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A "How To" Guide For Improving Maternal and Newborn Health?

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August 30, 2012

Yesterday, on Impatient Optimists, Jennifer James of Mom Bloggers for Social Good profiled three projects in sub-Saharan Africa to save the lives of women and newborns. She wrote, “If we can replicate these programs, bring them to other countries or regions, we can save more lives.” We agree completely. But how does this happen? How do successful interventions in family health get scaled up to reach more communities and improve the health of many more people? A recently published paper, “A model for scale up of family health innovations in low-income settings: a mixed methods study,” looks at that question and proposes a framework to use as a guide to achieving the impact necessary to save many more lives. That framework, called AIDED (Assess/Innovate/Develop/Engage/Devolve), will help us get to the next level in terms of spreading the proven health care solutions to communities that desperately need them.

The next question to ask is: Why do we care?

When the Family Health team at the Gates Foundation commissioned this study, our team was less than a year old and had decided to tackle head-on the challenge of increasing availability, access, and use of life-saving products and technologies in many poor countries around the world. We were actively looking for a “how-to” guide, which would direct our efforts at ensuring we’re effectively caring for the health and lives of women, newborns, and children around the world and we’re doing so sustainably.

We started by looking at the mechanisms through which innovations, knowledge, and technologies spread across organizations, human social networks, and different geographies. Very early in the process we found out that we were not alone in this search to understand these mechanisms. Even with higher levels of global health funding, many other organizations working on global health issues were also stymied by the reality: it’s one thing to understand which interventions will improve health in certain communities, such as the promotion of exclusive breastfeeding to improve nutrition. However, ensuring that exclusive breastfeeding is broadly adopted so as to truly make a difference in a community’s health is another.

When we set out to better understand the spread of innovations in health, we looked to Yale University’s Global Health Leadership Institute to help us improve our understanding of how to scale up practices or behaviors like exclusive breastfeeding, effective and safe products like the contraceptive Depo-Provera, and platforms to deliver family health services including community health workers.

Through a literature review and extensive in-depth interviews with various experts, the Yale team developed the AIDED framework to help spread these exciting innovations. The framework has five interdependent and non-linear elements which include: 1) Assess the landscape of users contexts, 2) Innovate to increase user receptivity, 3) Develop support for the innovation, 4) Engage user groups; and 5) Devolve for the spread of innovations.

In November of last year, Melinda Gates hosted the Achieving Lasting Impact at Scale convening, which sparked the conversation on impact at scale among researchers, practitioners, policy makers and funders. Attendees had the opportunity to provide massive amounts of highly valuable feedback, which is reflected in this final paper.

If the convening was the start of the conversation, this paper is the next thread of the dialogue. It is only fitting that those who attended the meeting and the many others working for women’s and children’s health celebrate the publication of this valuable piece of research and keep the conversation and the learning alive.

This is a framework, ultimately, for sharing what works. Whether it’s exclusive breastfeeding for the first six months of a newborn’s life, or it's consistent access to Depo-Provera, a popular contraceptive option for women in the developing world, the critical factor is ensuring that those who need these interventions actually get them and use them. This framework helps get all of us one step closer.  

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