<div class="title-block" style="border-bottom-color: #628bb3"><h1><img class="title-image" src="http://www.heart-resources.org/wp-content/themes/heart/images/health.svg">Maternal, Newborn and Child Health</h1><div class="post-type-description"></div></div> – Health and Education Advice and Resource Team http://www.heart-resources.org Providing DFID staff and other development actors with health, education and nutrition knowledge and expertise from around the world Fri, 02 Mar 2018 13:10:49 +0000 en-US hourly 1 https://wordpress.org/?v=4.9.4 Independent Evaluation of the Reduction of Maternal and Neonatal Mortality in Kenya – Formative Evaluation Findings http://www.heart-resources.org/assignment/independent-evaluation-reduction-maternal-neonatal-mortality-kenya-formative-evaluation-findings/ http://www.heart-resources.org/assignment/independent-evaluation-reduction-maternal-neonatal-mortality-kenya-formative-evaluation-findings/#respond Wed, 12 Jul 2017 11:41:55 +0000 http://www.heart-resources.org/?post_type=assignment&p=29800 Read more]]> The Reduction of Maternal and Neonatal Mortality Programme (MNH Programme) in Kenya aims to reduce delays in mothers and newborns receiving good maternity care. The three main problems the programme seeks to address are: 1) delay in decision to seek care; 2) delay in reaching care; and 3) delay in receiving care.

The midterm evaluation documented many positive changes in community attitudes, the use of health services, and in obstetric outcomes in the programme counties. Because of the late start of the MNH Programme, however, these changes could not be directly attributed to programme activities.

The overall MNH Programme approach to improving the quality of maternity care by focusing on the health facilities that provide most of the deliveries is appropriate and efficient. However, it leaves out many smaller health centres that provide a major amount of antenatal care. A further limitation of the MNH Programme has been its predominant focus on public sector health facilities. Support to private and faith-based facilities should be considered.

The close contact of the Maternal and Newborn Initiative (MANI) with county authorities in Bungoma County has resulted in a cohesive operational programme with the ability to introduce interventions efficiently. The mode of delivery differs significantly from that in counties under the UNICEF programme mandate. UNICEF-supported counties are more complex dealing with many different sub-contracted partners which is less successful but more sustainable.

The main needs for health systems strengthening identified by the midterm evaluation in all counties are the development, planning and mobilisation of human resources, the assurance of stable and adequate financing of maternity services, and the provision of appropriate infrastructure.

The midterm evaluation found that the evaluation methodology of documenting changes at county and sub-county level was not appropriate for the programme in Nairobi. Hospitals and health centres are in close proximity, and clients do not seek care within the geographic and political boundaries of their communities. For further evaluation activities, a different approach for Nairobi will be proposed and negotiated.

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Independent Evaluation of the Reduction of Maternal and Neonatal Mortality in Kenya Programme – Project Overview http://www.heart-resources.org/assignment/independent-evaluation-reduction-maternal-neonatal-mortality-kenya-programme/ http://www.heart-resources.org/assignment/independent-evaluation-reduction-maternal-neonatal-mortality-kenya-programme/#respond Wed, 12 Jul 2017 09:59:26 +0000 http://www.heart-resources.org/?post_type=assignment&p=29792 Read more]]> The Reduction of Maternal and Neonatal Mortality in Kenya programme supports a range of interventions to improve maternal and neonatal health (MNH) including training of health workers, health systems strengthening, community mobilisation, and demand generation. It is implemented in six counties with different sociodemographic contexts.

A formal evaluation has been contracted with four components: 1) annual mapping of key data and trends; 2) in-depth comparative studies in matched sub-counties; 3) additional studies to assess specific Programme components and to answer evaluation questions; and 4) comprehensive analysis of the Programme at the start and end of the evaluation phase (2016-18).

Data collected through these four evaluation components will be triangulated. An independent expert group will enforce credibility. Evaluation results will be communicated to Programme partners and stakeholders in 2016 with a view to recommend adjustments of programme activities in order to reach intended outcomes, as and if needed. This synthesis will be repeated towards the end of 2018 in a summative evaluation that will document final programme outcomes and lessons learned.

The first set of findings are reported here.

