Implementation outcomes of a community-based maternal and newborn care model in rural South Sudan: an implementation research study

<title>Abstract</title> <p>South Sudan reports among the highest maternal and neonatal mortality rates in the world. To address gaps in service access, the International Rescue Committee implemented a Community-Based Maternal and Newborn Care service delivery model, on which an implementation research study was conducted to understand its acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability. The workload of Boma Health Workers (BHW), the providers in this model, appeared as a program constraint, while the local trust and embeddedness of BHWs appeared to facilitate the model’s success. Behavioral interventions appeared less salient, but did not necessarily translate into lower measured uptake. Data capture and documentation were a challenge for low-literate BHWs despite relevant adaptations being made. Incomplete institutional ownership of the program posed a further risk sustainability. Misoprostol for prevention of postpartum hemorrhage appeared to be one point where data diverged in its acceptability by those more proximate versus more distal to service delivery. Evidence-based maternal and newborn care services can be delivered by community health workers in challenging contexts. The model's strengths such as community acceptability, appropriate adaptations to service delivery, and high adoption represent a meaningful foundation for scale-up. However, several structural vulnerabilities require attention for sustained impact.</p>