Introducing pulse oximetry in routine IMCI services in Bangladesh: A context-driven approach to influence policy and programme through stakeholder engagement.
| Title: | Introducing pulse oximetry in routine IMCI services in Bangladesh: A context-driven approach to influence policy and programme through stakeholder engagement. |
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| Authors: | Rahman, Ahmed Ehsanur, Jabeen, Sabrina, Fernandes, Genevie, Banik, Goutom, Islam, Jahurul, Ameen, Shafiqul, Ashrafee, Sabina, Hossain, Aniqa Tasnim, Shah Alam, Husan Md, Majid, Tamanna, Saberin, Ashfia, Ahmed, Anisuddin, Ehtesham Kabir, A. N. M., Chisti, Mohammod Jobayer, Ahmed, Sabbir, Khan, Mahbuba, Jackson, Tracy, Dockrell, David H., Nair, Harish, El Arifeen, Shams |
| Source: | Journal of Global Health; 2022, Vol. 12, p1-14, 14p |
| Abstract: | Background Pneumonia is the leading cause of under-five child deaths globally and in Bangladesh. Hypoxaemia or low (<90%) oxygen concentration in the arterial blood is one of the strongest predictors of child mortality from pneumonia and other acute respiratory infections. Since 2014, the World Health Organization recommends using pulse oximetry devices in Integrated Management of Childhood Illness (IMCI) services (outpatient child health services), but it was not routinely used in most health facilities in Bangladesh until 2018. This paper describes the stakeholder engagement process embedded in an implementation research study to influence national policy and programmes to introduce pulse oximetry in routine IMCI services in Bangladesh. Methods Based on literature review and expert consultations, we developed a conceptual framework, which guided the planning and implementation of a 4-step stakeholder engagement process. Desk review, key informant interviews, consultative workshops and onsite demonstration were the key methods to involve and engage a wide range of stakeholders. In the first step, a comprehensive desk review and key informant interviews were conducted to identify stakeholder organisations and scored them based on their power and interest levels regarding IMCI implementation in Bangladesh. In the second step, two national level, two district level and five sub-district level sensitisation workshops were organised to orient all stakeholder organisations having high power or high interest regarding the importance of using pulse oximetry for pneumonia assessment and classification. In the third step, national and district level high power-high interest stakeholder organisations were involved in developing a joint action plan for introducing pulse oximetry in routine IMCI services. In the fourth step, led by a formal working group under the leadership of the Ministry of Health, we updated the national IMCI implementation package, including all guidelines, training manuals, services registers and referral forms in English and Bangla. Subsequently, we demonstrated its use in real-life settings involving various levels of (national, district and sub-district) stakeholders and worked alongside the government leaders towards carefully resuming activities despite the COVID-19 pandemic. Results Our engagement process contributed to the national decision to introduce pulse oximetry in routine child health services and update the national IMCI implementation package demonstrating country ownership, government leadership and multi-partner involvement, which are steppingstones towards scalability and sustainability. However, our experience clearly delineates that stakeholder engagement is a context-driven, time-consuming, resource-intensive, iterative, mercurial process that demands meticulous planning, prioritisation, inclusiveness, and adaptability. It is also influenced by the expertise, experience and positionality of the facilitating organization. Conclusions Our experience has demonstrated the value and potential of the approach that we adopted for stakeholder engagement. However, the approach needs to be conceptualised coupled with the allocation of adequate resources and time commitment to implement it effectively. [ABSTRACT FROM AUTHOR] |
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| Database: | Complementary Index |
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| Items | – Name: Title Label: Title Group: Ti Data: Introducing pulse oximetry in routine IMCI services in Bangladesh: A context-driven approach to influence policy and programme through stakeholder engagement. