MHTF at EngenderHealth

2008 to 2011

From 2008 to 2011, the MHTF was based at EngenderHealth. During this period, the MHTF provided small grants to projects based on the following criteria:

1. Identify and fill knowledge gaps
   
   A wide range of questions identified by MHTF partners have been addressed in the projects we have supported, including: What are the barriers to the implementation of evidence-based practices in maternal health care according to front line health workers? Can recently delivered women provide information on the indications for their cesarean sections? What is the economic impact of maternal morbidity on households?
2. Provide opportunities for debate and consensus building
   
   In collaboration with prominent partners, the MHTF has convened a series public dialogues with experts on neglected and emerging maternal health issues in Washington DC and Nairobi, small technical meetings on everything from budget monitoring to indicator measurement, and the Global Maternal Health Conference in 2010 brought together over 700 researchers, policy-makers and advocates in New Delhi.
3. Stimulate new thinking and new approaches
   
   The MHTF has supported a range of innovative models for improving maternal health care such as a new business model for high quality affordable private sector maternal health care in urban slums; adapted SIM card applications for community and district health workers to track ante-natal care and provide referrals for EMOC; and the integration of maternal health concerns into disaster risk reduction and emergency preparedness policies

Below are short descriptions of the many small grants that the MHTF made during its time at EngenderHealth.

Ashoka
Young Champions of Maternal Health

The MHTF and Ashoka partnered to create an innovative new program that charts the future of the maternal health field. The Young Champions of Maternal Health Program was the first-ever international fellowship dedicated exclusively to grooming a new generation of maternal health leaders. The Young Champions, selected through Ashoka’s Changemakers online competition and a rigorous interview process, hailed from 13 countries—including India, Ethiopia and Nigeria, countries with high maternal mortality rates. The 15 young people selected spent 9 months abroad working with and were mentored by an Ashoka Fellow with expertise in maternal health or a related field – social entrepreneurs with proven track records in providing system-changing solutions that address the world’s most urgent development challenges.

To learn more about the project, read the ebook, In Their Own Words: The Young Champions of Maternal Health, written by the Young Champions and Ashoka.

BRAC
BRAC-Click m-Health Project

The BRAC–Click mHealth Project was a unique public-private partnership between BRAC and ClickDiagnostics Inc, a global mhealth pioneer, to build an innovative information and communication technologies (ICT) platform and expand the scope and impact of the existing, highly functional Manoshi Project started and implemented by BRAC. With support from the MHTF and other donors, the BRAC–Click mHealth Project was a model in which community health workers used new and existing ICT to gather real time information about pregnant women and neonates, and provide targeted interventions. It remodeled the patient management and care system; expanded monitoring and reporting processes; and implemented an emergency management system that included a single hotline tagged with ambulance and blood donation services.

Centre for Development and Population Activities
Working on Integration Issues of HIV/AIDS and Maternal Health

Centre for Development and Population Activities (CEDPA) reviewed and compiled information on programs and policies that integrate HIV/AIDS and maternal health in India. From the information collected, CEDPA developed a collection of best practices for projects that integrate the two intertwined health issues. These best practices in turn informed recommendations and strategies for policy makers and program staff.

For more information on the project, read CEDPA’s blog posts.

Click here to read the (pdf) MH-HIV Integration Desk Review.

The Mexican Ministry of Health manages obstetric emergencies in Oaxaca province through the Advanced Life Support for Obstetrics Program (ALSO). Centro de Investigaciones y Estudios Superiores en Antropología Social (CIESAS) conducted an assessment of the program and determined whether ALSO’s education and training improved the technical skills of health care providers before the government decides to scale up the ALSO program to the national level.

For more information on the project, read CIESAS’ blog posts  and view a (pdf) presentation from the American Public Health Association annual meeting.

