BACKGROUND: Problem Solving for Better Health (PSBH) aims to strengthen healthcare systems through a ‘bottom up’ approach, optimizing use of existing resources to solve problems in low-resource contexts. Between November 2021 and June 2022, the Government of Lesotho sought to train about 900 nurses in PSBH (PSBHN), collaborating with the Lesotho-Boston Health Alliance. This dissertation evaluated PSBHN implementation.
METHODS: A mixed-methods single group pre-test, post-test design guided by the RE-AIM framework was employed. Change in problem-solving efficacy among nurses was assessed with Problem-Solving Inventory at baseline and 3–6 months post-training. We assigned quality scores for nurses’ planned quality improvement projects at training and assessed extent of project implementation 3–6-months later. We conducted in-depth interviews with the PSBHN implementers and nurses to understand experiences with PSBHN. Costs of implementation from a limited societal perspective and scenarios for future scale-up were estimated. We used Stata17, NVivo12 and Excel16 for data analyses.
RESULTS: A total of 89 of the planned 900 nurses were trained (10%). Approximately 66% of nurses achieved a medium quality score for the project designed at training; 31% scored high. At follow up, no significant change in problem solving efficacy was observed (p=0.658), but nearly 50% of nurses had initiated their projects, with a 35% increase in project initiation odds for every one-unit increase in project quality score (p<0.014). Qualitatively, coworker and manager support, along with personal drive enabled nurses. Both trainees and the implementation team reported challenges related to funding and resources, competing interests, and lack of stakeholder support. The total financial and economic implementation costs were US$36,413 and US$41,784, respectively. A four-year scale-up was estimated at US$665,142 in 2023 present value, representing 0.4% of the 2023 government’s health sector budget. Two scale-up alternatives were considered: a minimal case scenario at US$222,428 and an ambitious case scenario, US$987,897, both in 2023 present value.
CONCLUSION: Implementing costs are a modest proportion of the health budget, but challenges should be addressed to improve reach, adoption, and implementation effectiveness. Efforts to improve the quality of trainees’ planned projects and address barriers faced in the workplace could strengthen PSBHN implementation in Lesotho.
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/47900 |
| Date | 04 January 2024 |
| Creators | Akolbire, Doris |
| Contributors | Scott, Nancy A. |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
| Rights | Attribution 4.0 International, http://creativecommons.org/licenses/by/4.0/ |
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