UNASSIGNED: Despite close to all-embracing access to child healthcare, health divides exist among children in Sweden. Home visits to families with new-born babies are a cost-effective way to identify and strengthen vulnerable families. An extended postnatal home visiting programme has been implemented in a disadvantaged suburb in Stockholm with positive results.
UNASSIGNED: Longitudinal, prospective study and register study from medical records.
UNASSIGNED: A vulnerable rural area in Sweden.
UNASSIGNED: A parent advisor from the social services and a midwife performed an extended home visiting programme during the end of pregnancy to mothers of children born between 1 May 2018 and 31 May 2019. During these children\'s first 15 months, three additional home visits were made by a parent advisor and a child healthcare nurse. The aim of the study is to evaluate the effect of the intervention on the health of the children and the mothers.
UNASSIGNED: All firstborn children at the study site (N = 30 study, N = 55 control group).
UNASSIGNED: The proportion participating in visits to the child and maternal healthcare services, children being breastfed and receiving childhood vaccinations.
UNASSIGNED: There were fewer absentees in the study group during routine check-up visits (93 vs. 84%). More mothers in the study group attended the check-up with the midwives (90 vs. 80%). More children in the study group were breastfed (90 vs. 67%) and received all vaccinations (100 vs. 96%).
UNASSIGNED: Supplementing the extended home visiting programme with a visit at the end of pregnancy seems to contribute to fewer absentees at routine visits for both mothers and children; furthermore, more children were breastfed and vaccinated compared with the control group.
Evaluation of four additional home visits to all firstborn children by parent advisors and healthcare professionals during the end-of-pregnancy period and early childhood in a vulnerable area showed the following benefits:More children in the study were breastfed and received all vaccinations compared with the control group.There were fewer absentees at the routine check-up visits to the child healthcare centre in the study compared with the control group.More mothers in the study group attended the check-up visits to the midwife 2 months after delivery compared with the controls.

BACKGROUND: The National Maternal and Child Health Workforce Development Center provides training, coaching, and consultation to Title V programs. The flagship experience is the Cohort program, a 6-8-month leadership development program where Title V programs convene a multisector team to address a pre-selected state/jurisdictional challenge related to health systems transformation. The overall objective of this paper is to demonstrate the impact of skills developed via the Cohort program on state/jurisdictional capacities to address complex challenges.
METHODS: Qualitative, post-Cohort evaluation data were analyzed using inductive and deductive coding and the \"Sort and Sift, Think and Shift\" method. Themes and supporting text were summarized using episode profiles for each team and subsequently organized using the EvaluLEAD methodology for identifying and documenting impact.
RESULTS: Teams brought an array of challenges related to health systems transformation and 94% of teams reported achieving progress on their challenge six-months after the Cohort program. Teams described how the Cohort program improved workforce skills in strategic thinking, systems thinking, adaptive leadership, and communication. Teams also reported the Cohort program contributed to stronger partnerships, improved sustainability of their project, produced mindset shifts, and increased confidence. The Cohort program has also led to improved population health outcomes.
CONCLUSIONS: Through working with the Center, Title V leaders and their teams achieved episodic, developmental, and transformative results through application of Center tools and skills to complex challenges. Investment in the MCH workforce through skill development is critical for achieving transformative results and solving \"wicked\" public health problems.

Globally, many countries are adopting evidence-based workforce planning that facilitates progress towards achieving sustainable development goals for reproductive, maternal newborn and child health. We reviewed case studies on workforce planning for reproductive maternal newborn child health services at primary care level facilities using workload indicators of staffing need in five countries.
Using available workload indicators for staffing need reports from Bangladesh, Ghana, Kenya, Sultanate of Oman and Papua New Guinea, we generated descriptive statistics to explore comparable workload components and activity standards, health service delivery models with an emphasis on the primary care levels and the specific health occupations offering interventions associated with reproductive maternal, newborn and child health services.
The health services delivery models vary from one country to another. The results showed variability in the countries, in the workload components and activity standards of each regardless of facility level or occupational groups involved. All the countries have decentralized health services with emphasis on comprehensive primary care. Reproductive, maternal and new-born child health care services include antenatal, postnatal, immunization, family planning, baby wellness clinics, delivery and management of integrated minor childhood illnesses. Only Sultanate of Oman offers fertility services at primary care. Kenya has expanded interventions in the households and communities.
Since the health care services models, health services delivery contexts and the health care worker teams vary from one country to another, the study therefore concludes that activity standards cannot be adopted or adapted from one country to another despite having similar workload components. Evidence based workforce planning must be context-specific, and therefore requires that each country develop its own workload components and activity standards aligned to their local contexts.

