Operational research on implementation of tuberculosis guidelines in Mozambique

The overall objective of this thesis is to assess how guideline implementation and evaluation contribute to health care decision-making and to assess what critical factors contribute to successful or unsuccessful implementation of TB control guidelines through case studies mainly conducted in Mozambique. We specifically evaluate two components of the guideline development process: implementation and evaluation of guidelines.
The central research questions of this thesis are:
1. How can assessment of guideline implementation and its evaluation contribute to health care decision-making?
Guidelines support health care decision-making at both patient and health care service delivery level. To do so effectively, health care workers and decision-makers should use guidelines and monitor their outcomes. If this occurs either not or incompletely, the decision-making process lacks crucial information. This could lead to poor or no decision-making. In this thesis we evaluate outcomes described in guidelines with the aim to inform health care decision-making.
2. Which factors are critical for failure or success in guideline implementation?
Improved health care is one of the objectives of guidelines, however, implementation of these is often challenging. If the desired outcomes of guidelines are not achieved, assessment of the reasons for this need exploration. It seems logical to evaluate guideline implementation or the guideline itself, though this does not happen systematically. In this thesis we assess various aspects of guideline implementation to identify factors that contribute to failure and success of the implementation.