Background: Access to maternal care is a global challenge, exacerbated by socioeconomic disparities and shortages in healthcare staff. Since 2019, the German state of Baden-Württemberg funded 13 pilot projects to increase access to high-quality maternal health services. The projects aim to strengthen inter- and intraprofessional collaboration, midwives’ care capacities, and the provision of information and services in languages other than German. We studied facilitators and barriers to the pilot projects’ implementation and sustainability.
Methods: Using a multiple case study design, the research employs the RE-AIM framework and the Socio-Ecological Model to assess implementation processes regarding reach, effectiveness, adoption, implementation, and maintenance across societal, community, relationship, and individual levels. Individualized theories of change were developed for each project, acknowledging their unique contexts and goals. A total of 39 semi-structured interviews with project leads, implementers, network partners, end-users, stakeholders and the funder were conducted. Data was coded along the RE-AIM dimensions using NVivo.
Results: Preliminary results suggest that project success in reaching network partners and end-users was affected by project attractiveness, effective communication, and the integration into local structures. Project effectiveness was perceived through improved access to services, expanded outreach, and enhanced collaboration. Stakeholder interest in collaboration, and trustworthy communication were important factors for the adoption of the project by network partners and staff. Implementation was marked by the allocation of dedicated physical and communication spaces, motivated staff, and local support. Long-term sustainability was influenced by financial stability, resource availability, political support, and continued network activities. Communication with physicians, insufficient capacity of staff and difficulties due to COVID-19, were overall implementation barriers.
Conclusion: Early engagement with local stakeholders and comprehensive assessments of existing structures are vital to create a shared understanding of the healthcare landscape and addressing gaps in maternal healthcare services. Aligning projects and their financing with overarching political strategies is required to support their implementation and increase long-term sustainability. Knowledge management and documentation can facilitate continuity and transferability to other regions.
