Policy Engagement Framework for Public Health: A Tool to Enhance Maternal and Child Health Workforce Capacity.

PURPOSE: This paper proposes a framework for characterizing policy engagement that expands options available to MCH and other public health professionals. Its aim is to inform workforce capacity building and empower practitioners to better leverage policy for advancing population health and equity. DESCRIPTION: Policies of all types strongly influence population health and equity. Recognizing this, public health leaders identify policy engagement skills as key for public health professionals generally, and for maternal and child health (MCH) professionals specifically. Practitioners likewise see the importance of these skills and report deficiencies in them. Despite this gap, no literature to-date itemizes the range of policy engagement possibilities for public health professionals. ASSESSMENT: The Policy Engagement Framework for Public Health addresses this gap by providing a language and organizing structure for the numerous ways engagement may take shape. The possibilities are combinations of a particular target policy source (the what) and jurisdiction (the where), a policy process phase (the when), and an engagement role (the how). Policy source and jurisdiction are broken down to highlight the many types to consider for a given topic and population. Established public health constructs are adapted to enumerate policy phases and public health roles. CONCLUSIONS FOR PRACTICE: The Policy Engagement Framework can enhance workforce capacity by expanding mindsets about ways public health and MCH practitioners can consider engaging. It can facilitate communication and clarity within an organization regarding what activities are permitted in staff's official capacity. Finally, it can guide the strategic development of workforce education and training.

Shifting Power in Practice: The Importance of Contextual and Experiential Evidence in Guiding MCH Decision Making.

BACKGROUND: Evidence is central to all maternal and child health (MCH) decision-making processes, continuously interacting with and influencing our work. There is a growing emphasis in MCH on using evidence-based approaches when addressing public health challenges, but the field lacks a unified understanding of what constitutes evidence. MCH must operate from an expansive understanding of evidence that centers community voice and acknowledges the role of evidence prioritization in achieving equitable population-level outcomes. CALL TO ACTION: What we consider valid evidence has immense implications for MCH practice, including whose work is deemed worthy of funding and replication. The authors advocate for shifting the field's evidence paradigm from being primarily focused on research findings to also recognize the importance of community-rooted evidence. Contextual and experiential evidence, alongside research evidence, should be considered for two purposes: (1) to support the effectiveness of a given practice generally, and (2) to support that the practice will work in specific contexts. Putting this shift into practice requires explicit power shifting - the MCH workforce must cede power to those who have been historically barred from participating in and guiding research. To facilitate this, MCH professionals must build skills in communication, equitable leadership, and change management. CONCLUSION: The MCH workforce should position communities to set their own priorities and define, develop, and disseminate evidence representative of their priorities. Evidence co-creation is key to establishing and sustaining transformative relationships between community members and Title V programs, shifting power structures to build upon existing community leadership and assets.

Enhancing Title V Workforce Capacity to Address Complex Challenges: Impact of the National Maternal and Child Health Workforce Development Center.

INTRODUCTION: The National Maternal and Child Health Workforce Development Center provides training, coaching, and consultation to Title V programs. The flagship experience is the Cohort program, a 6-8-month leadership development program where Title V programs convene a multisector team to address a pre-selected state/jurisdictional challenge related to health systems transformation. The overall objective of this paper is to demonstrate the impact of skills developed via the Cohort program on state/jurisdictional capacities to address complex challenges. METHODS: Qualitative, post-Cohort evaluation data were analyzed using inductive and deductive coding and the "Sort and Sift, Think and Shift" method. Themes and supporting text were summarized using episode profiles for each team and subsequently organized using the EvaluLEAD methodology for identifying and documenting impact. RESULTS: Teams brought an array of challenges related to health systems transformation and 94% of teams reported achieving progress on their challenge six-months after the Cohort program. Teams described how the Cohort program improved workforce skills in strategic thinking, systems thinking, adaptive leadership, and communication. Teams also reported the Cohort program contributed to stronger partnerships, improved sustainability of their project, produced mindset shifts, and increased confidence. The Cohort program has also led to improved population health outcomes. DISCUSSION: Through working with the Center, Title V leaders and their teams achieved episodic, developmental, and transformative results through application of Center tools and skills to complex challenges. Investment in the MCH workforce through skill development is critical for achieving transformative results and solving "wicked" public health problems.

