This is the fifth blog post in a series of posts we've published over the last two weeks addressing the foundation's work in Family Health: Maternal, Newborn, and Child Health (MNCH), Nutrition, and Family Planning. With hundreds of grantees around the world, we hope to spark a conversation about—and with—the programs, projects, and organizations with which we work. Join the conversation; see our "Check Up Challenge" at the end of this post!
One of the comments we often hear from our grantees and partners about the foundation is how we appear to be constantly changing internally, shaking things up, and defining new strategies in the middle of implementing prior strategies. I think there is some truth to this, but only because we are open to change and to learning from experiences on the ground and in the global health community.
In other words, we can’t be stagnant in our efforts.
Last year, the Family Health division changed a few things. Below are some of the most important lessons we’ve learned and how we’ve responded with new approaches in our work:
Integration. In Bihar, India, one set of foundation partners, led by CARE, focuses on the delivery of integrated family health interventions and ensuring high quality frontline services. The BBC World Service Trust leads another consortium to shape social norms and family health behaviors and reinforce a few key practices proven to save the lives of women and children. A Project Concern International-led partnership works with communities to hold the government system accountable for provision of quality services, and another led by the International Finance Corporation works to strengthen efficiency and transparency of health payments. World Health Partners works with private providers to increase coverage of infectious disease case management.
Through these projects, we are learning a lot about how to get out of our technical ‘silos’ to foster synergies across intervention areas. What that looks like on the ground is a consortium of partnering organizations collaborating with each other, other development partners andthe Government of Bihar through a handful of complementary grants to support joint ownership of goals in project execution.
This highly integrated approach, very new to us, has not been without challenges and painful lessons learned: how to align the project goals and those of the local government; how to keep focused on the foundation’s vision by having clear milestones monitored in real-time to course correct rapidly and improve program performance; and how to organize structures to coordinate across a portfolio of partners and remain intensely engaged yet nimble and able to adjust as we learn in the effort.
Scaling-Up. I hope you see a theme emerging from this blog series across the three family health areas (MNCH, FP, Nutrition): numerous technologies already exist to address many maternal, newborn and child health risks – and there absolutely are gaps that technologies can yet fill - but the interventions that we already have in hand are not as widely available as they need to be. A major problem we face now as a global health community is how to adapt those technologies and develop new ones and ensure that they are adopted by frontline workers and families, to be highly impactful at scale.
We do a poor job of telling our stories of success and learning from our failures. Why does this matter? At the Achieving Lasting Impact at Scale convening this past November, participants discussed lessons learned in scaling up evidence-based interventions in low-income countries and disseminating innovations.
One of the many clear ideas which emerged was that public health has a great deal to learn in this regard from other sectors, including private enterprise and the entertainment and advertising industries; especially when it comes to storytelling.
There are important elements for telling our story: we each have a role to play to be a catalyst to ignite a chain of other positive reactions in global health; optimism is inherent when we realize the amount of intellectual firepower and rigor we could bring together; we all are impatient to take successes to scale; and we must collaborate and do this together.
Policy Engagement. There’s no question we must translate evidence of what works, in regards to key, life-saving innovations in maternal and child health, into effective policies at the country level. My team supports and is involved in various global partnerships which collect and synthesize empirical evidence about those interventions that have the highest likelihood of turning the tide on neonatal and maternal deaths. We have collectively learned that remaining focused on a few, key, life-saving innovations helps us maintain a high level of global interest on maternal, neonatal and child health.
Policy change that measurably improves the health of women and newborns is an important but oftentimes disregarded lever for the achievement of impact at scale. What we learned in the past year, though, is that we need to do a better job at engaging policy-makers in open, honest dialogue about priority-setting, resource allocation, and policy change. We don’t want to merely collect empirical evidence or have generic discussions about challenges and opportunities for achieving impact at scale; we want to engage with decision-makers in a sustained, evidence-informed conversation.
As the report from the Achieving Impact at Scale convening highlights, we can learn from successful projects, learn from projects that failed, and learn from innovations spreading without any deliberate project or intervention. And what we learn should be measurable and actionable. Changes will continue at the foundation (and I’ll give some insight into what’s next in my final blog post next week) but we strive to make them based on evidence; which leads to continuous improvements in our ability to achieve impact and reach the poorest of the world with transformational solutions.
If you have a question for Gary, don’t forget the Twitter conversation (#FHchat) on Thursday, February 23rd at 8 am pacific.
Check-up Challenge: I want to hear from you. How are our lessons learned from 2011 reflected in your own work?