Evaluation of large-scale implementation of obstetric point of care ultrasound in eight counties in Kenya using RE-AIM framework
Abstract Background Obstetric Point-of-Care Ultrasound (O-POCUS) holds promise for strengthening maternal health services particularly in low- and middle-income countries (LMICs). However, its widespread use is hindered by limited provider training and resource constraints within health facilities....
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BMC
2025-08-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-025-13212-8 |
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| author | Grace Githemo Anthony Wanyoro Jacob Masika Lister Onsongo Sarah Bett Stephen Githuku Grace Gachuiri Dilys Walker Nicole Santos Rakesh Ghosh George Otieno |
| author_facet | Grace Githemo Anthony Wanyoro Jacob Masika Lister Onsongo Sarah Bett Stephen Githuku Grace Gachuiri Dilys Walker Nicole Santos Rakesh Ghosh George Otieno |
| author_sort | Grace Githemo |
| collection | DOAJ |
| description | Abstract Background Obstetric Point-of-Care Ultrasound (O-POCUS) holds promise for strengthening maternal health services particularly in low- and middle-income countries (LMICs). However, its widespread use is hindered by limited provider training and resource constraints within health facilities. To address this gap, a large-scale O-POCUS program was implemented across eight counties of Kenya whereby 468 healthcare providers (HCPs) from 224 facilities were trained in five basic O-POCUS parameters. This study evaluated the reach, effectiveness, adoption, implementation, and maintenance of this program using the RE-AIM framework. Methods For this cross-sectional evaluation study, trained research staff conducted surveys and in-depth interviews with HCPs, stakeholders, and antenatal and postnatal care clients for one week from a random sample of about half of these facilities (n = 114) six months after O-POCUS introduction. A total of 249 HCPs, 2,292 antenatal and 1,704 postnatal clients were surveyed, and 96 HCPs/stakeholders and 114 clients were interviewed. Data were analyzed using descriptive and thematic methods and mapped onto the RE-AIM framework to assess program implementation. Results The findings revealed that O-POCUS was implemented across all 114 health facilities and 1937 (49%) of surveyed clients received a scan (reach). Over 80% of trained HCPs reported moderate to high confidence in performing key obstetric assessments, and 72% reported that O-POCUS influenced clinical decision-making including referrals (effectiveness). 41% of HCPs conducted more than 20 scans per month and 89% of the clients reported that they were likely to recommend O-POCUS to others (adoption). Lack of resources such as gel and paper towels were identified as major challenges (implementation), while 60% of HCPs reported the need for further training and mentorship (maintenance). Conclusion These findings demonstrate successful large-scale implementation of O-POCUS in Kenya and provide valuable insights for policymakers and healthcare organizations seeking to implement similar O-POCUS programs in resource-limited settings. Continuous strengthening through mentorship, supportive supervision and resource provision is recommended for sustained success of O-POCUS in improving maternal healthcare. |
| format | Article |
| id | doaj-art-e6db91d461584dea9e1c134ce04a16a4 |
| institution | Kabale University |
| issn | 1472-6963 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj-art-e6db91d461584dea9e1c134ce04a16a42025-08-20T03:42:40ZengBMCBMC Health Services Research1472-69632025-08-0125111410.1186/s12913-025-13212-8Evaluation of large-scale implementation of obstetric point of care ultrasound in eight counties in Kenya using RE-AIM frameworkGrace Githemo0Anthony Wanyoro1Jacob Masika2Lister Onsongo3Sarah Bett4Stephen Githuku5Grace Gachuiri6Dilys Walker7Nicole Santos8Rakesh Ghosh9George Otieno10School of Health Sciences, Kenyatta UniversitySchool of Health Sciences, Kenyatta UniversitySchool of Health Sciences, Kenyatta UniversitySchool of Health Sciences, Kenyatta UniversitySchool of Health Sciences, Kenyatta UniversitySchool of Health Sciences, Kenyatta UniversitySchool of Health Sciences, Kenyatta UniversityInstitute for Global Health Sciences, University of CaliforniaInstitute for Global Health Sciences, University of CaliforniaInstitute for Global Health Sciences, University of CaliforniaSchool of Health Sciences, Kenyatta UniversityAbstract Background Obstetric Point-of-Care Ultrasound (O-POCUS) holds promise for strengthening maternal health services particularly in low- and middle-income countries (LMICs). However, its widespread use is hindered by limited provider training and resource constraints within health facilities. To address this gap, a large-scale O-POCUS program was implemented across eight counties of Kenya whereby 468 healthcare providers (HCPs) from 224 facilities were trained in five basic O-POCUS parameters. This study evaluated the reach, effectiveness, adoption, implementation, and maintenance of this program using the RE-AIM framework. Methods For this cross-sectional evaluation study, trained research staff conducted surveys and in-depth interviews with HCPs, stakeholders, and antenatal and postnatal care clients for one week from a random sample of about half of these facilities (n = 114) six months after O-POCUS introduction. A total of 249 HCPs, 2,292 antenatal and 1,704 postnatal clients were surveyed, and 96 HCPs/stakeholders and 114 clients were interviewed. Data were analyzed using descriptive and thematic methods and mapped onto the RE-AIM framework to assess program implementation. Results The findings revealed that O-POCUS was implemented across all 114 health facilities and 1937 (49%) of surveyed clients received a scan (reach). Over 80% of trained HCPs reported moderate to high confidence in performing key obstetric assessments, and 72% reported that O-POCUS influenced clinical decision-making including referrals (effectiveness). 41% of HCPs conducted more than 20 scans per month and 89% of the clients reported that they were likely to recommend O-POCUS to others (adoption). Lack of resources such as gel and paper towels were identified as major challenges (implementation), while 60% of HCPs reported the need for further training and mentorship (maintenance). Conclusion These findings demonstrate successful large-scale implementation of O-POCUS in Kenya and provide valuable insights for policymakers and healthcare organizations seeking to implement similar O-POCUS programs in resource-limited settings. Continuous strengthening through mentorship, supportive supervision and resource provision is recommended for sustained success of O-POCUS in improving maternal healthcare.https://doi.org/10.1186/s12913-025-13212-8ObstetricPoint of careUltrasoundRE-AIMImplementation scienceKenya |
| spellingShingle | Grace Githemo Anthony Wanyoro Jacob Masika Lister Onsongo Sarah Bett Stephen Githuku Grace Gachuiri Dilys Walker Nicole Santos Rakesh Ghosh George Otieno Evaluation of large-scale implementation of obstetric point of care ultrasound in eight counties in Kenya using RE-AIM framework BMC Health Services Research Obstetric Point of care Ultrasound RE-AIM Implementation science Kenya |
| title | Evaluation of large-scale implementation of obstetric point of care ultrasound in eight counties in Kenya using RE-AIM framework |
| title_full | Evaluation of large-scale implementation of obstetric point of care ultrasound in eight counties in Kenya using RE-AIM framework |
| title_fullStr | Evaluation of large-scale implementation of obstetric point of care ultrasound in eight counties in Kenya using RE-AIM framework |
| title_full_unstemmed | Evaluation of large-scale implementation of obstetric point of care ultrasound in eight counties in Kenya using RE-AIM framework |
| title_short | Evaluation of large-scale implementation of obstetric point of care ultrasound in eight counties in Kenya using RE-AIM framework |
| title_sort | evaluation of large scale implementation of obstetric point of care ultrasound in eight counties in kenya using re aim framework |
| topic | Obstetric Point of care Ultrasound RE-AIM Implementation science Kenya |
| url | https://doi.org/10.1186/s12913-025-13212-8 |
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