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Guide to Fostering Change to Scale up Effective Health Services

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Guide to Fostering Change to Scale up Effective Health Services Guide to fostering change to scale up effective health services Guide to fostering change to scale up effective health services “It is not the strongest of the species that survives, nor the most intelligent, but rather the one most responsive to change.” -Charles Darwin WHO Library Cataloguing-in-Publication Data : Guide to fostering change to scale up effective health services. 1.Health services. 2.Health services administration. 3.Delivery of health care – standards. I.World Health Organization. ISBN 978 92 4 150658 8 (NLM classification: W 84.4) © World Health Organization 2013 All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercial distribution– should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Photo credits: All photos except page 40, courtesy of Photoshare Page 12 © 2009 RN Mittal Cover © 2005 Djodi Deutsch Page 14 © 2009 Titus Ojulong Page 3 © 2006 Pradeep Tewari. Page 16 © 1999 Kevork Toranian Page 4 © 2011 Alice Payne Merritt/JHU∙CCP Page 19 © 2012 Cassandra Mickish/CCP Page 5 © 2008 James Falaiye, Page 21 © 2008 Sean Hawkey Page 6 © 2005 David Colwell Page 22 © 2006 Bangladesh Center for Communication Programs Page 8 © 2001 Todd Shapera Page 28 © 2008 David G Bragin Page 9 © 2004 Aung Kyaw Moe Page 31 © 2009 Micah Albert Page 10 © 2008 Maggie Jacoby Page 36 © 1996 Center for Communication Programs Page 11 © 2009 Hanmanta V. Wadgave Page 44 Anonymous Table of contents Introduction to the Guide to Fostering Change 1 Purpose of the Guide 1 Audience for the Guide 1 About the IBP Consortium 1 Acknowledgements 2 Leading Changes in Practices to Improve Health 3 Consider Perceptions of the Innovation 4 Encourage Staff Buy-in and Acceptance of Assigned Responsibilities 5 Promote an Environment that Encourages Change 5 Identify the Characteristics of Potential Adopters 5 Mobilize Opinion Leaders 6 Encourage Others to Follow 6 Address Slow Changers Indirectly 6 Address People’s Reactions to Change 6 Create a Supportive Context: Principles of Fostering and Leading Change 8 A “How To” Process for Fostering Change 10 The Change Process: An Overview 11 Preliminary Phase: Form the Change Coordination Team 12 Phase I: Defining the Need for Change 13 Phase II: Planning for Demonstration and Scale-Up 15 Phase III: Supporting the Demonstration 19 Phase IV: Going to Scale with Successful Change Efforts 21 Fostering Change Indicators 26 Illustrative Examples 28 Scaling up and institutionalizing essential obstetric care in Ecuador 28 Scaling up best practices in essential obstetric, neonatal care and family planning in Yemen 31 The right provider in the right place: scaling-up primary-level postabortion care in Kenya 36 Resource list 40 Preliminary Phase: Form the Change Coordination Team 40 Phase I: Defining the Need for Change 40 Phase II: Planning for Demonstration and Scale-Up 40 Phase III: Supporting the Demonstration 40 Phase IV: Going to Scale with Successful Change Efforts 41 References 42 Annexes 43 Annex 1. ExpandNet and WHO Tools for Fostering Change for Scale-up 44 Annex 2. Improvement Collaborative 47 Annex 3. Glossary of Terms 49 Resource list 51 Preliminary Phase: Form the Change Coordination Team 51 Phase I: Defining the Need for Change 51 Phase II: Planning for Demonstration and Scale-Up 51 Phase III: Supporting the Demonstration 51 Phase IV: Going to Scale with Successful Change Efforts 52 Introduction to the Guide to Fostering Change 1 Introduction to the Guide to Fostering Change This guide is based on the recognition that change is But sometimes the change “bubbles up” from the staff of a inevitable for survival and that directed and planned change health facility seeking to address a service delivery challenge. has a much greater chance of success than ad hoc attempts There are many examples of hospital directors who introduced to introduce new practices. Everyone working to improve proven practices to reduce infection rates or clinic nurses who health, including donors, researchers, technical experts, mobilized their staff to improve counselling to increase family service providers and advocates at the global, national, planning acceptors. district, community and family level is in the business A range of groups can act together as a Change Coordination of fostering, leading or implementing change. But not Team to support change, including international, regional everyone involved in this work has a clear pathway that links and country members of the IBP Consortium; representatives proven change practices with evidence-based clinical and from Ministries of Health and other government ministries; programmatic innovations. non-governmental organizations (NGOs) and faith-based organizations (FBOs); regional and country WHO, UNFPA, and Purpose of the Guide IPPF offices; USAID missions; and regional and country offices Successful change is not an end in itself. Rather, it is a means of USAID cooperating agencies and other donors and decision of improving the availability and quality of services, expanding makers. Active players in a successful change process often utilization and, ultimately, improving health outcomes. This include representatives of national, regional or institutional guide links effective change practices with proven clinical and organizations who are in a position to support the change programmatic practices to achieve results by: as part of the coordination team, as well as those who are implementing the change on the ground at a programme level, • Describing principles fundamental to effective change. service delivery site or in the community. • Increasing awareness of proven approaches to effective change. About the IBP Consortium • Providing “how-to” steps for successful change including The IBP Initiative is a global partnership involving 38 scale-up. international agencies dedicated to demonstrating a dynamic model of international and local cooperation to: • Describing key challenges of scaling up and recommending strategies, tools or approaches for meeting • Encourage the introduction, adaptation, utilization, scaling those challenges. up and monitoring of proven technical and managerial practices to improve utilization and the quality of • Offering cases that show how the steps have been reproductive health services. implemented in real-life situations. • Promote evidence-based provision of quality services. Audience for the Guide • Support ministries of health or other national bodies to facilitate the coordination of partners implementing This guide is for policy-makers, programme managers, reproductive health activities in-country. operations researchers or other health professionals who want to bring about change in a health practice or set of practices. • Reduce duplication of effort. Changes in health practices can originate at different levels. Sometimes an evidence-based practice is introduced • Harmonize approaches and identify synergies that can nationally or regionally to resolve a widespread public health accelerate the implementation and scaling up of effective concern. For example, a Minister of Health or donor might practices. initiate the provision of insecticide-treated bed nets to reduce • Promote creativity and innovation. infant deaths from malaria or the provision of MgSO4 to prevent deaths from eclampsia. • Sustain momentum by keeping networks connected and communicating. 2 Guide to fostering change to scale up effective health services The IBP Initiative was started by the WHO Department of Acknowledgements Reproductive Health and Research in collaboration with USAID, UNFPA and a small group of international agencies The IBP Consortium would like to acknowledge: in 1999 and was formalized as the IBP Consortium in 2003. • United States Agency for International Development, Office IBP partners self-select to work in task teams on specific of Population and Reproductive Health for their technical assignments identified by partners as contributing to our goal and financial support.
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