Catalysing scale-up of maternal and newborn child health innovations: a qualitative study in Ethiopia, Uttar Pradesh, India and northeast Nigeria

Background While donors commonly introduce innovative practices and technologies to improve health in low-income settings many innovations that are found to be effective are not adopted by country governments and implemented at scale. Our qualitative study explores scale-up of donor-funded maternal and newborn child health (MNCH) innovations targeting rural populations in Ethiopia, Uttar Pradesh in India and northeast Nigeria. We seek to answer two questions: a) what actions to catalyse scale-up of MNCH innovations are effective and why? b) what contextual factors enable and inhibit scale-up of MNCH innovations? Methodology We conducted 220 semi-structured interviews in 2012/13 and 2014/15 with government officials, development agencies, civil society programme implementers, professional associations and academics across the three settings. We developed a common analytic coding frame for cross-country analysis. Results Based on our study we present a conceptual framework encompassing: a) Critical actions for catalysing scale-up of MNH innovations: • Planning: embedding scale-up activities, time and resources in programme design; assessing country contexts; designing scalable innovations; building implementer capacity; • Persuading government to adopt innovations at scale: effective advocacy; strong evidence; involving government; invoking policy champions; aligning with health priorities and systems; harmonisation among donor programmes; • Supporting government to scale innovations: contributing to policy development; capacity strengthening government health systems and staff; • Stimulating community uptake of innovations at scale: involving mass media and community opinion leaders, mobilisation teams and role models. b) Contextual factors enabling and inhibiting scale-up of MNCH innovations: • Policy making contexts; • Prioritising and funding MNCH; • Development partner harmonisation; • Health systems capacity; • Security; • Sociocultural contexts; • Healthcare access. Conclusion Our study suggests that implementers, donors and governments should each play critical roles in accelerating MNCH innovation impact at scale-up – including committing time and resources, assessing country contexts and fostering improved harmonisation and alignment