BackgroundHealth system strengthening is critical to ensure the integration and scaling-up of priority health promotion, disease prevention and control programs. Normative guidelines are available to address health system function imbalances while strategic and analytical frameworks address critical functions in complex systems. Tacit knowledge-based health system constructs can help identify actors' perspectives, contributing to improve strengthening strategies. Using maternal health as an example, this paper maps and analyses the health system functions that critical actors charged with formulating and delivering priority health programs consider important for their success.MethodsUsing concept mapping qualitative and statistical methods, health system functions were mapped for different categories of actors in high maternal mortality states of Mexico and at the federal level. Functions within and across maps were analyzed for degree of classification, importance, feasibility and coding.ResultsHospital infrastructure and human resource training are the most prominent functions in the maternal health system, associated to federal efforts to support emergency obstetric care. Health policy is a highly diffuse function while program development, intercultural and community participation and social networks are clearly stated although less focused and with lower perceived importance. The importance of functions is less correlated between federal and state decision makers, between federal decision makers and reproductive health/local health area program officers and between state decision makers and system-wide support officers. Two sets of oppositions can be observed in coding across functions: health sector vs. social context; and given structures vs. manageable processes.ConclusionsConcept mapping enabled the identification of critical functions constituting adaptive maternal health systems, including aspects of actor perspectives that are seldom included in normative and analytical frameworks. Important areas of divergence across actors' perceptions were identified to target capacity strengthening efforts towards better integrated, performing health systems.

BackgroundThis review is part of a European Commission project, MASCOT, aimed at reducing maternal and child health inequalities. The purpose was to identify and describe the literature on community-based interventions on maternal health in high-income countries (HIC) and conceptually map the literature according to country focus, topics addressed, nature of the intervention and the intervention provider, and interventions designed to address inequalities in maternal health.MethodsThe research protocol for this review was based on a low-income country (LMIC) systematic review protocol within the MASCOT Project. We searched PubMED and CINAHL databases for literature published between January 2000 and April 2013. OECD countries were used to determine the HIC and different terms were used to refer to community based interventions, defined as those “delivered in community settings or any activities occurring outside of health facilities”.Results119 publications were selected for inclusion in this mapping study. 95 (80%) were Randomised Control Trials (RCTs) and 24 (20%) were systematic reviews (SRs). We categorised the study topics according to the main interventions covered: breastfeeding assistance and promotion, preventing and treating post-natal depression, interventions to support and build capacity around parenting and child care, antenatal interventions preparing women for birth, postnatal planning of future births and control trials around changing maternal behaviours. The home was used as the most common setting to implement these interventions and health professionals accounted for the largest group of intervention providers.ConclusionsThis review maps and brings knowledge on the type of studies and topics being addressed in community based interventions around maternal health in HICs. It opens the opportunity for further studies on interventions’ effectiveness and knowledge transfer to LMICs settings.

Let A be an abelian category. For a pair (X , Y) of classes of objects in A, we define the weak and the (X , Y)-Gorenstein relative projective objects in A. We point out that such objects generalize the usual Gorenstein projective objects and others generalizations appearing in the literature as Ding-projective, Ding-injective, X -Gorenstein projective, Gorenstein ACprojective and G C -projective modules and Cohen-Macaulay objects in abelian categories. We show that the principal results on Gorenstein projective modules remains true for the weak and the (X , Y)-Gorenstein relative objects. Furthermore, by using Auslander-Buchweitz approximation theory, a relative version of Gorenstein homological dimension is developed. Finally, we introduce the notion of W-cotilting pair in the abelian category A, which is very strong connected with the cotorsion pairs related with relative Gorenstein objects in A. It is worth mentioning that the W-cotilting pairs generalize the notion of cotilting objects in the sense of L. Angeleri Hügel and F. Coelho [3]. Contents 1. Introduction. 1 2. Auslander-Buchweitz approximation theory 3 3. General properties of the relative Gorenstein objects 8 4. Relative Gorenstein homological dimensions 22 5. Cotorsion pairs and relative Gorenstein projective objects 34 6. Cotilting objects and W-cotilting pairs 41 References 46

IMSP is responding to the Mesoamerican region's public health needs.