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Learning Across Geographies: Common Challenges and Innovative Approaches to Save Mothers and Babies

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October 12, 2016

A woman lies in bed behind a hospital curtain, recovering from her recent delivery. She’s so quiet, we barely notice her or the newborn she’s holding as we tour the health center in Delocha, Ethiopia. There were many critical steps that led to this delivery and many more needed to ensure the survival of both mother and baby. It’s a success story just feet from where we stand, and one that’s becoming more frequent in this district. Delocha is one of the areas where the Last 10 Kilometers Project (L10K) has worked since 2008 to increase facility births and to improve health care workers’ ability to successfully manage obstetric and newborn emergencies.


Ethiopia is one of the few low income countries to achieve the Millennium Development Goals to reduce maternal and child mortality. Therefore, it was a compelling setting to bring together a community of Maternal, Newborn, and Child Health (MNCH) practitioners to share what’s worked in the field, how, and why. In June 2016, the foundation’s MNCH delivery and implementation partners came together from the Democratic Republic of Congo, Ethiopia, India, Malawi, and Nigeria to create a marketplace of strategies where participants identified new approaches to adapt to their own settings. As part of the meeting, participants identified lagging high impact interventions in their own countries and developed plans to bring them to scale and accelerate coverage in their health systems using ideas from the marketplace. The plans defined goals, activities, responsibilities, and timelines for implementing and testing potential solutions to increase coverage, utilization, and quality of MNCH services in collaboration with local stakeholders and governments. The country teams left the meeting with  plans to improve maternal and newborn health outcomes in their own settings.


For example, the Technical Support Unit (TSU) in Uttar Pradesh, India developed a plan to ensure Kangaroo Mother Care (KMC)—a low cost, life-saving intervention where a baby is positioned skin-to-skin with the mother—is available in both facilities and communities. According to the recent Annual Health Survey, one-third of births take place in the home, and small and sick babies need care in the community as well as referrals to facilities. Key changes they plan to make include instituting a policy that mothers should not be discharged within 48 hours if they have a low birthweight baby. They will also train community health workers (ASHAs) in KMC to enable them to support this intervention in the home.


Another example was from the Nigeria team, who had already started a plan to introduce a new community Village Health Worker (VHW) program in Gombe state based on a national model. They focused on identifying aspects of Ethiopia’s Health Extension Worker platform that could be transferred to Nigeria. They learned how VHWs can help pregnant women access health facilities for delivery – one of the biggest challenges they face in Gombe State; currently more than two-thirds of births take place in the home (according to recent data from the IDEAS team at the London School of Hygiene and Tropical Medicine).


Furthermore, the team from the L10K project in Ethiopia learned about a record-keeping system used in India to help track and ensure early quality postnatal care visits to mothers and newborns. Program data shows postnatal care is a significant challenge in Ethiopia with fewer than 8% of mothers and newborns having a recommended visit. After the meeting, they decided to try and adapt this system to their programs in Ethiopia to increase utilization and quality of early postnatal care.  The new system will help ensure mothers and babies, like those we observed in Delocha, stay healthy and safe when they return home. Our goal is a world where mothers and babies don’t just survive a day or night after labor and delivery, but they live a lifetime of healthy days thereafter.


We will work with our partners to track progress of these new approaches to improve care for mothers and babies. Stay tuned for future blogs on this topic. We look forward to sharing our progress.

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