Organizational analysis of maternal mortality reduction programs in Madagascar
Article first published online: 10 DEC 2010
Copyright © 2010 John Wiley & Sons, Ltd.
The International Journal of Health Planning and Management
Volume 26, Issue 3, pages e186–e196, July/September 2011
How to Cite
Harimanana, A., Barennes, H. and Reinharz, D. (2011), Organizational analysis of maternal mortality reduction programs in Madagascar. Int. J. Health Plann. Mgmt., 26: e186–e196. doi: 10.1002/hpm.1077
- Issue published online: 27 JUL 2011
- Article first published online: 10 DEC 2010
- maternal mortality;
- organizational analysis;
- policy implementation
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.