A Governance Framework for Implementing a Locally Adapted Paediatric Advanced Life Support Programme in Ethiopian Tertiary Hospital: The TASH–IMEGH Model
This paper describes the development and successful implementation of a seven-domain clinical governance framework, known as the TASH–IMEGH model, which enabled the creation of a sustainable, locally adapted Paediatric Advanced Life Support programme at an Ethiopian tertiary hospital, resulting in improved knowledge and confidence among clinical teams.
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In hospitals around the world, when a child's heart stops beating, the minutes that follow are a race against time. The difference between life and death often depends on how quickly a medical team recognizes the danger, how well they work together under pressure, and how confidently they can perform life-saving procedures. In many low- and middle-income countries, children often arrive at hospitals very late in their illness, and the teams trying to save them may not have had recent, hands-on training in advanced life support. While standard training courses exist, they are often designed for wealthy hospitals with abundant equipment and different team structures, making them difficult to copy exactly in resource-limited settings. The challenge is not just to teach the skills once, but to build a system that keeps those skills sharp, ensures the training is safe, and proves that the training actually helps patients survive.
A team of researchers and doctors at Tikur Anbessa Specialized Hospital in Ethiopia, working with partners from Rwanda and international health organizations, tackled this challenge by creating a new way to organize pediatric life support training. Instead of simply running a one-off class, they built a seven-part management framework to guide the entire process, from how teachers are trained to how patient safety is monitored. This approach, known as the TASH–IMEGH model, treats the training program like a clinical service that must be constantly improved, rather than just a single educational event. By adapting the curriculum to use local equipment and realistic scenarios, and by establishing rules for how the program runs and evolves, the team successfully delivered a course that improved the knowledge and confidence of local medical staff.
The core of their work was a governance framework, which is essentially a set of rules and responsibilities designed to ensure quality and safety. The team identified seven key areas that needed attention to make the program sustainable. First, they focused on education and training, ensuring that the doctors teaching the course were not just experts in medicine but also skilled in how to lead simulation exercises and give helpful feedback. Second, they implemented clinical audits, a system of checking and reviewing the course after every session to see what worked and what needed fixing. Third, they planned for clinical effectiveness, meaning they designed the program with the ultimate goal of improving patient survival rates, even though measuring those rates would take time and new data collection systems.
The framework also addressed risk management, recognizing that simulation training can be stressful and that hospital hierarchies sometimes stop junior staff from speaking up. The team created a safe environment where everyone could practice without fear of judgment. They established information governance to ensure that teaching materials were saved and updated properly so the program would not collapse if a key teacher left. They considered patient and public involvement by designing the course based on the actual needs of the hospital staff and the children they treat. Finally, they committed to research and development, treating the program as a learning opportunity to generate new knowledge about how to save lives in similar settings.
To test this framework, the team ran a pilot course at their hospital. They first surveyed local medical staff and found that most had never received formal advanced life support training, despite frequently encountering sick children. They then adapted the training materials to fit their reality. For example, instead of using expensive drills to teach how to insert needles into bone for emergency drug delivery, they used chicken bones and standard needles, a low-cost method that worked just as well. They filmed videos using the hospital's own defibrillators so staff could learn to use the specific machines they would encounter in an emergency. The course was offered free of charge, removing financial barriers for the participants.
The results of this pilot were encouraging. Thirteen medical professionals, including residents and nurses, took the course. Before the training, their average score on a test of medical knowledge was 71.5 percent. After the training, that average rose to 84.6 percent. More importantly, the participants reported feeling much more confident in their ability to handle difficult situations, particularly in using defibrillators and leading a team during a cardiac arrest. Every single participant said they intended to change how they practice medicine as a result of the training. The doctors leading the course also noted that some staff members lacked basic life support skills, a finding that will help them adjust future courses to include more foundational practice.
The researchers are careful to note that while the training improved knowledge and confidence, they have not yet proven that it has saved lives, as that requires tracking patient outcomes over a longer period. They have laid out a clear path to do this in the future by setting up systems to record data on cardiac arrests. The success of this project lies in its structure; by using a governance framework, the hospital created a system that can survive staff changes and continue to improve. This model offers a practical blueprint for other hospitals in similar settings, showing that with local leadership, adapted resources, and a commitment to quality, sustainable life-saving education is possible even with limited funds. The work demonstrates that the key to saving children in these settings is not just better equipment, but a better system for teaching the people who use it.
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