Exploring health facility review meetings and factors influencing their implementation in districts in Uganda. A case of Nakaseke District

Abstract

Introduction: Despite concerted efforts to improve Reproductive, Maternal, Neonatal Child and Adolescent Health (RMNCAH) conditions, it remains important to explore the factors influencing the successful implementation of review meetings used to monitor RMNCAH conditions in health facilities. Methodology: This study utilized a mixed methods multiple case design employing concurrent triangulation mixed method of data collection with main focus on the qualitative component from seven conveniently selected health facilities implementing Result Based Financing (RBF). A total of 53 purposively chosen participants for being prescribed to participate in review meetings in the RBF guidelines were enrolled in the study. Simple linear regression was used to assess the association of review meetings with facility deliveries and DPT3 dropout rate at 95% confidence interval. The impact of RBF on the proportion of review meetings was analyzed using Interrupted time series. Exploratory factor analysis (EFA) was applied to generate a suitable structure indicating factors influencing the conduct of review meetings. Descriptive analysis of items in the generated structure through EFA was undertaken utilizing the consolidated framework for implementation research (CFIR) index whilst verbatim transcripts from the focus group discussions underwent directed content analysis, referencing the adapted CFIR Research model Findings: The study revealed the target of 21 review meetings to have been met only in July- September 2021 and October-December 2021 out of the 16 quarters. Result Based Financing was not significantly associated with the implementation of review meetings. The implementation of review meetings was not significantly associated with facility deliveries. DPT3 dropout rate decreased significantly by 0.032% for every additional percentage of review meeting. Availability of external change agents, sharing of data, coordination with supportive organizations, supportive supervision as well as staff self-motivation were facilitators of review meeting implementation. Lack of incentives, inadequate feedback on action points from previous meetings to participants as well as inadequate human resource were barriers to review meeting implementation. Conclusion: It is important to provide incentives such as lunch to meeting participants for review meeting conduct. Staffing, feedback on recommendations and supportive supervision in health facilities should also be improved for implementation of the valuable review meetings in Nakaseke District.