BACKGROUND: The purpose of this paper is to describe the curriculum and self-reported outcomes on measures of interdisciplinary leadership skills for work within the field of developmental disabilities from trainees in one interprofessional training program.
METHODS: The paper highlights one program\'s curriculum and strategy for capturing self-report survey measures from trainees in cohorts from 2014-2018 (n = 86) on two surveys (Interdisciplinary Attitudes and Skills and Leadership Self-Evaluation Form) and three time points across the training year: before training (T1), mid-year (T2), and after training (T3).
RESULTS: Data from 86 trainees are reported including demographics (nearly 80% white, 92% female), non-descriptive statistics due to non-normative samples, and tertiles demonstrating changes between time points. Significant differences between medians are reported between T1-T3 specifically related to utilizing interdisciplinary skills and gains in leadership competencies. Specific utilization of skills was reported to be \'Greatly\' attributable to the LEND program related to sharing ideas and asking for help across disciplines.
CONCLUSIONS: Trainees\' self-report from before training to after training indicates an increase in competence and utilization of interdisciplinary skills to be expected from participation in the curriculum. Self-report measures are.

OBJECTIVE: To gain insight into how participants in the Maternal and Child Health Public Health Leadership Institute (MCH PHLI) report applying the leadership skills gained through the program at the \"Others\" and \"Wider Community\" levels of the MCH Leadership Competencies 4.0.
METHODS: 111 mid- to senior-level MCH leaders participating in the MCH PHLI gave < 5 min oral presentations detailing the impacts resulting from implementation of the skills gained through the leadership development training. Presentations were recorded and transcribed then qualitatively analyzed in reference to the MCH Leadership Competencies 4.0. Impacts were stratified by the \"Others\" and \"Wider Community\" levels.
RESULTS: Analysis resulted in 1510 separate coded examples, 948 of which were coded as aligning with the MCH Leadership Competency 4.0 areas of \"Others\", \"Wider Community\" and with an additional emerging competency. In many examples Participants estimated the numbers of people affected by these leadership activities, which totaled more than 80,773 people across the US.
UNASSIGNED: This analysis suggests that mid-to-senior level intensive leadership development strategies benefit organizations, communities, and systems quite broadly through a virtual \"ripple effect\" of training. Capturing qualitative data can help elucidate the return on investment for leader development programs in terms of impacts on communities and systems.

In 2010, the Bill and Melinda Gates Foundation (BMGF) partnered with the Government of Bihar (GoB), India to launch the Ananya program to improve reproductive, maternal, newborn and child health and nutrition (RMNCHN) outcomes. The program sought to address supply- and demand-side barriers to the adoption, coverage, quality, equity and health impact of select RMNCHN interventions. Approaches included strengthening frontline worker service delivery; social and behavior change communications; layering of health, nutrition and sanitation into women\'s self-help groups (SHGs); and quality improvement in maternal and newborn care at primary health care facilities. Ananya program interventions were piloted in approximately 28 million population in eight innovation districts from 2011-2013, and then beginning in 2014, were scaled up by the GoB across the rest of the state\'s population of 104 million. A Bihar Technical Support Program provided techno-managerial support to governmental Health as well as Integrated Child Development Services, and the JEEViKA Technical Support Program supported health layering and scale-up of the GoB\'s SHG program. The level of support at the block level during statewide scale-up in 2014 onwards was approximately one-fourth that provided in the pilot phase of Ananya in 2011-2013. This paper - the first manuscript in an 11-manuscript and 2-viewpoint collection on Learning from Ananya: Lessons for primary health care performance improvement - seeks to provide a broad description of Ananya and subsequent statewide adaptation and scale-up, and capture the background and context, key objectives, interventions, delivery approaches and evaluation methods of this expansive program. Subsequent papers in this collection focus on specific intervention delivery platforms. For the analyses in this series, Stanford University held key informant interviews and worked with the technical support and evaluation grantees of the Ananya program, as well as leadership from the India Country Office of the BMGF, to analyse and synthesise data from multiple sources. Capturing lessons from the Ananya pilot program and statewide scale-up will assist program managers and policymakers to more effectively design and implement RMNCHN programs at scale through technical assistance to governments.

