背景:扩大规模和可持续性通常是分开研究的,很少有研究研究这两个过程之间的相互依赖性以及疟疾预防和控制创新的实施背景。研究人员和实施者对创新的内容给予了更多的关注,因为他们专注于技术层面和扩张条件。研究人员通常认为创新是线性序列,其中扩大规模和可持续性代表了最后阶段。在这份手稿中使用系统思维,我们通过2014年至2018年在布基纳法索采用和实施季节性疟疾化学预防措施(SMC),分析了复杂的规模和可持续性过程.
方法:我们进行了一项定性案例研究,涉及141个回顾性次要数据(行政,按,科学,工具和登记册,和逐字记录)从2012年到2018年。我们用2018年2月至3月期间收集的主要数据补充了这些数据,这些数据是通过对SMC利益相关者和非参与者观察的15次个人半结构化访谈的形式收集的。过程分析使我们能够根据不同的垂直和水平分析水平及其相互联系,随着时间的推移概念化扩展和可持续性过程。
结果:我们的结果表明,SMC的六个内部和外部决定因素可能对其规模扩大和可持续性产生负面影响或负面影响。这些决定因素是有效性,监测和评估系统,资源(财务,材料,和人类),领导和治理,适应当地环境,和其他外部元素。我们的结果表明,捐助者和执行行为者将财政资源优先于其他决定因素。相比之下,我们的研究清楚地表明,创新的可持续性,以及它的扩大,在很大程度上取决于对决定因素相互关联性的考虑。每个决定因素都可以同时构成创新成功的机遇和挑战。
结论:我们的发现强调了系统观点在考虑所有环境(国际,国家,国家以下,和局部)实现质量的大规模改进,股本,以及全球卫生干预措施的有效性。因此,复杂和系统的思维使我们有可能观察到新兴和动态的创新行为以及可持续性和扩大过程的动态。
Scale-up and sustainability are often studied separately, with few studies examining the interdependencies between these two processes and the implementation contexts of innovations towards malaria prevention and control. Researchers and implementers offer much more attention to the content of innovations, as they focus on the technological dimensions and the conditions for expansion. Researchers have often considered innovation a linear sequence in which scaling up and sustainability represented the last stages. Using systems thinking in this manuscript, we analyze complex scaling and sustainability processes through adopting and implementing seasonal malaria chemoprevention (SMC) in Burkina Faso from 2014 to 2018.
We conducted a qualitative
case study involving 141 retrospective secondary data (administrative, press, scientific, tools and registries, and verbatim) spanning from 2012 to 2018. We complemented these data with primary data collected between February and March 2018 in the form of 15 personal semi-structured interviews with SMC stakeholders and non-participant observations. Processual analysis permitted us to conceptualize scale-up and sustainability processes over time according to different vertical and horizontal levels of analysis and their interconnections.
Our results indicated six internal and external determinants of SMC that may negatively or positively influence its scale-up and sustainability. These determinants are effectiveness, monitoring and evaluation systems, resources (financial, material, and human), leadership and governance, adaptation to the local context, and other external elements. Our results revealed that donors and implementing actors prioritized financial resources over other determinants. In contrast, our study clearly showed that the sustainability of the innovation, as well as its scaling up, depends significantly on the consideration of the interconnectedness of the determinants. Each determinant can concurrently constitute an opportunity and a challenge for the success of the innovation.
Our findings highlight the usefulness of the systemic perspective to consider all contexts (international, national, subnational, and local) to achieve large-scale improvements in the quality, equity, and effectiveness of global health interventions. Thus, complex and systems thinking have made it possible to observe emergent and dynamic innovation behaviors and the dynamics particular to sustainability and scaling up processes.