A Governance Framework for Implementing a Locally Adapted Paediatric Advanced Life Support Programme in Ethiopian Tertiary Hospital: The TASH–IMEGH Model

Abstract Background: Children in low- and middle-income countries frequently present late in their disease course, often after significant barriers to accessing care. Although simulation-based resuscitation training can strengthen the preparation of clinical teams managing critically ill children, locally adapted programmes and governance structures required to sustain them remain scarce. At Tikur Anbessa Specialized Hospital (TASH), Ethiopia, a local needs assessments identified gaps in paediatric resuscitation knowledge and confidence. Prior to this initiative, no locally adapted, easily accessible Paediatric Advanced Life Support (PALS) programme nor governance framework existed. Programme Description: We describe the development and prospective application of a seven-domain clinical governance framework for locally adapted PALS education, illustrated through its implementation at TASH in partnership with the Initiative for Medical Equity and Global Health (IMEGH), Rwanda. The framework encompasses Education and Training, Clinical Audit, Clinical Effectiveness, Risk Management, Information Governance, Patient and Public Involvement and Research and Development. This framework is mapped to the World Health Organization quality-of-care domains and was designed to ensure programme safety, sustainability, continuous improvement and progression towards evaluation of clinical outcomes. We describe the governance framework applied and how it informed the contextual adaptations required for implementation in a resource-limited setting including locally adapted simulation models, faculty development and pathway towards cardiac arrest outcome monitoring. A clinical governance framework was chosen over an educational framework as it includes mechanisms required to govern a sustainable educational programme rather than evaluation of educational intervention alone. The accompanying implementation checklist provides a practical guide for replication. Implementation on a locally adapted PALS course demonstrated improvement in mean MCQ knowledge and improved self-reported confidence across all technical and non-technical domains. Conclusion: We describe the implementation and experience applying a seven-domain clinical governance framework for locally adapted PALS course within an Ethiopian tertiary hospital. The framework provides a reproducible structure linking educational delivery, quality improvement, sustainability and future outcomes evaluation. Together with the accompanying implementation checklist (Appendix A), it offers a practical tool for institutions in other LMIC settings seeking to establish locally led and sustainable resuscitation education programmes.