Abstract
Introduction: Good-quality antenatal care (ANC) is critical to reducing maternal and perinatal mortality in Nepal. Electronic decision-support systems (EDSS) aim to improve quality of care through adherence to evidence-based guidelines. Our project assessed the potential of two EDSS (the ‘mIRA’ EDSS and the World Health Organization EDSS) to improve the quality of ANC in primary-level healthcare facilities in Nepal. This paper reports integrated results of the evaluation.
Methods: We conducted a theory-driven, mixed-methods evaluation in 19 facilities with eight types of data collection: health-facility survey; ANC clinical observations; longitudinal case studies and validation workshop; in-depth interviews; monitoring visits; fieldworker debriefing meetings; healthcare provider attitude survey and stakeholder engagement and feedback meetings. Results from the different data sources were integrated using concurrent triangulation to develop explanations about the implementation process and the effects observed.
Results: We identified nine themes on implementation challenges which hindered the EDSS from generating the desired improvements to ANC quality. Facility readiness and provider confidence in using the EDSS was mixed. It was not always used, or used as intended, and the approach to ANC provision did not change. EDSS inflexibility did not reflect how staff made decisions about pregnant women’s needs, or ensure tests were done at the right time. There was mixed evidence that ANC staff believed that the EDSS benefited their work. The EDSS did not become fully integrated into existing health systems. Engagement of essential stakeholders fell short.
Discussion: Different understandings of, and inconsistent use of the EDSS highlighted the need for increased training and support periods, greater stakeholder engagement, and further integration into existing health systems. Our novel approach to integrating findings from multiple mixed-methods sub-studies in one paper offers uniquely valuable insights into the many factors needed for successful implementation of an EDSS to improve quality of ANC in Nepal.
Methods: We conducted a theory-driven, mixed-methods evaluation in 19 facilities with eight types of data collection: health-facility survey; ANC clinical observations; longitudinal case studies and validation workshop; in-depth interviews; monitoring visits; fieldworker debriefing meetings; healthcare provider attitude survey and stakeholder engagement and feedback meetings. Results from the different data sources were integrated using concurrent triangulation to develop explanations about the implementation process and the effects observed.
Results: We identified nine themes on implementation challenges which hindered the EDSS from generating the desired improvements to ANC quality. Facility readiness and provider confidence in using the EDSS was mixed. It was not always used, or used as intended, and the approach to ANC provision did not change. EDSS inflexibility did not reflect how staff made decisions about pregnant women’s needs, or ensure tests were done at the right time. There was mixed evidence that ANC staff believed that the EDSS benefited their work. The EDSS did not become fully integrated into existing health systems. Engagement of essential stakeholders fell short.
Discussion: Different understandings of, and inconsistent use of the EDSS highlighted the need for increased training and support periods, greater stakeholder engagement, and further integration into existing health systems. Our novel approach to integrating findings from multiple mixed-methods sub-studies in one paper offers uniquely valuable insights into the many factors needed for successful implementation of an EDSS to improve quality of ANC in Nepal.
| Original language | English |
|---|---|
| Number of pages | 12 |
| Journal | Global Health Science and Practice |
| Volume | 13 |
| Issue number | 1 |
| Early online date | 9 Jan 2025 |
| DOIs | |
| Publication status | E-pub ahead of print - 9 Jan 2025 |