Evidence-based behavior change interventions addressing health systems must be identified and disseminated to improve child health outcomes. Studies of the efficacy of such interventions were identified from systematic searches of the published literature. Two hundred twenty-nine of the initially identified references were judged to be relevant and were further reviewed for the quality and strength of the evidence. Studies were eligible if an intervention addressed policy or health systems interventions, measured relevant behavioral or health outcomes (e.g., nutrition, childhood immunization, malaria prevention and treatment), used at least a moderate quality research design, and were implemented in low- or middle-income countries. Policy or systems interventions able to produce behavior change reviewed included media (e.g., mass media, social media), community mobilization, educational programs (for caregivers, communities, or providers), social marketing, opinion leadership, economic incentives (for both caregiver and provider), health systems strengthening/policy/legislation, and others. Recommendations for policy, practice, and research are given based on fairly strong data across the areas of health service delivery, health workforce, health financing, governance and leadership, and research.
Systematic reviews show that access to community-based health services reduces neonatal mortality and still births, but t he effect on maternal mortality is harder to detect. However, the evidence so fr has come from small sample size studies, mainly conducted in Asia and with very little information from Sub-Saharan Africa and Latin America. Only a few studies assess Maternal Neonatal and Child Health (MNCH) services at the community level, and focus on interventions at the level of primary care. More large scale research factoring in specific contexts is particularly needed. Additional investigation on the cost-effectiveness of health services is also required and will help in promoting and scaling up community-based interventions for maternal and newborn care.
