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Implementation Science at UW

Keywords: Steve Gloyd

✪ Strengthening primary care facility management: a systematic review of management interventions, implementation strategies, and outcomes in six sub-Saharan African countries

Authors:

Ermyas Birru, Sandra Urusaro, Aneth Dinis, Stélio Tembe, Teresa Jewell, Steve Gloyd, Kenneth Sherr, & Lisa R. Hirschhorn

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: July 2026

Read the full text in the open access journal BMC Primary Care

Abstract:

Background

Although primary health care (PHC) is central to health system performance, effective facility-level management is a critical determinant of service quality, resource use, and improved health outcomes. We conducted a systematic review to synthesize evidence on interventions, implementation strategies, and outcomes aimed at strengthening PHC facility management in Sub-Saharan Africa (SSA).

Methods

We conducted a systematic review using thematic synthesis. Eight electronic databases were searched for peer-reviewed studies and grey literature published between 2012 and 2022, focusing on interventions targeting PHC facility management in SSA. Implementation strategies were mapped to the thematic cluster areas of the Expert Recommendations for Implementing Change (ERIC) framework. Implementation outcomes were classified using Proctor’s Implementation Outcome Framework, and management effectiveness domains were identified through thematic analysis.

Results

Of 3,752 studies screened, nine met the inclusion criteria. These studies represented six SSA countries: Botswana, Ethiopia, Kenya, South Africa, Tanzania, and Zambia. Four categories of intervention were identified: (1) training and capacity building programs, (2) peer-to-peer learning, (3) audit and feedback-based quality management systems, and (4) supportive supervision. These interventions were delivered through multiple implementation strategies, including training and education, coaching and mentoring, learning collaboratives, interactive continuous learning, and routine data monitoring. Acceptability was the most consistently reported implementation outcome. Improvements in management effectiveness were identified across four domains: financial management, organizational climate and culture, resource management and utilization, and human resource management. Five studies also reported intermediate service-level outcomes including improvements in maternal and child health indicators.

Conclusion

Interventions aimed at strengthening PHC facility management in SSA primarily emphasize skill development, collaboration, and ongoing managerial support, typically delivered through multiple strategies. However, few studies have evaluated these interventions using rigorous experimental or pragmatic study designs. More robust implementation research is needed to identify effective strategies for strengthening PHC facility management and supporting the consistent implementation of national PHC guidelines.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**

✪ Cost of an Audit and Feedback intervention to increase uptake of maternal and child health services in Mozambique’s Primary health care

Authors:

Ermyas Birru, Aneth Dinis, Jonny Crocker, Quinhas Fernandes, Sarah Gimbel, Steve Gloyd, Artur Gremu, Lisa R. Hirschhorn, Isaías Ramiro, Stelio Tembe, Orvalho Augusto & Kenneth Sherr

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: March 2026

Read the full text in the open access journal Implementation Science Communications

Abstract:

Introduction

Despite high coverage of facility-based maternal and child health (MCH) services in Mozambique, preventable maternal and neonatal deaths remain among the highest globally. To address this, the Integrated District Evidence-to-Action (IDEAs) program was implemented from 2016 to 2020 in central Mozambique as a facility-level Audit and Feedback (A&F) strategy. IDEAs adapted traditional A&F into three components: 1) biannual facility readiness assessments, 2) A&F meetings to develop action plans, and 3) supportive supervision with funding for implementation. This study estimates total and component-specific implementation costs of IDEAs and compares them to average district health budgets.

Methods

Costs were estimated from a payer perspective following CHEERS guidelines, using both Gross and Microcosting methods. Costs were annualized over five years (2016–2020) with a 3% discount rate and are reported in 2020 USD. Staff time estimates were based on program staff consultations and national salary data. Outcomes include average cost per district and total annual cost by intervention component. We conducted a deterministic sensitivity analysis to identify cost drivers with the most significant impact on the overall cost.

Results

The IDEAs programs total (2016–2020) incurred total costs were $2,224,341 (2020 USD), with $1,702,648 (76.5%) for recurrent expenses and $495,323 (22.3%) for Capital expenses. Average annual district-level costs were $41,967, including A&F meetings ($10,893; 26.0%), Capital expenditures ($8255; 19.7%), targeted support ($9323; 22.2%) which includes $5700 (13.6%) for district-level cash transfers and $3623 (8.6%) for facility supervision, and readiness assessments ($6351; 15.1%).Per diems accounted for 52.0% of A&F meeting costs. IDEAs represented approximately 6.6% of the average district health budget. Implementation involved 33 participants with 2560 h yearly per district. Capital expenses were highly sensitive to when applying a standard 25% increase or decrease compared to other cost categories.

Conclusion

Our findings offer practical guidance for district-level planners to adapt and scale IDEAs. Policymakers and donors should integrate recurring costs into budgets and explore cost-saving strategies like virtual tools or streamlined meetings to improve sustainability. Future research must assess long-term integration into government programs and test alternative approaches across diverse low-resource settings to guide scaling.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**