Scaling Up Business Plans in Tajikistan: a Qualitative Study of the History, Barriers, Facilitators and Lessons Learnt

Overview

Journal Glob Health Action

Specialty Public Health

Date 2021 Aug 3

PMID 34342247

Citations 1

Authors

Sarah S Werner

Gulara Afandiyeva

Gulzira Karimova

Sabine Kiefer

Nasrullo Abdujabborov

Muazamma Dzhamalova

Ilhom Bandaev

Helen Prytherch

Affiliations

Soon will be listed here.

Abstract

Background: To improve health planning at primary health care (PHC) level, Business Plans were introduced in Tajikistan by the Enhancing Primary Health Care (EPHC) Services Project.

Objective: To describe the history and process of implementation of Business Plans and to identify barriers, facilitators and lessons learnt from scaling up Business Plans.

Methods: Set in a qualitative research design, we conducted a desk review of project and official documents and seventeen semi-structured interviews with key stakeholders at national and sub-national levels between May and July 2020. We used an interview guide informed by the ExpandNet/WHO framework and analyzed the data following a content analysis approach facilitated by MAXQDA.

Results: With the participation of various user organizations and resource teams and through a variety of strategic scale-up choices, Business Plans have been scaled up from a vertical pilot project to institutionalized health management tools covering 45% of Tajikistan's PHC facilities. The most prominent facilitators for scaling up Business Plans were the institutionalization and integration of the tool into the Tajik health system, the close collaboration with Community Health Teams (CHTs), the high acceptance of the tool among the users, the advocacy through champions and policy-makers and the large dissemination network. The most outstanding barriers to scaling up Business Plans were insufficient financial or human resources, general weaknesses in health governance, the lack of a strategic scale-up plan and strategic decisions, the lack of motivation or overall vision to implement Business Plans at a large scale and difficulties in donor coordination.

Conclusion: To ensure the continuity of scaling up Business Plans, developing a scale-up strategy, strengthening cross-sectoral collaboration and participation during scaling up, and capacitating the user organizations of Business Plans are important next steps to ensure the sustainability and effectiveness of Business Plans in the future.

Citing Articles

Barriers to and enablers of quality improvement in primary health care in low- and middle-income countries: A systematic review.

Odhus C, Kapanga R, Oele E PLOS Glob Public Health. 2024; 4(1):e0002756.

PMID: 38236832 PMC: 10796071. DOI: 10.1371/journal.pgph.0002756.

References

Khodjamurodov G, Sodiqova D, Akkazieva B, Rechel B . Tajikistan: Health System Review. Health Syst Transit. 2016; 18(1):1-114. View

Milat A, Bauman A, Redman S . Narrative review of models and success factors for scaling up public health interventions. Implement Sci. 2015; 10:113. PMC: 4533941. DOI: 10.1186/s13012-015-0301-6. View

Barker P, Reid A, Schall M . A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa. Implement Sci. 2016; 11:12. PMC: 4731989. DOI: 10.1186/s13012-016-0374-x. View

Starfield B, Shi L, Macinko J . Contribution of primary care to health systems and health. Milbank Q. 2005; 83(3):457-502. PMC: 2690145. DOI: 10.1111/j.1468-0009.2005.00409.x. View

Yamey G . Scaling up global health interventions: a proposed framework for success. PLoS Med. 2011; 8(6):e1001049. PMC: 3125181. DOI: 10.1371/journal.pmed.1001049. View

Ben Charif A, Plourde K, Guay-Belanger S, Zomahoun H, Gogovor A, Straus S . Strategies for involving patients and the public in scaling-up initiatives in health and social services: protocol for a scoping review and Delphi survey. Syst Rev. 2021; 10(1):55. PMC: 7877693. DOI: 10.1186/s13643-021-01597-6. View

Tong A, Sainsbury P, Craig J . Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007; 19(6):349-57. DOI: 10.1093/intqhc/mzm042. View