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Evidence on how to scale up demand-side maternal and newborn health interventions in Zambia http://www.heart-resources.org/blog/evidence-scale-demand-side-maternal-newborn-health-interventions-zambia/ http://www.heart-resources.org/blog/evidence-scale-demand-side-maternal-newborn-health-interventions-zambia/#respond Fri, 09 Dec 2016 10:13:27 +0000 http://www.heart-resources.org/?post_type=blog&p=29709 Read more]]> In order to translate global commitments of ensuring access to sexual and reproductive healthcare services for every woman and every girl into practical, affordable and sustainable interventions, policy makers and implementers need to be able to draw on solid evidence of what does and does not work.

The More Mobilising Access to Maternal Health Services in Zambia programme (MORE MAMaZ), funded by the UK charity Comic Relief (2014-2016), achieved transformational change for women and girls, particularly those who are under-supported at household and community level by successfully scaling up an evidence-based demand-side intervention in support of the Ministry of Health’s safe motherhood policy response.

MORE MAMaZ punched above its weight in so many ways. The health-related results achieved can be seen in this infographic, including institutional delivery rates up at 89% in intervention districts, compared to the national average for rural areas of 56%. There has also been a significant improvement in the proportion of women opting for early antenatal care, which is a key priority of the MOH.

Behind these results lie other gains which are just as important: considerable empowerment-related gains, which will help to position women and girls so that they benefit from other development-related opportunities in the future; a very significant reduction in gender-based violence; and evidence that the most difficult to reach women and girls are being targeted and supported by their communities.

It is also worth noting that the training approach used by the programme helped produce volunteer retention rates of 82% among volunteers trained 4-5 years ago and 95% among volunteers trained two years ago. These rates are much higher than those achieved by many other similar programmes globally.

MORE MAMaZ showcases to a large extent what Health Partners International does best: developing and supporting implementation of practical and sustainable systems-oriented solutions to global health challenges; achieving value for money – MORE MAMaZ achieved more than MAMaZ while working on a considerably larger scale; and forming honest and lasting partnerships with government and consortium partners, while building sustainable local capacity.

We invite you to read the programme’s seven evidence briefs, which showcase the results achieved, and different components of the approach, and other programme materials, including the 8 key messages for policy makers in the health sector, and to share them within your networks. Many of the strategies and approaches developed by the programme and its local partners lend themselves to adaptation for implementation in different contexts.

By Cathy Green, Technical Lead- Community Health Systems, Health Partners International

For more information on how Health Partners International is transforming health systems and the lives of women and girls please visit www.healthpartners-int.co.uk or contact info@healthpartners-int.co.uk.


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Urban Health http://www.heart-resources.org/mmedia/urban-health/ http://www.heart-resources.org/mmedia/urban-health/#respond Tue, 29 Nov 2016 14:54:39 +0000 http://www.heart-resources.org/?post_type=mmedia&p=29705 Read more]]> Dr Helen Elsey is from the Nuffield Centre for International Health and Development, University of Leeds. In this HEART Talks she talks through the urban health HEART reading packs that she has put together with Dr Siddharth Agarwal from the Urban Health Resource Centre in India. The three reading packs are: A) Data and evidence, B) Improving population health – strategies for inter-sectoral action, and C) Interventions and pro-poor service provision.

The world is urbanising. Globally, more people live in urban areas than in rural areas. By 2050, it is expected that 66% of the world’s population will be urbanites. Africa and Asia are urbanising the fastest. By 2050 56% will be urban in Africa and 64% in Asia. There are currently 28 mega-cities (i.e. with a population of 10 million or more). By 2030, the world is projected to have 41 mega-cities. However, the fastest growing urban areas are medium-sized cities and those with less than 1 million inhabitants located in Asia and Africa. UN-Habitat estimates the number of people living in slum conditions is now 863 million; growing from 760 million in 2000 and 650 million in 1990. Cities are at the forefront of ‘disease transition’ with malnutrition and obesity occurring simultaneously. Water and sanitation provision is grossly inadequate in urban slums. Tobacco consumption is a major concern among urban poor men, and increasingly women; a risk factor for both NCDs and TB. There are multi-sector influences on urban health.

Local governments are key to coordinating inter-sectoral action. Donors are increasingly working with local government to strengthen capacity to plan, manage services, link with sector ministries, enforce public health legislation and establish local level governance structures.

