Global Health Initiatives

 

UNC WHO Collaborating Center for Research Evidence for Sexual and Reproductive Health continues global impact through collaboration with the World Health Organization 

 
 

UN Secretary General’s Global Strategy for Women’s and Children’s Health: Accelerating Progress in the Implementation of the Reproductive, Maternal and Newborn Health Programme in Malawi, 19-21, January 2011

 
Location: CARE Headquarters, Atlanta, GA, USA
 
Co-organizers: CARE, CDC, UNFPA, UNICEF, WHO with support provided by the UNC WHO Collaborating Center for Research Evidence for Sexual and Reproductive Health
 
The 2 ½ day meeting (agenda attached as Appendix 1) was held on behalf of H4+ (WHO, UNFPA, UNICEF, World Bank, UNAIDS) and was hosted by CARE and CDC (attendees attached as Appendix 2). All presentations have been provided to participants as electronic files and are listed below. The primary purpose of the meeting was to determine the potential contribution of implementation science for accelerating progress in the implementation of the national RMNH programme in Malawi, including integration of HIV and MNH services.

The goals of the meeting were to: 1) discuss how to assist the Ministry of Health of Malawi and key stakeholders in Malawi to use implementation science to accelerate progress in preventing maternal and newborn deaths and 2) contribute to the H4+ planning process in Malawi, related to the Global Strategy on Women’s and Children’s Health.

The objectives of the meeting were to: 1) assess the link between the implementation challenges for the RMNH programme in Malawi and the implementation science to address these challenges, 2) provide a detailed partners’ perspective of the programme/intervention implementation challenges in Malawi, and 3) determine key common implementation bottlenecks in Malawi, especially those that are likely to be broadly applicable.

Day 1: Defining the Problem
The meeting began with an overview of the window of opportunity created with the launch of the United Nations Secretary General’s Global Strategy for Women’s and Children’s Health in September 2010, the related commitments to dramatically reduce maternal and newborn deaths in the 49 lowest income countries in which the majority of such deaths occur, and the increasing commitments to MDG4 and 5 expressed by the G8 and G20. To realize this opportunity will require a concerted, well-coordinated, innovative and highly effective effort that uses the best available science for addressing challenges in each country. The presentations that followed the overview described challenges and opportunities from the perspectives of UN H4+, the Ministry of Health of Malawi, H4+ Malawi, CDC headquarters and CDC/Malawi, USAID headquarters and USAID/Malawi, CARE headquarters and CARE/Malawi, and the Flemish International Cooperation Agency – which addressed related work in Mozambique. Dr.Chisale Mhango spoke on behalf of the Ministry of Health of Malawi and noted the National Vision (2020): “Malawi will be secure, democratically mature, environmentally sustainable, self-reliant with equal opportunities for and active participation by all, having social services, vibrant cultural and religious values and a technologically driven middle-income economy” and Growth and Development Strategy: “Poverty reduction through sustainable economic growth and infrastructure development”. He also identified six priority challenges for sexual and reproductive health in Malawi: 1) high unmet need for family planning, 2) high teenage fertility, 3) weak health system, including (a) inadequate health care workforce, (b) poor referral system, (c) inadequate physical infrastructure – all contributing to poor quality of care, 4) inadequate resources for SWAp POW for all strategies of sexual and reproductive health, 5) HIV and AIDS pandemic, and 6) malaria pandemic.

Day 2: Defining the Solution
The meeting continued with an overview and discussion of potential options for solving priority challenges in Malawi and beyond – with a focus on the role of implementation science and innovative approaches that will include: (1) planning and execution with strategies driven by country needs; (2) data driven decision- making; and (3) willingness to tackle complex challenges with a problem-solving mindset, drawing on all relevant approaches and disciplines. The group affirmed the importance of using implementation science to rapidly accelerate progress in at least 3 major areas: 1) the implementation of interventions to solve challenges in low-resource settings, 2) the development and use of innovative technologies and processes to accelerate progress in scaling-up in these settings and 3) the transformations in health systems in these settings needed for implementation of life-saving services. The group recognized the importance of implementation science for addressing social, economic, and political obstacles to implementation by informing the development of sound strategies for successful and sustainable implementation activities. Further, the group recognized the importance of using implementation science to address a package of interventions in sexual and reproductive health, including family planning to prevent unintended pregnancies and HIV prevention and treatment. The first presentation, by Francesco Aureli, gave an overview of the potential link between plans being discussed and funding priorities for G8, the Global Fund for HIV, TB and Malaria, and other major donors. Subsequent presentations addressed innovative approaches, including data driven management to drive real time improvement; the use of implementation science to solve implementation challenges; innovations in health systems strengthening; and innovations in the integration of interventions, including integration of HIV prevention and treatment services and antenatal care services.

