From paper to practice: Grounding maternal, newborn and sexual reproductive health policy in local realities

Many global health and development policies do not reflect how change actually happens in practice. Too often, policy design assumes change is linear and technical, overlooking the social, political and complex realities that shape implementation. Policies are frequently developed at national or global levels with limited input from communities and frontline workers. As a result, even well‑intentioned and technically sound policies often prove weak when put into practice. 

Health outcomes are shaped by social, economic, political and environmental factors, yet programs remain narrowly focused on the health sector. Learning and reflection are episodic, relying on after-the-fact evaluation rather than continuous adaptation during implementation. Without strong feedback loops, cross‑sector collaboration and attention to system dynamics, policies struggle to deliver meaningful and lasting results, particularly in complex and uncertain settings.  

Why grounding health policy in local realities matters

Maternal, newborn and adolescent sexual and reproductive health (MNASRH) policies are a good example. Too often, these policies focus on big promises and high‑level targets, as well as siloed sectoral thinking, instead of how services actually work, who is being left out and what really influences decisions on the ground. The outcome is predictable: strategies that appear progressive on paper underperform in practice and are repeatedly revised without addressing the real problems.  

Situation analysis changes this by forcing policy to confront reality.

Situation analysis in MNASRH refers to an assessment of the current health status, service coverage and key challenges affecting mothers, newborns and adolescents. It outlines existing needs, gaps and contextual factors shaping sexual and reproductive health outcomes, not simply to describe them, but to inform realistic policy choices. 

A comprehensive, integrated situation analysis provides a roadmap for unpacking complex problems and showing pathways to aligning solutions. It is a lens through which key actors can reflect on what has worked, what has stalled and what is feasible going forward.  

Here are some of the essential qualities for a situation analysis that strengthen understanding of the current context and inform effective action:  

• Being fact based. First, it replaces competing narratives with a shared factual baseline. Ministries, donors, implementers and civil society often work from different — and sometimes contradictory — versions of the problem. A rigorous situation analysis consolidates routine data, surveys, budgets, policies and frontline perspectives into a single point of reference. This does not eliminate disagreement, but it anchors debate in evidence rather than assumptions, reducing fragmentation and enabling real prioritization. 
• Being practice-oriented. Second, it shifts policy attention from ambition to execution. Most countries do not struggle because they lack MNASRH policies; they struggle because they do not understand why those policies stall. Situation analysis makes the implementation gap explicit — whether the binding constraint is workforce deployment, commodity availability, referral breakdowns, provider bias, or financing rigidity. This moves policy discussion away from generic solutions and toward reforms that address the actual mechanisms of underperformance. 
• Being inclusive and people-centred. Third, it brings real-world constraints, incentives and context into the policy conversation. Current policy processes often treat economy, power dynamics, institutional incentives, legal constraints and social norms as “background issues.” Situation analysis brings them to the foreground — showing how, for example, decentralization shapes accountability, how faith‑based providers influence service access, or how legal ambiguity constrains post‑abortion care. This enables policymakers to distinguish what is desirable from what is feasible and to design strategies that reflect real coalitions, incentives and risks. 
• Being grounded. Finally, it makes advocacy actionable rather than rhetorical. Vague calls for “more funding” or “stronger systems” rarely move decisions. Situation analysis sharpens the ask: reallocate a specific budget line, amend a guideline that delays emergency care, or target midwife deployment to defined districts. Precision increases credibility and accelerates uptake because decision‑makers know exactly what is being requested and why. 

An illustrative example is the IDRC-supported project on Catalyzing policy improvement in Africa for maternal, newborn, sexual and reproductive health — implemented by the United Nations University’s International Institute of Global Health — which conducted a situation analysis in Tanzania. Led by the Ifakara Health Institute, it sought to understand why adolescent sexual and reproductive health and rights (ASRHR) outcomes remain poor despite the presence of multiple national policies. 

The analysis identified systemic barriers undermining implementation, including fragmented information systems, weak coordination, provider bias, sociocultural constraints and insufficient financing. As a result, ASRHR outcomes continue to show geographic and wealth-based disparities, and many policy objectives reflect international agendas more than local realities. 

The findings underscore the need to use evidence more deliberately, strengthen coordination and align policies with local context if meaningful change is to occur. 

What decision‑makers should do differently

Decision-makers play a role not only in using evidence, but also in shaping how it is generated and applied. When evidence is understood and used well, decisions can be made more quickly and with greater clarity. 

Situation analysis supports this by connecting evidence directly to real policy choices. When it is treated as more than a box‑ticking exercise and used instead to guide decisions, it helps focus attention on what matters most, and why.  

New or revised MNASRH policies should clearly state which implementation bottlenecks they are addressing, which populations are being prioritized and why, and which political, legal, or institutional constraints are being navigated, along with the associated resource implications and sustainability considerations. 

When decision-makers use situation analysis not only to describe problems but to clarify choices, sequence reforms and justify trade‑offs, it helps bridge implementation gaps, shifting policy away from a linear, technocratic exercise toward a dynamic, context‑responsive process grounded in how change actually happens.  

When evidence is used to decide — not merely to document — policy generates practical action rather than aspiration.