Scaling up Locally Adapted Clinical Practice Guidelines for Improving Childbirth Care in Tanzania: A Protocol for Programme Theory and Qualitative Methods of the PartoMa Scale-up Study

Jane Brandt Sørensen, Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Natasha Housseine, Medical College, Aga Khan University, Medical College East Africa, Dar Es Salaam Campus Tanzania.
Nanna Maaløe, Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Ib Christian Bygbjerg, Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Britt Pinkowski Tersbøl, Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Flemming Konradsen, Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Brenda Sequeira Dmello, Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Thomas van Den Akker, Athena Institute is the department, Athena Institute, VU University, Amsterdam, The Netherlands.
Jos van Roosmalen, Athena Institute is the department, Athena Institute, VU University, Amsterdam, The Netherlands.
Sangeeta Mookherji, Department of Global Health, George Washington University Milken Institute School of Public Health, Washington DC, US.
Eunice Siaity, Medical college, Aga Khan University, School of Nursing and Midwifery East Africa, Dar Es Salaam Campus Tanzania.
Haika Osaki, Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Rashid Saleh Khamis, Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Monica Lauridsen Kujabi, Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Thomas Wiswa John, Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Dan Wolf Meyrowitsch, Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Columba Mbekenga, Medical college, Aga Khan University, School of Nursing and Midwifery East Africa, Dar Es Salaam Campus Tanzania.
Morten Skovdal, Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Hussein L Kidanto, Medical College, Aga Khan University, Medical College East Africa, Dar Es Salaam Campus Tanzania.

Document Type

Journal Article

Publication Date

12-31-2022

Journal

Global health action

Volume

15

Issue

1

DOI

10.1080/16549716.2022.2034136

Keywords

Practice theory; co-creation; intervention; obstetrics; respectful maternity care

Abstract

Effective, low-cost clinical interventions to improve facility-based care during childbirth are critical to reduce maternal and perinatal mortality and morbidity in low-resource settings. While health interventions for low- and lower-middle-income countries are often developed and implemented top-down, needs and circumstances vary greatly across locations. Our pilot study in Zanzibar improved care through locally co-created intrapartum clinical practice guidelines (CPGs) and associated training (the PartoMa intervention). This intervention was context-tailored with health-care providers in Zanzibar and now scaled up within five maternity units in Dar es Salaam, Tanzania. This PartoMa Scale-up Study thereby provides an opportunity to explore the co-creation process and modification of the intervention in another context and how scale-up might be successfully achieved. The overall protocol is presented in a separate paper. The aim of the present paper is to account for the Scale-up Study's programme theory and qualitative methodology. We introduce social practice theory and argue for its value within the programme theory and towards qualitative explorations of shifts in clinical practice. The theory recognizes that the practice we aim to strengthen - safe and respectful clinical childbirth care - is not practiced in a vacuum but embedded within a socio-material context and intertwined with other practices. Methodologically, the project draws on ethnographic and participatory methodologies to explore current childbirth care practices. In line with our programme theory, explorations will focus on meanings of childbirth care, material tools and competencies that are being drawn upon, birth attendants' motivations and relational contexts, as well as other everyday practices of childbirth care. Insights generated from this study will not only elucidate active ingredients that make the PartoMa intervention feasible (or not) but develop the knowledge foundation for scaling-up and replicability of future interventions based on the principles of co-creation and contextualisation.

Department

Global Health

Link to Full Text

Share

COinS