1. Mainstreaming a health systems’ approach to maternal health programming: trans-disciplinary research in Rwanda and South Africa Maternal Health in South Africa and Rwanda (MHSAR) Project

2. Overview  July 2012 - June 2016  South Africa and Rwanda  Centre for Health Policy (CHP), Wits University  School of Public Health, UWC  Nijmegen International Center for Health Systems Research and Education (NICHE), Radboud University  Ministry of Health, Rwanda  Gauteng and Eastern Cape DoH, South Africa  Aim to investigate the linkages between key health system components and maternal health

3. Sub- project 1a Systematic review of the impact of health system supply & demand interventions on MH health in LMICs Sub- project 1b Realist review impact of health system supply & demand interventions on MH in selected LMICs Sub- project 2a Case studies in Rwanda and South Africa using EmOC and HIV as health system probes to investigate linkages between health system components & MH Sub- project 2b Action research health system interventions to improve organisation and delivery of MH services MHSAR sub-projects

4. Policy Relevant Questions  What has been the impact of health system interventions (health system strengthening) on maternal health?  What are the most important health system factors influencing the performance of maternal health programmes?  What health system interventions should be implemented to improve maternal health in South Africa and Rwanda?

5. Progress  1a. Systematic review: Completed  1b. Realist review: Ongoing  2a. Case studies  Eastern Cape: Completed  Gauteng: Ongoing  Rwanda: Ongoing  2b. Action research: Initiating  2 PhDs: Ongoing  1 Post-Doc: Completed

6. Main Stakeholders  Health system + MH policymakers & managers (national, provincial, district)  Health professional organisations  International agencies  NGOs & advocacy groups  Health system + MH researchers

7. Stakeholder Engagement Strategies  Inception workshop  Active partnerships with DoH/MoH  Joint planning meetings  Participation in annual project meetings  Feedback workshops

8. KT Products To Date Planned  Feedback workshops  Media briefing  WHO guidelines  Academic papers  Academic conferences  Case study policy engagement workshops  Policy briefs  Academic papers  Academic conferences  Video?

9. Preliminary Key Messages  Inadequate attention to HSS in maternal health  Focus mostly on HR & financing building blocks  Key HS resource gaps undermine performance  Importance of governance & accountability in explaining variation in MH performance  But require packages of HS interventions addressing multiple building blocks  Systematic review filler text er text  Comparative case studies filler text filler text filler text filler text filler text

10. KT Opportunities & Challenges Opportunities Challenges  Direct involvement of MoH/DoH  Policy engagement in sub-project 2b  Existence of MH policy groups  Involvement in WHO guidelines  Balancing partnership and criticism  Engaging with other stakeholders (women, media)  Multiple health system levels  Limited KT human & financial resources

11. KT Support Needed  Financial support for Eastern Cape policy engagement workshops (2 nd KTNet Call)  Collaboration in Rwanda case study dissemination (Sharenet small grant)  Expertise for video documentary  Advise on engagement with media, pregnant women