Implementation and Quality (IMPAQT) team

Our aim is to generate knowledge on how to develop, implement, and evaluate strategies to improve the quality of care globally. We focus largely, but not exclusively, on low-resource settings. The subgroup is part of the research group Health Systems and Policy.

We recognize the complexity of sustainably improving health-care quality and health systems and that strong and long-term collaborations with universities, research institutions and policy-makers throughout the world are essential. Our research is rooted in the contextual realities and the needs of people, health providers and local managers, guided by local, national and global priorities. We work on methods for evaluating quality and evaluate ‘implementation interventions’ thus such interventions that support health workers, facilities or health systems to use available resources most effectively for good quality care.

In our group we have researchers experienced in epidemiology, quantitative and qualitative methods, implementation science, measurement and metrics, health systems, policy and health services research and clinical care.

Our work is rooted in the contextual realities and the needs of people, health providers and local managers, guided by local, national and global priorities. Our research aims to evaluate quality and investigates ‘implementation interventions’ that support health workers, facilities or health systems to use available resources most effectively for good quality care.

Research projects

ALERT (Action Leveraging Evidence to reduce perinatal Mortality and morbidity in Sub-Saharan Africa)

The ALERT project is a hospital maternity-based quality improvement and implementation science project in Benin, Malawi, Tanzania and Uganda (2020 – 2024) funded under Horizon 2020 

Contact: Claudia Hanson

QUALI-DEC (Appropriate use of Caesarean section through QUALIty DECision-making by women and providers)

QUALI-DEC aims to evaluate a 4-component non-clinical intervention to optimise Caesarean sections rates in Argentinian, Burkina Faso, Thailand and Vietnam (2020 – 2024) funded by Horizon 2020.

Contact: Claudia Hanson

Kuwa Macho Action to prevent intrapartum-related complication in Eastern

Uganda This project aims to improve the understanding of contributing factors and long-term morbidity and mortality of hypoxic-ischemic events during childbirth in Uganda (2020-2023) funded by the Swedish Research Council

Contact: Claudia Hanson

ONGEZA Cracking the measurement nut for maternal and newborn health. Innovations and applications for quality of care in Southern Tanzania: The Ongeza project

This is a joint project together with a Swedish NGO and Ifakara Health Institution in Tanzania to piloted and evaluate a scanning technology for processing routine health management information (2018-2020) funded by the Swedish Research Council (leaflet to come)

Contact: Claudia Hanson

HMS-BAB

The Helping Mothers Survive - Bleeding After Birth project aims to evaluate the impact of a short training session on maternal morbidity and mortality from post-partum haemorrhage in Tanzania and Uganda (2016-2018) funded by Laerdal Foundation through FIGO and additional SIDA funding for a PhD project. The evaluation in Tanzania includes an evaluation of the providers perspective of the training. 

Publications

Evaluating the effect of the Helping Mothers Survive Bleeding after Birth (HMS BAB) training in Tanzania and Uganda: study protocol for a randomised controlled trial.
Hanson C, Pembe AB, Alwy F, Atuhairwe S, Leshabari S, Morris J, et al
Trials 2017 07;18(1):307

Effect of the competency-based Helping Mothers Survive Bleeding after Birth (HMS BAB) training on maternal morbidity: a cluster-randomised trial in 20 districts in Tanzania.
Alwy Al-Beity F, Pembe A, Hirose A, Morris J, Leshabari S, Marrone G, et al
BMJ Glob Health 2019 ;4(2):e001214

"We do what we can do to save a woman" health workers' perceptions of health facility readiness for management of postpartum haemorrhage.
Alwy Al-Beity F, Pembe AB, Kwezi HA, Massawe SN, Hanson C, Baker U
Glob Health Action 2020 ;13(1):1707403

Essential Emergency and Critical Care (EECC)

Critical illness results in millions of deaths each year. Care for those with critical illness is often neglected due to a lack of prioritisation, co-ordination, and coverage of timely identification and basic life-saving treatments. To improve care, we are working on the innovative concept, Essential Emergency and Critical Care (EECC) – the care that all critically ill patients should receive in all hospitals in the world.

Essential emergency and critical care should be part of universal health coverage, is appropriate for all countries in the world, and is intended for patients irrespective of age, gender, underlying diagnosis, medical specialty, or location in the hospital. Essential emergency and critical care is pragmatic and low-cost and has the potential to improve care and substantially reduce preventable mortality. 

