scholarly journals What mechanisms drive uptake of family planning when integrated with childhood immunisation in Ethiopia? A realist evaluation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shari Krishnaratne ◽  
Jessie K. Hamon ◽  
Jenna Hoyt ◽  
Tracey Chantler ◽  
Justine Landegger ◽  
...  
Keyword(s):  
Family Planning ◽  
Child Health ◽  
Maternal And Child Health ◽  
Realist Evaluation ◽  
Religious Leaders ◽  
Community Members ◽  
Theoretical Frameworks ◽  
Programme Theory ◽  
Integrated Delivery ◽  
And Child Health

Abstract Background Maternal and child health are key priorities among the Sustainable Development Goals, which include a particular focus on reducing morbidity and mortality among women of reproductive age, newborns, and children under the age of five. Two components of maternal and child health are family planning (FP) and immunisation. Providing these services through an integrated delivery system could increase the uptake of vaccines and modern contraceptive methods (MCMs) particularly during the post-partum period. Methods A realist evaluation was conducted in two woredas in Ethiopia to determine the key mechanisms and their triggers that drive successful implementation and service uptake of an intervention of integrated delivery of immunisations and FP. The methodological approach included the development of an initial programme theory and the selection of relevant, published implementation related theoretical frameworks to aid organisation and cumulation of findings. Data from 23 semi-structured interviews were then analysed to determine key empirical mechanisms and drivers and to test the initial programme theory. These mechanisms were mapped against published theoretical frameworks and a revised programme theory comprised of context-mechanism-outcome configurations was developed. A critique of theoretical frameworks for abstracting empirical mechanisms was also conducted. Results Key contextual factors identified were: the use of trained Health Extension Workers (HEWs) to deliver FP services; a strong belief in values that challenged FP among religious leaders and community members; and a lack of support for FP from male partners based on religious values. Within these contexts, empirical mechanisms of acceptability, access, and adoption of innovations that drove decision making and intervention outcomes among health workers, religious leaders, and community members were identified to describe intervention implementation. Conclusions Linking context and intervention components to the mechanisms they triggered helped explain the intervention outcomes, and more broadly how and for whom the intervention worked. Linking empirical mechanisms to constructs of implementation related theoretical frameworks provided a level of abstraction through which findings could be cumulated across time, space, and conditions by theorising middle-range mechanisms.

scholarly journals What mechanisms drive uptake of family planning when integrated with childhood immunisation in Ethiopia? A realist evaluation

2021 ◽  
Author(s):  
Shari Krishnaratne ◽  
Jessie K. Hamon ◽  
Jenna Hoyt ◽  
Tracey Chantler ◽  
Justine Landegger ◽  
...  
Keyword(s):  
Family Planning ◽  
Child Health ◽  
Maternal And Child Health ◽  
Realist Evaluation ◽  
Religious Leaders ◽  
Community Members ◽  
Theoretical Frameworks ◽  
Programme Theory ◽  
Integrated Delivery ◽  
And Child Health

Abstract Background: Maternal and child health are key priorities among the Sustainable Development Goals, which include a particular focus on reducing morbidity and mortality among women of reproductive age, newborns, and children under the age of five. Two components of maternal and child health are family planning (FP) and immunisation. Providing these services through an integrated delivery system could increase the uptake of vaccines and modern contraceptive methods (MCMs) particularly during the post-partum period. Methods: A realist evaluation was conducted in two woredas in Ethiopia to determine the key mechanisms and their triggers that drive successful implementation and service uptake of an intervention of integrated delivery of immunisations and FP. The methodological approach included the development of an initial programme theory and the selection of relevant, published implementation related theoretical frameworks to aid organisation and cumulation of findings. Data from 23 semi-structured interviews were then analysed to determine key empirical mechanisms and drivers and to test the initial programme theory. These mechanisms were mapped against published theoretical frameworks and a revised programme theory comprised of context-mechanism-outcome configurations was developed. A critique of theoretical frameworks for abstracting empirical mechanisms was also conducted. Results: Key contextual factors identified were: the use of trained Health Extension Workers (HEWs) to deliver FP services; a strong belief in values that challenged FP among religious leaders and community members; and a lack of support for FP from male partners based on religious values. Within these contexts, empirical mechanisms of acceptability, access, and adoption of innovations that drove decision making and intervention outcomes among health workers, religious leaders, and community members were identified to describe intervention implementation. Conclusions: Linking context and intervention components to the mechanisms they triggered helped explain the intervention outcomes, and more broadly how and for whom the intervention worked. Linking empirical mechanisms to constructs of implementation related theoretical frameworks provided a level of abstraction through which findings could be cumulated across time, space, and conditions by theorising middle-range mechanisms.

