Celestin’s research focuses on evaluating the effectiveness, cost-effectiveness and implementation fidelity of a multifaceted quality improvement intervention (ETAT+) implemented in Rwanda to improve quality of hospital care for newborns and children. Potential outcomes of his research will help inform practice, policy and research to improve newborn and child health outcomes.

 
Public Scholars Initiative
 
Research Description

ETAT+ (Emergency, Triage, Assessment and Treatment PLUS admission care), a multifaceted intervention employing evidence-based clinical practice guidelines, training, supervision and hospital audit to improve hospital care for severely ill newborns and children, has been implemented in Rwanda. While our prior research assessed the baseline quality of pediatric care in Rwanda and found great potential for impact from ETAT+, there has been no evaluation of the impact of ETAT+. My research will use a quasi-experimental longitudinal design to evaluate the impact of ETAT+ on the clinical practice of healthcare workers and, ultimately, on newborn and child health outcomes. Given that interventions are rarely implemented with perfect fidelity under real-world conditions, additional research methods will be employed to evaluate the real-world experiences with implementation of ETAT+ in order to identify barriers/facilitators to its successful implementation. Lastly, I will perform an economic evaluation of ETAT+ to guide policy decisions on resource allocations in Rwanda.

What does being a Public Scholar mean to you?

Being a public scholar means reaching beyond academia and engaging knowledge users in my research from inception through knowledge translation, which is critical to successful translation of evidence-based interventions into practice. With this in mind and relevant to my doctoral research, I hope to involve newborn and child health stakeholders including policy makers from the Ministry of Health, healthcare professionals & their professional associations, managers of hospitals & neonatal/pediatric departments, and newborn & child health program implementers in Rwanda.

In what ways do you think the PhD experience can be re-imagined with the Public Scholars Initiative?

With the PSI support, a PhD student has now opportunities to engage with knowledge users (which is critical to translating knowledge to practice) and, also to expand his/her network for future career opportunities.

How do you envision connecting your PhD work with broader career possibilities?

With the PSI support, I am able to involve newborn and child health stakeholders in my PhD work, which certainly provides me an unparalleled platform for networking with potential collaborators and/or employers down the road.

How does your research engage with the larger community and social partners?

I have been working closely with the Rwanda Pediatric Association (RPA) in the evaluation of ETAT+ in Rwanda. RPA is an association of healthcare professionals involved in providing neonatal and pediatric care in Rwanda, and also oversees the implementation of ETAT+ across the country. Given the importance of context and the reality that interventions are rarely implemented with perfect fidelity under real-world conditions, my doctoral research includes one sub-study that will evaluate the real-world experiences with implementation of ETAT+ in order to identify potential facilitators and barriers to its successful implementation and scale-up over time. This sub-study (which will be carried out thanks to the PSI support) will involve collaborating with RPA from inception to knowledge translation. Given a key aspect of my research is sharing the findings with knowledge users, working with RPA would provide a unique opportunity for knowledge exchange and translation.

How do you hope your work can make a contribution to the “public good”?

A major reason for the slow progress in reaching the millennium development goals in many low-income countries is the ‘know-do gap’– the gap between the existing knowledge on how to reduce the burden of illness and what is implemented. As such, my research would contribute to evidence on how to narrow the ‘know-do gap’ by advancing knowledge on effectiveness and cost-effectiveness of a locally adapted program, ETAT+. This will inform health-sector decision-making and policy development on resource allocation, including the potential national scale-up of ETAT+ across Rwanda. Further, a comprehensive assessment of process of clinical care across leading causes of under-five mortality in Rwanda will help identify further gaps in care and associated factors and, thus, inform policy, practice and further research to improve newborn and child health outcomes. Lastly, given the importance of context and the reality that interventions are rarely implemented with perfect fidelity under real-world conditions, evaluating the real-world experiences with implementation of ETAT+ will generate evidence on potential barriers to its successful implementation as well as factors that contribute to its successful adoption and scale-up over time. Identifying these facilitators/barriers would advance knowledge in implementation and delivery science of newborn and child health interventions, and thus, contribute to enhancing effectiveness and efficiency of health system strengthening interventions and, ultimately, improving health outcomes.

Why did you decide to pursue a graduate degree?

Growing up in a war-torn region, Rwanda, heavily influenced my decision to become a physician, and my clinical experiences, in turn, have fuelled my desire to become a clinician-researcher with a goal of contributing to health services and policy research (HSPR) to improve quality of healthcare and, ultimately, population health outcomes. As such, I am pursuing a PhD to acquire knowledge in advanced research methods and statistics, and to learn the practical challenges in HSPR.

Why did you choose to come to British Columbia and study at UBC?

UBC’s School of Population and Public Health (SPPH) has an established PhD program and its affiliated research centers, including Center for Health Services & Policy Research, have world-class researchers in the field of health services and policy research. Further, the SPPH PhD program offers both an opportunity to participate in an SPPH division, and get concentrated mentoring, the program also allows its students valuable opportunities to learn across domains, including epidemiology and health services/policy research.

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With the PSI support, I am able to involve newborn and child health stakeholders in my PhD work".