Vogel, Joshua P., Julia E. Moore, Caitlyn Timmings et al., “Barriers, Facilitators and Priorities for Implementation of WHO Maternal and Perinatal Health Guidelines in Four Lower-Income Countries: A GREAT Network Research Activity,” PLOS ONE 11, no.11 (November 2016), doi:10.1371/journal.pone.0160020

URL: journals.plos.org/plosone/article?id=10.1371/journal.pone.0160020

Abstract

Background: Health systems often fail to use evidence in clinical practice. In maternal and perinatal health, the majority of maternal, fetal and newborn mortality is preventable through implementing effective interventions. To meet this challenge, WHO’s Department of Reproductive Health and Research partnered with the Knowledge Translation Program at St. Michael’s Hospital (SMH), University of Toronto, Canada to establish a collaboration on knowledge translation (KT) in maternal and perinatal health, called the GREAT Network (Guideline-driven, Research priorities, Evidence synthesis, Application of evidence, and Transfer of knowledge). We applied a systematic approach incorporating evidence and theory to identifying barriers and facilitators to implementation of WHO maternal heath recommendations in four lower-income countries and to identifying implementation strategies to address these.

Methods: We conducted a mixed-methods study in Myanmar, Uganda, Tanzania and Ethiopia. In each country, stakeholder surveys, focus group discussions and prioritization exercises were used, involving multiple groups of health system stakeholders (including administrators, policymakers, NGOs, professional associations, frontline healthcare providers and researchers).

Results: Despite differences in guideline priorities and contexts, barriers identified across countries were often similar. Health system level factors, including health workforce shortages, and need for strengthened drug and equipment procurement, distribution and management systems, were consistently highlighted as limiting the capacity of providers to deliver high-quality care. Evidence-based health policies to support implementation, and improve the knowledge and skills of healthcare providers were also identified. Stakeholders identified a range of tailored strategies to address local barriers and leverage facilitators.

Conclusion: This approach to identifying barriers, facilitators and potential strategies for improving implementation proved feasible in these four lower-income country settings. Further evaluation of the impact of implementing these strategies is needed.

Recognizing that health systems often fail to implement evidence in clinical practice, and that the majority of maternal, fetal, and newborn mortality is preventable with appropriate interventions, this study looked at the effectiveness of implementing knowledge translation and knowledge-to-action steps in four low-income countries. Researchers found that despite varying contexts, barriers to effective care were often similar. Practical, geographical, economic, and social issues are often a greater barrier to quality care than lack of evidence or knowledge. More study and work is needed to identify the best practices to meet healthcare needs in a contextually appropriate way.