Abstract
Despite the existence of proven solutions to improve maternal health, innovative approaches are still necessary to support the implementation of programs and policies in real-world settings. To address this challenge, we developed a participatory capacity strengthening model based on Communities of Practice (CoPs) of maternal health frontline personnel and decision-makers involved in implementing maternal health programs in Latin America. The activities focused on the conduct and use of implementation research to enhance maternal health decision-making. Our objective is to evaluate the performance of the Communities of Practice in using implementation research to support decision-making in maternal health programs in Mexico and Nicaragua. We evaluated the CoPs’ performance using a mixed methods approach. We appraised the performance of CoPs using five criteria: (i) integration of the CoP, (ii) ownership of the methodology, (iii) timely delivery of products, (iv) feedback to decision-makers, and (v) influence on program changes. We also included an assessment of the barriers and facilitators to the conduct and uptake of implementation research findings in maternal health decision-making. Two CoPs showed “sub-optimal” performance, one was signaled as “needing strengthening,” and three reached “optimal” performance in the use of implementation research to enhance maternal health programs. The relationships between champions, facilitators, and research team were the main internal enabling factor for success. Externally, political and epidemiological environments acted as the main barriers to the performance of CoPs. Our study highlights the value of involving decision-makers in CoPs, ensuring varied skill sets and profiles of health professionals, as well as maintaining strong and continuous collaborations with researchers. Collaborative approaches and meaningful engagement of decision-makers and researchers are useful in conducting implementation research and promoting the use of evidence to improve maternal health programs in resource-strained settings.
Highlights
Despite the existence of proven solutions to improve maternal health, innovative approaches are still necessary to support the implementation of programs and policies in real-world settings
The majority of countries that committed to Millennium Development Goal (MDG) 5—reducing maternal mortality ratios by 75% between 1990 and 2015—were not able to
The objective of this paper is to evaluate the implementation and performance of Communities of Practice in the development of implementation research to enhance informed decision-making in maternal health programs in Mexico and Nicaragua, highlighting the barriers and facilitators to the use of evidence
Summary
Despite the existence of proven solutions to improve maternal health, innovative approaches are still necessary to support the implementation of programs and policies in real-world settings. Despite recent progress to address these issues [17, 18], maternal health policies and programs still face crucial challenges related to the availability of health resources, for disadvantaged groups, the quality of healthcare [8, 19,20,21,22], the organization of health services delivery, and maternal health promotion and education Addressing these challenges requires planning, development and implementation of maternal health interventions that are properly informed by evidence, and increasing research utilization among decision-makers [23, 24]. Uptake of evidence is impeded by limited staff competencies, budget constraints, and lack of decision-makers’ interest in research
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