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Implementation and Quality (IMPAQT)

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.

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

UNESTa

Contact: Peter Waiswa

The Uganda Newborn Study focuses on improving newborn mortality in Uganda by developing an integrated maternal-newborn care package that links community and facility care and evaluating its effects for policy information and scale-up. It is now well established that many low income countries will not achieve MDG 4 to reduce under-five mortality by two thirds unless neonatal mortality is well addressed. With evidence that integrating community health workers (CHWs) in health systems can lead to improved morbidity and mortality, many countries in Sub-Saharan Africa are scaling-up such programs. However, one of the challenges is how to integrate these CHWs in existing health system programs. The aim is to adapt, develop and cost an integrated maternal-newborn care package that links community and facility care, and will evaluate its effect on maternal and neonatal practices in order to inform policy and scale-up in Uganda.

UNEST is a community randomized controlled trial in Iganga/Mayuge Health Demographic Surveillance Site in eastern Uganda. Trained CHWs make 2 pregnancy and 3 postnatal visits in the first week after birth. In addition, basic health facility strengthening is done to make supply-side care better. Preliminary evaluations show marked improvements in key care practices such as birth preparedness, supervised deliveries, and neonatal care practices. In addition, the project has already had policy impact by contributing to the design of the country-wide community health work strategy. Furthermore, it has been used as a platform for funding of two new large scale projects: MANEST or maternal and newborn study in Uganda to be funded by DFID and WHO, and EQUIP or Expanded Quality Improvement Using Information Power to improve maternal and newborn health in Uganda and Tanzania.

HMS-BAB

Contact: Claudia Hanson

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 hemorrhage. Post-partum hemorrhage remains a leading cause of maternal morbidity and mortality in sub-Saharan Africa. It is estimated that up to 10% of mothers experience post-partum hemorrhage - a blood loss of > 500 ml. Around 30% of maternal deaths - 90,000 women every year - are because of severe bleeding, almost all of them in low and middle income countries.

The Active Management of the Third Stage of Labor (AMTSL), a very simple measure, can prevent severe post-partum bleeding. The most important intervention in AMSTL is the application of a uterotonic within one minute after the baby is born. To evaluate the impact of a 1-day training in AMTSL, complemented by in-service simulator practice over a period of six weeks, on maternal morbidity and mortality due to post-partum hemorrhage. The cluster randomized, facility-based intervention trial will be done in 20 health districts in both Tanzania and Kenya, where half of the included districts will be assigned to the intervention arm.

A most interesting aspect of this study is the use of the near-miss application to measure maternal mortality: using maternal morbidity defined as near miss', or 'a woman who nearly died by survived a complication that occurred during pregnancy, childbirth, or within 42 days or termination of pregnancy'.

Funding: Laerdal Foundation.

Information sheet with more detailed methods

EQUIP Expansion

Contact: Claudia Hanson, Stefan Peterson

Two studies will build on the original Expanded Quality Management Using Information Power (EQUIP) intervention to improve maternal and newborn mortality. One study aims to document community-oriented approaches to improve recognition and use of appropriate care-seeking for newborn and/or maternal complications in five countries, and the other will pilot the scale-up of the EQUIP approach. These two studies build on the EQUIP intervention to improve maternal and newborn mortality.

  • TRAction aims to achieve the systematic documentation of community-oriented approaches to improve recognition and use of appropriate care-seeking for newborn and/or maternal complications in five countries, including the EQUIP target countries of Uganda and Tanzania. The TRAction project provides resources for an improved understanding of what the EQUIP project was able to achieve in the community. Using qualitative research we aim to understand and document changes in the identification of potentially life-threatening complications, as well as timely and appropriate care-seeking in intervention and comparison districts. Funding: USAID
  • QUADS: The Quality Improvement for Maternal and Newborn Health at District-level Scale in Mtwara Region, Tanzania, will pilot the scale-up of the EQUIP approach within Mtwara region. EQUIP was implemented only in one intervention district in both Uganda and Tanzania. The QUADS project aims to assess whether the resource intensive mentoring and coaching of quality improvement teams can be integrated into the district and regional support functions; how can quality improvement be integrated into pre-existing district health systems? We aim to produce a model that can be streamlined and integrated into existing structures within the Tanzania health system, eliminating the resource-intensive external facilitation, which characterizes most quality improvement initiatives, and which limit their scale-up. The project will be evaluated using a realist evaluation throughout the intervention, based on internal monitoring, improved health management information system data on coverage and outcomes, among others.

Group members

  • Tim Baker, Post-doc
  • Ulrika Baker, PhD student
  • Jesper Gantelius, Post-doc
  • Claudia Hanson, Project coordinator
  • Helena Hildenwall, Senior researcher
  • Frida Kasteng, PhD student
  • Dorkus Kiwanuka, PhD student
  • Karin Källander, Senior lecturer
  • Ann Lindstrand, PhD student
  • Andreas Mårtensson, Professor
  • Joan Nakayaga, Lecturer
  • Stefan Peterson, Professor
  • Reza Rasti, PhD student
  • Peter Waiswa, Lecturer

Collaborations

Education

Members of our group teach on the MSc Global Health, MSc Public Health and MSc Economics, Management and Policy courses and PhD courses on Global Health, Health Policy and Management.

Contact

Sub-group leader

Claudia Hanson

Senior lecturer
Department of Public Health Sciences (PHS), K9