Practice of Leadership, Governance, and Management Related to Maternal Nutrition Intervention Research Embedded in Antenatal Care in Burkina Faso.

Abstract

Maternal nutrition intervention research (MNIR) embedded in antenatal care (ANC) was conducted in Burkina Faso to improve reproductive services. The aim of this study was to understand and document the contributions of leadership and management at various health system levels in improving resource management and maternal nutrition service coverage. It was a qualitative case study conducted from July to December 2022 with 44 participants from the Boucle du Mouhoun and Hauts-Bassins health regions. It consisted of interviews with key managers and document reviews. This study demonstrated that strengthening maternal nutrition through ANC in Burkina Faso was feasible and significantly impacted nutrition practices within a year. Coordination involved national and regional actors, nongovernmental organizations, and the private sector, ensuring effective collaboration. Leadership was shared with the private sector, but not effectively at the central level. Inputs and databases were managed by the private executive association and were not integrated into the National Health Information System. The health system's usual organization was respected, with well-defined roles and effective communication, despite some delays in per diem payments and a lack of implementation tools. Monitoring and follow-up were systematic, involving quarterly and monthly review meetings. The project showed significant improvements in maternal nutrition knowledge, weight gain, ANC visits, anemia management, and early breastfeeding initiation, despite minimal changes in self-efficacy, beliefs, and family support. The MNIR was successfully implemented in four health districts, with private sector involvement improving communication and leadership. The project enhanced the health system's resilience against terrorism and coronavirus disease 2019, demonstrating potential for expansion to national implementation.