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Table 2 Objectives, Questions, Data Sources for the MAHMAZ Implementation Effectiveness Protocol

From: Evaluating implementation effectiveness and sustainability of a maternity waiting homes intervention to improve access to safe delivery in rural Zambia: a mixed-methods protocol

ObjectiveEvaluation QuestionsData Sources
1. To assess the degree to which each individual intervention is effectively implemented according to the project plan and to document any adjustments and/or adaptationsa. At intervention sites, what is the proportion of MWHs that meet each component of the Core Model?
b. What proportion of intervention sites are operating according to the project standard operating procedures?
Quantitative
MWH Register
Others Register
MWH Activity Log
MWH Experience Survey
Core Model Checklist
Qualitative
Project records
2. To identify barriers and facilitators to implementation of the interventionsa. What are the barriers and facilitators to implementation of the:
1. Core Model?
2. Governance and management models?
3. IGAs?
Qualitative
IDI with MWH governance and management structures
IDI with IGA staff/volunteers
IDI with health facility/system staff
3 To assess the extent to which implementation of the Core Model is perceived as responsive to community standards of acceptability by both the community and the women.a. How does satisfaction with staying at the MWH compare in intervention sites relative to control sites?
b. To what degree are the intervention MWH perceived as responsive to community standards and needs?
c. What are the essential features and characteristic of the MWH as perceived by both women and communities?
d. What are continued barriers to accessing and utilizing MWH after the intervention?
Quantitative
MWH Experience Survey
Qualitative
IDIs with MWH governance and management structures
FGDs with pregnant/ recently delivered women (RDW), men with children < 1, community el ders, Safe Motherhood Action Group members (S MAGs)
4. To assess the ways in which health facility-level factors change over the course of implementation.a. How does capacity to handle obstetric emergencies change over time at the facility?
b. How do staff perceptions of care related to maternal health change over time?
c. What role does the MWH have in shaping staff perceptions of maternal health care?
Quantitative
Health Facility Assessment
Qualitative
IDI with health facility/system staff
5. To assess the ways in which service utilization patterns at both MWHs and rural health centers change over time.a. How does the utilization of the MWH change over time?
b. How do referral patterns, census and demographic of those utilizing health facilities change over time?
c. What are the perceived changes in service utilization at both MWH and health facilities over time?
Quantitative
Delivery Register
Maternity Ward Admissions Register (for referrals) or ad hoc referral register
Postnatal Care Register
MWH Register
Qualitative
IDI with health facility/system staff
IDI MWH governance and management structures
Project records
6. To develop a contextual history of other factors that may influence both the implementation and the outcomes at the community, district, provincial and national levels.a. What external factors may have influenced the implementation and outcomes observed?
b. How does the external and policy environment of the health system influence the utilization and uptake of MWH for delivery?
Qualitative
IDI with health facility/system staff
IDIs with MWH governance and management structures
FGDs with pregnant/ RDW women, men with children < 1, elders, SMAGs
Project records
7. To identify key features of the entrepreneurial strategies and managements models developed to support MWH operations and to assess their immediate and sustained effectiveness.a. What operational and financial systems are in place and functional at baseline?
b. What is the contribution of each strategy in the overall financial sustainability of the MWH, and how does this change over time?
c. Which strategies and managements models are perceived as viable for long-term sustainability? What differences exist between communities?
d. What is the effect of each strategy/management model on the utilization of the MWH?
Quantitative
MWH Main Cashbook
IGA Sales Journal
Monthly Goat Stock
MWH Register
Qualitative
IDI with health facility/system staff
IDI with MWH governance and management units
FGDs with pregnant/ RDW, men with children < 1, elders, SMAGs
Project records