Table 2 Pilot studies methodologies, activities, data collection methods and analysis, limitations, implementation lessons
Countries, Provinces and Districts | Methodologies (See Table 1 for definitions and methods) | Activities | Data Collection & Analysis |
|---|---|---|---|
Eswatini (1 malaria season 2016-17) Country-wide project | PPI exclusively | Pre-malaria season ‘system in the room’ workshops (c.40 participants) – challenge identification and formation of Task Team implementation subgroup, external expert inputs on malaria elimination; Coaching and facilitation support to individuals and teams; 3 x in-season Task Team workshops (c.12 participants) to develop and implement work plans; Post-malaria season ‘system in the room’ workshop – review outcomes and planning for next season (c.40 participants). | Workshop and Task Team participation evaluation tools Metrics for monitoring and evaluation of specific challenges developed in liaison with NMCP and font line staff (closest to the issues). Data collected and analysed by Task Team – aided by project team experts. Monitored through implementation country work plan. Results reported to sponsor via project team. |
Zimbabwe (3 malaria seasons 2016-19) Matabeleland South Beitbridge Gwanda Matapos Matabeleland North Binga Bubi Hwange Lupane Nkayi Tsholotsho Umgaza Midlands Chirumhanzu Kwekwe | PPI, QI, QM | NB the following activities were repeated 3 x 2016-19) Pre-malaria season ‘system in the room’ workshops (c.40-50 participants) – challenge identification and formation of Task Team implementation subgroups (12 in total), external expert inputs on malaria elimination; University certified training in CQPI (6 graduates); Coaching and facilitation support to individuals and teams; 3 x in-season Task Team (TT) workshops (c.12 participants) for each of the 12 districts (i.e., 12 TTs x 3) to develop and implement work plans; Post-malaria season ‘system in the room’ workshop – review outcomes and planning for next season (c.40-50 participants). | Workshop and Task Team participation evaluation tools Metrics for monitoring and evaluation of specific challenges developed in liaison with NMCP and font line staff (closest to the issues). Data collected and analysed by Task Team – aided by project team experts. Monitored through the 12 district-level implementation work plans. Results reported to sponsor via project team. |
Namibia (1 malaria season 2019-20) Kavango East Kavango West | PPI, QI, QM, in the form of the LEAD Framework | Pre-malaria season ‘system in the room’ workshop (c.50 participants) – challenge identification and formation of 2 x Task Team implementation subgroups (8 per district team – 16 total), external expert inputs on malaria elimination; University certified training in CQPI (12 graduates); Coaching and facilitation support to individuals and teams; 6 x in-season Task Team workshops for the 2 districts to develop and implement work plans; Post-malaria season ‘system in the room’ workshop – review outcomes and planning for next season (c.50 participants). | Workshop and Task Team participation evaluation tools Metrics for monitoring and evaluation of specific challenges developed in liaison with NMCP and font line staff (closest to the issues). Data collected and analysed by Task Team – aided by project team experts. Monitored through the 2 district-level implementation work plans. Results reported to sponsor via project team. |
Limitations - The impact of external influences on the program and outcomes was not assessed (e.g., co-investment by other agencies such as the United States Agency for International Development/President’s Malaria Initiative and/or the Global Fund to Fight AIDS, TB, and Malaria may have indirectly impacted some pilot studies results). - Neither experimental nor quasi-experimental design was employed. Control districts were not included as part of the pilots from which routine data could be collected as a comparison to intervention districts. Therefore we cannot say that the CQPI intervention was causal with improvement, only that in the observational pilot programs that CQPI is likely to have been the driver of improvement. - Project costs were relatively high in the design phase. With the training of local facilitators, costs decreased in later stages of implementation (e.g., graduates of a university certified training program in Zimbabwe were employed as consultants to assist with CQPI implementation in Namibia). - Limited evidence gathered for sustainability post-project due to limited funding and sustainability planning. | |||
Implementation: key lessons - It is imperative to negotiate and secure authorization for CQPI intervention at ministry level (e.g., official endorsement by NMCP director). NMCP-level participation in key CQPI events, such as, inception workshops and provincial review workshops is highly desirable as this can facilitate top level buy-in and support. In one of the pilots, the NMCP director changed mid-stream and the new role holder withdrew support for CQPI. This severely compromised the process and prevented further outcomes being achieved. - Active (authorized) participation of senior provincial staff in CQPI activities, e.g., Provincial Medical Directors (PMDs) attending and contributing to CQPI workshops and taking an active interest in the development and outcomes of district-level work plans. A supportive PMD often has the ability to mobilize the resources necessary to implement work plans. - Similarly, enrolment of senior district-level staff is critically important to successful implementation of CQPI. - The fuller the representation of the ‘system in the room’ (see Table 1 for definition) at key CQPI events, the better the chances of identifying and implementing ‘joined-up’ service delivery sollutions. Over the course of the three pilots, we learned that the involvement and buy-in of community leaders and influencers (e.g., faith leaders, traditional healers, etc.) impacted outcomes positively. - Devolvement of budgets to subnational level serves to improve implementation of solutions (enhances responsiveness of local actors to malaria challenges). Devolved budgets are planned in many countries as part of Universal Health Coverage plans. | |||