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Table 2 Facilitators of implementation cited in studies included in the systematic review for each research question

From: Factors affecting effective community participation in maternal and newborn health programme planning, implementation and quality of care interventions

Facilitators of implementation Community participation in quality improvement Community participation in MNH programme planning & implementation
Enabling/supportive environment
A supportive political environment with supportive policies makes it easier to implement programmes. 18, 19 28
Community awareness of and interest in MNH are high.   
 • When mortality is high, it is more likely that community members will see the problem and perceive the need for change.  • Use mass media campaigns (radio/TV) and other outreach methods to increase awareness of the issue. 18, 19 17, 25
Reinforce or nurture cultural norm of collective responsibility for better maternal & newborn health.   23, 24
Build on and/or develop more cohesive populations with tighter social networks. Rural programme sites had an easier time implementing than those in urban sites in part due to more cohesive populations, tighter social networks.   16, 21, 22
Community capacity
Community leadership
Having strong and stable community leadership facilitates implementation. 18, 19, 27 16, 18, 23, 24, 27
Improve community leadership, ownership & governance of programme 18, 20, 26, 27 16, 18, 20
Provide women/young people with opportunities for leadership, forum for participation 18, 20, 26 16, 18, 20, 21, 22, 28
Increase focus and attention to health in local council meetings 26, 27 25, 27
COMMUNITY PARTICIPATION & GOVERNANCE   
Ensure representation of the voices and perspectives of different groups 20, 26, 27 17, 20
Increase participation of marginalized, disadvantaged, less powerful groups 26, 27, 29 21,22, 27
Increase women’s participation in decision-making   23, 24, 28
Work with existing structures when they are functional or have flexibility to form new structures/mechanisms when they don’t exist or are dysfunctional (need to understand their purpose, roles and responsibilities). Establish and/or strengthen committees or other planning & coordination structures. 18, 19, 20, 26, 27 14, 15, 16, 17, 18, 21, 22, 23, 24, 25, 27, 28
COLLABORATION & PARTNERSHIP   
Establish and/or strengthen multi-organization partnership including public sector/local government at multiple levels. 18, 19 16, 17, 23, 24, 25, 28
Improve community - health services interaction/relations. 18, 19, 20, 29 15, 18, 20, 21, 22, 27
Increase awareness and support of community health workers.   14, 15, 23, 24
Strengthen social networks for information exchange/support.   21, 22, 25
 • Violence against women advocacy support network established, action taken to address this issue 18, 19 18, 19
COMMUNITY MANAGEMENT CAPACITY   
Strengthen community ability to use data for decision-making, monitoring, accountability & advocacy.   
 • Communities, households, services with more complete data; using data 20, 26 14, 20
 • Use of data for decision-making, advocacy 20, 26, 27  
 • Improved community monitoring and accountability of health services 18, 19, 26, 27 21, 22, 27
Strengthen community ability to leverage and manage resources.   
 • Transparency in decision-making and management of resources 18, 19, 20 18, 20, 23, 24
 • Community capacity to leverage and manage resources 18, 20 16, 20, 23, 24, 25
Strengthen community ability to plan; development of written action plan, “community contract” that guided implementation. 18, 19, 20, 27 20, 21, 22, 23, 24, 27
Strengthen community ability to problem-solve. 18, 19 18
Community capacity: health related technical knowledge, skills & abilities
Train village health workers/community volunteers to be able to provide health education and services. 19, 20, 26 14, 16, 17, 23, 24
Develop blood donor lists to identify potential donors, if needed. 18, 19 18, 19, 25
Improve knowledge of danger signs. 18, 19 17,18, 19
Health system
Sufficient number of trained staff in health facilities   14, 15
Improve quality of care/upgrade services [aim of all studies for this intervention] 14, 15, 18
Availability of accurate data on health situation, health services 19, 20, 27 16, 20, 27
Leadership at district and health facility levels 18, 19  
Community & health system interaction
Community health workers play a vital role linking communities and health services 18, 19, 20, 26, 29 14, 15, 16, 20, 23, 24
NGOs can facilitate the process, provide technical support to communities to help them develop capacity to plan and implement. Existing relationships of NGOs with communities and health services facilitate implementation. NGOs can support inter-cultural interaction. 18, 19, 27, 29 14, 16, 17, 18, 23, 24, 27
Bring communities and health service providers together to participate in joint assessment and dialogue before planning. 20, 29 20, 28
Use key questions to drive planning process dialogue. 20, 29 20
Schedule regular meetings (monthly, bimonthly, quarterly) to monitor, adjust strategies, problem-solve. 18, 19, 20, 26, 27  
Intercultural sensitivity /competence
Acknowledge and build on existing traditional/local beliefs and practices. 29 25
Develop/use culturally appropriate materials in local languages that are suitable for the range of literacy/numeracy skills in the programme context. 18, 19, 27, 29 15, 16, 18, 25, 27
Understand social networks and focus on changing social norms. 26 21, 22, 25
Maintain a gender rights focus and consider gender roles. 18, 19 16, 18, 25, 28
Other programme conditions
Use participatory methodology and techniques   21, 22, 25
Use a synergistic package of complementary interventions   18
Provide funding support for a longer period of time (this study was funded for 4 years)   28
Train programme facilitators (in MNH topics, data interpretation, dissemination, conflict resolution, management)   14, 15, 17, 18, 23, 24, 27
  1. Note: see numbered list of references at the end of the article to interpret the numbers presented in the columns below. This is a descriptive, qualitative analysis based on what the reviewed studies reported. The number of studies reporting each facilitating factor is not intended to be an indicator of the level of importance of the factor.