title: Using systematized tacit knowledge to prioritize implementation challenges in existing maternal health programs: implications for the post MDG era.
abstract: Strategic priority setting and implementation of strategies to reduce maternal mortality are key to the post Millennium Development Goal (MDG) 2015 agenda. This article highlights the feasibility and the advantages of using a systematized tacit knowledge approach, using data from maternal health program personnel, to identify local challenges to implementing policies and programs to inform the post MDG era. Communities of practice, conceived as groups of people sharing professional interests, experiences and knowledge, were formed with diverse health personnel implementing maternal health programs in Mexico and Nicaragua. Participants attended several workshops and developed different online activities aiming to strengthen their capacities to acquire, analyze, adapt and apply research results and to systematize their experience and knowledge of the actual implementation of these programs. Concept mapping, a general method designed to organize and depict the ideas of a group on a particular topic, was used to manage, discuss and systematize their tacit knowledge about implementation problems of the programs they work in. Using a special online concept mapping platform, participants prioritized implementation problems by sorting them in conceptual clusters and rating their importance and feasibility of solution. Two hundred and thirty-one participants from three communities of practice in each country registered on the online concept mapping platform and 200 people satisfactorily completed the sorting and rating activities. Participants further discussed these results to prioritize the implementation problems of maternal health programs. Our main finding was a great similarity between the Mexican and the Nicaraguan general results highlighting the importance and the feasibility of solution of implementation problems related to the quality of healthcare. The use of rigorously organized tacit knowledge of health personnel proved to be a feasible and useful tool for prioritization to inform implementation priorities in the post MDG agenda.
authors.affiliation: Instituto Nacional de Salud Pública / Centro de Investigación en Sistemas de Salud (National Institute of Public Health / Centre for Health Systems Research), Av. Universidad 655, Col. Santa María Ahuacatitlán, Cuernavaca, Morelos CP 62100, Mexico.
authors.forename: Victor
authors.initials: V
authors.lastname: Becerril-Montekio
authors.affiliation: Instituto Nacional de Salud Pública / Centro de Investigación en Sistemas de Salud (National Institute of Public Health / Centre for Health Systems Research), Av. Universidad 655, Col. Santa María Ahuacatitlán, Cuernavaca, Morelos CP 62100, Mexico jacqueline.alcalde@insp.mx.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Alcalde-Rabanal
authors.affiliation: Instituto Nacional de Salud Pública / Centro de Investigación en Sistemas de Salud (National Institute of Public Health / Centre for Health Systems Research), Av. Universidad 655, Col. Santa María Ahuacatitlán, Cuernavaca, Morelos CP 62100, Mexico Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
authors.forename: Blair G
authors.initials: BG
authors.lastname: Darney
authors.affiliation: Instituto Nacional de Salud Pública / Centro de Investigación en Sistemas de Salud (National Institute of Public Health / Centre for Health Systems Research), Av. Universidad 655, Col. Santa María Ahuacatitlán, Cuernavaca, Morelos CP 62100, Mexico.
authors.forename: Emanuel
authors.initials: E
authors.lastname: Orozco-Nuñez
mesh_terms: D002489:Central America; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000458:organization & administration; D006284:Health Plan Implementation / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration*; D008428:Maternal Mortality; D011247:Pregnancy; D011787:Quality of Health Care
keywords: : Communities of practice; implementation research; low- and middle-income countries; maternal health services; maternal mortality; quality; tacit knowledge