Title: Mobilizing stakeholders for implant removals in Burkina Faso using landscape
assessment data
Version: 0 Date: 06 Nov 2023
Reviewer's report:
Overall feedback:
I appreciate the way the manuscript focuses on the implementation/engagement aspect of this
work in Burkina Faso.  This aspect of work is frequently left out of manuscripts which makes it
impossible to replicate the work.  The data collection portion of your work is not well described
in the methods or results.  Further specific comments are included below.  The manuscript will
be considerably strengthened with a better description of your methods and results.  The results
can then be used to draw a clear picture of how you use these data to drive quality improvement
as your title suggests.
Introduction:
• Line 22: Performance Monitoring for Action (PMA), not Population Monitoring and
Accountability
• Lines 85-91: Contains repetitive info, consider tightening up language.
Methods:
• Landscape analysis methods are currently described in results section.  Please shift methods
to the methods section. Please explain how you planned for observing implant removals at your
selected facilities?  For example, did you go on a certain day when you knew removals were
occurring?  You discuss observing removals on arm models if clients were unavailable – how
did this happen?  Did you bring an arm model and ask the provider to demonstrate for you?
Please explain.
• How did you develop the implant removal skills checklist?  Please explain. Would also be
helpful if you included the checklist as a figure or appendix.
• How did you develop the facility assessment checklist? Please explain. Would also be helpful
if you included the checklist as a figure or appendix.
Results:
• Having a hard time following results, I think, in part because methods weren’t described clearly.
Please explain methods by each type of data collection (observation, facility readiness, etc.) and
then organize your results like this as well so we know where you got the data from.
• Include a table with results from provider observations
o How many removals did you observe per provider?
o What type of removals – anatomical model removals, client removals, client difficult
removals?
o How did the providers perform in terms of your skills checklist? Line 190 mentions 83% of
providers had lack of competence, but please expand on this in the text and show results in table.
• Facility readiness interview results aren’t described in text, only in table. Think it would be
more standard to describe results in text and include a results table with the numeric results.
• The stakeholder engagement, roadmap, etc. part of the manuscript is interesting and important,
but reads more like a study report than a manuscript.  Consider tightening up the text to tell the
story of engagement and beyond in a more engaging way.
Discussion:
• The discussion section focuses exclusively on part of your research and leaves out the provider
observations, facility readiness interviews, and provider interviews.
• Line 333-335: be cautious associating the concepts as we don’t have evidence for direct
relationship between the two in Burkina.
• Line 342-363: The Figure 3 and the text are repetitive.  Consider one or the other.