Abstract
Strategic priority setting and implementation of strategies to reduce maternal mortality are key to the post Millennium Development Goal (MDG) 2015 agenda. This article highlights the feasibility and the advantages of using a systematized tacit knowledge approach, using data from maternal health program personnel, to identify local challenges to implementing policies and programs to inform the post MDG era. Communities of practice, conceived as groups of people sharing professional interests, experiences and knowledge, were formed with diverse health personnel implementing maternal health programs in Mexico and Nicaragua. Participants attended several workshops and developed different online activities aiming to strengthen their capacities to acquire, analyze, adapt and apply research results and to systematize their experience and knowledge of the actual implementation of these programs. Concept mapping, a general method designed to organize and depict the ideas of a group on a particular topic, was used to manage, discuss and systematize their tacit knowledge about implementation problems of the programs they work in. Using a special online concept mapping platform, participants prioritized implementation problems by sorting them in conceptual clusters and rating their importance and feasibility of solution. Two hundred and thirty-one participants from three communities of practice in each country registered on the online concept mapping platform and 200 people satisfactorily completed the sorting and rating activities. Participants further discussed these results to prioritize the implementation problems of maternal health programs. Our main finding was a great similarity between the Mexican and the Nicaraguan general results highlighting the importance and the feasibility of solution of implementation problems related to the quality of healthcare. The use of rigorously organized tacit knowledge of health personnel proved to be a feasible and useful tool for prioritization to inform implementation priorities in the post MDG agenda.
Highlights
Maternal mortality remains a priority global health concern, and health programs addressing it face great expectations to achieve stated health and policy goals
We report on an innovative approach to using tacit knowledge from health personnel on the front lines of care to develop priorities for quality improvement activities or implementation research
Because the actual implementation of policies and programs in local settings is always related to contextual factors, we considered the role of tacit knowledge as an important element that can offer important information on how national policies and programs developed to achieve the Millennium Development Goal (MDG) are implemented and function locally
Summary
Maternal mortality remains a priority global health concern, and health programs addressing it face great expectations to achieve stated health and policy goals. Despite a number of policies and programs targeting Millennium Development Goal (MDG) 5 (to reduce maternal mortality by 75% between 1990 and 2015), only a few countries will reach this goal. Two years before 2015, the global average reduction only reached 45% (United Nations 2014). In 2013, the maternal mortality ratio in developing regions (230 maternal deaths per 100 000 live births) was 14 times higher than that of developed regions (United Nations 2014). Even though important progress has been made in almost all regions, many countries, among them Mexico and Nicaragua, will not meet MDG5. Failure to achieve desired results has been explained as failure of implementation, in developing countries (Peters et al 2013)
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