Evaluation of Large-Scale Implementation of Obstetric Point of Care Ultrasound in Eight Counties in Kenya Using RE-AIM Framework
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Date
2025-08
Journal Title
Journal ISSN
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Publisher
Springer Nature
Abstract
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.
Description
research article
Keywords
Citation
Githemo, Grace, et al. "Evaluation of large-scale implementation of obstetric point of care ultrasound in eight counties in Kenya using RE-AIM framework." BMC Health Services Research 25.1 (2025): 1016.