Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 8 2022 08 01 Challenges in Implementing Community-Based Healthcare Teams in a Low-Income Country Context: Lessons From Ethiopia’s Family Health Teams 1459 1471 4057 10.34172/ijhpm.2021.52 EN Teralynn Ludwick Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia Misganu Endriyas Health Research and Technology Transfer Office, SNNPR Regional Health Bureau, Hawassa, Ethiopia Alison Morgan Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia Sumit Kane Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia Margaret Kelaher Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia Barbara McPake Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia Journal Article 2020 10 27 Background Addressing chronic diseases and intra-urban health disparities in low- and middle-income countries (LMICs) requires new health service models. Team-based healthcare models can improve management of chronic diseases/complex conditions. There is interest in integrating community health workers (CHWs) into these teams, given their effectiveness in reaching underserved populations. However healthcare team models are difficult to effectively implement, and there is little experience with team-based models in LMICs and with CHW-integrated models more generally. Our study aims to understand the determinants related to the poor adoption of Ethiopia’s family health teams (FHTs); and, raise considerations for initiating CHW-integrated healthcare team models in LMIC cities. Methods Using the Consolidated Framework for Implementation Research (CFIR), we examine organizational-level factors related to implementation climate and readiness (work processes/incentives/resources/leadership) and systemlevel factors (policy guidelines/governance/financing) that affected adoption of FHTs in two Ethiopian cities. Using semi-structured interviews/focus groups, we sought implementation perspectives from 33 FHT members and 18 administrators. We used framework analysis to deductively code data to CFIR domains. Results Factors associated with implementation climate and readiness negatively impacted FHT adoption. Failure to tap into financial, political, and performance motivations of key stakeholders/FHT members contributed to low willingness to participate, while resource constraints restricted capacity to implement. Workload issues combined with no financial incentives/perceived benefit contributed to poor adoption among clinical professionals. Meanwhile, staffing constraints and unavailability of medicines/supplies/transport contributed to poor implementation readiness, further decreasing willingness among clinical professionals/managers to prioritize non-clinic based activities. The federally- driven program failed to provide budgetary incentives or tap into political motivations of municipal/health centre administrators. Conclusion Lessons from Ethiopia’s challenges in implementing its FHT program suggest that LMICs interested in adopting CHW-integrated healthcare team models should closely consider health system readiness (budgets, staffing, equipment/medicines) as well as incentivization strategies (financial, professional, political) to drive organizational change.

https://www.ijhpm.com/article_4057_e1e58373b65d594c1b5e2e5bd234b158.pdf