Centering Equity and Developing the Maternal Health Workforce: Building the National Maternal Health Learning and Innovation Center.

PURPOSE: The purpose of this article is to describe the development of the Maternal Health Learning and Innovation Center (MHLIC), a national initiative designed to enhance workforce capacity of maternal health professionals in the United States. DESCRIPTION: The mission of the MHLIC is to foster collaboration and learning among diverse stakeholders to accelerate evidence-informed approaches advancing equitable maternal health outcomes through engagement, innovation, and policy. Working to center equity in all efforts, the MHLIC builds workforce capacity through partnership, training, technical assistance, coaching, facilitation of peer learning, and a national resource repository. ASSESSMENT: The MHLIC employed several assessment strategies in its first year, including a baseline learning survey of awardees, a stakeholder survey of potential collaborators in maternal health, and advisory convenings. Internally the MHLIC team assessed its own intercultural development. Assessment results informed internal and external approaches to workforce development. CONCLUSIONS: Telehealth implementation, access to services for rural populations, racial inequities, and data use and dissemination were the primary gaps that awardees and other stakeholders identified. The MHLIC is unique in its collaborative design approach and the centering of equity as foundational to the structure, subject, and culture of its work. The MHLIC utilizes a collaborative approach that capitalizes on academic and practice partners' extensive expertise in maternal health systems. Key to the success of future maternal health efforts is workforce development that builds the awareness and capacity to advance racial and geographic equity for public health, community, and clinical professionals.

A vignette-based approach to understanding social norms around family planning in three Nigerian cities.

Understanding the mechanisms through which social norms shape contraceptive use can help prevent unintended pregnancies in low-income countries. The Nigerian Urban Reproductive Health Initiative (NURHI) aimed to increase contraceptive uptake through advocacy, service delivery, and demand generation. Using data from focus group discussions, we examined whether social norms around family planning (FP), and specifically use of modern contraception (MC), varied among women and girls of reproductive age exposed to varying levels of the programme in three Nigerian cities. Injunctive social norms were generally unfavourable of unmarried adolescent girls' use of MC, though participants often shared exceptions for certain types of adolescents whose use of MC would be acceptable. There was greater acceptability for MC use by women who wanted to space or limit pregnancies. Participants reported that norms around FP and MC use have become more accepting in their communities over time. Normative differences between cities were identified. Participants' perceptions of religious leaders' support for FP use may have contributed to positively influencing social norms.

A learning agenda to build the evidence base for strengthening global health information systems.

BACKGROUND: Evidence-based interventions are necessary for planning and investing in health information systems (HIS) and for strengthening those systems to collect, manage, sort and analyse health data to support informed decision-making. However, evidence and guidance on HIS strengthening in low- and middle-income countries have been historically lacking. OBJECTIVE: This article describes the approach, methods, lessons learned and recommendations from 5 years of applying our learning agenda to strengthen the evidence base for effective HIS interventions. METHODS: The first step was to define key questions about characteristics, stages of progression, and factors and conditions of HIS performance progress. We established a team and larger advisory group to guide the implementation of activities to build the evidence base to answer questions. We strengthened learning networks to share information. RESULTS: The process of applying the learning agenda provided a unique opportunity to learn by doing, strategically collecting information about monitoring and evaluating HIS strengthening interventions and building a body of evidence. There are now models and tools to strengthen HIS, improved indicators and measures, country HIS profiles, documentation of interventions, a searchable database of HIS assessment tools and evidence generated through syntheses and evaluation results. CONCLUSION: The systematic application of learning agenda processes and activities resulted in increased evidence, information, guidance and tools for HIS strengthening and a resource centre, making that information accessible and available globally. IMPLICATIONS: We describe the inputs, processes and lessons learned, so that others interested in designing a successful learning agenda have access to evidence of how to do so.

Trafficking and Health: A Systematic Review of Research Methods.

Trafficking in persons (TIP) is a human rights violation with serious public health consequences. Unfortunately, assessing TIP and its health sequelae rigorously and reliably is challenging due to TIP's clandestine nature, variation in definitions of TIP, and the need to use research methods that ensure studies are ethical and feasible. To help guide practice, policy, and research to assess TIP and health, we undertook a systematic literature review of 70 peer-reviewed, published articles to (a) identify TIP and health research methods being used, (b) determine what we can learn about TIP and health from these varied methodologies, and (c) determine the gaps that exist in health-focused TIP research. Results revealed that there are various quantitative and qualitative data collection and analysis methods being used to investigate TIP and health. Furthermore, findings show that the limitations of current methodologies affect what is known about TIP and health. In particular, varying definitions, participant recruitment strategies, ethical standards, and outcome measures all affect what is known about TIP and health. Moreover, findings demonstrate an urgent need for representative and nonpurposive recruitment strategies in future investigations of TIP and health as well as research on risk and protective factors related to TIP and health, intervention effectiveness, long-term health outcomes, and research on trafficked people beyond women trafficked for sex. We offer recommendations for research, policy, and practice based on review results.