Day 3: The Way Forward
The final day concluded with addressing: 1) “Who we are as a collaboration” – and in so doing committed to the creation of an effective, interdependent collaboration that will become a powerful force for good in Malawi and beyond, 2) “What we’ll do” – which included the use of implementation science to solve implementation challenges in countries, with this link supported by the development and application of innovative methodologies and tools (Figure 1) , and 3) “Our commitment to Malawi” – for using innovative tools to improve maternal, newborn and reproductive health, including HIV, with a focus on implementation of innovative interventions for successful integration; addressing the pressing challenges in human resources; and improving the quality of care (Figure 2).

The group affirmed its strong commitment to the formation of a new collaboration that will comprise a powerful interdependent workforce to assure that we seize this moment of unprecedented political will and commitment and translate it into a highly effective, coordinated effort for saving lives. The collaboration will be action-oriented and problem solving-focused and will support H4+ (WHO, UNFPA, UNICEF, World Bank and UNAIDS) in effective implementation of the renewed countries’ commitments to MDG 4 and 5. Strong commitments to this workforce have already been made by CDC and CARE and it is anticipated that new partners will be added soon as needed. Key attributes of the collaboration were discussed and the group agreed on the importance of it being interdependent. The importance of it being efficient and effective with a focus on potential “game-changers” was also affirmed, as was using capacities/comparative advantages of all partners and prioritizing activities that could be better achieved through the collaboration than by individual partners operating independently.

The group affirmed that the collaboration will use a conceptual framework that links implementation science to solving implementation challenges in countries (Figure 1). A key product of this effort will be the development of innovative methodologies and tools that will be generalizable and flexible to fit the context into which they are used. Successful translation of this framework into effective action-oriented plans for meeting country needs will require the development of priorities for the implementation of key interventions by Ministries of Health in each country as well as strategies for generating and executing the knowledge needed to succeed. Agencies with lead responsibilities for implementation will need to work closely with those with lead responsibilities for implementation science in both the planning and execution phases of this collaborative effort.

 
The organizers of this meeting and the Ministry of Health of Malawi did extensive preparatory work before the meeting during which the Ministry expressed interest in receiving support for its efforts in preventing maternal and newborn deaths in Malawi and its support for using this innovative collaborative effort as “proof of concept” for developing and scaling up similar strategies in other countries prioritized for the Secretary General’s Initiative, including ones that build on the infrastructure and capacity associated with HIV, TB and malaria programs. During this meeting, the group strongly affirmed its support for both efforts. Commitments for funding have been made by WHO (based on a € 500,000 contribution from the Government of Flanders) with a matching contribution by CARE ($700,000) and substantial in-kind and potential cash contributions by CDC. Next steps include a followup meeting in Malawi to develop the effort further, tentatively planned for the first week of April. The organizers of the meeting also affirmed their expectation that the initial collaboration that we have created to undertake this work in Malawi will be scaled up as the Secretary General’s Initiative continues to take off and realizes its full potential.

 

Presentations:

  1. U.N. Secretary General’s Global Strategy for Women’s and Children’s Health
  2. H4+: Working Together for Maternal and Newborn Health
  3. Implementation and Implementation Science: SG’s Global Strategy: Getting It Done
  4. Sexual Reproductive Health in Malawi: Program and Key Challenges
  5. Addressing Challenges
  6. DHHS-Malawi: MCH and HIV Activities
  7. USAID – Malawi
  8. Overview of CARE Programs in Malawi
  9. CARE: Perspectives, Priorities and Potential Contributions to “Getting It Done for Maternal and Newborn Health”
  10. Collaboration with Malawi and H4: Strengthening MCH Systems to Improve Maternal and Perinatal Health Outcomes
  11. Best Practices at Scale in the Home, Community and Facilities
  12. Data Driven Management to Improve Maternal Health
  13. The HHS Afgan Experience with EmONC Implementation Science
  14. Accountability on the Frontlines
  15. Innovations in Health Systems Strengthening
  16. Innovations in Integration of MCH Programs with Each Other and with HIV Programs
  17. Atlanta Meeting: Getting It Done for Maternal and Newborn Health, PwC: A Partner in Development