The Strengthening Mixed Health Systems (SMHS) project supported by Merck for Mothers (MfM), developed a PPE Ecosystem Framework to assist health system stakeholders in taking a whole of health system view of PPE. The PPE Ecosystem was informed by an evidence review that identified 237 studies published in the academic literature related to strengthening mixed health systems and maternal health. Ultimately, the review included a deep analysis of 76 of the papers.
Together, experience and evidence alike suggest that while the technical, or “hard”, elements of PPE and system integration, such as regulatory and financing landscapes and structural platforms for engagement, are important and often challenging — equally challenging and impactful are the “soft” factors, including relationships, dialogue, understanding and collaboration between the PPE actors.
Building on these findings, along with tacit knowledge, previous work and input from global experts and local partners, the project brought these “hard” and “soft” factors together to understand and propose a more holistic framework that describes a comprehensive PPE Ecosystem. The PPE Ecosystem recognizes that PPEs exist as part of a complex network of helping or hindering factors and multiple health system actors operating at various points in an engagement cycle.