abstract: 'There is a well-recognized need for empirical study of processes and

  factors that influence scale up of evidence-based interventions in

  low-income countries to address the `know-do'' gap. We undertook a

  qualitative case study of the scale up of chlorhexidine cleansing of the

  umbilical cord (CHX) in Bangladesh to identify and compare facilitators

  and barriers for the institutionalization and expansion stages of scale

  up. Data collection and analysis for this case study were informed by

  the Consolidated Framework for Implementation Research (CFIR) and the

  WHO/ExpandNet model of scale up. At the national level, we interviewed

  20 stakeholders involved in CHX policy or implementation. At the

  district level, we conducted interviews with 31 facility-based

  healthcare providers in five districts and focus group discussions

  (FGDs) with eight community-based providers and eight programme

  managers. At the community level, we conducted 7 FGDs with 53 mothers

  who had a baby within the past year. Expanded interview notes were

  thematically coded and analysed following an adapted Framework approach.

  National stakeholders identified external policy and incentives, and the

  engagement of stakeholders in policy development through the National

  Technical Working Committee for Newborn Health, as key facilitators for

  policy and health systems changes. Stakeholders, providers and families

  perceived the intervention to be simple, safe and effective, and more

  consistent with family preferences than the prior policy of dry cord

  care. The major barriers that delayed or decreased the public health

  impact of the scale up of CHX in Bangladesh''s public health system

  related to commodity production, procurement and distribution.

  Bangladesh''s experience scaling up CHX suggests that scale up should

  involve early needs assessments and planning for institutionalizing new

  drugs and commodities into the supply chain. While the five CFIR domains

  were useful for categorizing barriers and facilitators, additional

  constructs are needed for common health systems barriers in low-income

  settings.'
affiliation: 'Callaghan-Koru, JA (Corresponding Author), Univ Maryland, Dept Sociol
  Anthropol \& Hlth Adm \& Policy, 1000 Hilltop Circle,PUP 233, Baltimore, MD 21250
  USA.

  Callaghan-Koru, Jennifer A.; Sowe, Ardy, Univ Maryland, Dept Sociol Anthropol \&
  Hlth Adm \& Policy, 1000 Hilltop Circle,PUP 233, Baltimore, MD 21250 USA.

  Callaghan-Koru, Jennifer A., Johns Hopkins Bloomberg Sch Publ Hlth, Dept Int Hlth,
  615 N Wolfe St, Baltimore, MD 21205 USA.

  Islam, Munia; Khan, Marufa; Mannan, Imteaz Ibne; George, Joby, Save Children Int,
  MaMoni Hlth Syst Strengthening Project, House CWN A 35,Rd 43,Gulshan 2, Dhaka 1212,
  Bangladesh.

  Khan, Marufa, Pathfinder Int, 32 Gulshan Ave,Gulshan 2, Dhaka 1212, Bangladesh.

  Sowe, Ardy, Howard Univ, Coll Med, 520 W St NW, Washington, DC USA.

  Islam, Jahrul, Minist Hlth \& Family Welf, Dhaka, Bangladesh.

  Mannan, Imteaz Ibne, Jhpiego, House 71,Rd 4,Dist 4, Kabul, Afghanistan.'
author: Callaghan-Koru, Jennifer A. and Islam, Munia and Khan, Marufa and Sowe, Ardy
  and Islam, Jahrul and Mannan, Imteaz Ibne and George, Joby and Stu, Bangladesh Chlorhexidine
  Scale
author-email: jck@umbc.edu
author_list:
- family: Callaghan-Koru
  given: Jennifer A.
- family: Islam
  given: Munia
- family: Khan
  given: Marufa
- family: Sowe
  given: Ardy
- family: Islam
  given: Jahrul
- family: Mannan
  given: Imteaz Ibne
- family: George
  given: Joby
- family: Stu
  given: Bangladesh Chlorhexidine Scale
da: '2023-09-28'
doi: 10.1093/heapol/czz156
eissn: 1460-2237
files: []
issn: 0268-1080
journal: HEALTH POLICY AND PLANNING
keywords: Scale up; implementation; newborn health; Bangladesh; Chlorhexidine
keywords-plus: 'HEALTH-SYSTEMS; SCIENCE; CARE; INITIATIVES; ADAPTATION; INNOVATION;

  LESSONS; DEATHS; TIME'
language: English
month: MAY
number: '4'
number-of-cited-references: '72'
orcid-numbers: 'George, Joby/0000-0002-4791-901X

  Islam, Munia/0000-0002-7036-5318'
pages: 440-451
papis_id: d53b5341801c2b3b165b39a5b04062a7
ref: Callaghankoru2020factorsthat
researcherid-numbers: 'George, Joby/AAW-1365-2021

  Mannan, Imteaz/AAO-9935-2021

  '
times-cited: '4'
title: 'Factors that influence the scale up of new interventions in low-income settings:
  a qualitative case study of the introduction of chlorhexidine cleansing of the umbilical
  cord in Bangladesh'
type: Article
unique-id: WOS:000537392800007
usage-count-last-180-days: '0'
usage-count-since-2013: '3'
volume: '35'
web-of-science-categories: Health Care Sciences \& Services; Health Policy \& Services
year: '2020'