MNCH Country Exemplars Work, Data & Evidence

Dr. Hirschhorn will be responsible for the overall coordination and supervision of all aspects of the Bill & Melinda Gates Foundation Exemplars Grants. This includes hiring and supervision of research support in the US and Rwanda; development of the initial framework for data collection and tools for interpretation; conducting in-country research in Nepal, Senegal, and Bangladesh; completion of data analysis and findings, case studies, and desk reviews. Full project scope, for which Dr. Hirschhorn acts as Co-PI: University of Global Health Equity (UGHE), a fully owned subsidiary of Partners In Health, will use a mixed methods implementation science-based approach to understand how and why selected exemplar low- and middle-income countries (LMICs) have decreased amenable U5M between 2000 and 2015 beyond their regional neighbors and economic peers. These countries have successfully utilized and scaled evidence-based interventions, as well as implemented other health system-level programs, and initiatives and policies beyond the traditional health sector sphere to address the underlying leading amenable causes of child mortality within their countries. These countries work has also reflected the complex adaptive nature of the health systems, including adaption to address the barriers encountered during implementation, collaboration with sectors and stakeholders outside of the traditional health sector and incorporating a learning system approach to improvement. The approach is to evaluate these countries to understand what they did, including capturing how they decided on which evidence-based interventions they utilized to address common causes of child mortality, as well as how they adapted (upfront and during scale-up) and implemented those interventions. We will expand this research to understand the positive and negative influences of contextual factors at the global, national, ministry of health, and community level structures, including culture, programs, decisions, and events that may have affected the successes or challenges associated with the work to improve child health through the targeted interventions. We will also explore if and how countries able to adapt their approach or failed in this work in response to these contextual factors. As part of our focus of sustainability, we have designed the inquiry to identify as possible replicable strategies to sustain or accelerate and the improvements to meet the child health-related SDG goal in the future. The primary focus in 2000—2015., but as feasible, we will also explore the contextual factors and trends in selected EBI coverage and mortality in the previous time period from 1995-2000. We have developed an implementation science framework which combined both explanatory framework (the Consolidated Framework for Implementation Research) as well as process evaluation (EPIS: Exploration, Preparation, Implementation and Sustainment) as well as evaluative framework of RE-AIM (Reach, effectiveness, Adoption, Implementation and Maintenance applying Proctors implementation outcome including fidelity, feasibility, acceptability). The use of mixed methods allows us to both do an explanatory analysis of quantitative data from the desk review and other analyses using qualitative data from a qualitative document analysis and from key informant interviews to understand how and why causes of death were prioritized, interventions were chosen, adapted and implemented, as well the implementation outcomes achieved. We will also sue the qualitative data from the interviews do some confirmat