scholarly journals What mechanisms drive uptake of family planning when integrated with childhood immunisation in Ethiopia? A realist evaluation

2020 ◽  
Author(s):  
Shari Krishnaratne ◽  
Jessie K. Hamon ◽  
Jenna Hoyt ◽  
Tracey Chantler ◽  
Justine Landegger ◽  
...  
Keyword(s):  
Family Planning ◽  
Child Health ◽  
Maternal And Child Health ◽  
Realist Evaluation ◽  
Religious Leaders ◽  
Community Members ◽  
Theoretical Frameworks ◽  
Programme Theory ◽  
Integrated Delivery ◽  
And Child Health

Abstract Background:Maternal and child health are key priorities among the Sustainable Development Goals, which include a particular focus on reducing morbidity and mortality among women of reproductive age, newborns, and children under the age of five. Two components of maternal and child health are family planning (FP) and immunisation. Providing these services through an integrated delivery system could increase the uptake of vaccines and modern contraceptive methods (MCMs) particularly during the post-partum period. Methods:A realist evaluation was conducted in two woredas in Ethiopia to determine the key mechanisms and their triggers that drive successful implementation and service uptake of an intervention of integrated delivery of immunisations and FP. The methodological approach included the development of an initial programme theory and the selection of relevant, published implementation related theoretical frameworks to aid organisation and cumulation of findings. Data from 23 semi-structured interviews were then analysed to determine key empirical mechanisms and drivers and to test the initial programme theory. These mechanisms were mapped against published theoretical frameworks and a revised programme theory comprised of context-mechanism-outcome configurations was developed. A critique of theoretical frameworks for abstracting empirical mechanisms was also conducted. Results:Key contextual factors identified were: the use of trained Health Extension Workers (HEWs) to deliver FP services; a strong belief in values that challenged FP among religious leaders and community members; and a lack of support for FP from male partners based on religious values. Within these contexts, empirical mechanisms of acceptability, access, and adoption of innovations that drove decision making and intervention outcomes among health workers, religious leaders, and community members were identified to describe intervention implementation.Conclusions:Linking context and intervention components to the mechanisms they triggered helped explain the intervention outcomes, and more broadly how and for whom the intervention worked. Linking empirical mechanisms to constructs of implementation related theoretical frameworks provided a level of abstraction through which findings could be cumulated across time, space, and conditions by theorising middle-range mechanisms.

scholarly journals What mechanisms drive uptake of family planning when integrated with childhood immunisation in Ethiopia? A realist evaluation

2020 ◽  
Author(s):  
Shari Krishnaratne ◽  
Jessie K. Hamon ◽  
Jenna Hoyt ◽  
Tracey Chantler ◽  
Justine Landegger ◽  
...  
Keyword(s):  
Family Planning ◽  
Child Health ◽  
Maternal And Child Health ◽  
Realist Evaluation ◽  
Successful Implementation ◽  
Modern Contraceptive ◽  
Religious Leaders ◽  
Programme Theory ◽  
Integrated Delivery ◽  
And Child Health

Abstract Background: Maternal and child health are key priorities among the Sustainable Development Goals , which include a particular focus on reducing morbidity and mortality among women of reproductive age, newborns, and children under the age of five. Two key components of maternal and child health are family planning (FP) and immunisation. Providing these services through an integrated delivery system could increase the uptake of vaccines and modern contraceptive methods (MCMs) particularly during the post-partum period. Methods: A realist evaluation was conducted in two woredas in Ethiopia to determine the key mechanisms and their triggers that drive successful implementation and service uptake of an intervention of integrated delivery of immunisations and FP. This evaluation included the: 1) development of an initial programme theory; 2) review of relevant published theories; 3) analysis of project monitoring data; 4) analysis of qualitative data from 23 semi-structured interviews to determine key mechanisms and drivers; and 5) development of a revised programme theory comprised of context-mechanism-actor-outcome and context-mechanism-intervention-actor-outcome configurations based on empirical findings. Results: The proportion of women who brought their children for immunisation and received MCMs was 63.0% (4,260/6,764) overall [74.3% (2,944/3,961) in Assosa woreda and 46.9% (1,316/2,803) in Bambasi woreda]. Key contextual factors identified were: a strong belief in values among religious leaders and community members that challenged FP; a lack of support for FP from male partners based on religious values; and the use of trained Health Extension Workers (HEWs) to deliver FP services. Within these contexts, intervention components that focused on the alignment of religious texts with FP, the promotion of FP by religious leaders, and the training of HEWs and health care workers on FP counselling and service delivery, influenced the implementation of the intervention and triggered several mechanisms of acceptability, access, and adoption of innovations. Conclusions: Linking context and intervention components to the mechanisms they triggered helped explain the intervention outcomes, and more broadly how and for who the intervention worked. This enabled the development of a programme theory that could be used to inform the integrated delivery of FP services in similar contexts.

