Creating resources
Health systems function | Delivery innovation | Delivery control | Outcomes | Study design | Population | Country | Reference |
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Creating higher-skilled human resources for health through tele-education | |||||||
Training on neonatal resuscitation | Tele-education | Conventional classroom teaching | • Knowledge scores • Skills scores | RCT | Staff nurses | India | Jain et al. Journal of Perinatology 2010 [112] |
Training on retinopathy of prematurity diagnosis | Tele-education | Standard onsite training | • Sensitivity of retinopathy of prematurity diagnosis • Specificity of retinopathy of prematurity diagnosis | RCT | Ophthalmology residents | Mexico | Patel et al. Ophthalmology 2017 [113] |
Education on nursing, public health, child and adolescent health, mental health | Tele-education | No control | • Tele-education participation • User satisfaction | Process evaluation | Primary care staff | Brazil | Joshi et al. Journal of Telemedicine and Telecare 2011 [114] |
Creating higher-skilled human resources for health through telemedicine | |||||||
Endocrine surgery | Telemedicine (tele-education and surgical treatment planning, teleconsultation, telepathology, teleradiology, and telesurgical conferences) | Standard of care at the time of the study | • Endocrine surgery rate | UBA | General surgeons | India | Pradeep et al. World Journal of Surgery 2007 [115] |
Dermatological diagnosis | Internet-based teledermatology system | Face-to-face examination | • Agreement between the two diagnostic approaches | Validation study | Junior doctors | Brazil | Chao et al. Telemedicine Journal and Ehealth 2003 [116] |
Intensive care | Tele-intensive care unit | Standard of care at the time of the study | • Number of ICU patients per month | UBA | Nurses | Syria | Moughrabieh et al. Annals of the American Thoracic Society 2016 [117] |
Freeing up human resources through task-shifting to lower-skilled health workers | |||||||
HIV treatment initiation and management | Nurses | Standard of care at the time of the study (doctors) | • Mortality • Viral suppression | RCT | Adult HIV patients in primary care | South Africa | Fairall et al. Lancet 2012 [118] |
Depression and anxiety screening, diagnosis and treatment | Lay village health workers together with primary care doctors, supported by an electronic decision support system | Standard of care at the time of the study (trained mental health professionals) | • Coverage with mental health treatment • Depression score • Anxiety score | UBA | Members of rural scheduled tribe communities | India | Maulik et al. Journal of Global Health 2017 [119] |
Hypertension treatment | Community health nurses delivering the WHO Package of Essential NCD Interventions (WHO PEN) | Standard of care at the time of the study | • Blood pressure | RCT | Patients visiting community health centers | Ghana | Ogedegbe et al. Implementation Science 2014 [120] |
HIV and HIV risk screening and linkage to care for children | Community health workers | Standard of care at the time of the study | • Identification of HIV-infected and HIV-exposed children • Linkage to care | UBA | Children born to mothers living with HIV | Malawi | Ahmed et al. Journal of the International AIDS Society 2015 [121] |
HIV treatment | Lay health workers | Standard of care at the time of the study (doctors and nurses) | • Viral suppression | RCT | Adult HIV patients in primary care | Tanzania | Geldsetzer et al. BMC Health Services Research 2017 [122] |
Antenatal and postnatal counseling | Lay nurse aides using job aids | Professional nurses using job aids | • Coverage with correct antenatal and postnatal messages • Pregnant women with correct antenatal knowledge | NRC | Women in antenatal care | Benin | Jennings et al. Implementation Science 2011 [123] |
HIV treatment initiation | Community health workers providing home-based HIV treatment initiation | Standard of care at time of the study (only facility-based initiation of HIV treatment) | • HIV treatment initiation | RCT | General population | Malawi | Macpherson et al. JAMA 2014 [124] |
Freeing up human resources through task-shifting to clients | |||||||
HIV testing | HIV self-testing | Standard of care at the time of the study (facility HIV testing) | • HIV testing rates | RCT | Female sex workers | Uganda, Zambia | |
HIV testing | Unsupervised HIV self-testing | Provider-supervised HIV self-testing | • Sensitivity | RCT | Fisherfolk | Uganda | Asiimwe et al. AIDS & Behavior 2014 [127] |
Cervical cancer screening | Vaginal self-collection of specimens | Cervical specimens collection by clinician | • Sensitivity • Specificity | Validation study | Adult women | India, Nicaragua, Uganda | Jeronimo et al. International Journal of Gynecological Cancer 2014 [128] |
Freeing up human resources through new models of care | |||||||
HIV treatment | Community-based adherence clubs | Standard of care at the time of the study | • Loss to follow-up • Viral suppression | NRC | Adult HIV patients in primary care | South Africa | Grimsrud et al. JAIDS 2016 [62] |
Buruli ulcer detection and treatment | Buruli ulcus community of practice composed of hospital staff, former patients, CHWs, and traditional healers | Standard of care at the time of the study | • Buruli ulcus detection rate • Buruli ulcus treatment adherence | UBA | General population | Cameroon | Awah et al. PLOS Neglected Tropical Diseases 2018 [129] |
Family healthcare services | Community-based family health program | Standard of care at the time of the study | • Mortality rates • Causes of death • Adult employment • School enrollment | UBA | Children (aged 10–17) and adults | Brazil | Rocha et al. Health Economics 2010 [130] |
