From local to global: A qualitative review of the multi-leveled impact of a multi-country health research capacity development partnership on maternal health in Sudan

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Study Justification:
– The study aims to examine the long-term effects of a multi-country health research capacity development partnership on maternal health in Sudan.
– It provides insights into the contribution of the partnership to capacity strengthening, public advocacy, and policy influence at different levels.
– The study highlights the practical achievements of the partnership in addressing access to maternal health services in Sudan.
Study Highlights:
– The ChRAIC project in Sudan successfully achieved its deliverables, including a national knowledge synthesis report on Sudan’s health system, identification of research priorities, and capacity building.
– Culturally sensitive and locally specific research and capacity strengthening methods were adopted at the district level.
– The partnership led to the establishment of country-level initiatives and a research unit, which gained recognition globally through awards and membership in global health forums.
Recommendations for Lay Reader:
– The study shows that the multi-country partnership had a positive impact on maternal health in Sudan.
– It emphasizes the importance of adopting culturally sensitive approaches in research and capacity building.
– The findings highlight the need for continued investment in research capacity development to improve access to maternal health services.
Recommendations for Policy Maker:
– The study suggests that partnerships like ChRAIC can effectively contribute to capacity strengthening, public advocacy, and policy influence in the health sector.
– Policy makers should consider supporting and replicating successful partnership models to address health system challenges.
– Continued investment in research capacity development is crucial for sustainable improvements in maternal health outcomes.
Key Role Players:
– Ministry of Health in Sudan
– Research and academic institutions in Sudan
– ChRAIC project coordinator
– Local research team members
– Donors and funding agencies
Cost Items for Planning Recommendations:
– Funding for research activities and capacity building programs
– Support for knowledge synthesis and research assessments
– Resources for establishing and maintaining country-level initiatives and research units
– Budget for organizing cross-country and steering group meetings
– Costs associated with stakeholder engagement and advocacy efforts

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The authors reflect on the project in Sudan over a five-year duration and provide specific project data collected during that period. The data includes donor reports, evaluations, and a Ph.D study conducted by a member of the Sudanese research team. The authors also mention the achievements of the project, such as the training and graduation of a Sudanese team member with a Ph.D and the establishment of country-level initiatives. However, the abstract does not provide details on the methodology used in the data collection and analysis, which could have strengthened the evidence. To improve the evidence, the authors could consider providing more information on the research methodology and data collection techniques used in the project.

Background: There is a substantial body of literature on the principles of good partnerships and the rationale for such partnerships in research capacity strengthening. This paper illustrates the long term effects of a multi-country (8 countries) global partnership for health systems research capacity development (Connecting health Research in Africa and Ireland Consortium – ChRAIC) in relation to its contribution to capacity strengthening, public advocacy and policy influence at different levels and its practical achievements in Sudan in addressing access to maternal health services. Methods: The authors (all members of the global partnership) reflect on the project in one of its’ partner countries, Sudan, over its’ five year duration. This reflection is supported by specific project data collected over the period of the project (2008-2014). The data collected included: (i) 6 monthly and annual donor reports; (ii) a mid-term internal and end of project independent evaluation of the entire project, and (ii) a Ph.D study conducted by a member of the Sudanese research team. Results: The ChRAIC project in Sudan achieved the deliverables set out at the beginning of the project. These included a national knowledge synthesis report on Sudan’s health system; identification of country level health systems research priorities; research capacity assessment and skills training, and the training and graduation of a Sudanese team member with a Ph.D. Mechanisms established in Sudan to facilitate these achievements included the adoption of culturally sensitive and locally specific research and capacity strengthening methods at district level; the signing of a Memorandum of Understanding at country level between the Ministry of Health, research and academic institutions in Sudan, and the establishment of country level initiatives and aresearch unit. The latter being recognized globally through awards and membership in global health forums. Conclusion: We surmise that the ‘network of action’ approach adopted to partnership formation facilitated the benefits gained, but that adopting such an approach is not sufficient. More local and contextual factors influenced the extent of the benefits and the sustainability of the network.

A reflective practice approach was used to monitor the impact of the ChRAIC partnership on health research capacity development throughout the life of the project. Due to the cyclical and iterative nature of the reflective cycles that took place Gibbs [17] model of reflection (Description, Feelings, Evaluation, Analysis, Conclusion, Action) best describes the process undertaken. Though the reflective process applied to the entire project, this paper examines the reflections specific to Sudan. These reflective cycles took place in annual cross country meetings, quarterly steering group meetings, and through the six monthly and annual reports to the funder. Additionally, a midterm evaluation of the partnership by the ChRAIC project coordinator and an end of term independent evaluation of the ChRAIC project informed our reflections. At the country (Sudan) level additional data was available from the data collected in South Sudan as part of a Ph.D thesis by the Sudanese student who was a member of the ChRAIC team. This data included: Participatory Ethnographic Evaluation and Research (PEER) – 42 interviews conducted by 14 locally trained women and 42 debriefing sessions conducted with these women; 13 critical incident cases, and; 37 stakeholder interviews [18]. The knowledge synthesis and research capacity assessments in Sudan also assisted with the reflection, especially in the analysis phase.

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Based on the provided description, here are some potential innovations that could be used to improve access to maternal health:

1. Culturally sensitive and locally specific research and capacity strengthening methods: This approach recognizes the importance of tailoring interventions to the specific cultural context of Sudan. By understanding and respecting local customs and practices, maternal health services can be designed and delivered in a way that is more accessible and acceptable to the community.

