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Family Health "Check Up": Looking Forward

May 20, 2013

This is the sixth post in the six-part Family Health "Check Up" 2103 series which provides a window into the ways in which we think about our Family Health strategy, at the foundation. Follow @gatesfoundation and @gdarmsta on Twitter to join the conversation.

This year’s strategy review process provided an opportunity to look back and reflect on successes and failures in an effort to improve our performance and increase our impact in Family Health. As a result, our outlook includes two cross-cutting areas that we found critical for achieving lasting impact at scale.

The first critical area is increased integration across our various teams. Previously, teams have tended to focus on achieving their own strategic goals and had little incentive to look for synergies across strategies. This resulted in missed opportunities for bundling solutions that, were they to be delivered in an integrated fashion, would likely increase the effectiveness and equity of our scale-up efforts. Going forward, not only will we endeavor to approach large-scale implementation in maternal, newborn and child health, nutrition, and family planning in a more integrated and systematic way, we will also harness the learning arising from our existing and future portfolio of investments.

 As a team we are committed to develop a knowledge-sharing practice to enhance the flow of knowledge, ideas and innovations between and across partners through properly curated and facilitated events as well as networks.

Most immediately, this can be seen in Nigeria with the government’s initiative of Saving One Million Lives and in Malawi with The President’s Maternal Health and Safe Motherhood Initiative. Both of these initiatives stem from high-level political commitment to improve, in measurable ways, the health status of women and young children.  In Nigeria, the focus is on the development and institutionalization of a performance management system that relies heavily on timely access to high-quality data that will be used to address local health system bottlenecks and reward high performing states. The Malawi program is focused on addressing persistent barriers to reducing maternal, neonatal and child mortality through improved delivery of care by frontline health workers and community mobilization. Our work in Malawi responds to President Banda’s request to work with Village Chiefs to mobilize communities and to focus on key healthy household and community practices; to develop and test a model for use of maternity waiting homes to provide health education, antenatal care, counseling and ready access to referral-level care for complications; and to support the training of community midwives. Both of these initiatives present a cross-cutting, integrated approach to improved care across foundation strategies.

The second critical area is the development of a learning and knowledge-sharing agenda that benefits the overall Family Health ecosystem –internal as well as external. We realize that we are falling short of capturing the value of, and harnessing the practical and empirical knowledge generated by the implementation efforts of our partners. As a team we are committed to develop a knowledge-sharing practice to enhance the flow of knowledge, ideas and innovations between and across partners through properly curated and facilitated events as well as networks.

In addition to learning from each other, we have identified three challenges that span our Family Health strategies which we likely will need to better understand before we determine the optimal path forward.

The first challenge is low birth weight as a significant, intergenerational problem requiring a multifaceted and holistic approach directed at social, health and nutrition drivers. The causes of low birth weight start before pregnancy, and the problems that stem from low birth weight continue throughout life. Because of the multi-faceted aspects of this challenge, it must be addressed holistically and ideally through trans-disciplinary efforts.

The second area is the adolescent girl who is at that critical intersection of childhood and adulthood. The premature transition of an adolescent girl into adulthood, oftentimes the case in poor societies, has several important consequences for her health and that of her children, as well as her future economic empowerment and self-determination. We are committed to support a learning agenda to better understand the challenges and opportunities in reaching adolescents and the levers that can be unleashed for catalytic change.

The third area for cross-cutting learning is equity, including using a gender lens. Disparities in health outcomes are related to economic, political and social power imbalances. This concept is demonstrated in Nigeria, a country that has reduced their maternal mortality ratio from 1,100 maternal deaths per 100,000 live births to 545 per 100,000 live births. This change appears impressive until you look at the regional differences. The rural maternal mortality rate is 828; the rate in urban areas is 351. The north-east region has an astronomical rate of 1,549 per 100,000 live births, while the south-east boasts a rate of 165. As this data illustrates, inequities may become more pronounced while overall measures of health outcomes show improvements. Using a gender focus for these inequities will identify how gender norms, attitudes and constraints influence participation and access to health programs. This better understanding should lead to programs that respond to the problem of gender inequity in order to improve health outcomes for women and children.

Franklin D. Roosevelt is quoted as saying, “There are many ways of going forward, but only one way of standing still.”

Over the past weeks in this six-part Family Health Check-up series, we have provided a more in-depth look into our strategies, the progress made to date, the challenges remaining, and the lessons learned along the way. We have also shared our reflections about how we are adapting and evolving, by correcting our course and improving our performance. Its these thoughts, as President Roosevelt so poignantly noted, that lay out our way forward to improve the health of women and children. Standing still is not an option.

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