There is a growing consensus that maternal health outcomes can only be improved through policies and programmes that combine interventions to address the different causes of ill health and target multiple groups. Such policies and programmes are complex in nature as they involve coordination between different tiers in the health system and multiple actors including communities, health workers and managers. User fee exemption for delivery and emergency obstetric care (EmOC) is one such policy that has been introduced by several African countries with the aim of improving access to care and thus improving maternal and neonatal outcomes. However, the current evidence base regarding the impact of this policy is not well developed, in part because of evaluation designs that are not able to capture all the necessary information for policy-makers to make informed decisions. This proramme aims to reduce this gap by developing research methodologies and tools that will lead to enhanced research on policy implementation, stronger evidence and improved dissemination.
1. To develop enhanced methods for the evaluation of complex interventions involving various levels of the health system and carried out on a large scale. Innovation will relate to the following areas:
- developing a policy implementation measurement tool that describes interventions in terms of their adherence to original objectives, their eventual scope and penetration;
- developing innovative methodologies for health policy analysis, focusing on what drives policy change and how policy is transferred, both from international to national level (and back), but also regionally;
- developing a Policy Effects Mapping tool (POEM) and a comparative case study design, based on realist evaluation that focuses on adequacy and plausibility of effect of intervention rather than on probability and provides policy relevant information;
- using critical events (near miss) as an entry point for the evaluation of health outcomes and quality of care;
Tools will be developed in year one, tested in year two and finalised for external use in year three.
2. To apply these enhanced research methods to evaluate the impact, cost-effectiveness and mechanisms of fee exemptions for delivery care, especially emergency delivery care, in Benin, Mali, Morocco and Burkina Faso.
The evaluation results will be generated by the start of year three. These will be synthesised regionally and disseminated within that year.
3. To pilot a new way of synthesising and disseminating results to policy-makers using a network beyond the four countries - a ‘community of practice’ which encourages cross-learning between policy-makers, international organisations and researchers and between countries in the region.
The CoP will be established from the start of the project, and will continue after the project’s end, if it is positively evaluated, both internally and externally.
To download a short summary of the FEMHealth programme, click here.