浪花直播

鈥淲e are seeing increasingly self-reliant countries develop national health sector plans solidly grounded on technical evidence,鈥� said Dr. Jim Ricca of the United States Agency for International Development (USAID)鈥檚 flagship at a recent 浪花直播 Center event. Expanding successful reproductive, maternal, newborn, child, and adolescent healthcare (known as RMNCAH) interventions to the national level could make a significant contribution to meeting the 2030 Sustainable Development Goals for mortality reduction, he said.

Evidence-Based Interventions

To scale up maternal and newborn healthcare, countries need to bolster interventions that have already accumulated 鈥渆nough evidence to get a 鈥榞o鈥� signal from country decision-makers for scale-up efforts, but are not yet part of routine practice,鈥� said Dr. Ricca, such as improving water sources, using the antiseptic , vaccinating against rotavirus, and managing sepsis.

Most likely, these efforts will 鈥渢ake place over years in a complex and not completely predictable environment,鈥� said Dr. Ricca, 鈥渨here critical features of [the] landscape might change, like the political or economic situation.鈥� Therefore, strategic, evidence-based planning is critical for achieving positive, timely, and widespread results.

Local evidence, for example, provided the impetus for successfully , said Dr. Abosede Adeniran, Director of the Child Health Division for Nigeria鈥檚 Federal Ministry of Health. When applied to the umbilical cord, can reduce severe infection by 68 percent and mortality by 23 percent, potentially saving more than 300,000 lives each year.

After the success of 鈥攊n Sokoto and Bauchi鈥攖he Nigerian government launched the . 鈥淲e鈥檝e been able to make some remarkable progress with the federal government providing the strategic direction,鈥� said Dr. Adeniran. 鈥淲e do not want to lose that momentum.鈥�

Sustaining Success

鈥淭here鈥檚 a tendency in this kind of world to focus on the introduction phase of something, and not necessarily on the continuation phase,鈥� said Larry Cooley, President Emeritus of Management Systems International. To sustain impact, efforts to scale-up healthcare must take on a long-term, systemic approach that is particularly sensitive to private-sector incentives. Program designers need to ask: 鈥淲hat鈥檚 the funding necessary to get something on stream? And what鈥檚 the funding necessary to sustain it over time?鈥� said Cooley.

Ideally should also involve a broad spectrum of stakeholders, including those outside the global health sector, said Laura Ghiron, Vice President of Partners in Expanding Health Quality and Access. Programs that partner with external agencies鈥攕uch as the ministry of planning, the ministry of finance, and private sector organizations鈥斺�渉ave a much better chance of moving-ahead in lock-step and having the funds available,鈥� said Ghiron.

To be sure, 鈥渙ne cap does not fit all,鈥� said Dr. Stephen Hodgins, Associate Professor for Global Health at the University of Alberta and Editor-in-Chief of Global Health: Science and Practice. Consequently, 鈥渋t is important to understand the scale-up environment where you're introducing your intervention,鈥� he said.

Dr. Hodgins advocates for a two-tiered. 鈥淪ingle loop learning鈥� involves closely monitoring and evaluating implementation issues鈥攕uch as interruptions in the supply chain鈥攁nd making adjustments when necessary. Whereas, Hodgins explained, 鈥渄ouble loop learning鈥� involves re-examining the underlying assumptions and causal models of a scale-up project to determine if and when a completely new strategy is required.

Country Stories: Rwanda and the Democratic Republic of the Congo

In , the expansion of community case management has dramatically reduced childhood illnesses such as malaria, diarrhea, pneumonia, and malnutrition. Since 2005, the DRC has trained more than 14,000 healthcare professionals on integrated management of these diseases, ultimately affecting more than 10 million people across all 26 provinces, said Dr. Jean Fid猫le Ilunga Mubayi of the DRC鈥檚 Ministry of Health.

鈥淔or the very first time, the national has a specific line dedicated to supporting maternal and child health,鈥� said Dr. Ilunga. Synergistic partnerships are pivotal in achieving and maintaining such positive results, he said. 鈥淪ome [partners] provide support through training and supervision; others help with procurement of drugs and commodities, and others implement supporting programs, such as result-based financing.鈥�

Rwanda implemented by collaborating with technical working groups that specialize in data collection and measurement, said Dr. Jacqueline Umunyana, Senior Program Learning and Scale Up Advisor for MCSP Rwanda. These and other MSCP-supported interventions ultimately expanded into 10 districts and contributed to the steady decrease of birth asphyxia, which had previously been the leading cause of neonatal death in Rwanda.

Where There鈥檚 a Will, There鈥檚 A Way

Despite significant advancements in newborn and maternal health in Nigeria and Rwanda, both Dr. Umunyana and Dr. Ilunga pointed to several issues that need critical attention moving forward, including making healthcare more accessible in remote locations, developing , and at the operational level.

Though many scale-up projects will inevitably encounter shocks and stresses along the way, 鈥渋f you have an adapted learning approach, then you can make things work,鈥� said Dr. Koki Agarwal, MCSP Director. 鈥淥ur country teams have demonstrated that where there鈥檚 a will, there鈥檚 a way,鈥� she said. 鈥淎nd the country examples show us very clearly that they can, and they are.鈥�

Written by Julianne Liebenguth and edited by Meaghan Parker.