Desai Sapna, Sivaram Sharmada, Ramkumar S, Dohtdong Patricia, Nanda Ankit, Ramesh Sowmya, Kumar Sampath
Population Council Institute, New Delhi, India.
Government of Meghalaya, India.
Ann Glob Health. 2025 Mar 3;91(1):11. doi: 10.5334/aogh.4587. eCollection 2025.
There is widespread agreement on the potential of multisectoral action to address the social determinants of maternal health. We conducted an implementation research study in Meghalaya, a northeastern Indian state with a high burden of maternal mortality where the government initiated "Rescue Mission" to strengthen the health system and to address underlying determinants to improve maternal health indicators. The initiative was grounded in building state capability and decentralised leadership. We developed a theory of change and examined implementation barriers and enablers through an implementation research study with government and community actors and institutions. We conducted multiple rounds of qualitative data collection over a period of eighteen months across six districts. Participants included primary care providers in the public health system and frontline workers in thirty sampled facilities. We also interviewed officials across three government departments, observed meetings and met regularly in a feedback loop with government. Data were analysed thematically and synthesised according to pathways of change. The state institutionalised multisectoral collaboration across governance levels through building technical and adaptive leadership. Processes included joint meetings at the facility, district and state levels to develop action plans and facilitate collaboration, community engagement through frontline workers and decentralised use of data. Strength of participation by different sectors varied widely; non‑health cadres reported challenges such as being accountable to multiple departments. Political priority and administrative leadership were the key elements of the State's ability to implement a multisectoral approach. Overall, health outcomes improved and the State largely achieved its commitment to building technical skills, but also recognised the need for further investments to develop a sense of purpose amongst government officials. Meghalaya's experience in multisectoral collaboration demonstrates the potential of health systems reform grounded in a state capabilities enhancement approach, with a focus on participation and building decentralised leadership.
对于多部门行动在解决孕产妇健康的社会决定因素方面的潜力，人们已达成广泛共识。我们在印度东北部的梅加拉亚邦开展了一项实施研究，该邦孕产妇死亡率负担沉重，政府发起了“救援任务”，以加强卫生系统并解决根本决定因素，从而改善孕产妇健康指标。该倡议基于建设国家能力和下放领导权。我们制定了一个变革理论，并通过与政府、社区行为体和机构开展的实施研究，审视了实施障碍和促进因素。在18个月的时间里，我们在六个地区进行了多轮定性数据收集。参与者包括公共卫生系统的初级保健提供者以及30个抽样设施中的一线工作人员。我们还采访了三个政府部门的官员，观察了会议，并与政府定期进行反馈交流。对数据进行了主题分析，并根据变革途径进行了综合分析。该邦通过培养技术和适应性领导力，在各级治理层面将多部门合作制度化。这些流程包括在设施、地区和邦层面召开联席会议，以制定行动计划并促进合作，通过一线工作人员进行社区参与，以及分散使用数据。不同部门的参与力度差异很大；非卫生干部报告了诸如要对多个部门负责等挑战。政治优先事项和行政领导是该邦实施多部门方法能力的关键要素。总体而言，健康结果得到改善，该邦在很大程度上实现了其提升技术技能的承诺，但也认识到需要进一步投资，以培养政府官员的使命感。梅加拉亚邦在多部门合作方面的经验表明，以增强国家能力为途径、注重参与和建立下放式领导力的卫生系统改革具有潜力。