2. Memorandum of Understanding (MoU) at country level: The signing of an MoU between the Ministry of Health, research, and academic institutions in Sudan establishes a formal agreement and commitment to collaborate on improving maternal health. This can facilitate coordination, resource sharing, and joint efforts to address the barriers to access.

3. Country-level initiatives and research unit: The establishment of country-level initiatives and a research unit dedicated to maternal health demonstrates a commitment to addressing the specific challenges faced in Sudan. These initiatives can focus on developing evidence-based interventions, conducting research, and implementing programs to improve access to maternal health services.

4. Participatory Ethnographic Evaluation and Research (PEER): This innovative approach involves training local women to conduct interviews and debriefing sessions to gather insights and perspectives on maternal health. By involving community members in the research process, a more comprehensive understanding of the barriers and facilitators to accessing maternal health services can be obtained, leading to more targeted interventions.

5. Knowledge synthesis and research capacity assessments: Conducting a national knowledge synthesis report on Sudan’s health system and assessing research capacity can provide valuable insights into the existing strengths and weaknesses in the maternal health sector. This information can guide the development of strategies to strengthen research capacity and improve access to maternal health services.

These innovations, when implemented effectively, can contribute to improving access to maternal health services in Sudan and potentially serve as models for other countries facing similar challenges.
AI Innovations Description
Based on the information provided, the recommendation to improve access to maternal health would be to establish and strengthen partnerships for health systems research capacity development. This can be done by adopting a “network of action” approach to partnership formation, which involves collaborating with multiple countries and stakeholders.

Key steps to implement this recommendation include:

1. Forming partnerships: Establish collaborations between different countries, research institutions, and academic institutions to create a global partnership for health systems research capacity development.

2. Conducting knowledge synthesis: Conduct a comprehensive review of the existing knowledge and research on the health system in the target country (in this case, Sudan) to identify gaps and priorities related to maternal health.

3. Assessing research capacity: Evaluate the existing research capacity in the target country to identify strengths and weaknesses. This assessment will help determine the specific areas where capacity strengthening is needed.

4. Providing skills training: Offer training programs and workshops to enhance the research skills of local researchers and healthcare professionals in the target country. This will enable them to conduct high-quality research on maternal health and contribute to evidence-based decision-making.

5. Supporting local initiatives: Facilitate the establishment of country-level initiatives and research units dedicated to addressing maternal health issues. This can be done through the signing of Memorandums of Understanding (MoUs) between the Ministry of Health, research institutions, and academic institutions.

6. Promoting advocacy and policy influence: Use the research findings and evidence generated through the partnership to advocate for policy changes and improvements in maternal health services at the national and global levels. This can be done through participation in global health forums and recognition of country-level initiatives.

7. Monitoring and evaluation: Continuously monitor and evaluate the impact of the partnership on health research capacity development and access to maternal health services. This can be done through regular reporting to funders, conducting independent evaluations, and using reflective practice approaches.

By implementing these recommendations, the partnership can contribute to improving access to maternal health services by strengthening research capacity, informing policy decisions, and promoting evidence-based practices.
AI Innovations Methodology
Based on the provided description, here are some potential recommendations for innovations to improve access to maternal health:

1. Mobile Health (mHealth) Solutions: Develop and implement mobile applications or SMS-based systems to provide pregnant women with information on prenatal care, nutrition, and appointment reminders. These solutions can also facilitate communication between healthcare providers and pregnant women, allowing for remote consultations and monitoring.

2. Telemedicine: Establish telemedicine services to connect pregnant women in remote or underserved areas with healthcare professionals. This can enable virtual prenatal consultations, remote monitoring of vital signs, and timely access to medical advice.

3. Community Health Workers (CHWs): Train and deploy CHWs to provide maternal health education, antenatal care, and postnatal support in communities with limited access to healthcare facilities. CHWs can also serve as a bridge between pregnant women and healthcare facilities, ensuring timely referrals and follow-ups.

4. Transport and Emergency Services: Improve transportation infrastructure and establish emergency transportation services to ensure timely access to healthcare facilities for pregnant women in remote areas. This can include ambulances, motorcycle taxis, or community-based transportation networks.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed using the following steps:

1. Define the indicators: Identify key indicators to measure the impact of the recommendations, such as the number of pregnant women receiving prenatal care, the reduction in maternal mortality rates, or the increase in facility-based deliveries.

2. Data collection: Gather baseline data on the selected indicators before implementing the innovations. This can include data from health facilities, surveys, or existing health information systems.

3. Implement the innovations: Introduce the recommended innovations in selected pilot areas or communities. Ensure proper training and support for healthcare providers and community workers involved.

4. Monitor and evaluate: Continuously collect data on the selected indicators during the implementation phase. This can be done through routine reporting, surveys, or monitoring systems specifically designed for the innovations.

5. Analyze the data: Use statistical analysis techniques to assess the impact of the innovations on the selected indicators. Compare the data collected before and after the implementation to identify any significant changes.

6. Interpret the results: Analyze the findings to understand the effectiveness of the innovations in improving access to maternal health. Identify any challenges or barriers encountered during the implementation and suggest potential solutions.

7. Scale-up and replication: Based on the positive outcomes observed, consider scaling up the innovations to reach a larger population. Share the methodology and findings with relevant stakeholders to encourage replication in other settings.

It is important to note that the methodology may vary depending on the specific context and available resources. Collaboration with local stakeholders, including healthcare providers, policymakers, and community members, is crucial for the successful implementation and evaluation of these innovations.

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