Fostering Local Ownership of Infection Prevention and Control Strategies: A Multi-country Program

Background: The United States Agency for International Development Medicines, Technologies, and Pharmaceutical Services (MTaPS) program supported partner countries to implement infection prevention and control (IPC)-related programs. We evaluated the extent to which MTaPS-supported IPC programs fostered local ownership, such that members of local or national-level health systems had agency in developing and running programs. Methods: We surveyed three respondent groups involved in MTaPS IPC programs across eight African countries: (1) healthcare facility staff, (2) national-level stakeholders, and (3) MTaPS-contracted country implementers. Multiple-choice survey questions asked respondents to rate the quality of collaboration and capacity-building between their country and MTaPS, and the extent to which MTaPS fosters local ownership. Open-response questions inquired about factors that did or did not foster local ownership. We described the proportion of respondents reporting each multiple-choice response option, and conducted qualitative content analysis of open responses to generate themes about respondent perceptions of MTaPS support and local ownership. Results: We included 85 survey respondents: health facility staff (56%), MTaPS-contracted country implementers (29%) and national-level stakeholders (14%). Nearly all respondents rated the quality of MTaPS collaboration and capacity building "good" or "excellent." Overall, 75%-92% of respondents rated the quality of MTaPS collaboration and capacity strengthening as "mostly" supportive of local ownership and 8%-25% rated it "sometimes," supportive (0% selected "rarely/never"). Qualitatively, respondents described six activities as conducive to local ownership, including training, data collection/monitoring, stakeholder engagement, guideline/protocol standardization, creation/development of local committees, and supervision/mentorship/direct technical assistance. A reported barrier to MTaPS' support of local ownership was the inconsistent implementation of activities. Conclusions: IPC programs should continue to prioritize strategies for fostering local ownership, particularly as the funding landscape shifts. To increase IPC program sustainability in advance of future infectious disease threats, additional resources are needed to scale up activities perceived as conducive to local ownership.