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Less external support by upper echelons induced the weakness of leadership; thereby decreasing the strength of implementation activities exhibited by an informal and less coordinated 'muddling through'-behavior.
With one exception (Case F), this effect was illustrated across the sites, as all of them introduced 'experience-based' implementation procedures: The 'roll out' started with so-called pilot offices, mainly to gain initial results referring to the strength of implementation activities.
Health impact studies rarely reported process or outcome indicators that would help understand health outcomes and relate these to the strength of implementation.
One challenge to program evaluation at scale is determining the strength of implementation, defined here as the quantity of a program delivered to a population.
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We assessed the strength of iCCM implementation and the quality of care provided by health extension workers (HEWs).
This method for assessing the strength of program implementation also represents an important step forward for the rigorous evaluation of public health programs at scale.
Late neonatal mortality (7-27 days) was inversely associated with the strength of KMC implementation (R=-0.43; p<0.01) after adjustment for the technology score of the maternity unit and region of the country [ 117].
The strength of this implementation study is that not only a thorough evaluation is executed on the effects of the CI-strategy on professional practice, but that the effects on client and caregiver treatment outcomes are evaluated as well.
Factors that contribute to the strength of KMC implementation include: training and orientation; supportive supervision; integrating KMC into quality improvement; continuity of care; involvement of and support from government, district, and institutional managers; and client-oriented care.
An emphasis on better information at the district level through routine monitoring and special exercises, such as telephone surveys among iCCM-trained HSAs to assess drug supplies, frequency and content of supervision, and use of services, 16 will provide additional information about the strength of CCM implementation and allow program managers to identify ongoing weaknesses for improvements.
In intervention and comparison areas, survey teams collected information on the strength of iCCM/routine CCM implementation.
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