This blog was originally published on USAID’s Health Research Program website here.
Coordinating Implementation Research to Communicate Learning and Evidence
Michelle C. May, Research Associate, CIRCLE Project
The Zika outbreak greatly affected several Latin American and Caribbean countries to the extent that the World Health Organization declared it an international public health emergency on February 1, 2016. USAID is assessing the extent to which the outbreak affected Maternal, Newborn and Child Health (MNCH) service delivery and the resiliency of the health system in five affected countries: Colombia, El Salvador, Honduras, Guatemala, and the Dominican Republic.
Resiliency is defined as “the ability of people, households, communities, countries, and systems to mitigate, adapt to, and recover from shocks and stresses in a manner that reduces chronic vulnerability and facilitates inclusive growth” (USAID, 2017).
Under the guidance of USAID’s Health Research Program, the CIRCLE Project, with implementing partner G|Exponencial, is conducting a five-country learning assessment using mixed methods to better understand the resiliency of each country’s health system to deliver MNCH services in response to the Zika outbreak. This assessment aims to identify recommendations to improve health service delivery and build more resilient health systems to better mitigate stressors during future outbreaks.
In only three months, the partners organized two technical advisory group meetings, developed a research methodology, implemented a training workshop and pilot testing, and conducted 387 key informant interviews and 44 focus group discussions with a total of 345 individuals in five countries. This was quite an accomplishment given the short timeframe. The learning assessment kicked off on February 25 with a week-long training workshop in Bogotá, Colombia. The workshop brought together the five country teams including lead investigators, qualitative experts, team consultants, transcribers and coders. Overall, 64 people participated in the training workshop. The training was focused on ensuring that all team members understood the objectives of the learning assessment, the overall timeline and the quantitative and qualitative data collection instruments. Country teams presented their health system’s structure, which provided a much-needed context on how MNCH health services are organized and delivered, and identified similarities or differences among the five countries. A review of qualitative interviewing techniques and mock interviews proved very effective and helped interviewers increase familiarity with the study and its objectives.
In early March, the country teams worked together in the Colombian cities of Buga and Cali, to pilot the key informant interview guides and focus group discussion guides. In addition to gauging the effectiveness of the instruments and practicing interviewing techniques, the pilot test exposed some logistical challenges that were quickly addressed in order to mitigate similar challenges in the other countries. When the team gathered to de-brief at the end of each day, areas for improvement and emergent themes from the interviews were identified and incorporated for further improvement.
The pilot test was also an opportunity to assess the transcription and coding processes and identify methods to ensure quality control. The transcription leader checked transcriptions for quality and accuracy while coding pairs were assigned to each country team to check for coding errors or discrepancies. In addition, a coding lead reviewed all coded transcripts for an added level of quality control.
Starting in mid-March, the immense undertaking of data collection began simultaneously in each of the five countries. The lessons learned from the pilot enabled the study teams to successfully complete the data collection in four weeks.
This intensive process yielded rich information which will be analyzed in the coming months to understand how each country’s health system responded and adapted to the Zika outbreak. The information will identify what areas of each country’s health system were disrupted by the outbreak, how MNCH service delivery was affected, and to what extent health systems adapted.
The results of this assessment will provide a better understanding of how health systems are structured, their response to unexpected outbreaks, and identification of strengths and weaknesses. Findings will help pave the way for the development of more resilient health systems capable of responding to future outbreaks – like Zika – without disrupting MNCH service delivery. These learnings will also contribute to the global body of evidence surrounding health systems strengthening and outbreak response.