Learning to Harness Innovation in Global Health for Quality Care (HIGH-Q)

Essential technologies could improve quality and outcomes of care if successfully adopted but benefits in LMIC are threatened by workforce shortages and implementation that fails to consider context and system complexity. Thus, many technologies fail, wasting valuable resources or worsening care quality. Our proposal addresses this key emerging issue in global health and with this multiple priority areas: Quality of Care, including user and staff experiences, as hospitals care for sick newborns and introduce new technologies; Health Workforce Management and Planning, as we explore how technologies can support or undermine service delivery and how this affected by staffing levels; and Integrating Health Services & Improved Data Quality and Use, by exemplifying human centred design methods to develop a tool that connects providers and families, houses key patient information and supports timely post-discharge care for vulnerable newborns. We have extensive experience in Kenya and focus on hospitals that must provide high quality neonatal care at scale to help LMIC achieve SDG 3.2. Using neonatal care as an exemplar, we address the urgent need to advance evaluation methods used in LMIC and have two broad objectives: i) to learn how technologies can be better designed and introduced in weak health systems to yield benefits and reduce harms and waste, and ii) to build capacity for rigorous evaluation of complex interventions that inform health systems strengthening using an embedded research approach. To achieve these Work-package 1 will include a co-designed, multi-disciplinary evaluation leveraging the resources of a large existing hospital technology intervention programme to yield time-series data and adding a workforce enhancement intervention and detailed qualitative research to explore the effects on quality and technology adoption of workforce shortages. In Work-package 2, we focus on human-centred design methods to develop a contextually adapted solution to information-sharing and integration of post-discharge neonatal care. In Work-package 3 we tackle cross-cutting issues including the governance of technology related interventions and the effect technologies have on professional roles and the capabilities needed by staff to enhance the everyday resilience that sustains quality in complex social settings. Methodologically we aim to exemplify for all stakeholders and trainees how to use rigorous methods that take a systems perspective to examine the social and organisational processes and actors (providers and users) involved in the success or failure of technologies. Across our work we will be guided by the Non-adoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability (NASSS) framework, combining this with a realist logic for theory of change development and testing, while using multiple sub-studies to understand the routines and needs of workers and users to surface and explore complexity. We will achieve impact through capacity building for policy makers and other stakeholders linked to an increasingly independent Kenyan research team comprising a Co-PI, 2 post-doctoral scientists, 4 PhD students and 4 graduate scientists with national and global collaborator networks. We will directly engage government on planning for technology and workforce enhancements through its technical advisory groups and evaluation governance policies. Globally we will advance thinking and strengthen evaluation practice.