Developing State Leadership in Maternal and Child Health: Process Evaluation Findings from a Work-Based Learning Model for Leadership Development.

OBJECTIVES: Since 2013 the MCH Bureau has supported the National MCH Workforce Development Center to strengthen the Title V MCH workforce. This article describes the Center's Cohort Program and lessons learned about work-based learning, instruction, and coaching. DESCRIPTION: The Cohort Program is a leadership development program that enrolls state-level teams for skill development and work-based learning to address a self-identified challenge in their state. Teams attend a Learning Institute that teaches concepts, skills, and practical tools in systems integration; change management and adaptive leadership; and evidence-based decision-making and implementation. Teams then work back home on their challenges, aided by coaching. The Program's goals are for teams to expand and use their skills to address their challenge, and that teams would strengthen programs, organizations, and policies, use their skills to address other challenges, and ultimately improve MCH outcomes. METHODS: This process evaluation is based on evaluation forms completed by attendees at the three-day Learning Institute; six-month follow-up interviews with team leaders; and a modified focus group with staff. RESULTS: Participants and staff believe the Cohort Program effectively merges a practical skill-based curriculum, work-based learning in teams, and coaching. The Learning Institute provides a foundation of skills and tools, strengthens the team's relationship with their coach, and builds the team. The work-based learning period provides structure, accountability, and a "practice space" for teams to apply the Cohort Program's skills and tools to address their challenge. In this period, teams deepen collaborations and often add partners. The coach provides accessible and tailored guidance in teamwork and skill application. These dimensions helped teams in develop skills and address state-level MCH challenges. CONCLUSIONS FOR PRACTICE: Continuing professional development programs can help leaders learn to address complex state-level MCH challenges through integrated classroom-based skills development, work-based learning on state challenges, and tailored coaching.

A randomized trial of iron- and zinc-biofortified pearl millet-based complementary feeding in children aged 12 to 18 months living in urban slums.

BACKGROUND & AIMS: Biofortification of staple crops with higher levels of micronutrients via traditional breeding methods is a sustainable strategy and can possibly complement fortification and other interventions to target micronutrient deficiencies in low resource settings, particularly among vulnerable populations such as children. We aimed to determine if iron- and zinc-biofortified pearl millet (FeZnPM, Dhanashakti, ICTP-8203Fe)-based complementary feeding improves nutritional status, including iron biomarkers and growth, in children living in urban slums of Mumbai. METHODS: We conducted a randomized controlled trial of FeZnPM among 223 children aged 12-18 months who were not severely anemic at baseline (hemoglobin ≥9.0 g/dL). Children were randomized to receive either FeZnPM or conventional non-biofortified pearl millet (CPM) daily for 9 months. Iron status (hemoglobin, serum ferritin), plasma zinc, and anthropometric indicators (length, weight, mid-upper arm circumference, triceps and subscapular skinfolds) were evaluated at enrollment and throughout the trial. World Health Organization (WHO) anthropometric z-scores were calculated using WHO growth standards. Primary outcomes were hemoglobin and serum ferritin concentrations, and growth, defined as WHO z-scores. An intent to treat approach was used for analyses. We used the Hodges-Lehmann-Sen test to assess the change in primary outcomes between baseline and the last visit and report corresponding 95% confidence intervals. RESULTS: At baseline, 67.7% of children were anemic (hemoglobin <11.0 g/dL) and 59.6% were iron deficient (serum ferritin <12.0 µg/L). FeZnPM did not significantly increase iron biomarkers or improve growth, compared to CPM. In subgroup analyses, FeZnPM improved hemoglobin concentrations in male children, and in children with iron deficiency or iron depletion (serum ferritin <25.0 µg/L) at baseline, relative to CPM. CONCLUSIONS: Daily consumption of FeZnPM-based complementary foods did not significantly impact iron and zinc status or growth in children living in Mumbai's urban slums. However, the intervention significantly improved hemoglobin concentrations among male children and among individuals who were iron-deficient or iron-depleted at baseline. TRIAL REGISTRATION: This trial is registered with Clinicaltrials.gov (ID: NCT02233764), and Clinical Trials Registry of India (ID: REF/2014/10/007731).