Making Space for Qualitative Evidence in Global Maternal and Child Health Policymaking

The success of health interventions often hinges on complex processes of implementation, the impact of sociopolitical and cultural contexts, resource constraints and opportunity costs, and issues of equity and accountability. Qualitative research offers critical insights for understanding these issues. “Qualitative evidence syntheses” (or QES)—modeled on quantitative systematic reviews—have recently emerged as an important vehicle for integrating insights from qualitative evidence into global health policy. However, it is challenging to integrate QES into policymaking in ways that are both acceptable to the often-conservative health policy world and consonant with social science’s distinctive methodologies and paradigms. Based on my experiences participating in and observing numerous guideline working group meetings and interviews with key informants, this chapter offers an auto-ethnographic account of an effort to integrate QES into the World Health Organization’s global OptimizeMNH guidelines for task shifting in maternal and newborn health (MNH). It is based on my experiences participating in and observing numerous guideline working group meetings as well as interviews with several key informants. Advocates of QES were successful in helping to make a place for qualitative evidence in this global guideline. Their work, however, required a delicate balance between adopting quantitatively inspired methods for evidence synthesis and innovating new methods that would both suit the project needs and be seen as legitimate by qualitative researchers. This case study of the development of one WHO guideline does not signal a revolution in knowledge production, but it does show there remains room—perhaps growing room—for a more expansive vision of what forms of knowledge need to be on the table when developing global health policy.