Publication

The global need for essential emergency and critical care.
Schell CO, Gerdin Wärnberg M, Hvarfner A, Höög A, Baker U, Castegren M, et al
Crit Care 2018 Oct;22(1):284

Contact: Tim Baker

Critical Illness and Sepsis Prevalence and Outcomes Studies (CRISPOS)

We are conducting prospective cohort studies of the prevalence and outcomes of patients with critical illness and sepsis in hospitals in Malawi, Sri Lanka and Sweden. The aims are to determine the proportion of in-patients that are critically ill and that have sepsis and to determine the mortality rates and the relative risk of critical illness and sepsis.

Publication

The Prevalence and Outcomes of Sepsis in Adult Patients in Two Hospitals in Malawi.
Kayambankadzanja RK, Schell CO, Namboya F, Phiri T, Banda-Katha G, Mndolo SK, et al
Am. J. Trop. Med. Hyg. 2020 Apr;102(4):896-901

Contact: Tim Baker

Improving the care of critically ill patients in Malawi and Tanzania

We are conducting several projects in hospitals in Malawi and Tanzania to improve the care and outcomes of patients with critical illness. Projects include the Vital Signs Directed Therapy project, the ICU Register and Outcomes project, paediatric critical care projects and peri-operative mapping projects.

Publications

Vital Signs Directed Therapy: Improving Care in an Intensive Care Unit in a Low-Income Country.
Baker T, Schell CO, Lugazia E, Blixt J, Mulungu M, Castegren M, et al
PLoS ONE 2015 ;10(12):e0144801

Risk Factors for Mortality in Severely Ill Children Admitted to a Tertiary Referral Hospital in Malawi.
Ngwalangwa F, Phiri CHA, Dube Q, Langton J, Hildenwall H, Baker T
Am. J. Trop. Med. Hyg. 2019 09;101(3):670-675

Contact: Tim Baker

Collaboration with the Guangdong Provincial Hospital of Chinese Medicine and the Health System and Policy group

Collaboration with the hospital and the HSP research group on research capacity strengthening. The collaboration involves provision of method courses, workshop and supervision of doctoral students (PI is Professor Cecilia Stålsby Lundborg). One of the doctoral students are supervised in the IMPAQT team and  working on the feasibility and acceptability of Chinese Pediatric Massage. We are looking at home- and facility-based prevention and management of recurrent respiratory tract infections in young children in an urban area in southern China.

Contact: Helle Mølsted Alvesson

Maximizing the potential of the research platform for capacity development and generation for Makerere University Center for Health and Population Research (MUCHAP)

MUCHAP is a population-based research center located in Eastern Uganda districts of Iganga and Mayuge with a population of over 97,000 people under surveillance. MUCHAP provides a support platform for community-based research, and for research training for students and faculty at Makerere University and other stakeholders.

Contact: Dorcus Kiwanuka Henriksson

Teaching

Within our group, we are actively contributing to strengthening the interaction and synergies between education and research. We see education and training as part of our global commitment to thrive to a sustainable development. We are interdisciplinary and intercultural teachers who try to emphasize that teaching needs to go hand in hand with research at a university.

Within our group we have members active in education management, course leadership and lecturing. We supervise doctoral and master students in global public health, students from other programmes at Karolinska Institutet and at other Universities in and outside of Sweden.

The team are involved in: 

Team member Helle Mölsted Alvesson also is responsible for the module on qualitative methods in the course “Research Methods” in the Master’s programme in Global Health.

Educational development within the Nordic Universities for the Global Health Challenges Network

The team are involved in educational development within the Nordic Universities for the Global Health Challenges Network which is a Nordplus funded project (2020-2022) with the overall aim of identify opportunities and barriers to the integration of case challenges into the university curriculum at Nordic universities.

A case challenge is a pedagogic teaching format that provides a unique opportunity for students to work together in interdisciplinary teams and contribute to the development of innovative solutions on pertinent real-world problems. Other network members are Uppsala University, University of Copenhagen, and Norwegian University of Science and Technology.

Contact: Dorcus Kiwanuka Henriksson

PhD training courses

Claudia Hanson leads the two-week course “Core concepts in Global Health and Global Burden of Disease”. This course gives broad overview of trends in the global burden of disease, including infectious disease, non-communicable disease, mental health, accidents and violence; Drivers of global inequalities in health; Challenges in measuring and analysing the global burden of disease; Global health governance and financing and other important current challenges in global health. The course is provided ever 2 years as part of the BIGH programme.

The team also teach undergraduates, postgraduates, doctors, nurses and other health workers on-the-ground in countries such as Malawi and Tanzania.

Group members

Claudia Hanson

Lecturer senior
K9 Department of Global Public Health