. In all three countries, the use of CPGs by health workers in practice was perceived to be limited.

Conclusion

Our cross-country study suggests that it is not poor quality of content or lack of evidence base that constitute the major barrier for CPGs to positively impact on quality improvement in maternal care in SSA. It rather emphasises the need to prioritise the format of guidelines to increase their usability and applicability and to consider these attributes together with implementation strategies as integral to their development processes.

【 授权许可】

   
2012 Baker et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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