title: Designing for action: adapting and implementing a community-based newborn care package to affect national change in Uganda.
abstract: BACKGROUND
  There is a lack of literature on how to adapt new evidence-based interventions for maternal and newborn care into local health systems and policy for rapid scale-up, particularly for community-based interventions in low-income settings. The Uganda Newborn Study (UNEST) was a cluster randomised control trial to test a community-based care package which was rapidly taken up at national level. Understanding this process may help inform other studies looking to design and evaluate with scale-up in mind.
  
  
  OBJECTIVE
  This study aimed to describe the process of using evidence to design a community-based maternal and newborn care package in rural eastern Uganda, and to determine the dissemination and advocacy approaches used to facilitate rapid policy change and national uptake.
  
  
  METHODS
  We reviewed UNEST project literature including meeting reports and minutes, supervision reports, and annual and midterm reports. National stakeholders, project and district staff were interviewed regarding their role in the study and perceptions of what contributed to uptake of the package under evaluation. Data related to UNEST formative research, study design, implementation and policy influence were extracted and analysed.
  
  
  RESULTS
  An advisory committee of key players in development of maternal and newborn policies and programmes in Uganda was constituted from many agencies and disciplines. Baseline qualitative and quantitative data collection was done at district, community and facility level to examine applicability of aspects of a proposed newborn care package to the local setting. Data were summarised and presented to stakeholders to adapt the intervention that was ultimately tested. Quarterly monitoring of key activities and events around the interventions were used to further inform implementation. The UNEST training package, home visit schedule and behaviour change counselling materials were incorporated into the national Village Health Team and Integrated Community Case Management packages while the study was ongoing.
  
  
  CONCLUSIONS
  Designing interventions for national scale-up requires strategies and planning from the outset. Use of evidence alongside engagement of key stakeholders and targeted advocacy about the burden and potential solutions is important when adapting interventions to local health systems and communities. This approach has the potential to rapidly translate research into policy, but care must be taken not to exceed available evidence while seizing the policy opportunity.
authors.affiliation: Department of Health Policy, Planning and Management, School of Public Health, College of Health Science, Makerere University, Kampala, Uganda.|Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; pwaiswa@musph.ac.ug.
authors.forename: Peter
authors.initials: P
authors.lastname: Waiswa
authors.affiliation: Department of Health Policy, Planning and Management, School of Public Health, College of Health Science, Makerere University, Kampala, Uganda.
authors.forename: Gertrude
authors.initials: G
authors.lastname: Namazzi
authors.affiliation: Saving Newborn Lives, Save the Children, Cape Town, South Africa.
authors.forename: Kate
authors.initials: K
authors.lastname: Kerber
authors.affiliation: Department of Health Policy, Planning and Management, School of Public Health, College of Health Science, Makerere University, Kampala, Uganda.|Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.|International Maternal and Child Health Unit, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Peterson
mesh_terms: D000328:Adult; D002662:Child Health Services / Q000458:organization & administration*; D003153:Community Health Services / Q000458:organization & administration*; D003906:Developing Countries; D019317:Evidence-Based Medicine / Q000458:organization & administration; D005260:Female; D006291:Health Policy; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000458:organization & administration*; D007231:Infant, Newborn; D008297:Male; D008427:Maternal Health Services / Q000458:organization & administration*; D008875:Middle Aged; D011181:Postnatal Care / Q000458:organization & administration*; D011203:Poverty; D011247:Pregnancy; D012424:Rural Population; D014454:Uganda
keywords: Uganda; community health worker; formative research; health policy; maternal health; newborn health; postnatal care; pregnancy
references.citation: BMC Pregnancy Childbirth. 2008;8:21
references.pmid: 18570672
references.citation: J Perinatol. 2005 Mar;25 Suppl 1:S108-22
references.pmid: 15791272
references.citation: Glob Health Action. 2015 Mar 31;8:23968
references.pmid: 25843491
references.citation: Trials. 2012;13:213
references.pmid: 23153395
references.citation: BMC Pregnancy Childbirth. 2010;10:9
references.pmid: 20178626
references.citation: Health Policy Plan. 2012 Jul;27 Suppl 3:iii6-28
references.pmid: 22692417
references.citation: J Perinatol. 2008 Dec;28 Suppl 2:S1
references.pmid: 19057562
references.citation: Lancet. 2013 Jun 22;381(9884):2184-92
references.pmid: 23578528
references.citation: Child Care Health Dev. 2013 Jan;39(1):20-6
references.pmid: 22680250
references.citation: Am J Trop Med Hyg. 2012 Nov;87(5 Suppl):46-53
references.pmid: 23136277
references.citation: Lancet. 2004 Sep 11-17;364(9438):970-9
references.pmid: 15364188
references.citation: Health Policy Plan. 2012 Jul;27 Suppl 3:iii104-117
references.pmid: 22692413
references.citation: Trop Med Int Health. 2010 Aug;15(8):964-72
references.pmid: 20636527
references.citation: Glob Health Action. 2015 Mar 31;8:24584
references.pmid: 25843498
references.citation: Lancet. 2005 Mar 19-25;365(9464):1087-98
references.pmid: 15781104
references.citation: Lancet. 2005 Mar 12-18;365(9463):977-88
references.pmid: 15767001
references.citation: J Perinatol. 2008 Dec;28 Suppl 2:S46-52
references.pmid: 19057568
references.citation: Lancet. 2005 Mar 5-11;365(9462):891-900
references.pmid: 15752534
references.citation: PLoS One. 2013;8(11):e81610
references.pmid: 24312326
references.citation: Trop Med Int Health. 2013 Jul;18(7):898-906
references.pmid: 23551394
references.citation: J Perinatol. 2008 Dec;28 Suppl 2:S14-22
references.pmid: 19057563
references.citation: Trop Med Int Health. 2010 Oct;15(10):1140-7
references.pmid: 20723185
references.citation: Lancet. 2008 Sep 27;372(9644):1151-62
references.pmid: 18926277
references.citation: J Perinatol. 2008 Dec;28 Suppl 2:S38-45
references.pmid: 19057567
references.citation: Lancet. 2008 Jun 7;371(9628):1936-44
references.pmid: 18539225
references.citation: Lancet. 2011 Jan 29;377(9763):403-12
references.pmid: 21239052
references.citation: Implement Sci. 2007 Dec 09;2:42
references.pmid: 18067681
references.citation: Health Policy Plan. 2008 Mar;23(2):101-17
references.pmid: 18267961