Spicer N, Alkali Hamza Y, Berhanu D, Gautham M, Schellenberg J, Tadesse F . 'The development sector is a graveyard of pilot projects!' Six critical actions for externally funded implementers to foster scale-up of maternal and newborn health innovations in low and middle-income countries. Global Health. 2018; 14(1):74. PMC: 6063024. DOI: 10.1186/s12992-018-0389-y. View

Spicer N, Bhattacharya D, Dimka R, Fanta F, Mangham-Jefferies L, Schellenberg J . 'Scaling-up is a craft not a science': Catalysing scale-up of health innovations in Ethiopia, India and Nigeria. Soc Sci Med. 2014; 121:30-8. DOI: 10.1016/j.socscimed.2014.09.046. View

10.

Bao J, Rodriguez D, Paina L, Ozawa S, Bennett S . Monitoring and Evaluating the Transition of Large-Scale Programs in Global Health. Glob Health Sci Pract. 2015; 3(4):591-605. PMC: 4682584. DOI: 10.9745/GHSP-D-15-00221. View

11.

Bulthuis S, Kok M, Raven J, Dieleman M . Factors influencing the scale-up of public health interventions in low- and middle-income countries: a qualitative systematic literature review. Health Policy Plan. 2019; 35(2):219-234. PMC: 7050685. DOI: 10.1093/heapol/czz140. View

12.

Hobday K, Hulme J, Prata N, Wate P, Belton S, Homer C . Scaling Up Misoprostol to Prevent Postpartum Hemorrhage at Home Births in Mozambique: A Case Study Applying the ExpandNet/WHO Framework. Glob Health Sci Pract. 2019; 7(1):66-86. PMC: 6538124. DOI: 10.9745/GHSP-D-18-00475. View

13.

Macinko J, Starfield B, Erinosho T . The impact of primary healthcare on population health in low- and middle-income countries. J Ambul Care Manage. 2009; 32(2):150-71. DOI: 10.1097/JAC.0b013e3181994221. View

14.

Gotsadze G, Chikovani I, Sulaberidze L, Gotsadze T, Goguadze K, Tavanxhi N . The Challenges of Transition From Donor-Funded Programs: Results From a Theory-Driven Multi-Country Comparative Case Study of Programs in Eastern Europe and Central Asia Supported by the Global Fund. Glob Health Sci Pract. 2019; 7(2):258-272. PMC: 6641812. DOI: 10.9745/GHSP-D-18-00425. View

15.

Yamey G . What are the barriers to scaling up health interventions in low and middle income countries? A qualitative study of academic leaders in implementation science. Global Health. 2012; 8:11. PMC: 3514334. DOI: 10.1186/1744-8603-8-11. View

16.

Kringos D, Boerma W, Zee J, Groenewegen P . Europe's strong primary care systems are linked to better population health but also to higher health spending. Health Aff (Millwood). 2013; 32(4):686-94. DOI: 10.1377/hlthaff.2012.1242. View

17.

Callaghan-Koru J, Khan M, Islam M, Sowe A, Islam J, Billah S . Implementation outcomes of the national scale up of chlorhexidine cord cleansing in Bangladesh's public health system. J Glob Health. 2019; 9(2):020410. PMC: 6793170. DOI: 10.7189/jogh.09.020410. View

18.

Bitton A, Fifield J, Ratcliffe H, Karlage A, Wang H, Veillard J . Primary healthcare system performance in low-income and middle-income countries: a scoping review of the evidence from 2010 to 2017. BMJ Glob Health. 2019; 4(Suppl 8):e001551. PMC: 6703296. DOI: 10.1136/bmjgh-2019-001551. View

19.

Mangham L, Hanson K . Scaling up in international health: what are the key issues?. Health Policy Plan. 2010; 25(2):85-96. DOI: 10.1093/heapol/czp066. View

20.

Ben Charif A, Zomahoun H, Leblanc A, Langlois L, Wolfenden L, Yoong S . Effective strategies for scaling up evidence-based practices in primary care: a systematic review. Implement Sci. 2017; 12(1):139. PMC: 5700621. DOI: 10.1186/s13012-017-0672-y. View