There is a need to coordinate health services between local government and health ministries. The urban public health service is woefully inadequate. There has been underinvestment due to years of the perceived ‘urban advantage’. Responsibilities for staff, their training, equipment/drugs, and facilities often fall between the Ministry of Health (MOH) and the Municipality. The poor are left with little option but to use meagre resources on private facilities resulting in high levels of catastrophic health expenditure. There are poor referral mechanisms due to the plethora of NGO and private providers. There is a need for monitoring and enforcement of quality standards among providers and pharmacies. Secondary care is insufficient with maternity hospitals not open all hours and weak services. Tertiary hospitals are overloaded and not easy to access for the poor.

Public Private Partnerships (PPPs)
There are challenges with different forms of PPPs, private for-profit and not-for profit forms. For-profit PPPs have no incentive to reach out to the urban poor. They are not keen to partner for outreach care which is the key to preventative healthcare and the most crucial for urban deprived communities. Non-profit agencies tend to have few resources. Bangladesh’s Urban Primary Healthcare Programme uses partnerships with NGOs, private clinics and government health centres to expand services to slum and vulnerable communities. There are still challenges with monitoring, quality, and referrals between providers which covered in some detail by in the reading packs.

Health promotion
Helping people remain healthy and not in need of health services is a fundamental goal of any urban health strategy. There is a lack of evidence on which health promotion approaches are likely to be effective in changing ‘lifestyle behaviours’ such as tobacco use, diet, and exercise among the urban poor. Encouraging waist measurement, desired diet, physical activity and mental wellbeing at community level; peer education approaches to nutrition, physical activity, and promoting optimal behaviours in schools have shown some success. Community healthworkers (CHWs) have been effective at changing behaviours in Bangladesh, India, and Ethiopia. CHW and slum women’s groups promoting peer-to-peer health promotion shows promise. Mass media through mobile phones, print, radio and television have wide audience reach in urban centres, but it is hard to compete in the cluttered media environment. Instant messaging for skilled birth attendants is more effective in urban areas. There has been increases in zinc treatment awareness following TV, radio, and newspaper media campaign in urban areas.

Water, sanitation and hygiene (WASH)
WASH needs to be promoted in households and schools to improve, health, nutrition and education. The three interventions of the WASH sector (hand-washing, food storage, garbage disposal) – depend on one another for full realisation of their benefits. For example most sanitation systems cannot function without water. School WASH impacts education outcomes, especially for girls. Menstrual hygiene and girl friendly toilets in schools affect school attendance of girls and reproductive tract infections. Hand-washing with soap and water and other personal hygiene practices have the potential to substantially reduce within household transmission of diarrhoea and improve nutrition. Promoting practices such as hand-washing with soap and water, and safe disposal of child faeces benefit health and nutrition and can be incorporated in a wide range of public health strategies at low cost.

Participatory neighbourhood mapping
Participatory mapping has been used in India to expand the reach of urban services. Slum women’s groups use hand drawn maps to ensure that no family is left out from municipal/NGO lists used for housing, sewage systems, toilets, and entitlements. They are also used to track access to health services eg. immunisation, antenatal care,  and delivery. The maps help identify recent migrants for linkage to services and entitlements. Gentle negotiation is occurring through collective petitions. Inclusive urbanisation requires disadvantaged communities to actively participate in governance.

Healthy places
Pressure from real estate developers, poor governance and corruption undermines local government’s role in controlling urban development to keep healthy places within the city. Access to green spaces reduces mental illness and has been shown to reduce inequities in cardio vascular disease and all-cause mortality in high income countries. Green spaces are rarely considered in controlled and uncontrolled expansion of urban areas. Urban agriculture can make an important contribution to household food security, especially in times of food crisis or food shortages. This needs support and regulation so food is grown in healthy environments.

Health and safe places for children
Urban poor women are more likely to work outside the home than other women in urban or rural settings. Working outside the home provides opportunities to improve income and increase self-esteem and gender equity. However, there is a lack of childcare and supervision for children. This could be solved with early childhood development opportunities. An NGO mobile crèche run day care centres in partnership with government’s National Creche scheme and with support funding agencies in India. Day care centres operate in coordination with builders and contractors near construction sites.

Transport and communications
10 billion trips are made every day in urban centres around the world. An increasing proportion of urban trips are using high carbon and energy-intensive private motorised vehicles. The urban poorest are disproportionately affected by key negative externalities generated by transport, including road accidents, air pollution and displacement when transport developments are occuring. Regulation to improve road safety can make a substantial difference to accidents. For example regulation of ‘matatus’ (mini-buses) in Kenya was introduced where drivers had to increase their driving and safety skills. This legislation resulted in a 73% reduction in accidents. Keeping cities compact, with opportunities for walking, cycling and public transport reduces emissions and support public health.