scholarly journals What mechanisms drive uptake of family planning when integrated with childhood immunisation in Ethiopia? A realist evaluation

2020 ◽  
Author(s):  
Shari Krishnaratne ◽  
Jessie K. Hamon ◽  
Jenna Hoyt ◽  
Tracey Chantler ◽  
Justine Landegger ◽  
...  
Keyword(s):  
Family Planning ◽  
Child Health ◽  
Maternal And Child Health ◽  
Realist Evaluation ◽  
Successful Implementation ◽  
Modern Contraceptive ◽  
Religious Leaders ◽  
Programme Theory ◽  
Integrated Delivery ◽  
And Child Health

Abstract Background:Maternal and child health are key priorities among the Sustainable Development Goals , which include a particular focus on reducing morbidity and mortality among women of reproductive age, newborns, and children under the age of five. Two key components of maternal and child health are family planning (FP) and immunisation. Providing these services through an integrated delivery system could increase the uptake of vaccines and modern contraceptive methods (MCMs) particularly during the post-partum period. Methods:A realist evaluation was conducted in two woredas in Ethiopia to determine the key mechanisms and their triggers that drive successful implementation and service uptake of an intervention of integrated delivery of immunisations and FP. This evaluation included the: 1) development of an initial programme theory; 2) review of relevant published theories; 3) analysis of project monitoring data; 4) analysis of qualitative data from 23 semi-structured interviews to determine key mechanisms and drivers; and 5) development of a revised programme theory comprised of context-mechanism-actor-outcome (CAMO) and context-mechanism-intervention-actor-outcome (CIAMO) configurations based on empirical findings. Results:The proportion of women who brought their children for immunisation and received MCMs was 63.0% (4,260/6,764) overall [74.3% (2,944/3,961) in Assosa woreda and 46.9% (1,316/2,803) in Bambasi woreda]. Key contextual factors identified were: a strong belief in values among religious leaders and community members that challenged FP; a lack of support for FP from male partners based on religious values; and the use of trained Health Extension Workers (HEWs) to deliver FP services. Within these contexts, intervention components that focused on the alignment of religious texts with FP, the promotion of FP by religious leaders, and the training of HEWs and health care workers on FP counselling and service delivery, influenced the implementation of the intervention and triggered several mechanisms of acceptability, access, and adoption of innovations. Conclusions:Linking context and intervention components to the mechanisms they triggered helped explain the intervention outcomes, and more broadly how and for who the intervention worked. This enabled the development of a programme theory that could be used to inform the integrated delivery of FP services in similar contexts.

scholarly journals What makes advocacy work? Stakeholders’ voices and insights from prioritisation of Maternal and Child Health programme in Nigeria

2020 ◽  
Author(s):  
Benjamin Uzochukwu ◽  
Chioma Onyedinma ◽  
Chinyere Okeke ◽  
Obinna Onwujekwe ◽  
Ana Manzano ◽  
...  
Keyword(s):  
Child Health ◽  
Maternal And Child Health ◽  
Communication Theory ◽  
Realist Evaluation ◽  
Civil Society Organizations ◽  
The Political ◽  
Programme Theory ◽  
The Media ◽  
Effective Advocacy ◽  
And Child Health

Abstract Background: The Nigerian government introduced and implemented health programmes to improve maternal and child health (MCH) called Subsidy Reinvestment and Empowerment programme for MCH (SURE-P/MCH). It ran from 2012 and ended abruptly in 2015 and was followed by increased advocacy for sustaining the MCH as a policy priority. Advocacy is important in allowing social voice, facilitating prioritization and bringing different forces/actors together. Therefore, the study set out to unpack how advocacy works - through understanding what effective advocacy implementation processes comprise and what mechanisms are triggered by which contexts to produce the intended outcome Methods: The study used a Realist Evaluation through a mixed quantitative and qualitative methods case study approach. The advocacy programme theory (PT) was developed from the literature (three substantive social theories of power politics, media influence communication theory and the three-streams theory of agenda setting), data and programme design documentation. We report information from 22 key informant interviews at both National and sub-national levels and review of relevant documents on advocacy events post-SURE-P. Results: Key advocacy organizations and individuals including health professional groups, the media, civil society organizations, powerful individuals and policy makers were involved in advocacy activities. The nature of their engagement included organizing workshops, symposium, town hall meetings, individual meetings, press conferences, demonstrations, and engagements with media. Effective advocacy mechanism involves alliance brokering to increase influence, the media supporting and engaging in advocacy, and use of champions, influencers and spouses (Leadership and Elite Gendered Power Dynamics). The key contextual influences which determined the effectiveness of advocacy measures for MCH include the political cycle, availability of evidence on the issue, networking with powerful and interested champions and alliance building in advocacy. All these enhanced the entrenchment of MCH on the political and financial agenda Conclusions: Advocacy is a useful tool to bring together different forces through allowing expression of voices and ensuring accountability. In the context of poor health outcomes, interest from policymakers and politicians in MCH, combined with advocacy from key policy actors and stakeholders armed with evidence, can lead to prioritization and sustained implementation of MCH services within the context of UHC

