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Barriers, Facilitators and Priorities for Implementation of W.H.O. Maternal and Perinatal Health Guidelines in Four Lower-Income Countries: A GREAT Network Research Activity

Wednesday, 16th of November 2016

PLoS One. 2016 Nov 2;11(11):e0160020. doi: 10.1371/journal.pone.0160020. eCollection 2016.

Barriers, Facilitators and Priorities for Implementation of W.H.O. Maternal and Perinatal Health Guidelines in Four Lower-Income Countries: A GREAT Network Research Activity

Vogel JP¹, Moore JE², Timmings C², Khan S², Khan DN¹, Defar A³, Hadush A⁴, Minwyelet Terefe M⁵, Teshome L⁴, Ba-Thike K⁶, Than KK^7,8, Makuwani A⁹, Mbaruku G¹⁰, Mrisho M¹⁰, Mugerwa KY¹¹, Puchalski Ritchie LM^2,12, Rashid S², Straus SE², Gülmezoglu AM¹.

Abstract below; full text is at http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0160020

 

BACKGROUND:

Health systems often fail to use evidence in clinical practice. In maternal and perinatal health, the majority of maternal, fetal and newborn mortality is preventable through implementing effective interventions. To meet this challenge, WHO´s Department of Reproductive Health and Research partnered with the Knowledge Translation Program at St. Michael´s Hospital (SMH), University of Toronto, Canada to establish a collaboration on knowledge translation (KT) in maternal and perinatal health, called the GREAT Network (Guideline-driven, Research priorities, Evidence synthesis, Application of evidence, and Transfer of knowledge). We applied a systematic approach incorporating evidence and theory to identifying barriers and facilitators to implementation of WHO maternal heath recommendations in four lower-income countries and to identifying implementation strategies to address these.

METHODS:

We conducted a mixed-methods study in Myanmar, Uganda, Tanzania and Ethiopia. In each country, stakeholder surveys, focus group discussions and prioritization exercises were used, involving multiple groups of health system stakeholders (including administrators, policymakers, NGOs, professional associations, frontline healthcare providers and researchers).

RESULTS:

Despite differences in guideline priorities and contexts, barriers identified across countries were often similar. Health system level factors, including health workforce shortages, and need for strengthened drug and equipment procurement, distribution and management systems, were consistently highlighted as limiting the capacity of providers to deliver high-quality care. Evidence-based health policies to support implementation, and improve the knowledge and skills of healthcare providers were also identified. Stakeholders identified a range of tailored strategies to address local barriers and leverage facilitators.

CONCLUSION:

This approach to identifying barriers, facilitators and potential strategies for improving implementation proved feasible in these four lower-income country settings. Further evaluation of the impact of implementing these strategies is needed.

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