Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda.
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Front Public Health. 2022 Nov 23;10:952213. doi: 10.3389/fpubh.2022.952213. eCollection 2022.
Health system strengthening initiatives in low and middle-income countries are commonly hampered by limited implementation readiness. The uses a system "readiness" theory of change to address implementation obstacles. is documented based on field experiences, incorporating best practices, and lessons learned from two decades of maternal, newborn, and child health (MNCH) programming in East Africa.
The is informed by four sequential and progressively larger MNCH interventions in Uganda and Tanzania. Intervention evaluations incorporating qualitative and quantitative data sources assessed health and process outcomes. Implementer, technical leader, stakeholder, and policymaker reflections on sequential experiences have enabled adaptation and documentation, using an implementation lens and an implementation science readiness theory of change.
The comprises three core components. (meetings, equipping, training, mentoring) describe key activity types that build general and intervention-specific capacity to maximize and sustain intervention effectiveness. The (can, rient, lan, quip, rain, ct, eflect) is a series of purposeful steps that, in sequence, drive each implementation level (district, health facility, community). A identifies foundational factors (self-reliance, collective-action, embeddedness, comprehensiveness, transparency) that motivate participants and enhance intervention adoption. Components aim to enhance implementer and system readiness while engaging broad stakeholders in capacity building activities toward health outcome goals. Activities align with government policy and programming and are embedded within existing district, health facility, and community structures.
This case study demonstrates feasibility of the to support district wide MNCH programming in two low-income countries, supportive of health outcome and health system improvements. The has potential to engage districts, health facilities, and communities toward sustainable health outcomes, addressing intervention implementation gaps for current and emerging health needs within and beyond East Africa.
在中低收入国家，加强卫生系统的举措常常受到实施准备不足的限制。该方案利用系统“准备就绪”的变革理论来解决实施障碍。该方案是基于实地经验编写的，纳入了最佳实践，并从过去二十年在东非开展的母婴和儿童健康（MNCH）规划中吸取了经验教训。
该方案的灵感来自于在乌干达和坦桑尼亚进行的四项先后进行且规模逐渐扩大的母婴和儿童健康干预措施。干预评估结合了定性和定量数据源，评估了健康和过程结果。实施者、技术领导者、利益攸关方和决策者对连续经验的反思，使该方案能够适应和记录，使用实施视角和实施科学准备就绪变革理论。
该方案由三个核心部分组成。（会议、装备、培训、指导）描述了构建通用和干预特定能力的关键活动类型，以最大限度地提高和维持干预效果。（能够、定位、计划、装备、培训、行动、反思）是一系列有目的的步骤，按顺序推动每个实施层面（区、卫生机构、社区）。一个（自主性、集体行动、嵌入性、全面性、透明度）确定了激励参与者并增强干预措施采用的基础因素。这些组成部分旨在增强实施者和系统的准备程度，同时让广泛的利益攸关方参与能力建设活动，实现健康结果目标。活动与政府政策和规划保持一致，并嵌入到现有区、卫生机构和社区结构中。
本案例研究表明，该方案在两个低收入国家支持全地区母婴健康规划是可行的，支持改善健康结果和卫生系统。该方案有可能使地区、卫生设施和社区参与进来，实现可持续的健康结果，解决当前和新出现的卫生需求在东非内外的干预实施差距。
