Institutionalizing community-focused maternal, newborn, and child health strategies to strengthen health systems: A new framework for the Sustainable Development Goal era

Abstract

BackgroundStronger health systems, with an emphasis on community-based primary health care, are required to help accelerate the pace of ending preventable maternal and child deaths as well as contribute to the achievement of the Sustainable Development Goals (SDGs). The success of the SDGs will require unprecedented coordination across sectors, including partnerships between public, private, and non-governmental organizations (NGOs). To date, little attention has been paid to the distinct ways in which NGOs (both international and local) can partner with existing national government health systems to institutionalize community health strategies.DiscussionIn this paper, we propose a new conceptual framework that depicts three primary pathways through which NGOs can contribute to the institutionalization of community-focused maternal, newborn, and child health (MNCH) strategies to strengthen health systems at the district, national or global level. To illustrate the practical application of these three pathways, we present six illustrative cases from multiple NGOs and discuss the primary drivers of institutional change. In the first pathway, “learning for leverage,” NGOs demonstrate the effectiveness of new innovations that can stimulate changes in the health system through adaptation of research into policy and practice. In the second pathway, “thought leadership,” NGOs disseminate lessons learned to public and private partners through training, information sharing and collaborative learning. In the third pathway, “joint venturing,” NGOs work in partnership with the government health system to demonstrate the efficacy of a project and use their collective voice to help guide decision-makers. In addition to these pathways, we present six key drivers that are critical for successful institutionalization: strategic responsiveness to national health priorities, partnership with policymakers and other stakeholders, community ownership and involvement, monitoring and use of data, diversification of financial resources, and longevity of efforts.ConclusionWith additional research, we propose that this framework can contribute to program planning and policy making of donors, governments, and the NGO community in the institutionalization of community health strategies.

Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare

“…Stefanini, A. and Ruck, N [ 41 ] 1992 Conceptual framework to monitor the performance of externally-assisted health projects To monitor a project’s efforts towards sustainability 61. Story et al [ 67 ] 2017 Conceptual framework for institutionalization of community-focused maternal, newborn & child health strategies To encourage collaboration and contribute to programme planning and policy making for the institutionalisation of community-focused health strategies 62. Tuyet Hanh, T.T.…”

“… Monitoring progress over-time (the ability to monitor the initiative using standardised systems or mechanisms over-time) appeared in 84% of the approaches . Approaches to monitoring included diverse areas to assess including having appropriate data to document progress [ 64 , 65 ], having a management or monitoring system in place [ 15 , 53 , 61 , 66 , 67 ], and having regular reporting and feedback mechanisms [ 46 , 47 , 52 , 54 , 68 , 69 ]. …”

A scoping review of the uses and institutionalisation of knowledge for health policy in low- and middle-income countries

“…While the exact nature of institutionalisation of evidence use is still poorly understood in LMIC health systems, there is clearly a need to devote more research and attention to furthering this line of inquiry. This extends to institutionalisation of a variety of forms of knowledge that have been the focus of recent research not included in this review such as efforts to instutionalise national health accounts [83] and health system strengthening strategies [84,85]. Refinement of existing frameworks to understand the process, the politics surrounding policy design, and long-term financing strategies to ensure sustainability are all of paramount importance if the wealth of various types of knowledge are to be harnessed to inform policy deliberation and debate in LMICs.…”

Filling the human resource gap through public-private partnership: Can private, community-based skilled birth attendants improve maternal health service utilization and health outcomes in a remote region of Bangladesh?

“…Community support system. Recognizing that previous efforts to establish a cadre of CSBAs were challenged by the lack of community awareness of and support for their services, CARE included its Community Support System (CmSS) approach in this model [26][27][28]. These Community Support Groups identify and track each pregnant woman, helping her and her family develop safe birthing plans and pool community funds to subsidize care to lowincome households and support emergency transport.…”