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

Global Health Action, vol. 15, pp. 2034136

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.

Authors 19

1. Jane Brandt Sørensen corresponding

   University of Copenhagen

   Affiliation as printed

   Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark

2. Natasha Housseine

   Aga Khan University

   Affiliation as printed

   Medical College, Aga Khan University, Medical College East Africa, Dar Es Salaam Campus Tanzania

3. Nanna Maaløe

   University of Copenhagen · Hvidovre Hospital

   Affiliation as printed

   Department of Obstetrics and Gynaecology, Hvidovre University Hospital, Hvidovre, Denmark

   Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark

4. Ib Christian Bygbjerg

   University of Copenhagen

   Affiliation as printed

   Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark

5. Britt Pinkowski Tersbøl

   University of Copenhagen

   Affiliation as printed

   Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark

6. Flemming Konradsen

   University of Copenhagen

   Affiliation as printed

   Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark

7. Brenda Sequeira Dmello

   University of Copenhagen · Aga Khan University

   Affiliation as printed

   Comprehensive Community Based Rehabilitation in Tanzania Tanzania

   Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark

   Medical College, Aga Khan University, Medical College East Africa, Dar Es Salaam Campus Tanzania

8. Thomas van den Akker Aachen Department of Obstetrics and Gynaecology

   Leiden University · Leiden University Medical Center · Vrije Universiteit Amsterdam

   Affiliation as printed

   Athena Institute is the department, Athena Institute, VU University, Amsterdam, The Netherlands

   Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands

9. Jos van Roosmalen Aachen Department of Obstetrics and Gynaecology

   Leiden University · Leiden University Medical Center · Vrije Universiteit Amsterdam

   Affiliation as printed

   Athena Institute is the department, Athena Institute, VU University, Amsterdam, The Netherlands

   Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands

10. Sangeeta Mookherji

    George Washington University

    Affiliation as printed

    Department of Global Health, George Washington University Milken Institute School of Public Health, Washington DC, US

11. Eunice Siaity

    Aga Khan University

    Affiliation as printed

    Medical college, Aga Khan University, School of Nursing and Midwifery East Africa, Dar Es Salaam Campus Tanzania

12. Haika Osaki

    University of Copenhagen · Aga Khan University

    Affiliation as printed

    Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark

    Medical College, Aga Khan University, Medical College East Africa, Dar Es Salaam Campus Tanzania

13. Rashid Saleh Khamis

    University of Copenhagen

    Affiliation as printed

    Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark

14. Monica Lauridsen Kujabi

    University of Copenhagen

    Affiliation as printed

    Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark

15. Thomas Wiswa John

    University of Copenhagen · Aga Khan University

    Affiliation as printed

    Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark

    Medical College, Aga Khan University, Medical College East Africa, Dar Es Salaam Campus Tanzania

16. Dan Wolf Meyrowitsch

    University of Copenhagen

    Affiliation as printed

    Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark

17. Columba Mbekenga

    Aga Khan University

    Affiliation as printed

    Medical college, Aga Khan University, School of Nursing and Midwifery East Africa, Dar Es Salaam Campus Tanzania

18. Morten Skovdal

    University of Copenhagen

    Affiliation as printed

    Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark

19. Hussein Lesio Kidanto

    Aga Khan University

    Affiliation as printed

    Medical College, Aga Khan University, Medical College East Africa, Dar Es Salaam Campus Tanzania