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Spreading IDEAs: the integrated district evidence to action program to improve maternal, newborn and child health

The second phase of the African Health Initiative is a six-year program that builds off the successes with notable refinements to the intervention to incorporate learning from phase 1, and to focus on strengthening MNCH services (with a special emphasis on reducing neonatal mortality). A principal focus of phase 2.0 will be to adapt the district performance review and enhancement meetings into an iterative, cyclical approach that will include 1) periodic service readiness and data quality assessments at a rotating sample randomly selected facilities (2 per district every 6 months, carried out by the Centro de Investigação Operacional da Beira); 2) a refined list of service output measures for secular trend analysis (including services at or around the time of birth); 3) adapted action plan formats to enable efficient measurement of success and linkage across iterative meetings; 4) targeted mentorship and resources to address health system bottlenecks identified through action plan development; and 5) a systematic implementation approach that aligns meetings with key planning cycles held in the second and fourth quarters each year.

A total of 12 districts from Manica and Sofala have been selected for inclusion in the next phase of the AHI intervention, which include a total of 154 health facilities covering over 2.8 million people (72% of the population in the two provinces). As an implementation research project, the impact of this intervention will be rigorously evaluated via a quasi-experimental design covering 12 intervention and 36 matched districts that will assess intervention impact on health service strength, measures of service effectiveness, and measures of population-level health (neonatal mortality, 1q0, 5q0, and total fertility rate). In addition, a prospective process evaluation will be implemented to learn about the process of spreading the IDEA intervention. 

A second feature of the IDEA program is an ambitious implementation research development program that will include supporting research, and both in-service short courses on implementation research and in-residence graduate-level training. To stimulate implementation research in response to Ministry of Health priorities, the IDEA program will engage national and provincial leadership to identify priority research topics, and will subsequently support both Eduardo Mondlane University’s School of Medicine/Community Health Department and the CIOB to design, implement, analyze and disseminate results of these applied research endeavors. In addition, we envision that a total of 10 Mozambicans will be supported to pursue Master’s level training in Mozambique, and four rising junior researchers will be supported to pursue a PhD in Implementation Science at the University of Washington, Seattle. Ultimately, the intervention and capacity building training are designed to be complementary to generate evidence on how to successfully implement and scale-up evidence-based health interventions.