TY - JOUR
T1 - Challenges and facilitators to evidence-based decision-making for maternal and child health in Mozambique
T2 - District, municipal and national case studies
AU - Inguane, Celso
AU - Sawadogo-Lewis, Talata
AU - Chaquisse, Eusébio
AU - Roberton, Timothy
AU - Ngale, Kátia
AU - Fernandes, Quinhas
AU - Dinis, Aneth
AU - Augusto, Orvalho
AU - Covele, Alfredo
AU - Hicks, Leecreesha
AU - Gremu, Artur
AU - Sherr, Kenneth
N1 - Funding Information:
This study was conducted using funds from the Canada Department of Foreign Affairs Trade and Development through a sub-agreement between the Institute for International Programs at Johns Hopkins University, Baltimore, Maryland and Health Alliance International, Seattle, Washington. Celso Inguane was supported through the United States National Institutes of Health under award number R01HD092449. However, the content of the manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.’
Publisher Copyright:
© 2020 The Author(s).
PY - 2020/6/30
Y1 - 2020/6/30
N2 - Background: The need for evidence-based decision-making in the health sector is well understood in the global health community. Yet, gaps persist between the availability of evidence and the use of that evidence. Most research on evidence-based decision-making has been carried out in higher-income countries, and most studies look at policy-making rather than decision-making more broadly. We conducted this study to address these gaps and to identify challenges and facilitators to evidence-based decision-making in Maternal, Newborn and Child Health and Nutrition (MNCH&N) at the municipality, district, and national levels in Mozambique. Methods: We used a case study design to capture the experiences of decision-makers and analysts (n = 24) who participated in evidence-based decision-making processes related to health policies and interventions to improve MNCH&N in diverse decision-making contexts (district, municipality, and national levels) in 2014-2017, in Mozambique. We examined six case studies, at the national level, in Maputo City and in two districts of Sofala Province and two of Zambézia Province, using individual in-depth interviews with key informants and a document review, for three weeks, in July 2018. Results: Our analysis highlighted various challenges for evidence-based decision-making for MNCH&N, at national, district, and municipality levels in Mozambique, including limited demand for evidence, limited capacity to use evidence, and lack of trust in the available evidence. By contrast, access to evidence, and availability of evidence were viewed positively and seen as potential facilitators. Organizational capacity for the demand and use of evidence appears to be the greatest challenge; while individual capacity is also a barrier. Conclusion: Evidence-based decision-making requires that actors have access to evidence and are empowered to act on that evidence. This, in turn, requires alignment between those who collect data, those who analyze and interpret data, and those who make and implement decisions. Investments in individual, organizational, and systems capacity to use evidence are needed to foster practices of evidence-based decision-making for improved maternal and child health in Mozambique.
AB - Background: The need for evidence-based decision-making in the health sector is well understood in the global health community. Yet, gaps persist between the availability of evidence and the use of that evidence. Most research on evidence-based decision-making has been carried out in higher-income countries, and most studies look at policy-making rather than decision-making more broadly. We conducted this study to address these gaps and to identify challenges and facilitators to evidence-based decision-making in Maternal, Newborn and Child Health and Nutrition (MNCH&N) at the municipality, district, and national levels in Mozambique. Methods: We used a case study design to capture the experiences of decision-makers and analysts (n = 24) who participated in evidence-based decision-making processes related to health policies and interventions to improve MNCH&N in diverse decision-making contexts (district, municipality, and national levels) in 2014-2017, in Mozambique. We examined six case studies, at the national level, in Maputo City and in two districts of Sofala Province and two of Zambézia Province, using individual in-depth interviews with key informants and a document review, for three weeks, in July 2018. Results: Our analysis highlighted various challenges for evidence-based decision-making for MNCH&N, at national, district, and municipality levels in Mozambique, including limited demand for evidence, limited capacity to use evidence, and lack of trust in the available evidence. By contrast, access to evidence, and availability of evidence were viewed positively and seen as potential facilitators. Organizational capacity for the demand and use of evidence appears to be the greatest challenge; while individual capacity is also a barrier. Conclusion: Evidence-based decision-making requires that actors have access to evidence and are empowered to act on that evidence. This, in turn, requires alignment between those who collect data, those who analyze and interpret data, and those who make and implement decisions. Investments in individual, organizational, and systems capacity to use evidence are needed to foster practices of evidence-based decision-making for improved maternal and child health in Mozambique.
KW - Decision-making
KW - Evidence-based
KW - Maternal and child health
KW - Mozambique
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U2 - 10.1186/s12913-020-05408-x
DO - 10.1186/s12913-020-05408-x
M3 - Article
C2 - 32605564
AN - SCOPUS:85087413409
SN - 1472-6963
VL - 20
JO - BMC Health Services Research
JF - BMC Health Services Research
IS - 1
M1 - 598
ER -