Table 4 Key outputs summarised as a Theory of Change for policy labs held in Sierra Leone and Zambia

• Time

• Money

• Labour, i.e. Technical Working Group to support campaign delivery (including community engagement specialist; graphic designer; photographer)

• Equipment and resources, i.e. anti-hypertensive medications; magnesium sulphate; antenatal corticosteroids

1.Academic/ policy lab stakeholder: Co-production of Policy brief and Oral Presentations at International Conferences (e.g. NIHR Implementation Science Conference July 2023, UK; International Society of Hypertension Conference Sept 2023, India)

(Sierra Leone and Zambia)

2.Community based: Intentional community engagement through Pre-eclampsia health education campaign (Sierra Leone and Zambia)

-Co-develop a tailored approach with local stakeholders— e.g. co-development of a PE docu-film with pop-up cinema screenings to urban & rural communities; national media campaigns; development and distribution of educational infographics

- Use ‘Agents of change’ to increase PE awareness amongst peers (‘nothing about us without us’)

3.Community Based: Birth preparedness and complication readiness

(Sierra Leone and Zambia)

-Community education to promote early antenatal care attendance and raise awareness of obstetric danger signs

-Maternal health promotion groups integrated into antenatal care

4.Hospital Based: Specialized centres for PE care

(Sierra Leone and Zambia)

-Staff trained in care pathways integrating novel evidence

-Mentoring and supervision, and refresher training to increase competence and accountability

-Targeted PE resource management to prevent stock-outs (including integration of CRADLE VSA into National essential equipment lists)

-Co-development of Shared Decision Making tools (infographic and animations) to increase knowledge and participation around i) early detection of PE; ii) Planned Early Delivery

5.Hospital Based: Staff engagement and education sessions

(Zambia)

-Nationwide healthcare worker interviews regarding planned early delivery undertaken in collaboration with

Zambia Association of Obstetricians & Gynaecologists & Ministry of Health

-Engagement meetings to introduce planned early delivery evidence with midwives in all Lusaka delivery facilities

-Promote and upscale Kangaroo Care

• Women with previous pre-eclampsia/ eclampsia (‘Change Agents’)

• Education partners

• Community leaders

• Civil Society representatives

• Religious leaders

• Traditional healers

• Traditional birth attendants

• Teachers

• Midwives

• Nurses

• Obstetricians

• Paediatricians

• Pharmacists

• Hospital administrative and leadership staff

• Researchers

• Policy Makers

• NGO partners

• Government representatives

• Increased recognition amongst researchers/ policy makers of policy labs as an effective and feasible process to bring ‘evidence closer to policy’ in LMICs

(International)

• Raised PE awareness amongst multiple stakeholders nationally through:

-Nema’s Choice docu-film screenings via pop-up cinema to > 1000 mixed stakeholders including women and communities

- > 1500 PE infographics disseminated at markets and transport hubs

-Multiple National radio and TV broadcasts

(Sierra Leone)

-National media campaign TV and radio broadcasts during week of World PE day

(Zambia)

• Shared Decision Making as part of routine PE care pathways

• (Sierra Leone and Zambia)

• Universal access to accurate BP measurement & early PE detection

• (Sierra Leone and Zambia)

• Planned early delivery for suspected PE from 34 weeks integrated & observed as part of national PE guidelines

• (Sierra Leone and Zambia)

• Reduced maternal and neonatal mortality and morbidity related to Pre-eclampsia (Sierra Leone and Zambia)