Advancing implementation in maternal and newborn health: Two decades of experience

arshad Sanghvi, Jeffrey Michael Smith, Koki Agarwal, Blami Dao, onald Magarick Jhpiego In the past 15 years, Jhpiego has had the privilege of working with governments and other partners to implement interventions for maternal and newborn health (MNH) in nearly 40 countries. This Supplement to the International Journal of Gynecology and Obstetrics (IJGO) is our attempt to share our analysis and learning from those experiences as the global health community looks toward 2030 and beyond, and to ensure that implementation challenges, aswell as the resources required to address them, are an important part of the post-MillenniumDevelopment Goals conversation. The new global paradigm for MNH envisioned by the UN Secretary General’s Sustainable Development Goals and the Global Strategy for Women’s, Children’s, and Adolescents’ Health aims to bring evidencebased MNH interventions to national scale, setting ambitious targets to reach the unreached in every country and end all preventable deaths among women and children. Scale is not only about what works; it is about how to make that which has been proven to work in small, controlled areas apply equally well across all contexts. So wemust ask ourselves: What does it take for health systems to reach every woman, every child, everywhere, every time? The answer to this classic implementation science question is difficult to quantify, but we do have some evidence, and as with any scientific inquiry, we should startwith the evidence thatwe have. The papers in the Supplement have beenwritten by and for implementers, describing in detail what has been accomplished and highlighting lessons about what did and did not work. The lessons themselves will not be new to anyone who has worked in MNH as long as we have, but we believe that their thoughtful analysis and collective and inductive presentation is a unique illustration of the complexity of achieving—and then reinforcing—implementation results. Implementation science for MNH has a long road ahead. The papers in the first section directly confront the “how” of implementation. Even if we have all the right interventions, we need political commitment and partnerships to bring those interventions to populations in need. Sometimes these elements are beyond the control of implementers owing to contextual factors and prioritizations inherent in real-world public health environments, but there are common principles that can help navigate politics and partnerships more strategically and systematically to reach goals more rapidly and with longer-lasting efforts. We should not, however, sacrifice quality for speed; quality improvement, particularly the linkages between quality and health outcomes, remains a critical but under-funded area of our work. The second section examines the “who” of implementation, documenting ways to empower all cadres of frontline health workers with appropriate competencies to deliver evidence-based interventions, wherever women and children need them. It is our belief that those