All of these issues and more are covered in the reading packs which point out key resources.

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Health responses to humanitarian crises http://www.heart-resources.org/mmedia/chris-lewis-presentation-health-responses-humanitarian-crises/ http://www.heart-resources.org/mmedia/chris-lewis-presentation-health-responses-humanitarian-crises/#respond Mon, 24 Oct 2016 17:29:53 +0000 http://www.heart-resources.org/?post_type=mmedia&p=29457 Read more]]> This HEART Talks is a presentation from a humanitarian health seminar held at DFID 29th July 2016. In the video below DFID health adviser Chris Lewis talks about two of the HEART reading packs. The first is Health Responses to Humanitarian Crises and the second is Humanitarian Overview From Principles to Coordination.

Humanitarian crises are important as they contribute to 60% of all preventable maternal deaths. They also contribute to 53% of under 5 deaths, as well as 45% of neonatal deaths. The most common causes of mortality in emergencies are pneumonia, diarrhoea and malaria. As well as the initial response  to a crisis, it is important to consider the long-term impacts. Water borne diseases tend to emerge a week or two after a crisis. Vector borne diseases emerge after one or two months. In the video, Chris summarises the impact of crises on health systems.

Different types of monitoring are required for different post-crisis periods. Chris outlines how the initial assessment should be carried out in the first 72 hours. In weeks one to two field assessments shout be carried, and from week three onwards more health specific assessments should be conducted. Details of health assessment methods for each health topic are available in the reading pack. Key response activities for different diseases and health areas are presented.

Chris states that it is important to be aware of the opportunities for health system reform. The end of a crisis may be an opportunity to implement effective reform. Chris outlines the principles and conventions that exist within humanitarian response, which one of the reading packs is about. There are 11 clusters in the humanitarian system to be aware of. They have different roles and responsibilities that are outlined in the pack.

WHO global health cluster update

A recent WHO global health cluster update describes areas of crisis response planning that still require attention. More thought must be given to coordination efforts across the different support mechanisms. Chris describes humanitarian response as a continuum from humanitarian relief to sustainable development. Humanitarian advisers must consider the opportunities to strengthen health systems after a crisis.

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Fiscal space analysis in Sierra Leone: the free health care initiative and universal health coverage http://www.heart-resources.org/assignment/fiscal-space-analysis-sierra-leone-free-health-care-initiative-universal-health-coverage/ http://www.heart-resources.org/assignment/fiscal-space-analysis-sierra-leone-free-health-care-initiative-universal-health-coverage/#respond Mon, 17 Oct 2016 09:49:07 +0000 http://www.heart-resources.org/?post_type=assignment&p=29448 Read more]]> This brief highlights how Sierra Leone can improve the sustainability of the free health care initiative (FHCI) financing, lower household out-of-pocket (OOP) payments on health care, and decrease its dependence on donors. A secondary analysis provides insights into how Sierra Leone could work towards achieving its longer-term health goal of Universal Health Coverage (UHC).

If Sierra Leone’s FHCI and UHC policies continue as they are, both areas will be increasingly underfunded within ten years. Neither the economy, nor the tax base, is projected to be strong enough to create the fiscal space to invest as needed in health if current policies are sustained. With a reprioritised focus on the FHCI financing policy, the resource gap can be closed.

The most effective domestic financing mechanism is government spending, whether purely budgetary or health insurance allocations. The continuation of external donor support is essential to continue to deliver FHCI and UHC services in an effective manner throughout the country. The government needs to improve Public Financial Management (PFM) in the health sector in order to increase the confidence of donors.


For other reports in this series on Sierra Leone’s Free Health Care Initiative, see:

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Monitoring and evaluation in Sierra Leone’s health sector http://www.heart-resources.org/assignment/monitoring-evaluation-sierra-leones-health-sector/ http://www.heart-resources.org/assignment/monitoring-evaluation-sierra-leones-health-sector/#respond Mon, 17 Oct 2016 09:43:59 +0000 http://www.heart-resources.org/?post_type=assignment&p=29444 Read more]]> As part of the review of Sierra Leone’s Free Health Care Initiative (FHCI), researchers assessed its monitoring and evaluation (M&E) system, strengths and weaknesses, and the changes that took place as a result of the FHCI.

