Analyzing implementation dynamics using theory-driven evaluation principles: lessons learnt from a South African centralized chronic dispensing model

Simple item page
dc.contributor.authorMagadzire, Bvudzai Priscilla
dc.contributor.authorMarchal, Bruno
dc.contributor.authorMathys, Tania
dc.contributor.authorLaing, Richard
dc.contributor.authorWard, Kim
dc.date.accessioned2017-12-11T09:00:47Z
dc.date.available2017-12-11T09:00:47Z
dc.date.issued2017
dc.description.abstractBACKGROUND: Centralized dispensing of essential medicines is one of South Africa’s strategies to address the shortage of pharmacists, reduce patients’ waiting times and reduce over-crowding at public sector healthcare facilities. This article reports findings of an evaluation of the Chronic Dispensing Unit (CDU) in one province. The objectives of this process evaluation were to: (1) compare what was planned versus the actual implementation and (2) establish the causal elements and contextual factors influencing implementation. METHODS: This qualitative study employed key informant interviews with the intervention’s implementers (clinicians, managers and the service provider) [N = 40], and a review of policy and program documents. Data were thematically analyzed by identifying the main influences shaping the implementation process. Theory-driven evaluation principles were applied as a theoretical framework to explain implementation dynamics. RESULTS: The overall participants’ response about the CDU was positive and the majority of informants concurred that the establishment of the CDU to dispense large volumes of medicines is a beneficial strategy to address healthcare barriers because mechanical functions are automated and distribution of medicines much quicker. However, implementation was influenced by the context and discrepancies between planned activities and actual implementation were noted. Procurement inefficiencies at central level caused medicine stock-outs and affected CDU activities. At the frontline, actors were aware of the CDU’s implementation guidelines regarding patient selection, prescription validity and management of non-collected medicines but these were adapted to accommodate practical realities and to meet performance targets attached to the intervention. Implementation success was a result of a combination of ‘hardware’ (e.g. training, policies, implementation support and appropriate infrastructure) and ‘software’ (e.g. ownership, cooperation between healthcare practitioners and trust) factors. CONCLUSION: This study shows that health system interventions have unpredictable paths of implementation. Discrepancies between planned and actual implementation reinforce findings in existing literature suggesting that while tools and defined operating procedures are necessary for any intervention, their successful application depends crucially on the context and environment in which implementation occurs. We anticipate that this evaluation will stimulate wider thinking about the implementation of similar models in low- and middle-income countries.en_US
dc.identifier.citationMagadzire, B.P. et al. (2017). Analyzing implementation dynamics using theory-driven evaluation principles: lessons learnt from a South African centralized chronic dispensing model. BMC Health Services Research, 17(Suppl 2): 724en_US
dc.identifier.issn1472-6963
dc.identifier.urihttp://dx.doi.org/10.1186/s12913-017-2640-2
dc.identifier.urihttp://hdl.handle.net/10566/3310
dc.language.isoenen_US
dc.privacy.showsubmitterFALSE
dc.publisherBioMed Centralen_US
dc.rights© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
dc.status.ispeerreviewedTRUE
dc.subjectChronic Dispensing Uniten_US
dc.subjectCentralized dispensingen_US
dc.subjectMedicines supply chainen_US
dc.subjectTheory-driven evaluationen_US
dc.subjectAccess to medicinesen_US
dc.subjectWestern Capeen_US
dc.subjectSouth Africaen_US
dc.titleAnalyzing implementation dynamics using theory-driven evaluation principles: lessons learnt from a South African centralized chronic dispensing modelen_US
dc.typeArticleen_US

Files

Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
Anderson_Social-responsibility_2017.pdf
Size:
307.08 KB
Format:
Adobe Portable Document Format
Description:
Download
License bundle
Now showing 1 - 1 of 1
No Thumbnail Available
Name:
license.txt
Size:
1.71 KB
Format:
Item-specific license agreed upon to submission
Description:
Download

Collections

Research Articles (School of Public Health)