Table 2 Embedded implementation research findings and health policy/programme impact

Argentina

Implementation of the of perinatal health regionalisation strategy is heterogeneous across different sub-regions of the province; communication among all stakeholders and organisation of transport between levels were identified as the main barriers; general agreement with the strategy is a potential facilitator

Action plan to enhance monitoring and improve implementation

Policy brief; deliberative dialogue

Involvement and participation of key stakeholders from the five sub-regions; establishment of new process indicators to monitor implementation of the regionalisation strategy

Argentina

Major obstacles in the implementation of the National Chagas Program included little articulation between stakeholders, lack of training, difficulties in follow-up of patients and barriers associated with access to services

Decentralisation strategy

Report; website communications

A pilot of decentralisation was carried out, evaluating strategies to optimise intervention on a large scale; results will be reintegrated in scale-up activities

Bolivia

Although healthcare workers believe 100% of pregnant women should be screened, only 55% of the reviewed clinical records indicate syphilis laboratory results and only 37% of perinatal medical histories are reporting the syphilis laboratory results; barriers to syphilis screening included insufficient time for staff to raise awareness among pregnant women about the benefits of screening for syphilis and other diseases, and gaps in communication between medical and laboratory staff

Action plan for periodic review of the coverage of syphilis testing in pregnant women

Workshops and meetings with key stakeholders, including health services providers of Los Andes Health Network, and coordinators of health networks of El Alto rural and urban areas of La Paz Department; discussions on syphilis testing coverage in pregnant women

Strengthening the clinical records and registry; follow-up and monitoring

Brazil

Barriers of tuberculosis (TB)/HIV co-infection management included lack of knowledge of clinical protocols, insufficient human resources, low commitment to address the two diseases, differences in recommendation, e.g. frequency of visits for TB/HIV, and oversubscription of specialist services

Monitoring strategy for integrated TB/HIV care

Results were discussed with managers and health promoters of the HIV/AIDS/hepatitis and TB programmes

Development of a protocol of TB medication adherence

Chile

Adolescents reported difficulties accessing the centres’ contraception services due to cultural factors, lack of information, administrative requirements and existing bureaucratic practices; there were errors in professionals’ management of standards and legal procedures concerning fertility, and no existing interpretive framework recognising sexual and reproductive rights to guide actions; adolescents’ needs associated with their rights are invisible and unsatisfied, and health professionals do not share common criteria for addressing this topic with adolescents

Strategies to improve the programme, in terms of professionals’ training, process of designing and implementing a protocol outlining how to access contraception needs, and active incorporation of adolescents’ feedback

Presentation of results in the Study Local Committee and incorporation of new ideas arising from the Study Coordinator’s participation in the intersectoral network of the Municipality of Huechuraba Departments of Youth and Education, which was formed to implement public policies focused on adolescents

The findings prompted the creation of a training programme on gender and sexual and reproductive rights for professional teams from health centres in the municipality; additionally, a protocol outlining adolescents’ access to health services will be designed and established; the results of the study also contributed to the planning process of a safe space for adolescents, outside of the clinical setting, and the formation of an intersectoral network focused on public policies concerning adolescents; these actions served to address the identified obstacles and improve the quality of programme offerings directed toward adolescents’ sexual and reproductive rights

Chile

The main challenge was lack of a structured process for development and management of clinical practice guidelines; the major strategy recommended to overcome this challenge was the development of an optimised workflow for the development and implementation of clinical practice guidelines, tailored to the Chilean context

Workflow, including strategies, flowchart, management protocols, handbook for clinical practice guideline development

Workshops, publications, staff meetings

Eighty clinical practice guidelines were updated by of the Ministry of Health using the GRADE methodology; administrative changes included transferring the current department to the Division of Health Planning and merging with the Health Technology Assessment Department; an internal document was created to guide the roles and functions of the clinical practice guidelines coordinator within the Ministry of Health

Colombia

Of those who responded to the survey, 86% knew about the clinical practice guidelines (CPG), 86% prioritised the CPG recommendations, 82% used the factsheets and 79% used the interactive flowcharts; 41% had never used the implementation tools; of those who had used the implementation tools, 55% used them on desktops at their work, 24% on smartphones and 21% elsewhere; the most useful implementation tool was the factsheet (98%), followed by interactive flowchart (98%) and prioritised recommendation (92%)

New or revised tools to support implementation

Tools will be disseminated through the Colombian Health Technology Assessment Institute (IETS) web page, conferences and direct technical support to hospitals and other health services providers

Implementation tools will be fine-tuned based on the feedback received; preferred tools will be prioritised

Mexico

The internet connection bandwidth hampers information exchange for teleconsultations; the specialties most in demand are internal medicine and gynaecology; areas for improvement were identified in the programme’s process manuals

Online courses; manual for implementation and operation of TeleHealth program; refresher training; contingency plan for information technology failure; induction programme

Meetings; workshops; presentations

The activities of the Telehealth Coordination (THC) were integrated in the strengthening strategy of the networks of medical units in the state. The THC in Oaxaca was recognised in the Internal Rules of the Health Services of Oaxaca. It increased the number of rural medical units incorporated into the Telehealth Care Network. The schedule of medical specialists of the internal medicine service was extended and is now available on Saturdays, Sundays and holidays

Peru

Barriers identified: little or no coordination between TB and HIV teams, management of the TB/HIV co-infected patients at different levels of care, inadequate financing, scarce or poorly trained human resources and the absence of an integrated information system

Strategy for HIV/AIDS and TB co-infection; technical document to regulate TB/HIV joint activities

Meetings, training sessions

Development of a TB/HIV integrated care model; changes to regulatory framework; planning of joint activities

Saint Lucia

High acceptability of the heel prick (HP) test; the majority of healthcare workers were familiar with the HP test (85.7%) but 74.3% and 72.9% had not attended training sessions on the procedure or the collection of the sample, respectively; a total of 92.9% reported that the HP test was useful; regarding safety, 81.4% felt that the test was not harmful to babies;

healthcare workers reported that the test was painful for the baby (74.3%) and 58.6% felt uncomfortable doing the test

Strategy for implementing newborn blood spot screening programme

Presentations and reports; meeting with steering committee

Results have not yet been reintegrated into the screening programme