This brief notes that a strong M&E system is crucial to help improve performance and achieve results. Several key points were identified as part of the review to strengthen health sector M&E processes. These include: consulting key data users to clarify what information should be collected and how frequently, and using this as the basis to develop a new M&E strategy; improving the quality and coherence of the various health data sources, especially for maternal mortality; increasing the publication and dissemination of health data analysis in user-friendly formats; strengthening the demand for and use of health information particularly through health sector reviews and accountability processes.

For other reports in this series on Sierra Leone’s Free Health Care Initiative, see:

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The free health care initiative (FHCI) in Sierra Leone: real gains for mothers and young children http://www.heart-resources.org/assignment/free-health-care-initiative-fhci-sierra-leone-real-gains-mothers-young-children/ http://www.heart-resources.org/assignment/free-health-care-initiative-fhci-sierra-leone-real-gains-mothers-young-children/#respond Mon, 17 Oct 2016 09:38:23 +0000 http://www.heart-resources.org/?post_type=assignment&p=29439 Read more]]> In 2010, the Free Health Care Initiative (FHCI) abolished health user fees for pregnant women, lactating mothers and children under five. This was a response to very high mortality and morbidity levels among mothers and children and reports that financial costs were a major barrier to health service uptake and use by these groups.

This brief highlights that FHCI triggered some real gains in the health system such as revitalised structures for sector governance; increased staffing; and better systems for staff management and pay, and for getting funds to the facilities. New monitoring and evaluation systems were introduced and facility audits conducted; infrastructure improved from a very weak starting point; and a communication campaign was initiated with resulting high population awareness.

Further, more financial resources led to a prioritisation of maternal and child health programmes and to some degree a switch from household to donor spending. Household spending as a proportion of total health expenditure went from 83 per cent in 2007 to 62 per cent in 2013. Donor funding went from a low of 12 per cent in 2007 to a high of 32 per cent in 2013.


For other reports in this series on Sierra Leone’s Free Health Care Initiative, see:

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Sierra Leone’s free health care initiative: financing implications http://www.heart-resources.org/assignment/sierra-leones-free-health-care-initiative-financing-implications/ http://www.heart-resources.org/assignment/sierra-leones-free-health-care-initiative-financing-implications/#respond Mon, 17 Oct 2016 09:33:22 +0000 http://www.heart-resources.org/?post_type=assignment&p=29436 Read more]]> In 2010, the Government of Sierra Leone (GoSL) took steps towards establishing the Free Health Care Initiative (FHCI). At its core, this was the removal of user fees (on drugs and consultations) for pregnant women, lactating mothers and children under five.

This brief is based on an independent review of FHCI completed in 2016, which looked at financing changes following the initiative’s launch, and focuses on the pre-Ebola outbreak years (2010-2013). It outlines how financing flows changed, and highlights some of the major strengths and weaknesses in resourcing the initiative.

In putting forth several recommendations, the brief notes, that the government should prepare a health financing strategy which outlines: a plan for future donor expenditure; a plan for increasing pre-financed domestic expenditure on health; a plan for improving the efficiency of existing expenditure on health; and a set of solutions that help align and coordinate government and donor funding.


For other reports in this series on Sierra Leone’s Free Health Care Initiative, see:

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Quality of maternal and newborn services – a learning resource for thinking and action http://www.heart-resources.org/announcements/quality-maternal-newborn-services-learning-resource-thinking-action/ http://www.heart-resources.org/announcements/quality-maternal-newborn-services-learning-resource-thinking-action/#respond Mon, 11 Jul 2016 08:33:48 +0000 http://www.heart-resources.org/?post_type=announcements&p=29231 Read more]]> This freely accessible online learning resource produced by HEART provides an overview of the key issues in relation to quality of services (QoS) for maternal and newborn health (MNH), and signposts key resources for further reading. Originally designed for the cadre of Health Advisers at DFID, it has been adapted to suit a broad range of actors involved in strengthening policy and programming interventions.

The learning resource:

  • includes sections of a broad range of issues, including in relation to: why quality matters; what the burden of global MNH is; how quality is defined and modelled; what the key quality improvement strategies are; and how to best measure quality and quality improvement trends.
  • provides interactive maps and data visualisations drawing on up-to-date data sources on which researchers, policy-makers, and practitioners can draw on for their own learning about available data.
  • summarises a series of seminars delivered for DFID staff and email updates providing timely summaries of topical issues related to QoS.
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