Table 1 (abstract P35). Interaction between selected contextual factors and implementation strategies

Global

Donor funding priorities and availability

(Facilitator in all countries but was a barrier at times in Senegal)

Facilitator: If efficient and coordinated, results in the prioritization of U5M and provides the financing.

Barrier: Could be a barrier if donors and national priorities are not aligned and if the funding is limited or time constrained.

• Leveraging donor support

• Donor coordination

• Government financing

National/

subnational

Existing national priority for health including U5M

(Facilitator in all countries)

Facilitator: Sustained commitment to health allows for accountable EBI implementation.

Barrier: When absent, can lead to reduced accountability. Leadership in MOH is key.

Multisectoral approach

National leadership and accountability for EBI and U5M

MOH/health systems

Community health system and structure

(Facilitator in all)

Facilitator: If present and strong, it can bridge the gap between the healthcare system and communities.

Barrier: If the community health workers are not well trained and the system is weak, it can lead to gaps in implementation and affect sustainability.

• Community engagement

• Community education and sensitization

• Community-based care delivery

• Leveraging existing systems

• Focus on equity

Community/

individual

Culture and beliefs

(Barrier in Nepal, Ethiopia and Peru, facilitator in Rwanda and Senegal, both in Bangladesh)

Facilitator: Culture and beliefs can facilitate acceptance of EBIs.

Barrier: If a barrier, this contextual factor can lead to low uptake of EBIs.

• Local stakeholder engagement

• Community education and sensitization

• Community engagement

• Data use for prioritization

• Focus on equity