Bill & Melinda Gates Foundation

Behind the Scenes: Maternal, Newborn, and Child Health at the Gates Foundation

February 16, 2012

This is the fourth blog post in a series of posts we'll publish over the next 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!

What if we could predict the life-saving potential—using technology—of newborns and mothers in the developing world? Turns out, we can.

MANDATE—Maternal and Neonatal Directed Assessment of Technology—managed by RTI International, focuses on creating an interactive, quantitative model that compares emerging technologies and their potential for saving maternal and newborn lives. The model links the existing technologies and interventions to the main causes of pregnancy-related and newborn deaths. The early model of the interactive presentation by MANDATE is captivating. We have much more to do to adapt and improve those technologies and get them into the hands of families and frontline workers at the appropriate level of the health system.

Beyond technology, frontline workers—such as trained medical professionals, private drug sellers, community health workers, skilled birth attendants, religious leaders, peer counselors, etc.—are vital for delivering health care solutions to mothers, newborns and families. These workers are often the first point of contact with the health system and can reach mothers, newborns and children in an integrated manner. We want to improve interactions between frontline workers and families in number, quality, efficiency and equity because we believe that improved interactions will increase the coverage of key life-saving interventions.

It is amazing to see this happening in Ethiopia where the country has rapidly expanded their Health Extension Program and put in place tens of thousands of frontline workers to help residents of rural communities improve their health. These workers often walk miles to reach families in remote areas to teach about sanitation, disease prevention, maternal health and newborn care. And these efforts are having an impact.

Preliminary results from the Demographic and Health Survey from 2011 show a significant decrease in under-five mortality from 123 in 2005 to 88 per 1,000 live births in 2010. Use of modern contraceptives has also dramatically increased in the same time period from 14 percent to 27 percent, and most significantly in the rural areas. Although these are great steps forward, the rate of neonatal deaths, those in the first month of life, disturbingly did not significantly improve, and other indicators only had moderate improvements.

Efforts in Ethiopia and globally need to continue to focus on the care women are provided during pregnancy and childbirth and the conditions in which babies are born. And on the community side, our grantees encourage families to learn from frontline workers and from each other, and adopt healthy behaviors for moms and babies. Over the past year, we’ve invested a lot on the technology side—including testing new and adapted solutions to prevent and treat postpartum hemorrhage and newborn infections, and also efforts to better understand the underlying reasons for conditions such as preterm births and preeclampsia.

We are really fortunate to be living in a time when technological gains in maternal and newborn care are advancing rapidly. Sometimes it can be confusing to know which new interventions could actually turn into a product that is efficient, economical, scalable, and, most importantly, useful to frontline workers and families to save mothers and newborns.

As the Maternal, Newborn, and Child Health team moves into 2012, we will continue to build upon our successes and face challenges head on. We recognize the need to focus our advocacy efforts to lead to identifiable and tangible change at scale. We face many unknowns about the biological reasons of high-risk pregnancies, preterm births and stillbirths. We must continue to focus on increasing demand at the community level for quality family health care while improving the tools available to those frontline workers to provide it.

Check-up Challenge: One of the simple interventions slowly spreading through low-income countries is kangaroo mother care, providing skin-to-skin care for newborns. Why isn’t this intervention reaching all infants – preterm and term – the world over? Please respond in the comments below.

If you have a question for Gary, don’t forget the Twitter conversation (#FHchat) on Thursday, February 23rd at 8 am pacific.

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