Table 3. Context-mechanism-outcome configuration.

SRH Tracers	Context	Strategies/ Measures	Mechanism Triggered	Outcome
a) Pregnancy, safe delivery and post-natal care	General context Sociocultural acceptance of pregnancy within marriage; legitimacy due to two lives at stake 1st phase (1960s–1990s)Outer context High MMR High levels of poverty 70% of the population resided in rural areas – - Rural population health needs and demands - Difficulties in access to care Local beliefs and customs on traditional medicines and home deliveries – valued the social and spiritual support received from traditional birth attendants (TBAs) during pregnancy and post-natal care Inner context Limited trained medical personnel, especially doctors	Strategy 1: Generate public demand/ social support through community participation and mobilisation – working with village development committees, NGO such FRHAM and National Family Planning Board (now known as National Population and Family Development Board) Strategy 3: Engage champion – trained midwives to work with TBAs	Strong demand and buy-in generated from the communities Increased political commitment since 1960s MOH ownership of the process	Increased the political will to invest and make pregnancy, childbirth and post-natal care as country’s health priorities. Budget and resources were committed and allocated in various country development plans to strengthen the health system to deliver these services. Significant reduction of MMR.
	2nd phase (1990s – present)Outer context Significant reduction of MMR in the 1990s – disease burden has shifted to non-communicable diseases Stagnant MMR since then until present Teenage pregnancy and stagnant adolescent fertility rate Inner context Stigma and discrimination from healthcare providers towards teenage pregnancies and unmarried women who access pregnancy and delivery care services	Strategy 2: Link it with international commitments – to achieve MDGs and SDGs Strategy 4: Reframe issues appealing to values & beliefs – Reframe the needs to provide pregnancy and delivery care for adolescents, young people and unmarried women under the umbrella of “Family Health”	Increased political will to provide continuing support for pregnancy and delivery care Created mutual understanding and buy-in on the need to provide pregnancy and delivery care for adolescents, young people and unmarried within healthcare providers and the community.	Pregnancy, childbirth and post-natal care have continued to be the country’s priorities with constant operational budget being allocated.
b) GBV and OSCC services	From pilot intervention to scale-upOuter context Perceived as a “private matter” that prevented others from intervening and prohibited victims from reporting GBV due to stigma, fear of retribution and socio-cultural beliefs. Burgeoning international movement on the rights of women and sexual and reproductive health in the early 1990s Domestic Violence Act passed under Penal Code in 1994	Strategy 2: Link it with international commitments – ICPD-PoA, Beijing Declaration and CEDAW Strategy 3: Engage champion – NGO working with health experts, engaging with champion from health sectors Strategy 4: Reframe issues appealing to values & beliefs – Reframe GBV as a health issue instead of rights issue	DVA enactment created legitimacy to engage health sector champion to generate buy-in of GBV solution (OSCC) Reframed the impact of GBV as a health issue to create mutual understanding and facilitate the buy-in The success of pilot OSCCs also increased the buy-in of MOH	OSCC has been partially prioritised as a feasible solution to address the health impact of GBV without additional operational budget support – mainly depended on the on the capacity of the hospitals as well as the volition of the decision-makers
c) Safe abortion services and post-abortion care	Development of Termination of Pregnancy (TOP) Guideline (2012)Outer context Perceived as a sensitivity issue – sociocultural norm deem abortion as taking a life as human life Legitimised and regulated by Penal Code Inner context Lack of data on maternal death due to unsafe abortion Lack of data on abortion services Health providers have vague interpretation of the legal context of abortion	Strategy 1: Generate public demand/ social support for the guideline: - including religious views and perspectives - introducing details on the eligibility and procedures for abortion, e.g. who can access, where and how abortion shall be conducted Strategy 4: Reframe issues appealing to values & beliefs – Reframe abortion services so as to address unsafe abortion and reduce MMR	Created the mutual understanding and buy-in at the top-management/policy making level	TOP guideline has been issued to all MOH’s hospitals. However, the services have not been prioritised. Services only available when there is a serious threat of medical complications. No specific budget being allocated for abortion services and the training for abortion services Healthcare providers may still not be comfortable to provide such services due to personal values or the lack of skills.