AUTHOR=Kyomuhangi Teddy , Manalili Kimberly , Kabakyenga Jerome , Turyakira Eleanor , Matovelo Dismas , Khan Sobia , Kyokushaba Clare , MacIntosh Heather , Brenner Jennifer L. 

TITLE=Health system strengthening using a Maximizing Engagement for Readiness and Impact (MERI) Approach: A community case study

JOURNAL=Frontiers in Public Health

VOLUME=10

YEAR=2022

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2022.952213

DOI=10.3389/fpubh.2022.952213

ISSN=2296-2565

ABSTRACT=<sec><title>Introduction</title><p>Health system strengthening initiatives in low and middle-income countries are commonly hampered by limited implementation readiness. The <italic>Maximizing Engagement for Readiness and Impact (MERI) Approach</italic> uses a system “readiness” theory of change to address implementation obstacles. <italic>MERI</italic> is documented based on field experiences, incorporating best practices, and lessons learned from two decades of maternal, newborn, and child health (MNCH) programming in East Africa.</p></sec><sec><title>Context</title><p>The <italic>MERI Approach</italic> is informed by four sequential and progressively larger MNCH interventions in Uganda and Tanzania. Intervention evaluations incorporating qualitative and quantitative data sources assessed health and process outcomes. Implementer, technical leader, stakeholder, and policymaker reflections on sequential experiences have enabled <italic>MERI Approach</italic> adaptation and documentation, using an implementation lens and an implementation science readiness theory of change.</p></sec><sec><title>Key programmatic elements</title><p>The <italic>MERI Approach</italic> comprises three core components. <italic><bold>MERI</bold></italic><bold>Change Strategies</bold> (meetings, equipping, training, mentoring) describe key activity types that build general and intervention-specific capacity to maximize and sustain intervention effectiveness. The <underline><bold>SOPETAR Process</bold></underline><bold>Model</bold> (<bold>S</bold>can, <bold>O</bold>rient, <bold>P</bold>lan, <bold>E</bold>quip, <bold>T</bold>rain, <bold>A</bold>ct, <bold>R</bold>eflect) is a series of purposeful steps that, in sequence, drive each implementation level (district, health facility, community). A <italic><bold>MERI</bold></italic><bold>Motivational Framework</bold> identifies foundational factors (self-reliance, collective-action, embeddedness, comprehensiveness, transparency) that motivate participants and enhance intervention adoption. Components aim to enhance implementer and system readiness while engaging broad stakeholders in capacity building activities toward health outcome goals. Activities align with government policy and programming and are embedded within existing district, health facility, and community structures.</p></sec><sec><title>Discussion</title><p>This case study demonstrates feasibility of the <italic>MERI Approach</italic> to support district wide MNCH programming in two low-income countries, supportive of health outcome and health system improvements. The <italic>MERI Approach</italic> has potential to engage districts, health facilities, and communities toward sustainable health outcomes, addressing intervention implementation gaps for current and emerging health needs within and beyond East Africa.</p></sec>