Using a Rapid Knowledge Translation Approach for Better Sexual and Reproductive Health and Rights in Bangladesh, Burundi, Indonesia, and Jordan

Kimberley Meijers; Anke van der Kwaak; Ibrahim Aqel; Robert Borst; Françoise Jenniskens; Aryanti Radyowijati; Arnob Chakrabarty; Eric Nzeyimana; Ely Sawitri; Noor Tromp

doi:10.9745/GHSP-D-21-00461

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FIGURE
CRIM-KT Applied by SRHR Knowledge Platforms in Bangladesh, Burundi, Indonesia, and Jordan
Abbreviations: CRIM-KT, Collaborative Rapid Improvement Model for knowledge translation; AP, action period; LS, learning session; SRHR, sexual and reproductive health and rights.
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Participants in Bangladesh work on a stakeholder mapping during a local learning session. © 2018 Share-Net Bangladesh
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Participants in Burundi learn about the CRIM-KT theory during local learning session 2. © 2018 Share-Net Burundi
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Participants in Jordan created a mind map of child marriage during local learning session 1. © 2017 Share-Net Jordan
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During a break-out exercise in learning session 1, participants in West Lombok, Indonesia, created a mind map to present information on child marriage. © 2018 Rutgers Indonesia

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TABLE 1.

Proposed SRHR Focus Topics in Each Country Knowledge Platform

Share-Net Bangladesh	Share-Net Burundi	Share-Net Jordan	Share-Net Netherlands
Child marriage	Teenage pregnancy	Child marriage	The knowledge platform in the Netherlands did not propose SRHR focus topics but followed the joint decision made by the other knowledge platforms to focus on child marriage or teenage pregnancy. The Dutch knowledge platform identified a member organization willing to implement CRIM-KT with a focus on child marriage in Indonesia.
Comprehensive sexuality education for adolescents	Sexual and gender-based violence	Youth-friendly reproductive health services
		Reproductive and sexual health education for youth

Abbreviations: CRIM-KT, Collaborative Rapid Improvement Model for Knowledge Translation; SRHR, sexual and reproductive health and rights.

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TABLE 2.

First Change Package Developed by Share-Net Jordan During Action Period 1

Problem Statement	Lack of coordination, sharing, translating, and using knowledge and establishment of consensus around possible solutions between different stakeholders to address child marriage in Jordan.
Aim	To effectively share, translate, and use knowledge among stakeholders where consensus is established around evidence-informed policies and practices related to child marriage in Jordan.
Key Drivers^{^a}	Change Ideas^{^b} (Concepts)	Specific Actions	Responsibility	Output Measure	Outcome Measure
Collaboration and engagement among stakeholders	Stakeholders are actively engaged in a collective effort to address child marriage	Form a steering committee composed of different stakeholders to define roles and responsibilities around reduction of child marriage (Action period 1)	Country team	Established steering committee	Stakeholders executing their defined and agreed-upon roles and responsibilities
		Organize 2 round tables (Action period 1)	Country team	Organized 2 round tables	Stakeholders established consensus on strategies, initiatives, and activities needed to prevent child marriage
		Conduct 2 workshops for stakeholders to develop a national action plan around the recommendations derived from round tables (Action periods 1 and 2)	Country team	Conducted 2 workshops Developed draft national action plan	Strategies, initiatives, and activities around child marriage are adopted in stakeholders' plans
		Finalize national action plan (Action period 1 and 2)	Country team and local stakeholders	Finalized national action plan around the recommendations that have been approved by the cabinet	Initiatives and/or interventions are implemented jointly by different stakeholders

↵a Key drivers are the conditions that need to be in place to achieve the goal.
↵b A change idea is a general notion or approach to change found to be useful in developing specific actions that lead to improvement.

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TABLE 3.

CRIM-KT Outcomes at Country Knowledge Platform Level, Including Knowledge Products and Knowledge-Sharing and Translation Strategies

