"It's Everyone's Problem": Institutionalising Multisectoral Action for Maternal Health in Meghalaya, India

Area of Science:

• Public Health
• Health Systems Research
• Implementation Science

Background:

• Multisectoral action is key for addressing social determinants of maternal health.
• Meghalaya, India, initiated the "Rescue Mission" to combat high maternal mortality rates.
• The initiative focused on strengthening health systems and building state capability.

Purpose of the Study:

• To develop a theory of change for multisectoral action.
• To examine implementation barriers and enablers in Meghalaya's maternal health initiative.
• To understand the role of government and community actors.

Main Methods:

• Qualitative data collection over 18 months across six districts.
• Interviews with primary care providers, frontline workers, and government officials.
• Thematic analysis and synthesis of data according to pathways of change.

Main Results:

• Multisectoral collaboration was institutionalized through joint planning and community engagement.
• Political priority and administrative leadership were crucial for implementation.
• While health outcomes improved and skills were built, further investment is needed to foster a shared sense of purpose.

Conclusions:

• Meghalaya's experience highlights the potential of health system reforms focused on enhancing state capabilities.
• Decentralized leadership and participation are vital for successful multisectoral collaboration.
• Strengthening health systems through a capability-enhancement approach can improve maternal health indicators.