The Launch and Scale Speedometer blog series.
January 11, 2022

Every day, women and children around the world die from conditions and diseases for which proven and effective health interventions exist, but are inaccessible or reach them too slowly. Lifesaving interventions addressing the MNCH continuum are imperative at all levels of the health system. Barriers in the pathways to the introduction and scaling of these interventions are part and parcel to the failure to get them to the end-user. Conversely, mechanisms that support the uptake of interventions should be encouraged and explored further to foster their use and speed their delivery to the end user.

The latest research by the Launch and Scale Speedometer team, A Qualitative Analysis of the Introduction and Uptake Pathways, Enablers, and Barriers of Health Interventions in India and Ethiopia, seeks to understand and analyze lifesaving intervention pathway bottlenecks and enablers in India and Ethiopia.

Why India and Ethiopia? 

These two middle-income countries represent contrasting health systems (one primarily driven by the private sector and the latter primarily public or government-run) and approaches to health policy from South Asia and East Africa respectively. We identified and prioritized strategies to increase access to interventions for the MNCH population, noted challenges and opportunities in the ecosystem, and developed recommendations to urgently address these barriers and challenges. We organized our findings by presenting recommendations on key factors that influence launch and scale. Comparing the findings in India and Ethiopia we found country specific as well as several common barriers and enablers affecting the provision of MNCH interventions in both countries.


Key Takeaways and Recommendations 

India and Ethiopia harbor unique health ecosystems that reflect their respective contexts. Our findings confirmed and aligned with assertions from previous studies that the most important factors (enablers or barriers) that influence scale up are:

  1. The availability of financial and human resources
  2. Health systems capacity
  3. Supply chain capacity
  4. Advocacy, acceptability, partnerships, and engagement of local implementers
  5. Community participation

While there are notable differences between the two countries highlighted in our findings, we identified common push and pull factors that influence the launch and scale up of interventions. Based on the barriers, enablers, and overarching insights we ascertained from our research, we offer the following recommendations to expedite and streamline pathways for effective interventions to reach intended end-users:

  1. Generate stronger qualitative and quantitative evidence in these contexts. Establish a research team within the MNCH service (or within appropriate health systems research division) that is charged with developing and implementing research protocols focusing on scaling up interventions in MNCH, to establish a national evidence base of effective interventions and share it with the health community
  2. Increase accountability mechanisms. Incorporate monitoring and evaluation of scaling up MNCH interventions within national and subnational service delivery programs, including impact targets. Establish mechanisms for regular reporting to health officials, local government and patient population
  3. Strengthen national regulatory approval mechanisms. Build capacity for new medical device regulation and champion more efficient and transparent regulatory processes for introducing new medical devices, with tracking of progress
  4. Seek and promote more proactive early collaboration and engagement across multiple levels. Establish a forum for public and private sector MNCH product developers, including health authorities, policy makers and healthcare providers to regularly exchange ideas, review new evidence, address challenges across the trajectory of launch and scaling innovation, and discuss new challenges
  5. Support an analysis of current status of public and private sector investment in scaling up proven MNCH interventions in these two countries, which can become a template for other countries.

Read the full paper Qualitative Analysis of the Introduction and Uptake Pathways, Enablers, and Barriers of Health Interventions in India and Ethiopia on our website.

The Duke Global Health Innovation Center is a proud partner of the Launch and Scale Speedometer. The Launch and Scale Speedometer aims to systematically analyze the factors that support or hinder the introduction and scaling of interventions, including but not limited to drugs, diagnostics, and devices, to address critical global health challenges.

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A Qualitative Analysis of the Introduction & Uptake Pathways, Enablers, & Barriers of Health Interventions In India & Ethiopia