Saving Mothers, Giving Life: It Takes a System to Save a Mother (Republication)

Conlon, Claudia Morrissey; Serbanescu, Florina; Marum, Lawrence; Healey, Jessica; LaBrecque, Jonathan; Hobson, Reeti; Levitt, Marta; Kekitiinwa, Adeodata; Picho, Brenda; Soud, Fatma; Spigel, Lauren; Steffen, Mona Mehta; Velasco, Jorge Giovanni Vargas; Cohen, Robert; Weiss, William

doi:10.9745/ghsp-d-19-00092

Cited by 14 publications

(20 citation statements)

References 36 publications

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“…Although the project reportedly reduced maternal mortality rate by 40%, it was never sustained because it had minimal design involvement by the MOH, was costly, and was too complex for district health systems to absorb after the departure of external financing and nongovernmental organization management. 11 Examples of successful projects that have been institutionalized in Uganda include immunization and the supply of critical antimalarial drugs and family planning commodities in health facilities.…”

Section: Attributes For Successful Institutionalizationmentioning

confidence: 99%

Institutionalization of Projects Into Districts in Low- and Middle-Income Countries Needs Stewardship, Autonomy, and Resources

Waiswa

2020

Glob Health Sci Pract

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Section: Attributes For Successful Institutionalizationmentioning

confidence: 99%

Institutionalization of Projects Into Districts in Low- and Middle-Income Countries Needs Stewardship, Autonomy, and Resources

Waiswa

2020

Glob Health Sci Pract

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“…For example, most of the intervention package was implemented using existing personnel to enable sustainability. Besides the PRONTO mentors and QI consultant, there were no additional staff brought in by the project, which is often part of large intervention studies [ 33 ], particularly in LMICs where human resources are limited. This posed an additional challenge in that for Kenyan sites, regular staff transfers occurred every 6 months, from either control to intervention facilities or vice versa, thereby potentially confounding or diluting the effect.…”

Section: Discussionmentioning

confidence: 99%

Implementing an intrapartum package of interventions to improve quality of care to reduce the burden of preterm birth in Kenya and Uganda

Namazzi

Achola

Jenny

et al. 2021

Implement Sci Commun

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Background Quality of care during the intrapartum and immediate postnatal period for maternal and newborn health remains a major challenge due to the multiple health system bottlenecks in low-income countries. Reports of complex interventions that have been effective in reducing maternal and newborn mortality in these settings are usually limited in description, which inhibits learning and replication. We present a detailed account of the Preterm Birth Initiative (PTBi) implementation process, experiences and lessons learnt to inform scale-up and replication. Methods Using the TiDieR framework, we detail how the PTBi implemented an integrated package of interventions through a pair-matched cluster randomized control trial in 20 health facilities in Migori County, Kenya, and the Busoga region in east central Uganda from 2016 to 2019. The package aimed to improve quality of care during the intrapartum and immediate postnatal period with a focus on preterm birth. The package included data strengthening (DS) and introduction of a modified WHO Safe Childbirth Checklist (mSCC), simulation-based training and mentoring (PRONTO), and a Quality Improvement (QI) Collaborative. Results In 2016, DS and mSCC were introduced to improve existing data processes and increase the quality of data for measures needed to evaluate study impact. PRONTO and QI interventions were then rolled out sequentially. While package components were implemented with fidelity, some implementation processes required contextual adaptation to allow alignment with national priorities and guidelines, and flexibility to optimize uptake. Conclusion Lessons learned included the importance of synergy between interventions, the need for local leadership engagement, and the value of strengthening local systems and resources. Adaptations of individual elements of the package to suit the local context were important for effective implementation, and the TIDieR framework provides the guidance needed in detailed description to replicate such a complex intervention in other settings. Detailed documentation of the implementation process of a complex intervention with mutually synergistic components can help contextualize trial results and potential for scale-up. The trial is registered at ClinicalTrials.govNCT03112018, registered December 2016, posted April 2017.

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“…54 Indeed studies conducted in Uganda and Zambia suggest that independently addressing any of the 3Ds produces positive impact, but it is not sufficient to impact maternal mortality. [55][56][57][58][59] From Rwanda's experience, effective policy design requires carefully selected policy instruments cutting across 3D in optimal combinations to target immediate, medium and long term maternal mortality. 60 The incoherencies and inconsistencies observed among policy instruments across different policy shifts notwithstanding the failure to achieve the policy goal of reducing maternal mortality over years are typical of policy layering.…”

Section: Discussionmentioning

confidence: 99%

Designed to Fail? Revisiting Uganda’s Maternal Health Policies to Understand Policy Design Issues Underpinning Missed Targets for Reduction of Maternal Mortality Ratio (MMR): 2000-2015

Mukuru

Gorry

Kiwanuka

et al. 2021

Int J Health Policy Manag

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Background: Despite Uganda and other Sub-Saharan African countries missing their Maternal Mortality Ratio (MMR) targets for Millenium Development Goal (MDG) 5, limited attention has been paid to policy design in the literature examining the persistence of preventable maternal mortality. This study examined the specific policy interventions designed to reduce maternal deaths in Uganda and identified particular policy design issues that underpinned MDG 5 performance. We suggest a novel prescriptive and analytical (re)conceptualization of policy in terms of its fidelity to ‘3Cs’ (coherence of design, comprehensiveness of coverage and consistency in application) that could have implications for future healthcare programming. Methods: We conducted a retrospective study. Sixteen Ugandan maternal health policy documents and twenty-one national programme performance reports were examined, and six key informant interviews conducted with national stakeholders managing maternal health programmes during the reference period 2000-2015. We applied the analytical framework of the ‘three delay model’ combined with a broader literature on ‘policy mixing’. Results: Despite introducing fourteen separate policy instruments over 15 years with the goal of reducing maternal mortality. By the end of the MDG period in 2015, only 87.5% of the interventions for the three delays were covered with a notable lack of coherence and consistency evident among the instruments. The three delays persisted at the frontline with 70% of deaths by 2014 attributed to failures in referral policies while 67% of maternal deaths were due to inadequacies in healthcare facilities and trained personnel in the same period. By 2015, 37.3% of deaths were due to transportation issues. Conclusions: The piecemeal introduction of additional policy instruments frequently distorted existing synergies among policies resulting in persistence of the three delays and missed MDG 5 target. Future policy reforms should address the ‘three delays’ but also ensure fidelity of policy design to coherence, comprehensiveness and consistency.

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Saving Mothers, Giving Life: It Takes a System to Save a Mother (Republication)

Cited by 14 publications

References 36 publications

Institutionalization of Projects Into Districts in Low- and Middle-Income Countries Needs Stewardship, Autonomy, and Resources

Institutionalization of Projects Into Districts in Low- and Middle-Income Countries Needs Stewardship, Autonomy, and Resources

Implementing an intrapartum package of interventions to improve quality of care to reduce the burden of preterm birth in Kenya and Uganda

Designed to Fail? Revisiting Uganda’s Maternal Health Policies to Understand Policy Design Issues Underpinning Missed Targets for Reduction of Maternal Mortality Ratio (MMR): 2000-2015

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