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Glob Health Action. 2017 Aug;10(sup4):1346925. doi: 10.1080/16549716.2017.1346925.

Maternal and neonatal implementation for equitable systems. A study design paper.

Author information

a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda.
b Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden.
d Maternal and Neonatal Health Center of Excellence, Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda.
c Global Health Division , Karolinska Institutet , Stockholm , Sweden.
e Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
f School of Public Health , University of the Western Cape , Robert Sobukwe Road , Bellville 7535 , Republic of South Africa.



Evidence on effective ways of improving maternal and neonatal health outcomes is widely available. The challenge that most low-income countries grapple with is implementation at scale and sustainability.


The study aimed at improving access to quality maternal and neonatal health services in a sustainable manner by using a participatory action research approach.


 The  study consisted of a quasi-experimental design, with a participatory action research approach to implementation in three rural districts (Pallisa, Kibuku and Kamuli) in Eastern Uganda. The intervention had two main components; namely, community empowerment for comprehensive birth preparedness, and health provider and management capacity-building. We collected data using both quantitative and qualitative methods using household and facility-level structured surveys, record reviews, key informant interviews and focus group discussions. We purposively selected the participants for the qualitative data collection, while for the surveys we interviewed all eligible participants in the sampled households and health facilities. Descriptive statistics were used to describe the data, while the difference in difference analysis was used to measure the effect of the intervention. Qualitative data were analysed using thematic analysis.


This study was implemented to generate evidence on how to increase access to quality maternal and newborn health services in a sustainable manner using a multisectoral participatory  approach.


MANIFEST - Maternal and Neonatal Implementation for Equitable Systems Study; Participatory action research; community health workers; health insurance; implementation science; low-income countries; maternal and neonatal health; sustainability and local capacity

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