Stakeholder Engagement to Facilitate an Effective Uptake of Gastroschisis Care Bundle in Tanzania

Abstract

Background: Care for babies born with gastroschisis varies across Sub-Saharan Africa, with mortality rates of up to 100% in some centres. Tanzania has implemented a gastroschisis care bundle, but its implementation faces challenges.
Objective: We conducted a stakeholder engagement exercise, guided by implementation science frameworks, to understand barriers and design strategies to increase fidelity in uptake of the gastroschisis care bundle in Tanzania.
Methods: A qualitative, participatory approach was applied through a structured 2-day stakeholder engagement workshop. Participants comprised a multidisciplinary team of healthcare providers involved in a national gastroschisis care initiative alongside key societal stakeholders, including patient advocates (parents of gastroschisis survivors), community representatives, and media personnel. We used the Hyper Island approach to facilitate discussions. CFIR and ERIC frameworks were used to identify key barriers to practice and to map them to targeted implementation strategies.
Results: Forty people (healthcare providers, policymakers, academicians, researchers, media and family/community) from 10 regions participated. We noted implementation gaps across sites, especially on nutrition care and infection prevention and control (IPC). Breastfeeding remained the most commonly used approach, as parenteral nutrition was unavailable. Through stakeholder input, the nutrition and IPC were revised. Participants highlighted the need for scheduled capacity building, advocacy and resource mobilisation, and similar engagement with policymakers and practitioners were key strategies identified for sustainability.
Conclusion: Stakeholder engagement is effective, feasible and highly needed in global surgery to ensure fidelity and sustainability of scaled evidence-based interventions. Integrating clinical expertise, lived experience and community views has the potential of ensuring sustainable national health-system strategy.