OBJECTIVE: The Health Resources and Services Administration\'s Maternal and Child Health Bureau (HRSA MCHB) developed a three-tiered performance measure framework for the Title V Maternal and Child Health Block Grant program (MCH Title V). The third tier, evidence-based/informed strategy measures (ESMs) are developed by states to address National Performance Measures (NPM) goals. To support states\' efforts, MCHB funded the \"Strengthen the Evidence for Maternal and Child Health\" (STE) to: (1) define the concept of evidence for the field with an emphasis on strength; (2) identify available evidence for each NPM, (3) translate ESM research for use at the state level; and (4) provide technical assistance (TA) to states to facilitate implementation.
METHODS: The program conducted evidence reviews defining an \"evidence continuum\" emphasizing a continuum of strength, provided individual and group TA to MCH Title V grantees, launched a TA referral system, and reviewed state ESMs to assess use of evidence-based/informed strategies.
RESULTS: Ten evidence reviews identified multiple strategies as having \"emerging\" or \"moderate\" evidence. TA reached all MCH Title V programs, encompassing 59 US states and jurisdictions, and the TA referral system effectively partnered with MCHB resources. All MCH Title V states and territories submitted ESMs for the Block Grant program\'s first year reporting requirement.
CONCLUSIONS: STE is the first program to review available evidence on effective strategies addressing NPMs for MCH Title V. Identifying actionable next steps responsive to state needs will be a key factor for continued implementation of ESMs and achieving improvements in MCH.

OBJECTIVE: To gain insights into how participants in the Maternal and Child Health Public Health Leadership Institute (MCH PHLI) report applying the personal leadership skills gained through the program at the \"Self\" level of the MCH Leadership Competencies 4.0.
METHODS: 112 mid- to senior-level MCH leaders completed the MCH PHLI, which is a year-long intensive leadership training program. At graduation, 111 participants gave < 5-min oral presentations detailing the actions taken and impact created by implementation of the skills gained through the MCH PHLI training. Presentations were recorded, transcribed and then qualitatively analyzed in reference to the \"Self\" level of the MCH Leadership Competencies 4.0.
RESULTS: Participants reported 562 coded examples of activities in which they implemented skills aligning with each competency in the Self-Level of the MCH Leadership Competencies 4.0 and with three other competency areas that emerged as themes from the data: networking, confidence, and career advancement.
UNASSIGNED: This analysis suggests that intensive leadership development strategies focused on the mid-to-senior level leader benefit the individual and their organizations in broad and strategic ways that can be captured and described. Further, these applications of skills can create a virtual \"ripple effect\" of the workforce development program, by ultimately impacting a far greater number of people. Finally, this type of reflective assignment can be a valuable addition to intensive workforce development programs.

Globally, there remain significant knowledge and evidence gaps around how to support Community Health Worker (CHW) programmes to achieve high coverage and quality of interventions. India\'s Integrated Child Development Services scheme employs the largest CHW cadre in the world-Anganwadi Workers (AWWs). However, factors influencing the performance of these workers remain under researched. Lessons from it have potential to impact on other large scale global CHW programmes. A qualitative study of AWWs in the Indian state of Bihar was conducted to identify key drivers of performance in 2015. In-depth interviews were conducted with 30 AWWs; data was analysed using both inductive and deductive thematic analysis. The study adapted and contextualised existing frameworks on CHW performance, finding that factors affecting performance occur at the individual, community, programme and organisational levels, including factors not previously identified in the literature. Individual factors include initial financial motives and family support; programme factors include beneficiaries\' and AWWs\' service preferences and work environment; community factors include caste dynamics and community and seasonal migration; and organisational factors include corruption. The initial motives of the worker (the need to retain a job for family financial needs) and community expectations (for product-oriented services) ensure continued efforts even when her motivation is low. The main constraints to performance remain factors outside of her control, including limited availability of programme resources and challenging relationships shaped by caste dynamics, seasonal migration, and corruption. Programme efforts to improve performance (such as incentives, working conditions and supportive management) need to consider these complex, inter-related multiple determinants of performance. Our findings, including new factors, contribute to the global literature on factors affecting the performance of CHWs and have wide application.

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