Share-Net Bangladesh	Share-Net Burundi	Share-Net Jordan	Share-Net Netherlands in Indonesia
Created an information hub for organizations working on child marriage on the knowledge platform's website. Shared list of organizations and their best practices to prevent child marriage in Bangladesh.	Conducted a mapping and analysis of stakeholders working on the issue of adolescent pregnancy in Burundi.	Developed a national action plan to end child marriage to provide a general framework for limiting the marriage of individuals under 18. This included a 5-year strategy for countrywide interventions.⁴⁶ Presented the action plan successfully to the Prime Minister, endorsed by the Cabinet, and shared with the relevant ministries to allow them to incorporate the proposed interventions in their annual plan if their budget allowed.	In collaboration with the district working group, organized multiple meetings with stakeholders, including traditional and religious leaders, government authorities, parents, and young people. Developed and launched a guideline on the local merarik cultural practice.⁵⁰ Through advocacy efforts, included this guideline as an attachment in the Local Regulation of Child Marriage Prevention that had just been issued by the Parliament.
A booklet titled Highlights of an initiative addressing child marriage in Bangladesh was published and disseminated.⁴²	Organized a joint broadcasting initiative in the form of a talk show on 12 radio stations to raise awareness among the general public of the risks associated with adolescent pregnancy. This activity was financially supported by an external funder.	Held meetings with potential donors to share the 2018–2022 national action plan and to explore funding opportunities for the different interventions included in the plan.	Developed a syllabus for training on the merarik guideline. Facilitated training for 40 village heads. Integrated training of the village heads on the merarik guideline into the YES I DO program.
A roundtable discussion with policy makers, researchers, and practitioners was held to share the lessons learned in promoting the issue of child marriage in Bangladesh was organized.	Performed a desk review: Known best interventions to reduce or prevent adolescent pregnancy in Burundi, Kenya, Ethiopia, and the Demographic Republic of Congo, and a position paper: How the joint program should or might improve adolescent pregnancy in Burundi.	With external funds, held a workshop on the mechanisms for integrating child marriage into the plans of civil society institutions and societies.	The Department of Women's Empowerment and Family Planning of West Lombok allocated a budget to expand the coverage of training in the villages outside the 5-year YES I DO program.
The country platform organized a knowledge fair on SRHR where stakeholders shared their knowledge products and efforts to address child marriage and other SRHR issues in Bangladesh.	Held a round table discussion and published a report: Analyzing the current mechanisms of monitoring adolescent pregnancies in Burundi,⁴³ in collaboration with the National Reproductive Health Program and the National Health Information Management System.	A multistakeholder partnership raised their own funds and focused on awareness training in hospitals, research on the economic and social drivers of child marriage outreach to Syrian schoolgirls, and an awareness campaign at 60 schools.	Added the merarik guideline as an attachment to the Local Regulation of Child Marriage Prevention issued by the parliament in 2020.

Abbreviations: CRIM-KT, Collaborative Rapid Improvement Model for Knowledge Translation; SRHR, sexual and reproductive health and rights.

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TABLE 4.

Factors Contributing to Changes in Policy and Practice, Related to CRIM-KT and Country Context in Bangladesh, Burundi, Indonesia, and Jordan

	Related to CRIM-KT	Related to country context
Enabling factors	Participatory approach involving stakeholders Systematic and structured approach, allowing for contextual adaptation Short time frame, creating a sense of urgency Efficient tools such as simple change package format that forced prioritization of objectives Openness about making mistakes or admitting that strategies do not work Time for reflection through storyboards Cross-learning on 2 levels (international and country collaboration teams) New methods for stakeholder involvement Transparency of international and local activities and involvement of coordinators in program Feelings of pride in sharing successes with other platforms during international learning sessions	Personal connections between stakeholders Strong knowledge platform secretariat Embedding/structure of knowledge platform: e.g., being a government institution working directly for Prime Minister (Jordan) Availability of existing multistakeholder platforms Embedding in other projects (e.g., YES I DO program) and leadership of local government staff (Indonesia) Ability to talk to government authorities Alignment with government priorities (Jordan and Indonesia) Relatively low costs for organizing meetings (Indonesia) Alignment with local priorities (Indonesia)
Disabling factors	Short time frame Limited capacity strengthening for facilitation of local collaboration Limited funds available to develop and organize activities during the local action periods Content of some international learning sessions less applicable to local (community) level Geographical distance between knowledge platform and international knowledge experts providing communication/support Limited funds available to develop and organize activities during the local action periods	Natural disasters (earthquake in Lombok) Staff turnover among stakeholders and within knowledge platform participants in CRIM-KT (Indonesia and Jordan) Power dynamics among local stakeholders Staff of knowledge platform falling ill (Bangladesh and Burundi) Lack of government willingness to collaborate with nongovernmental organizations (Burundi) Resistance of religious actors to address child marriage (Indonesia and Jordan) Limited capacity of knowledge platform to produce research (Burundi) Limited funding available from government and/or other stakeholders to financially support the implementation of activities proposed in local learning sessions (Burundi and Bangladesh) Political context: e.g., elections and the office was closed in Burundi for some time Language barriers: English level of Burundi staff hampered full participation in international learning sessions held in English