scholarly journals What makes advocacy work? Stakeholders’ voices and insights from prioritisation of Maternal and Child Health programme in Nigeria

2020 ◽  
Author(s):  
Benjamin Uzochukwu ◽  
Chioma Onyedinma ◽  
Chinyere Okeke ◽  
Obinna Onwujekwe ◽  
Ana Manzano ◽  
...  
Keyword(s):  
Child Health ◽  
Maternal And Child Health ◽  
Realist Evaluation ◽  
The Political ◽  
Power Dynamics ◽  
Programme Theory ◽  
Study Approach ◽  
Effective Advocacy ◽  
And Child Health ◽  
Health Programme

Abstract Background : The Nigerian government introduced and implemented a health programme to improve maternal and child health (MCH) called Subsidy Reinvestment and Empowerment programme for MCH (SURE-P/MCH). It ran from 2012 and ended abruptly in 2015.This was followed by increased advocacy for sustaining the MCH (antenatal, delivery, postnatal and immunization) services as a policy priority. Advocacy is important in allowing social voice, facilitating prioritization, and bringing different forces/actors together. Therefore, the study set out to understand how advocacy works - through understanding what effective advocacy implementation processes comprise and what mechanisms are triggered by which contexts to produce the intended outcomes. Methods: The study used Realist Evaluation design through a mixed methods case study approach. The programme theory was developed from three substantive social theories (power politics, media influence communication, and the three-streams theory of agenda-setting), data and programme design documentation, and subsequently tested. We report information from 22 key informant interviews including national and State policy and law makers, policy implementers, CSOs, Development partners, NGOs, health professional groups, media practitioners and review of relevant documents on advocacy events post-SURE-P. Results: Key advocacy organizations and individuals were involved in advocacy activities. The nature of their engagement included organizing workshops, symposiums, town hall meetings, individual meetings, press conferences, demonstrations, and engagements with media. Effective advocacy mechanism involved alliance brokering to increase influence, the media supporting and engaging in advocacy, and the use of champions, influencers, and spouses (Leadership and Elite Gendered Power Dynamics). The key contextual influences which determined the effectiveness of advocacy measures for MCH included the political cycle, availability of evidence on the issue, networking with policy champions, and alliance building in advocacy. All these enhanced the entrenchment of MCH on the political and financial agenda at the State and Federal levels. Conclusions: Our result suggest that advocacy can be a useful tool to bring together different forces by allowing expression of voices and ensuring accountability of different actors. In the context of poor health outcomes, interest from policymakers and politicians in MCH, combined with advocacy from key policy actors, can improve prioritization and sustained implementation of MCH services.

Child Saving and Child Spacing in Africa: The Evolution of a Concept

1973 ◽  
Vol 3 (4) ◽  
pp. 765-768
Author(s):  
Robert D. Wright
Keyword(s):  
Family Planning ◽  
Child Health ◽  
Maternal And Child Health ◽  
Child Death ◽  
Child Health Services ◽  
Tropical Africa ◽  
Low Visibility ◽  
Child Spacing ◽  
High Level ◽  
And Child Health

In tropical Africa the primordial presence of enormous young child death rates precludes a successful frontal attack on birth rates through specialized programs. Experience in Nigeria indicates that gradual, quiet pressure can influence the power structure to tolerate and eventually espouse child spacing as an integral part of a program of services for child saving. The approach involves four phases: a low visibility start; obtaining high level acceptance; establishment of a federal training center to train cadres for state training programs; and deployment of trained primary care auxiliaries as a local maternal and child health-family planning service. In tropical Africa governmental attitudes toward family planning range from positive policy, to neutrality, to strong opposition. At present most Anglophone countries are favorable. Most Francophone countries are opposed. The general trend is toward a more favorable attitude toward family planning when it is a part of maternal and child health services.

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