Grant: Project Grant

Despite progress in recent years, maternal mortality rates remain unacceptably high with the majority of maternal deaths occurring in low- and middle-income countries (LMICs) and resulting from causes for which proven interventions exist but are not optimally implemented. Effective implementation requires that barriers and facilitators to implementation are identified and addressed using theory-informed, evidence-based implementation strategies adapted to the relevant political and cultural context. However, optimizing implementation involves a complex series of steps that are resource intensive and dependent on expertise often not readily available in LMICs where improved implementation could achieve the greatest benefit. Our goal is to develop and evaluate an inexpensive tool-kit designed for use by non-experts to support effective implementation planning and execution. Our group includes implementation scientists, maternal health content experts, and stakeholders including front line clinicians, researchers, and policy makers based in participating LMICs. Prior work conducted by our group found a high degree of commonality among barriers and facilitators to implementation across a range of LMICs and clinical areas, as well as unique barriers and facilitators requiring specific attention. Based on a comprehensive literature review, our prior research and our experience in conducting implementation planning workshops with LMIC stakeholders, we will develop and usability test a novel tool-kit, designed to facilitate assessment of barriers and facilitators to implementation and mapping of barriers and facilitators to theory-informed evidence-based implementation strategies. The tool-kit will be pilot tested in 2 LMICs with varying levels of in-country implementation experience and barrier/facilitator distributions within a locally identified maternal health implementation priority with the ultimate goal of improving maternal health outcomes.