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Table 3 Health system guideline/recommendation adaptation strategies (FRAME)

From: Strategies to adapt and implement health system guidelines and recommendations: a scoping review

Author

Adaptation strategies

Justification

When the modification occurred; was adaptation planned

Who participated in the decision to modify

What was modified; content of modification

Level of delivery

Andrade et al. (2017) [75]

Attention to chronic conditions model (ACCM)

Lack of resources

Not reported; planned proactive

Steps were conditioned for the ability of health professionals to understand the seven macro processes and their engagement based on available resources

The seven steps of the ACCM (they cut three of the steps to adapt to this health system); removing/skipping elements

Health professionals are the primary and secondary level of care

Armstrong et al. (2014) [90]

Maternal and perinatal death reviews (MPDR) system implementation

Adaptations based on challenges that were identified through a case review including lack of training

These are suggested solutions to challenges that were identified—may or may not have been put into practice; reactive

Determined these during an MPDR meeting

Training and evaluation—providing skills and education to maternity staff and women in the community, respectively; adding elements—training and education

Community (women) and clinic/unit level (maternity staff at hospital/reproductive and child health coordinator)

Bryce et al. (2005) [58]

IMCI generic guidelines can be adapted by any country or area to reflect their specific epidemiological profile and health system characteristics

WHO worked to develop guidelines for the country adaptation process, including evidence for intervention choices, models for how to incorporate additional diseases and conditions into the training materials, and how to conduct local studies to identify terminology and local foods

Cadres of “IMCI adaptation consultants” were trained at regional and global levels

Review of the guideline expectations

Pre-implementation and early implementation; proactive

Countries that implement this programme adapt it to fit their local context

Contextual—setting; tailoring to their local context

Target intervention group

Carneiro et al. (2018) [100]

The more physicians in Brazil programme (MPBP) has resulted in changes in the work processes of the Family Health Strategy (FHS), including changes to the management and control models used in the region

Municipalities experienced strong ascending trends in the number of prenatal consultations and lack of access to resources

Implementation; reactive

Ministry of Health (MoH)

Contextual—how treatment is delivered; tailoring/tweaking/refining—reorganization of the prenatal care

Target intervention group

Gueye et al. (2016) [108]

Strategies were adapted to implement management of malaria programme

Introducing new or adapting strategies, from insecticide rotation to lessen the risk of insecticide resistance, to an increase in parasitological screening in development areas to curtail the risk of transmission, to collaborations with the private sector

None reported

Early implementation; reactive

Staff

Contextual; tailoring to local context

Organization

Halpern et al. (2010) [77]

Adaptation of a standardized HIV patient monitoring system (PMS)

WHO provided training on the HIV care and antiretroviral treatment (ART) PMS, and the technical working group adapted each component for Guyana

System tools and functions were modified based on feedback from the training session participants, and a pilot PMS was subsequently implemented at one site

None reported

Pre-implementation; planned/proactive

Technical working group

Contextual—patient chart data elements and functionality to PMS system; tailoring/tweaking, adding elements to patient chart

Clinic-unit level—HIV care ART

Kihembo et al. (2018) [57]

Implement nationwide ISDR training to health facilities based on the revised guidelines developed

Post-training support through integrated supervision

Two challenges from the first implementation:

Lack of funding resulted in a lack of resources and capacities at the operational level

A need for a harmonized outbreak response and information flow at the district level

Pre-implementation; planned

Ministry of health along with key partners

Aimed to enhance the capacity of districts to promptly detect, access and effectively respond to public health emergencies; adding elements—training

Health workforce all the way up to the operational national level

Leethongdee (2007) [83]

Government decided to fund the scheme by pooling the Ministry of Public Health (MoPH) budgets for public hospitals, other health facilities, and Medical Welfare Scheme (MWS) and voluntary health card scheme and providing additional money

The initial plan met resistance from quarters such as the civil service and the labour unions

Pre-implementation; reactive

Civil service and labour unions rejected the initial plan, government then had to reassess

Implementation and scale-up activities; substituting the funding structures

Target intervention group

Mutabazi et al. (2020) [87]

Over the years, the prevention of mother-to-child transmission of HIV/AIDS (PMTCT) guidelines have been adapted, but no strategies reported

None reported

None reported

None reported

None reported

None reported

Ryan et al. (2020) [109]

Comprehensive community mental health programme (CCMHP)

A scale-up initiative for the general mental health policy implementation in Nigeria through public–private partnership in healthcare delivery

Absence of more clinical resources

Scale-up; reactive

None reported

Phone psychiatrists as needed; adding element

Community psychiatric nurses (CPNs) and community health extension worker (CHEWs)

Schneider and Nxumalo (2017) [97]

Re-engineering of primary healthcare (PHC)

To meet the needs and demands of each community health programme

Not reported; planned proactive

District managers, senior provincial managers, PHC facility managers, outreach team leaders, senior district official, subdistrict managers, PHC facility supervisors, professional nurses, environmental health officers

Health posts vs PHC re-engineering

Roles of nongovernmental organizations were redefined

Change in the method of payment of CHW

New curricula and training processes; tailoring leadership and governance changes

Healthcare workers—specifically community-based workers

Stein et al. (2008) [106]

Incorporating counselling skills into the Practical Approach to Lung Health in South Africa (PALSA) PLUS model

Ongoing onsite training provides emotional support

Given the limiting understanding of nurse counselling skills (i.e. they often threatened patients instead of making recommendation), nurses conceive counselling as “advice” that must be complied with rather than the patient feeling empowerment in decision-making

During the implementation of the PALSA PLUS programme and this evaluation; reactive

Not reported

Ongoing site training and counselling; adding elements—incorporation of a prayer into nurse-training sessions, as a means of accessing spiritual reserves for emotional support

Primary healthcare nurses

Wingfield et al. (2015) [113]

Innovative socioeconomic intervention against TB (ISIAT) strategy was evaluated under the community randomized evaluation of a socioeconomic intervention to prevent TB (CRESIPT) project

Regular steering meetings, focus group discussions and contact in the health posts

Increase adherence and participation in the programme

Pre-implementation and implementation; proactive

Stakeholders + recipients

Contextual—increased the speed of bank transfers; substituting the funding structures

Target intervention group

Zakumumpa et al. [85]

ART scale-up

Nonphysician cadre were prescribing antiretroviral therapy

The shortage of physician-level cadre was identified as a constraint

Scale-up; reactive

Individual practitioners

Implementation and scale-up activities; tweaking—nonphysician cadre were prescribing ART due to rapidly expanding patient volumes

Clinic/unit level, individual practitioner