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Organizational analysis of maternal mortality reduction programs in Madagascar
Author(s) -
Harimanana Aina,
Barennes Hubert,
Reinharz Daniel
Publication year - 2010
Publication title -
the international journal of health planning and management
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.672
H-Index - 41
eISSN - 1099-1751
pISSN - 0749-6753
DOI - 10.1002/hpm.1077
Subject(s) - incentive , public relations , exploit , capacity building , business , work (physics) , health care , economic growth , knowledge management , marketing , political science , economics , computer science , computer security , engineering , mechanical engineering , microeconomics
SUMMARY Little is known about the organizational factors involved in policy creation and programs implementation aimed at reducing maternal mortality in Madagascar. A qualitative case study was performed to investigate organizational factors influencing the health system's capacity to elaborate and implement maternal mortality reduction programs. Semi‐structured interviews were conducted with 53 participants. A conceptual framework based on Gamson's coalition theory and Hinings and Greenwood's archetypes concept was used. Three major conclusions emerge: the Ministry of Health is a poor leader in the development of national strategies, due to its dependency on external financial resources and expertise, and because of poor transmission of key information from the field; at a meso level (regions and districts), the capacity to adapt programs is highly dependent on the collaboration with NGOs; at the micro level, there are few incentives provided to field workers to participate in a collective effort and little attempt to exploit complementarities between scare resources. The Madagascar health system should consider the need for improvement in data analysis capacity, and implementing behavior‐changing tools suitable for stimulating providers who work inside and outside the health care system, to participate to a coordinated collective effort. Copyright © 2010 John Wiley & Sons, Ltd.