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Rahman%2C+Ahmed+Ehsanur%22">Rahman, Ahmed Ehsanur</searchLink><br /><searchLink fieldCode="AR" term="%22Jabeen%2C+Sabrina%22">Jabeen, Sabrina</searchLink><br /><searchLink fieldCode="AR" term="%22Fernandes%2C+Genevie%22">Fernandes, Genevie</searchLink><br /><searchLink fieldCode="AR" term="%22Banik%2C+Goutom%22">Banik, Goutom</searchLink><br /><searchLink fieldCode="AR" term="%22Islam%2C+Jahurul%22">Islam, Jahurul</searchLink><br /><searchLink fieldCode="AR" term="%22Ameen%2C+Shafiqul%22">Ameen, Shafiqul</searchLink><br /><searchLink fieldCode="AR" term="%22Ashrafee%2C+Sabina%22">Ashrafee, Sabina</searchLink><br /><searchLink fieldCode="AR" term="%22Hossain%2C+Aniqa+Tasnim%22">Hossain, Aniqa Tasnim</searchLink><br /><searchLink fieldCode="AR" term="%22Shah+Alam%2C+Husan+Md%22">Shah Alam, Husan Md</searchLink><br /><searchLink fieldCode="AR" term="%22Majid%2C+Tamanna%22">Majid, Tamanna</searchLink><br /><searchLink fieldCode="AR" term="%22Saberin%2C+Ashfia%22">Saberin, Ashfia</searchLink><br /><searchLink fieldCode="AR" term="%22Ahmed%2C+Anisuddin%22">Ahmed, Anisuddin</searchLink><br /><searchLink fieldCode="AR" term="%22Ehtesham+Kabir%2C+A%2E+N%2E+M%2E%22">Ehtesham Kabir, A. N. M.</searchLink><br /><searchLink fieldCode="AR" term="%22Chisti%2C+Mohammod+Jobayer%22">Chisti, Mohammod Jobayer</searchLink><br /><searchLink fieldCode="AR" term="%22Ahmed%2C+Sabbir%22">Ahmed, Sabbir</searchLink><br /><searchLink fieldCode="AR" term="%22Khan%2C+Mahbuba%22">Khan, Mahbuba</searchLink><br /><searchLink fieldCode="AR" term="%22Jackson%2C+Tracy%22">Jackson, Tracy</searchLink><br /><searchLink fieldCode="AR" term="%22Dockrell%2C+David+H%2E%22">Dockrell, David H.</searchLink><br /><searchLink fieldCode="AR" term="%22Nair%2C+Harish%22">Nair, Harish</searchLink><br /><searchLink fieldCode="AR" term="%22El+Arifeen%2C+Shams%22">El Arifeen, Shams</searchLink> – Name: TitleSource Label: Source Group: Src Data: Journal of Global Health; 2022, Vol. 12, p1-14, 14p – Name: Abstract Label: Abstract Group: Ab Data: Background Pneumonia is the leading cause of under-five child deaths globally and in Bangladesh. Hypoxaemia or low (<90%) oxygen concentration in the arterial blood is one of the strongest predictors of child mortality from pneumonia and other acute respiratory infections. Since 2014, the World Health Organization recommends using pulse oximetry devices in Integrated Management of Childhood Illness (IMCI) services (outpatient child health services), but it was not routinely used in most health facilities in Bangladesh until 2018. This paper describes the stakeholder engagement process embedded in an implementation research study to influence national policy and programmes to introduce pulse oximetry in routine IMCI services in Bangladesh. Methods Based on literature review and expert consultations, we developed a conceptual framework, which guided the planning and implementation of a 4-step stakeholder engagement process. Desk review, key informant interviews, consultative workshops and onsite demonstration were the key methods to involve and engage a wide range of stakeholders. In the first step, a comprehensive desk review and key informant interviews were conducted to identify stakeholder organisations and scored them based on their power and interest levels regarding IMCI implementation in Bangladesh. In the second step, two national level, two district level and five sub-district level sensitisation workshops were organised to orient all stakeholder organisations having high power or high interest regarding the importance of using pulse oximetry for pneumonia assessment and classification. In the third step, national and district level high power-high interest stakeholder organisations were involved in developing a joint action plan for introducing pulse oximetry in routine IMCI services. In the fourth step, led by a formal working group under the leadership of the Ministry of Health, we updated the national IMCI implementation package, including all guidelines, training manuals, services registers and referral forms in English and Bangla. Subsequently, we demonstrated its use in real-life settings involving various levels of (national, district and sub-district) stakeholders and worked alongside the government leaders towards carefully resuming activities despite the COVID-19 pandemic. Results Our engagement process contributed to the national decision to introduce pulse oximetry in routine child health services and update the national IMCI implementation package demonstrating country ownership, government leadership and multi-partner involvement, which are steppingstones towards scalability and sustainability. However, our experience clearly delineates that stakeholder engagement is a context-driven, time-consuming, resource-intensive, iterative, mercurial process that demands meticulous planning, prioritisation, inclusiveness, and adaptability. It is also influenced by the expertise, experience and positionality of the facilitating organization. Conclusions Our experience has demonstrated the value and potential of the approach that we adopted for stakeholder engagement. However, the approach needs to be conceptualised coupled with the allocation of adequate resources and time commitment to implement it effectively. [ABSTRACT FROM AUTHOR] – Name: Abstract Label: Group: Ab Data: <i>Copyright of Journal of Global Health is the property of Edinburgh University Global Health Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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