In Uganda, more than 336 out of every 100,000 women die annually during childbirth. Pregnant women, particularly in rural areas, often lack the financial resources and means to access health facilities in a timely manner for quality antenatal, delivery, and post-natal services. For nearly the past decade, the Makerere University School of Public Health researchers, through various projects, have been spearheading innovative interventions, embedded in implementation research, to reduce barriers to access to care. In this paper, we describe two of projects that were initially conceived to tackle the financial barriers to access to care – through a voucher program in the community - on the demand side - and a series of health systems strengthening activities at the district and facility level - on the supply side. Over time, the projects diverged in the content of the intervention and the modality in which they were implemented, providing an opportunity for reflection on innovation and scaling up. In this short report, we used an adaptation of Greenhalgh’s Model of Diffusion to reflect on these projects’ approaches to implementing innovative interventions, with the ultimate goal of reducing maternal and neonatal mortality in rural Uganda. We found that the adapted model of diffusion of innovations facilitated the emergence of insights on barriers and facilitators to the implementation of health systems interventions. Health systems research projects would benefit from analyses beyond the implementation period, in order to better understand how adoption and diffusion happen, or not, over time, after the external catalyst departs.

中文翻译：

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应用创新传播模型了解乌干达农村地区实施孕产妇和新生儿保健计划的促进者

在乌干达，每年每十万名妇女中有超过336人在分娩时死亡。孕妇，特别是在农村地区的孕妇，通常缺乏经济资源和手段，无法及时获得保健设施以提供优质的产前，分娩和产后服务。在过去的近十年中，马克雷雷大学公共卫生学院的研究人员通过各种项目，率先将创新干预措施嵌入实施研究中，以减少获得医疗服务的障碍。在本文中，我们描述了两个项目，这些项目最初是为解决获得医疗服务的财务障碍而设计的-通过社区的代金券计划-在需求方面-以及一系列在地区和设施级别加强活动的卫生系统-在供应侧。随着时间的推移，这些项目的干预内容和实施方式各不相同，为反思创新和扩大规模提供了机会。在这份简短的报告中，我们改编了格林哈尔（Greenhalgh）的扩散模型，以反思这些项目实施创新干预措施的方法，其最终目标是降低乌干达农村地区的孕产妇和新生儿死亡率。我们发现，创新传播的适应模型促进了对卫生系统干预措施实施过程中的障碍和促进因素的见解。卫生系统研究项目将受益于实施期以外的分析，以便更好地了解外部催化剂离开后，随着时间的流逝，采用和扩散的发生与否。