PMID- 36316131
OWN - NLM
STAT- MEDLINE
DCOM- 20221102
LR  - 20240123
IS  - 2169-575X (Electronic)
IS  - 2169-575X (Linking)
VI  - 10
IP  - 5
DP  - 2022 Oct 31
TI  - Designing for Impact and Institutionalization: Applying Systems Thinking to 
      Sustainable Postpartum Family Planning Approaches for First-Time Mothers in 
      Bangladesh.
LID - 10.9745/GHSP-D-22-00023 [doi]
LID - e2200023
AB  - Integrated service delivery approaches have shown promise to increase use of 
      services including postpartum family planning (PPFP) by young, first-time mothers 
      (FTMs) but have proven challenging to scale and institutionalize. Integration 
      adds complexity, requiring careful assessment of effects on a range of key system 
      functions from demand creation and service delivery to oversight and governance. 
      Through an innovative design process, we selected approaches to increase FTMs' 
      PPFP use through existing health systems. We generated programmatic options and 
      then sought to select approaches based on (1) potential impact on FTMs' PPFP 
      uptake and (2) potential to institutionalize in the health system. The latter 
      represented an innovation in addressing management systems' drivers of 
      scalability and sustainability; to accomplish it, we developed a participatory 
      design process to assess the potential of an approach to be institutionalized in 
      a specific context.We adapted a management systems theory, the Viable System 
      Model (VSM), which presents 5 essential organizational functions and the 
      relations required between them to improve the viability (performance and 
      institutionalization) of organizational systems. Drawing from the VSM, we 
      developed a process for reviewing the effects of proposed approaches on provider 
      workload, client flow, infrastructure, revisions to guidelines and job 
      descriptions, coordination and management, and information systems. The VSM 
      provided a structure to identify potential displacement of capacity in the health 
      system and mitigate often neglected organizational challenges that compromise 
      institutionalization. The process informed the elimination of approaches with 
      potential for impact but that had deal-breakers to institutionalization, such as 
      increased workload or shifted job descriptions, in the Bangladeshi context. For 
      the selected approaches, consideration of systems elements fostered discussion of 
      expected risks to institutionalization, highlighting needed mitigation efforts 
      and monitoring during implementation.
CI  - (c) Yahner et al.
FAU - Yahner, Melanie
AU  - Yahner M
AD  - Save the Children US, Fairfield, CT, USA. myahner@savechildren.org.
FAU - Muriuki, Angela
AU  - Muriuki A
AD  - Independent consultant; formerly of Save the Children Kenya, Nairobi, Kenya.
FAU - Mangieri, Amy
AU  - Mangieri A
AD  - Save the Children US, Washington, DC, USA.
FAU - Nitu, Syeda Nabin Ara
AU  - Nitu SNA
AD  - Save the Children Bangladesh, Dhaka, Bangladesh.
FAU - Shafinaz, Shumona
AU  - Shafinaz S
AD  - Independent consultant; formerly of Save the Children Bangladesh, Dhaka, 
      Bangladesh.
FAU - Sarriot, Eric
AU  - Sarriot E
AD  - Gavi, the Vaccine Alliance, Geneva, Switzerland; formerly of Save the Children 
      US, Washington, DC, USA.
LA  - eng
GR  - INV-010128/GATES/Bill & Melinda Gates Foundation/United States
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20221031
PL  - United States
TA  - Glob Health Sci Pract
JT  - Global health, science and practice
JID - 101624414
SB  - IM
MH  - Female
MH  - Humans
MH  - *Family Planning Services
MH  - *Mothers
MH  - Bangladesh
MH  - Postpartum Period
MH  - Institutionalization
MH  - Systems Analysis
PMC - PMC9622282
EDAT- 2022/11/01 06:00
MHDA- 2022/11/03 06:00
PMCR- 2022/10/31
CRDT- 2022/10/31 21:42
PHST- 2022/01/27 00:00 [received]
PHST- 2022/09/13 00:00 [accepted]
PHST- 2022/10/31 21:42 [entrez]
PHST- 2022/11/01 06:00 [pubmed]
PHST- 2022/11/03 06:00 [medline]
PHST- 2022/10/31 00:00 [pmc-release]
AID - GHSP-D-22-00023 [pii]
AID - 10.9745/GHSP-D-22-00023 [doi]
PST - epublish
SO  - Glob Health Sci Pract. 2022 Oct 31;10(5):e2200023. doi: 10.9745/GHSP-D-22-00023. 
      Print 2022 Oct 31.