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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
  1. Krystyna Makowiecka1,
  2. Tanya Marchant2,
  3. Wuleta Betemariam3,
  4. Anuraag Chaturvedi4,
  5. Laboni Jana5,
  6. Audu Liman6,
  7. Bereket Mathewos7,
  8. Fatima B Muhammad8,
  9. Katherine Semrau9,10,
  10. Sita Shankar Wunnava11,
  11. Lynn M Sibley12,
  12. Della Berhanu13,
  13. Meenakshi Gautham14,
  14. Nasir Umar15,
  15. Neil Spicer16,
  16. Joanna Schellenberg17
  1. 1 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
  2. 2 Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
  3. 3 The Last Ten Kilometers Project, JSI Research and Training Institute, Addis Ababa, Ethiopia
  4. 4 Public Health and Nutrition, Public Health Foundation of India, Gurgaon, Haryana, India
  5. 5 IntraHealth, New Delhi, India
  6. 6 Atiku Centre for Development, American University of Nigeria, Yola, Adamawa, Nigeria (formerly with PACT Nigeria)
  7. 7 Save the Children, Addis Ababa, Ethiopia
  8. 8 Society for Family Health, Abuja, Nigeria
  9. 9 Ariadne Labs, Brigham and Women's Hospital, Boston, Massachusetts, USA
  10. 10 Division of Global Health Equity and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  11. 11 Public Health Consultant, Coimbatore, Tamilnadu, India (formerly with PATH, New Delhi)
  12. 12 Emory University, Atlanta, Georgia, USA
  13. 13 Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
  14. 14 Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
  15. 15 Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
  16. 16 Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
  17. 17 Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Ms Krystyna Makowiecka; Krystyna.Makowiecka{at}lshtm.ac.uk

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.

  • ‘theory of change’ maternal
  • newborn
  • characterisation

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: http://creativecommons.org/licenses/by/4.0/.

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Footnotes

  • Handling editor Seye Abimbola

  • Contributors KM made substantial contributions to the conception and design of the study, acquisition of data and analysis of data. She drafted and critically revised the manuscript. TM and JS made substantial contributions to the conception and design of the study. They gave substantial intellectual input into drafting and critically revising the manuscript. WB contributed to the acquisition and interpretation of data and to revising the manuscript. AL made substantial contributions to the acquisition and interpretation of data and critically revised the manuscript. AC, LJ, BM, FBM and WSS contributed to the design of the characterisation framework and acquisition and interpretation of data, and critically revised the manuscript. KS made substantial contributions to the acquisition of data and critically revised the manuscript. LMS contributed to interpretation of data and critically revised the manuscript. DB, MG and NU contributed to the design of the characterisation framework, made substantial contributions to the acquisition of data and interpretation of results and made an important intellectual contribution to the manuscript. NS gave intellectual input on the revision of the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval This work was a component of the IDEAS project, approved by the London School of Hygiene and Tropical Medicine Ethics Committee (approval number 6088, December 2011).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No additional data are available.

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