Peter Hovmand | October 2015
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Presentation at the Global Maternal Newborn Health Conference, October 21, 2015

Background: Family planning and increased institutional delivery have been able to significantly reduce maternal mortality in Honduras. However, the benefits from further investments in these initiatives are diminishing as maternal mortality stabilizes. Salud Mesoamerica 2015 (SM2015) has created momentum among policy-makers in Honduras for the identification of policy and program alternatives that further reduce maternal mortality. This led to the use and application of system thinking tools to improve policy analysis for identifying and assessing potential leverage points, improving coordination among traditionally siloed vertical program, and developing capability to identify barriers to implementation and scale-up of impact.

Methods: A system dynamics approach was used to convene a series of group model building workshops with leaders from Honduras including hospital directors, physicians, and policy makers to address the problem of maternal and mortality. Starting in 2013, these workshops combined introductions to systems thinking along with formal model building and simulation to describe the community and delivery care system in Honduras, identify potential leverage points for intervention within the health system, and develop training toolkits for leadership development and health systems strengthening.

Results: Key insights from the group model building activities included the collective realization of the importance of developing multiple- as opposed to single-pronged solutions to avoid shifting mortality from the community to hospitals, developing shared definitions of risk for obstetric complications, and addressing “capability traps” in the production of obstetric deaths in hospital settings, among others.

Conclusions: The combination of rigorous systems thinking tools such as system dynamics modeling and computer simulation, combined with group model building, enabled a diverse group of decision makers to develop a shared view of their health care system, identify counter-intuitive insights, and reach consensus for broader and higher impact health systems changes by redesigning SM2015 interventions in neonatal health and quality improvement for emergency obstetric care.