Characterising innovations in maternal and newborn health based on a common theory of change: lessons from developing and applying a characterisation framework in Nigeria, Ethiopia and India

doi:10.1136/bmjgh-2019-001405

Review

. 2019 Jul 18;4(4):e001405.

doi: 10.1136/bmjgh-2019-001405. eCollection 2019.

Characterising innovations in maternal and newborn health based on a common theory of change: lessons from developing and applying a characterisation framework in Nigeria, Ethiopia and India

Krystyna Makowiecka¹, Tanya Marchant², Wuleta Betemariam³, Anuraag Chaturvedi⁴, Laboni Jana⁵, Audu Liman⁶, Bereket Mathewos⁷, Fatima B Muhammad⁸, Katherine Semrau^{9

10}, Sita Shankar Wunnava¹¹, Lynn M Sibley¹², Della Berhanu², Meenakshi Gautham¹³, Nasir Umar², Neil Spicer¹³, Joanna Schellenberg²

Affiliations

¹ Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
² Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
³ The Last Ten Kilometers Project, JSI Research and Training Institute, Addis Ababa, Ethiopia.
⁴ Public Health and Nutrition, Public Health Foundation of India, Gurgaon, Haryana, India.
⁵ IntraHealth, New Delhi, India.
⁶ Atiku Centre for Development, American University of Nigeria, Yola, Adamawa, Nigeria (formerly with PACT Nigeria).
⁷ Save the Children, Addis Ababa, Ethiopia.
⁸ Society for Family Health, Abuja, Nigeria.
⁹ Ariadne Labs, Brigham and Women's Hospital, Boston, Massachusetts, USA.
¹⁰ Division of Global Health Equity and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
¹¹ Public Health Consultant, Coimbatore, Tamilnadu, India (formerly with PATH, New Delhi).
¹² Emory University, Atlanta, Georgia, USA.
¹³ Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.

PMID: 31406587
PMCID: PMC6666810
DOI: 10.1136/bmjgh-2019-001405

Review

Characterising innovations in maternal and newborn health based on a common theory of change: lessons from developing and applying a characterisation framework in Nigeria, Ethiopia and India

Krystyna Makowiecka et al. BMJ Glob Health. 2019.

. 2019 Jul 18;4(4):e001405.

doi: 10.1136/bmjgh-2019-001405. eCollection 2019.

Authors

Affiliations

¹ Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
² Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
³ The Last Ten Kilometers Project, JSI Research and Training Institute, Addis Ababa, Ethiopia.
⁴ Public Health and Nutrition, Public Health Foundation of India, Gurgaon, Haryana, India.
⁵ IntraHealth, New Delhi, India.
⁶ Atiku Centre for Development, American University of Nigeria, Yola, Adamawa, Nigeria (formerly with PACT Nigeria).
⁷ Save the Children, Addis Ababa, Ethiopia.
⁸ Society for Family Health, Abuja, Nigeria.
⁹ Ariadne Labs, Brigham and Women's Hospital, Boston, Massachusetts, USA.
¹⁰ Division of Global Health Equity and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
¹¹ Public Health Consultant, Coimbatore, Tamilnadu, India (formerly with PATH, New Delhi).
¹² Emory University, Atlanta, Georgia, USA.
¹³ Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.

PMID: 31406587
PMCID: PMC6666810
DOI: 10.1136/bmjgh-2019-001405

Abstract

Government leadership is key to enhancing maternal and newborn survival. In low/middle-income countries, donor support is extensive and multiple actors add complexity. For policymakers and others interested in harmonising diverse maternal and newborn health efforts, a coherent description of project components and their intended outcomes, based on a common theory of change, can be a valuable tool. We outline an approach to developing such a tool to describe the work and the intended effect of a portfolio of nine large-scale maternal and newborn health projects in north-east Nigeria, Ethiopia and Uttar Pradesh in India. Teams from these projects developed a framework, the 'characterisation framework', based on a common theory of change. They used this framework to describe their innovations and their intended outcomes. Individual project characterisations were then collated in each geography, to identify what innovations were implemented where, when and at what scale, as well as the expected health benefit of the joint efforts of all projects. Our study had some limitations. It would have been enhanced by a more detailed description and analysis of context and, by framing our work in terms of discrete innovations, we may have missed some synergistic aspects of the combination of those innovations. Our approach can be valuable for building a programme according to a commonly agreed theory of change, as well as for researchers examining the effectiveness of the combined work of a range of actors. The exercise enables policymakers and funders, both within and between countries, to enhance coordination of efforts and to inform decision-making about what to fund, when and where.

