Identifying practices and ideas to improve the implementation of maternal mortality reduction programmes: findings from five South Asian countries.

OBJECTIVE The successful implementation of programmes to reduce maternal mortality is constrained by a 'know-do' gap: the disparity between what is known and the application of that knowledge in policy and practice. This study identified innovations, practices and ideas aimed to improve project and programme implementation. DESIGN Cross-sectional. SETTING Five South Asian countries: Afghanistan, Bangladesh, India, Nepal and Pakistan. SAMPLE Sixteen projects and programmes, and 100 key informants. METHODS In-depth review of documents, key informant interviews and focus-group discussions. MAIN OUTCOME MEASURES Innovations and ideas to improve programme implementation, and their perceived effects. RESULTS Delegation of duties to intermediate-level health workers, incentivisation of health workers, providing the means to overcome financial barriers for accessing care, quality improvements and knowledge transfer were examples of ideas put into practice to improve programme implementation. There was a perception that these improved service use and availability, but objective evidence was lacking. CONCLUSIONS Some innovations, practices and ideas are supported by evidence of effect, and could be replicated, whereas others have not been formally evaluated. Testing of these innovations is required before more widespread adoption can be recommended, although experiences should be shared to narrow the 'know-do' gap, even though the evidence on beneficial effects remains unclear.