Future Generations
Using Pregnancy Histories to Help Mothers

Future Generations worked with the Peruvian Ministry of Health to field test a method of reducing maternal and newborn mortality through organizing groups of pregnant women to share their pregnancy histories and experiences. Health workers guided discussions, documented benefits and developed materials that may be adopted at the national level. Sixty-three “Women Leaders” were selected from highland Andean communities and were trained to provide guidance to their pregnant peers.

Futures Institute
Maternal Health Content of the DHS Core Questionnaires

The MHTF hosted a 13-day online forum to gather a coordinated set of comments and recommendations for the Demographic and Health Surveys (DHS) core questionnaires for the current round of surveys. The Futures Institute provided background material for the forum as well as ongoing forum monitoring and facilitation. After the forum closed, the Futures Institute summarized the (pdf) comments and recommendations, consulted with the MHTF and sent the (pdf) information to the DHS for review. The newly revised DHS core questionnaires are available here.

Global Health Visions
U.S. Maternal Health Donors: A Landscape Analysis

Insufficient funding for maternal health has been identified as a major obstacle in achieving MDG5. To address this issue, the MHTF commissioned Global Heath Visions to conduct a landscaping of all the existing and potential maternal health donors based in the US. Some experts have called for a new maternal health donor affinity group, and this landscaping explored that feasibility. As global advocacy and activism for improved maternal health outcomes accelerates, so should funding. But this report found that is not the case, at least in the US. Further explorations into non-US funding for maternal health might yield more encouraging results. The report of the GHV landscaping exercise is found here, along with some annexes that identity specific activities and portfolios of current and potential MH donors.

Harvard Medical School
Feasibility Study of the Implementation of a Preeclampsia and Eclampsia Maternal Health Checklist

The purpose of this project was to develop a novel Preeclampsia and Eclampsia Checklist, study the feasibility of implementing the checklist along with health services organizational changes in the context of a quality improvement program, and assess its impact on the delivery of best practices on maternal and newborn care around the time of childbirth in the Dominican Republic. The project was conducted in collaboration with the National Center for Research on Maternal and Child Health of the Dominican Republic, and the Department of Maternal and Child Health of the Ministry of Public Health and Social Assistance of the Dominican Republic.

Ifakara Health Institute
Using Cell Phones for Obstetric Emergencies

Ifakara Health Institute (IHI) aimed to improve emergency care for pregnant women and newborns in Tanzania by providing free mobile phones and service for mid-level health care providers to enable better communication with senior medical staff at district headquarters. Cooperating with district councils and ZAIN, a mobile telephone company, IHI evaluated the cost, feasibility and implementation issues that arise if health workers at the district level have better access to long-distance counseling, faster referrals and resupply service, and emergency clinical support.

For more information on the project, read IHI’s blog posts.

International Centre for Diarrhoeal Disease Research, Bangladesh
Knowledge Sharing and Knowledge Translation

International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) translated new and existing knowledge about maternal health into proposals for change in government policy and practice in Bangladesh. The ICDDR,B team also finalized a knowledge translation curriculum which was implemented with ICDDR,B researchers. These researchers took the knowledge translation course, wrote their own knowledge translation brief and learned to enhance their communication with policy makers.

For more information on the project, read ICDDR,B’s blog posts.

Jacaranda Health
A New Approach for Maternity Care

Jacaranda Health is an award-winning innovative business model for private-sector maternity care in peri-urban areas of East Africa. It was designed by and for women of childbearing age living in poor urban areas in and around Nairobi. The MHTF supported a business model that successfully integrated evidence-based interventions into a sustainable fee-for-service model using dedicated mhealth applications for counseling, savings and monitoring. Jacaranda Health’s goal is to improve maternal and perinatal outcomes among the urban poor by increasing uptake of maternal health services, reducing costs and dramatically improving the quality of care to which women have access.

