Health system strengthening using a Maximizing Engagement for Readiness and Impact (Meri) Approach
A community case study
Bibliographic Data
Introduction Health system strengthening initiatives in low and middle-income countries are commonly hampered by limited implementation readiness. The Maximizing Engagement for Readiness and Impact (MERI) Approach uses a system “readiness” theory of change to address implementation obstacles. MERI is documented based on field experiences, incorporating best practices, and lessons learned from two decades of maternal, newborn, and child health (MNCH) programming in East Africa. Context The MERI Approach is informed by four sequential and progressively larger MNCH interventions in Uganda and Tanzania. Intervention evaluations incorporating qualitative and quantitative data sources assessed health and process outcomes. Implementer, technical leader, stakeholder, and policymaker reflections on sequential experiences have enabled MERI Approach adaptation and documentation, using an implementation lens and an implementation science readiness theory of change. Key programmatic elements The MERI Approach comprises three core components. MERI Change Strategies (meetings, equipping, training, mentoring) describe key activity types that build general and intervention-specific capacity to maximize and sustain intervention effectiveness. The SOPETAR Process Model ( S can, O rient, P lan, E quip, T rain, A ct, R eflect) is a series of purposeful steps that, in sequence, drive each implementation level (district, health facility, community). A MERI Motivational Framework identifies foundational factors (self-reliance, collective-action, embeddedness, comprehensiveness, transparency) that motivate participants and enhance intervention adoption. Components aim to enhance implementer and system readiness while engaging broad stakeholders in capacity building activities toward health outcome goals. Activities align with government policy and programming and are embedded within existing district, health facility, and community structures. Discussion This case study demonstrates feasibility of the MERI Approach to support district wide MNCH programming in two low-income countries, supportive of health outcome and health system improvements. The MERI Approach has potential to engage districts, health facilities, and communities toward sustainable health outcomes, addressing intervention implementation gaps for current and emerging health needs within and beyond East Africa
Community engagement · Political science · Public relations · Community Health and Development · Computer Science · Global Maternal and Child Health · Health Policy Implementation Science · Medicine · Psychology
Self-Determination Theory
Getting to outcomes
Making sense of implementation theories, models and frameworks
Rose's population strategy of prevention need not increase social inequalities in health
Evidence-based intervention sustainability strategies
Maternal mortality for 181 countries, 1980–2008
RE-AIM Planning and Evaluation Framework
A theory of organizational readiness for change
Readiness for Organizational Change
Fostering implementation of health services research findings into practice
Evaluation of a comprehensive maternal newborn health intervention in rural Tanzania
Five-year retention of volunteer community health workers in rural Uganda
Getting to Outcomes
Poor retention does not have to be the rule
Bridging the Gap Between Prevention Research and Practice
Transcending the Known in Public Health Practice
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