Implementation research to strengthen coordination mechanism and improve maternal health system in Kapilvastu district: R4R Learning Site II

Introduction

ReBUILD for Resilience (R4R), is an international research consortium funded by the UK government dedicated to strengthening resilience and building stronger health system in fragile and shock-prone settings, namely Lebanon, Myanmar, Nepal and Sierra Leone. In the first phase of R4R, a three-year participatory action research (2021-2024) had been launched in Kapilvastu Municipality with the aim to understand and support health system resilience by strengthening the capacity of local level in health sector planning, financing and governance. It served as the first Learning Site (LS1) for R4R. Based on the learnings and evidence from LS1, a two-year project (2024-2026) has been initiated in Kapilvastu district where intensive intervention will be applied in Suddhodhan Rural Municipality-the second Learning Site (LS2) and learnings will be shared across all local levels within the district. 

Implementation Approach  

An implementation research has been designed to strengthen coordination mechanism and improve maternal health system in Kapilvastu district. This research aims to understand the policy environment and contextual determinants of maternal health services at system, health facility and community levels and apply co-creation approach to design and implement interventions to improve overall service status.

As a part of the research, a researcher has been embedded in the learning site since July, 2024 to learn about the local health system, review the available Acts, policies and other relevant documents and secondary information and lead community level intervention. A baseline study utilizing mixed method approach is also on-going. The baseline study utilizes mixed method approach: a household survey in all of the wards of LS2 to collect information on the knowledge, awareness and utilization of maternal health services and Key Informant Interviews (KIIs) at federal, provincial and local level to identify the potential shocks and stressors for the local health system. Health facility assessment has been planned to determine the current status of health system and services including infrastructure, availability of human resource, medicines, etc and their readiness for emergencies. Additionally, the project plans to analyze the health sector budget allocation and expenditure in LS2 in order to determine the effectiveness of planning and budgeting. 

The findings of the baseline research will be shared with the stakeholders of different levels. Participatory workshops will be organized to co-create intervention packages with stakeholders including the community. The co-created intervention packages will be delivered at three levels – community, health facilities and local government. The interventions will be implemented intensively in LS2 and the learnings and experiences will be shared to other municipalities within the district, promoting scale up. To build mechanisms for the transfer of learnings, the intervention will emphasize establishing and strengthening coordination within and among the local levels, and with district, province and federal levels. At the end of the project, evaluation will be conducted to assess the feasibility, effectiveness and scalability of the interventions to establish an effective and functional coordination mechanism and to improve the utilization of maternal health services where institutional delivery will be the main outcome measure. 

Partners