Keywords: characterisation; newborn; ‘theory of change’ maternal.

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Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
Theory of change with agreed characterisation framework questions. MNH: maternal and newborn health.

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References

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1. Darmstadt GL, Bhutta ZA, Cousens S, et al. . Evidence-based, cost-effective interventions: how many newborn babies can we save? The Lancet 2005;365:977–88. 10.1016/S0140-6736(05)71088-6 - DOI - PubMed
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1. Dickson KE, Simen-Kapeu A, Kinney MV, et al. . Every newborn: health-systems bottlenecks and strategies to accelerate scale-up in countries. The Lancet 2014;384:438–54. 10.1016/S0140-6736(14)60582-1 - DOI - PubMed

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[1] Campbell OMR, Graham WJ. Strategies for reducing maternal mortality: getting on with what works. The Lancet 2006;368:1284–99. 10.1016/S0140-6736(06)69381-1 - DOI - PubMed

[2] Campbell OMR, Graham WJ. Strategies for reducing maternal mortality: getting on with what works. The Lancet 2006;368:1284–99. 10.1016/S0140-6736(06)69381-1 - DOI - PubMed

[3] Darmstadt GL, Bhutta ZA, Cousens S, et al. . Evidence-based, cost-effective interventions: how many newborn babies can we save? The Lancet 2005;365:977–88. 10.1016/S0140-6736(05)71088-6 - DOI - PubMed

[4] Darmstadt GL, Bhutta ZA, Cousens S, et al. . Evidence-based, cost-effective interventions: how many newborn babies can we save? The Lancet 2005;365:977–88. 10.1016/S0140-6736(05)71088-6 - DOI - PubMed

[5] The Partnership for Maternal Neonatal and Child Health A global review of the key interventions related to reproductive, maternal. Geneva, Switzerland: Newborn and Child Health, 2011.

[6] The Partnership for Maternal Neonatal and Child Health A global review of the key interventions related to reproductive, maternal. Geneva, Switzerland: Newborn and Child Health, 2011.

[7] Countdown Coverage Writing Group Countdown to 2015 for maternal, newborn, and child survival: the 2008 report on tracking coverage of interventions. The Lancet 2008;371:1247–58. 10.1016/S0140-6736(08)60559-0 - DOI - PubMed

[8] Countdown Coverage Writing Group Countdown to 2015 for maternal, newborn, and child survival: the 2008 report on tracking coverage of interventions. The Lancet 2008;371:1247–58. 10.1016/S0140-6736(08)60559-0 - DOI - PubMed

[9] Dickson KE, Simen-Kapeu A, Kinney MV, et al. . Every newborn: health-systems bottlenecks and strategies to accelerate scale-up in countries. The Lancet 2014;384:438–54. 10.1016/S0140-6736(14)60582-1 - DOI - PubMed

[10] Dickson KE, Simen-Kapeu A, Kinney MV, et al. . Every newborn: health-systems bottlenecks and strategies to accelerate scale-up in countries. The Lancet 2014;384:438–54. 10.1016/S0140-6736(14)60582-1 - DOI - PubMed

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Characterising innovations in maternal and newborn health based on a common theory of change: lessons from developing and applying a characterisation framework in Nigeria, Ethiopia and India

Affiliations

Characterising innovations in maternal and newborn health based on a common theory of change: lessons from developing and applying a characterisation framework in Nigeria, Ethiopia and India

Authors

Affiliations

Abstract

Conflict of interest statement

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