Abstract:
Background: We have conducted an intervention study aiming to improve hospital care for
children and newborns in Kenya. In judging whether an intervention achieves its aims, an
understanding of how it is delivered is essential. Here, we describe how the implementation team
delivered the intervention over 18 months and provide some insight into how health workers, the
primary targets of the intervention, received it.
Methods: We used two approaches. First, a description of the intervention is based on an analysis
of records of training, supervisory and feedback visits to hospitals, and brief logs of key topics
discussed during telephone calls with local hospital facilitators. Record keeping was established at
the start of the study for this purpose with analyses conducted at the end of the intervention
period. Second, we planned a qualitative study nested within the intervention project and used indepth
interviews and small group discussions to explore health worker and facilitators' perceptions
of implementation. After thematic analysis of all interview data, findings were presented, discussed,
and revised with the help of hospital facilitators.
Results: Four hospitals received the full intervention including guidelines, training and two to three
monthly support supervision and six monthly performance feedback visits. Supervisor visits, as well
as providing an opportunity for interaction with administrators, health workers, and facilitators,
were often used for impromptu, limited refresher training or orientation of new staff. The personal
links that evolved with senior staff seemed to encourage local commitment to the aims of the
intervention. Feedback seemed best provided as open meetings and discussions with
administrators and staff. Supervision, although sometimes perceived as fault finding, helped local
facilitators become the focal point of much activity including key roles in liaison, local monitoring
and feedback, problem solving, and orientation of new staff to guidelines. In four control hospitals
