Institutionalising community participation in decision-making in maternal and newborn health services in low-and middle-income countries: An analysis from 102 national health ministries.

In 2024, 194 countries endorsed World Health Assembly Resolution (WHA77.2) to strengthen participation in health-related decision-making. Achieving this requires strong leadership to institutionalise community participation by embedding it into health system functions. However, efforts are often fragmented and short-term, hindering both sustainability and scalability. There is limited understanding of how well countries have institutionalised community participation in decision-making for quality maternal and newborn health services. A secondary analysis of maternal and newborn health survey data was conducted using responses from 102 Ministries of Health in low-and middle-income countries. The analysis assessed progress in adopting and implementing maternal and newborn health recommendations on community participation. A descriptive approach was used to summarise the frequency of reported community participation activities. Percentages were applied to describe the data, which was disaggregated by 2024-2025 World Bank classifications for income level, and fragile and conflict-affected settings. Country responses were categorised using Lasswell's Policy Cycle heuristic. The findings indicate substantial gaps in institutionalising community participation in maternal and newborn health. Only half of countries reported integrating participation into national plans, and just one-third into implementation. In 90% of countries, parent groups were reported to be either absent or lacking influence on policymaking. National research on community participation, essential for evidence-based decision-making, was rarely reported. Across all regions, countries had varied progress, reflecting a diverse and uneven landscape of community participation. Stronger efforts are required to institutionalise community participation across the maternal and newborn health policy cycle. Strengthening this integration will require clear metrics to track implementation, enabling more accurate assessments of progress and accountability. Identifying countries where institutionalisation is advancing can surface positive deviance cases. Studying these in-depth may reveal drivers and effective strategies for fostering community participation to guide the adaption and integration of successful approaches into national health systems.