The article titled “How (not) to promote sub-national ownership of national initiatives in decentralised health systems: The free maternal and child health programme in Nigeria, 2008–2015” discusses the challenges faced in promoting sub-national ownership of national health initiatives in Nigeria’s decentralised health system. The study focuses on the implementation of a pilot free maternal and child health (MCH) programme in selected states between 2008 and 2015.
The findings of the study highlight that the programme design had conflicting goals. On one hand, the designers aimed to ensure programme performance by shielding its implementation from sub-national government politics and bureaucracy. On the other hand, they also sought to gain the buy-in of sub-national government politicians and bureaucrats by demonstrating programme performance. However, the potential for community advocacy for sub-national adoption and scale-up was not considered in the design.
As a result, limited involvement of sub-national governments in the programme design led to limited sub-national ownership during implementation. Additionally, limited oversight of implementation by sub-national government policymakers further hindered programme performance.
The study concludes that efforts to promote sub-national ownership of national initiatives in decentralised health systems should prioritize inclusiveness in design, implementation, and oversight. It also emphasizes the importance of well-resourced community advocacy to encourage sub-national governments to adopt and scale up such programs.
The article was published in the International Journal of Health Planning and Management in 2022, Volume 37, No. 6.
AI Innovations Description
Based on the information provided, the recommendation to improve access to maternal health is to prioritize inclusiveness in the design, implementation, and oversight of national initiatives in decentralised health systems. This includes involving sub-national governments in the program design to ensure their ownership and engagement throughout the implementation process. Additionally, well-resourced community advocacy should be established to encourage sub-national governments to adopt and scale up the program. By addressing these factors, it is more likely that national initiatives aimed at improving maternal health will be effectively implemented and sustained at the sub-national level.
AI Innovations Methodology
To simulate the impact of the main recommendations mentioned in the abstract on improving access to maternal health, a mixed-methods approach could be employed. Here is a brief methodology:
1. Study Design: Conduct a comparative study in multiple states within a decentralised health system, such as Nigeria, where a national initiative to improve maternal health has been implemented. Select states that have varying levels of sub-national ownership and engagement in the program.
2. Data Collection:
a. Quantitative Data: Collect quantitative data on key indicators related to maternal health, such as maternal mortality rates, antenatal care coverage, skilled birth attendance, and access to emergency obstetric care. Gather this data from national health surveys, routine health information systems, and program monitoring data.
b. Qualitative Data: Conduct in-depth interviews with key stakeholders involved in the program, including national and sub-national government officials, healthcare providers, community leaders, and program beneficiaries. Also, conduct focus group discussions with community members to gather their perspectives on the program’s implementation and impact.
3. Data Analysis:
a. Quantitative Analysis: Analyze the quantitative data using statistical methods to compare the maternal health indicators between states with varying levels of sub-national ownership and engagement. This analysis will help identify any associations between sub-national ownership and improved maternal health outcomes.
b. Qualitative Analysis: Transcribe and analyze the qualitative data using thematic coding. Identify themes related to the involvement of sub-national governments in program design, implementation, and oversight, as well as the role of community advocacy. This analysis will provide insights into the factors influencing sub-national ownership and the impact on program performance.
4. Integration of Findings: Combine the quantitative and qualitative findings to provide a comprehensive understanding of the impact of sub-national ownership on improving access to maternal health. Identify any patterns or correlations between sub-national ownership, program design, implementation, and maternal health outcomes.
5. Recommendations: Based on the study findings, develop recommendations to improve access to maternal health by prioritizing inclusiveness in program design, implementation, and oversight. Emphasize the importance of involving sub-national governments in program design and fostering community advocacy for adoption and scale-up.
6. Dissemination: Publish the study findings in a peer-reviewed journal, such as the International Journal of Health Planning and Management, to contribute to the existing knowledge on promoting sub-national ownership of national initiatives in decentralised health systems.
By following this methodology, researchers can gain insights into the impact of sub-national ownership on improving access to maternal health and provide evidence-based recommendations for future program design and implementation.
