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. 2024 Feb 2;24(1):164.
doi: 10.1186/s12913-024-10638-4.

Implementation outcomes of the integrated district evidence to action (IDEAs) program to reduce neonatal mortality in central Mozambique: an application of the RE-AIM evaluation framework

Aneth Dinis  1   2 , Quinhas Fernandes  3 , Bradley H Wagenaar  4   5 , Sarah Gimbel  4   6 , Bryan J Weiner  4 , Grace John-Stewart  4   5   7   8 , Ermyas Birru  4 , Stephen Gloyd  4 , Ruth Etzioni  9   10 , Dorlim Uetela  11 , Isaías Ramiro  12 , Artur Gremu  12 , Orvalho Augusto  4   13 , Stélio Tembe  4 , Jaime L Mário  14 , Jalilo E Chinai  15 , Alfredo F Covele  12 , Cassimo M Sáide  12 , Nélia Manaca  12 , Kenneth Sherr  4   5   16
Affiliations

Implementation outcomes of the integrated district evidence to action (IDEAs) program to reduce neonatal mortality in central Mozambique: an application of the RE-AIM evaluation framework

Aneth Dinis et al. BMC Health Serv Res. .

Abstract

Background: Scarce evidence exists on audit and feedback implementation processes in low-resource health systems. The Integrated District Evidence to Action (IDEAs) is a multi-component audit and feedback strategy designed to improve the implementation of maternal and child guidelines in Mozambique. We report IDEAs implementation outcomes.

Methods: IDEAs was implemented in 154 health facilities across 12 districts in Manica and Sofala provinces between 2016 and 2020 and evaluated using a quasi-experimental design guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Reach is the proportion of pregnant women attending IDEAs facilities. Adoption is the proportion of facilities initiating audit and feedback meetings. Implementation is the fidelity to the strategy components, including readiness assessments, meetings (frequency, participation, action plan development), and targeted financial support and supervision. Maintenance is the sustainment at 12, 24, and 54 months.

Results: Across both provinces, 56% of facilities were exposed to IDEAs (target 57%). Sixty-nine and 73% of pregnant women attended those facilities' first and fourth antenatal consultations (target 70%). All facilities adopted the intervention. 99% of the expected meetings occurred with an average interval of 5.9 out of 6 months. Participation of maternal and child managers was high, with 3076 attending meetings, of which 64% were from the facility, 29% from the district, and 7% from the province level. 97% of expected action plans were created, and 41 specific problems were identified. "Weak diagnosis or management of obstetric complications" was identified as the main problem, and "actions to reinforce norms and protocols" was the dominant subcategory of micro-interventions selected. Fidelity to semiannual readiness assessments was low (52% of expected facilities), and in completing micro-interventions (17% were completed). Ninety-six and 95% of facilities sustained the intervention at 12 and 24 months, respectively, and 71% had completed nine cycles at 54 months.

Conclusion: Maternal and child managers can lead audit and feedback processes in primary health care in Mozambique with high reach, adoption, and maintenance. The IDEAs strategy should be adapted to promote higher fidelity around implementing action plans and conducting readiness assessments. Adding effectiveness to these findings will help to inform strategy scale-up.

Keywords: Audit & Feedback; Health Systems Research; Implementation outcomes; Implementation science; Maternal and Child Health; Mozambique; Neonatal mortality; RE-AIM.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Steps of the IDEAs audit and feedback strategy
Fig. 2
Fig. 2
Number of problems identified in audit and feedback. (A) Overall and (B) By district
Fig. 3
Fig. 3
Rank of ten priority problems identified in A&F meetings. Note Fig. 3: EmOC: emergency obstetric complications; IPTp: intermittent preventive treatment for malaria; CCR: consulta da criança de risco (“at-risk child consultation” in Portuguese); ANC: antenatal care; PCR: polymerase chain reaction; FP: family planning
Fig. 4
Fig. 4
Distribution of general categories and subcategories of micro-interventions proposed in A&F meetings. Note Fig. 4: The following four subcategories with less than 1% were omitted in the figure: “regular sending of data,” “patient flow,” “health information system file improvement,” and “changes in service schedules.”
Fig. 5
Fig. 5
Summary of findings based on four RE-AIM domains
See this image and copyright information in PMC

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