Facilitators and Barriers Affecting the Implementation of Capacity Building and Mentorship Program (CBMP) in Improving Evidence-Based Decision-Making in Amhara Region, Northwest Ethiopia: An Exploratory Qualitative Study

Abstract

Background: The Capacity Building and Mentorship Program (CBMP) has been implemented in Amhara Region to enhance data use for decisions. Though the intervention is effectively improving the routine health data use for decision-making, knowledge on the facilitators and barriers in implementing the CBMP is scarce. Therefore, this study sought to explore the facilitators and barriers that affect the implementation of the CBMP in improving evidence-based decision-making in the Amhara National Regional State of Ethiopia.
Methods: A hermeneutical phenomenology qualitative study was done in five districts of the Amhara region from 5th June to 30th July/ 2020. The study recruited 25 key informants working at different health system levels using a heterogeneous purposive sampling method. Codes were developed and assigned to the data, ideas of patterns were searched, and themes and subthemes were identified using abductive thematic analysis.
Results: The overarching thematic areas spanning were 1) The need for Capacity Building and Mentorship Program (CBMP), 2) the Effectiveness of CBMP in Routine Health Information System (RHIS) Performances, 3) Implementation Facilitators, and 4) Implementation Barriers. The implementation facilitators and barriers subthemes were human-related, technical, organizational, and socio-economic context-related. Human-related (a favorable attitude towards recommendations for mentors, staff motivation, and leaders’ commitment), technical (skill in data management and use, and the capacity for conducting the performance monitoring team meeting), organizational (access to information, data availability, and resource supply), and contextual (policy support and government concern) were positive attributes. Human-related constraints include resistance to accepting the intervention at the early stage of the intervention period and lack of knowledge on the National Classification of Disease; technical barriers: lack of intra-facility information communication skills and inadequate training; organizational barriers: trained staff turnover, and lack of technology for intra-facility data sharing; and contextual barriers (the onset of the COVID19 and security issues.
Conclusion: Human, technical, organizational, and contextual attributes played massive roles in facilitating the implementation. However, strengthening the capacity of health workers, supporting health workers for good use of NCOD, installing intra-facility level data sharing mechanisms, and continuous re-assessment of the context in implementing the CBMP is required.