Resources for Topic 5 Maternal Mortality: Implementing an intervention
In the previous topics of this module we have discovered what maternal mortality is, how to measure it, and what interventions are useful for its reduction within and outsider of the health care system. In this topic, we will take a closer look at how to any relevant interventions might be implemented to achieve progress in maternal health. This is necessary because it is notoriously difficult to translate evidence from research into sustained action which results indeed into measurable progress, especially when the problem to be addressed is a complex one. The complexity of maternal mortality should have become clearly understood through the elaboration of the problem tree.
One of the first things to do in starting the development of actions aiming to address maternal mortality is to choose a lens through which to view it. Three commonly used viewpoints are:
- Framing maternal mortality as a health care problem - for example, in this paper: Factors associated with maternal mortality in Malawi: application of the three delays model
- Framing maternal mortality as result of problems with one or various social determinants of health -for example, in this paper: Social inequalities in maternal mortality among the provinces of Ecuador
- Framing maternal mortality as a human right's violation (for example, in this paper - Developing norms and standards on maternal mortality in Africa: lessons from UN human rights bodies
All three viewpoints are valid, none is better than another, but it is important to choose strategically to be able to create a common understanding among all stakeholders of the problem and a corresponding way forward.
Another important step in the process of addressing maternal mortality is building a careful understanding of the key actors and political ecosystem, including type of action required and mapping incentives, interests and hierarchies. The problem tree elaborated in the previous topics may be a start and serve as guidance. This paper describes the various steps required for developing successful multi-sectoral action, but parts of it are also applicable to the development of successful action within the health sector: Governing multisectoral action for health in low-income and middle income countries: an agenda for the way forward
It is important to give careful attention to the model of implementation of any chosen intervention(s). While it is outside the scope of this model to present in detail the fields of implementation science or complexity science, some understanding of the various models for scaling up and implementation of interventions is useful to avoid the naïve simplicity of linear planning without detailed attention to context, which is unlikely to result into change of a complex matter such as maternal mortality. These papers may provide some introduction:
- When complexity science meets implementation science: a theoretical and empirical analysis of systems change
- Narrative review of models and success factors for scaling up public health interventions
For those who are interested in more, there is an interesting free online course on systems thinking in public health from John Hopkins University via this link: https://www.coursera.org/learn/systems-thinking
Accountability for results achieved is key to provoke change and sustain progress. However, it is also important to carefully design lines and directions of accountability to avoid unexpected negative consequences. This paper 'The crowded space of local accountability for maternal, newborn and child health: a case study of the South African health system' describes practices of accountability in a South African setting.
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The following papers are some examples which describe in detail how implementation was done to enable results (or not), which might give some ideas for the final assignment of the module.