Freeing up human resources through technological innovations | |||||||
Encouragement to remain in postpartum care | Text messages | Standard of care at the time of the study | • Maternal postpartum visit attendance • Early infant HIV testing | RCT | Pregnant women enrolled in public sector PMTCT program | Kenya | Odeny et al. AIDS 2014 [131] |
Hypertension treatment | Automated self-management calls plus home blood pressure monitoring | Standard of care at the time of the study | • Systolic blood pressure | RCT | Adult patients with hypertension in primary care | Honduras and Mexico | Piette et al. Telemedicine Journal and Ehealth 2012 [132] |
Encouragement to adhere to hypertension treatment | Text messages | Standard of care at the time of the study | • Systolic blood pressure | RCT | Adult patients with hypertension in primary care | South Africa | Bobrow et al. Circulation 2016 [133] |
Encouragement to adhere to HIV treatment | Text messages | Standard of care at the time of the study | • Adherence • Viral suppression | RCT | Adult patients with hypertension in primary care | Kenya | Lester et al. Lancet 2010 [134] |
Neurocognitive impairment screening | NeuroScreen mobile app administered by a lay health worker | Neuropsychological test battery administered by research psychometrist | • Sensitivity • Specificity | Validation study | Adult HIV patients in primary care | South Africa | Robbins et al. Journal of Medical Internet Research Mhealth Uhealth 2018 [77] |
Increasing laboratory capacity through technological innovations | |||||||
Viral load monitoring | Point-of-care viral load test using capillary blood | Laboratory viral load test using venous blood | • Sensitivity • Specificity | Validation study | Adult HIV patients in primary care | Mozambique | Jani et al. Journal of Clinical Microbiology 2016 [135] |
CD4 testing | Point-of-care CD4 test using capillary blood | Laboratory CD4 test using venous blood | • Sensitivity • Specificity | Validation study | Adult HIV patients in primary care | Zimbabwe | Mtapuri-Zinyowera et al. Journal of Acquired Immune Deficiency Syndromes 2010 [136] |
CD4 testing | Point-of-care CD4 test using capillary blood | Laboratory CD4 test using venous blood | • Loss to follow-up | UBA | Adult HIV patients in primary care | Mozambique | Jani et al. Lancet 2011 [137] |
Tuberculosis diagnosis | Point-of-care TB test performed by nurses in primary care clinics | Laboratory TB test | • Sensitivity • Specificity • Same-day diagnosis • Same-day treatment initiation • Loss to follow-up | cRCT | Adult primary care patients | South Africa, Tanzania, Zambia, Zimbabwe | Theron et al. Lancet 2014 [138] |
Breast cancer screening | Point-of-care breast imaging device | Standard of care (clinical breast examination) | • Sensitivity • Specificity • Positive predictive value • Negative predictive value | Validation study | Healthy women visiting a hospital | India | Somashekar et al. Indian Journal of Gynecologic Oncology 2016 [139] |
Increasing the availability of medicines through supply chain innovations | |||||||
Nevirapine (NVP) prophylaxis for HIV-exposed infants | Pratt Pouch delivery system | No control | • Administration of NVP to infants • Infant dried blood spot NVP concentration | Process evaluation | HIV-exposed infants and their mothers | Tanzania | Dahinten et al. Pediatric Infectious Diseases 2016 [140] |
Access to artemisinin-based combination therapy (ACT) antimalarials | Private-sector Accredited Drug Dispensing Outlet (ADDO) | Public sector distribution | • Uptake of ACT • Availability of ACT | UBA | Adults and children | Tanzania | Rutta et al. Health Research Policy and Systems 2011 [141] |
Access to oral rehydration salts (ORS) and zinc for children | Private-sector distribution channels (Coca Cola) | Public sector distribution | • Availability of ORS and zinc at rural retail outlets • Distance traveled by caregivers to obtain ORS and zinc • Use of ORS and zinc in infants | CBA | Community retailers, children and their caregivers | Zambia | Berry et al. Endline report: Colalife Operational Trial Zambia 2014 [142] |
Vaccine supply chain | Public-private partnership for vaccine supply | Government-managed supply | • Vaccine stock • Immunization coverage | UBA | Regional zone stores, primary healthcare facilities | Nigeria | Molemodile et al. Global Public Health 2017 [143] |
Supply of health workers, essential medicines and equipment to remote villages | Systematic motorcycle fleet management for health care supplies (supply of high-quality motorcycles, driver training, preventive maintenance, fuel, on demand repair) | Standard of care motorcycle fleet management for health care supplies | • Trips to rural villages per health worker per week • Patient visits per health worker per week • Measles immunization per health worker per week • Child growth assessment per health worker per week | CBA | Village health workers | Zambia | Mehta et al. American Journal of Public Health 2015 [144] |
Changing behavior
Creativity and reverse innovation
Methods innovations
Creating research capacity
Course | Organization | Duration | Content |
---|---|---|---|
Fundamentals of Implementation Science | University of Washington, USA | 11 weeks | • Relevance of implementation science to global health • Impact evaluation methods • Economic analysis methods • Stakeholder and policy analysis • Qualitative health systems research • Quality improvement as a management tool • Disseminating research findings |
Specialist Certificate in Implementation Science | University of Melbourne, Australia | 6 months | • Conceptual models and frameworks • Role of data in driving implementation success • Different approaches to implementation • Process evaluation • Formative research • Outputs and outcomes • Impact evaluation |