MaiMwana
Community Based Maternal Death Review

MaiMwana piloted a project to strengthen the current Maternal Death Review system through a village-level program of maternal death audits. In each village of the program area, a verbal autopsy (structured interview) took place with relatives and neighbors within two weeks of every maternal death. MaiMwana identifed more maternal deaths than originally projected as it uncovered ‘silent deaths.’ The improved data allowed for deeper analysis of maternal deaths in Malawi and allowed MaiMwana to make recommendations to the Ministry of Health for a national audit procedure.

For more information on the project, read MaiMwana’s blog posts.

Medic Mobile
HealthChat, PatientView, and Medic Dashboard: Mobile Tools for Maternal Health

In late 2008, Medic Mobile recognized a demand for software, hardware, implementation strategies and impact analysis in mobile health. Their objective is to simplify technology, liberate talent, scale tools that work now and embrace the trends of the future. By eliminating barriers to entry for these tools, Medic Mobile’s aim is to create efficient, connected healthcare systems caring for healthier populations. The MHTF funded Medic Mobile to create three mobile tools that will improve maternal healthcare. HealthChat is a SIM toolkit providing decision support and supply chain monitoring for community health workers and was shipped to the field for use. PatientView is a lightweight patient records system that includes patient flags and was evaluated through randomized control trials in India and Ethiopia. Finally, Medic Dashboard is a web-based platform used to aggregate and visualize large quantities of data that has been successfully used even in settings with unreliable internet connections.

mothers2mothers
Using Cell Phones in PMTCT

mothers2mothers (m2m) strives to enhance the delivery and effectiveness of prevention of mother to child transmission of HIV (PMTCT) services. However, client drop-off throughout the PMTCT care continuum undermines effective uptake of and adherence to key PMTCT and maternal and infant follow-up services. With support from the MHTF, m2m explored the concept of Active Client Follow-Up, an intervention designed to follow up m2m clients who have defaulted on key PMTCT services, encouraging them to return to, and remain in, care.

For more information on the project, read mothers2mothers’ blog posts.

University of North Carolina
Systems for Evidence-based Guidance on Maternal and Perinatal Health

The MHTF supported a collaborative project between the University of North Carolina at Chapel Hill and the World Health Organization. The project took the first steps in establishing a science-driven system for continuously updated guidance on evidence-based practices in maternal and perinatal health. The system included identifying gaps in evidence, generating research and funding for filling those gaps, and detailing the evidence to provide up-to-date recommendations. A “family” of researchers, practitioners, donors and implementing agencies were assembled to participate in and oversee the process. Expert group meetings were held to develop a detailed strategy for creating and maintaining the new guidance system.

University of Oxford
Global Voices for Maternal Health

With support from the MHTF, researchers at the Nuffield Department of Obstetrics & Gynaecology at Oxford University conducted an online ‘crowd sourcing’ exercise among nearly 1500 maternal health providers in developing countries to document barriers to implementing safe, effective and affordable interventions. The researchers prepared and widely distributed a short paper summarizing the most effective interventions for the five most important causes of severe maternal morbidity and mortality (eclampsia/pre-eclampsia; post-partum hemorrhage; obstructed labor, unsafe abortion and sepsis.) The main barriers identified were: the inadequate availability, content and enforcement of clinical guidelines; inadequate pre-service and in-service training; lack of authorization for certain procedures; lack of specific resources; staff preference for less effective practices, as well as the cost of treatment for patients.

In their survey, the Oxford researchers confirmed the poor implementation rates of many interventions recommended for severe obstetric complications. Only 42% of key interventions were classified as having ‘medium’ or ‘high’ coverage. Across all regions, almost 50% of pregnant women attending birthing facilities may not have access to emergency interventions such as blood transfusions or to preventative measures such screening for preeclampsia or post-termination of pregnancy contraception. Other underutilized emergency procedures include assisted vaginal delivery and Caesarean section for prolonged/obstructed labour. In addition, there is an alarming pattern of poor coverage of many low-tech interventions, such as simple clean delivery practices, which are feasible even in the context of low-income settings.

As far as we are aware, this is the first time that crowdsourcing technology has been applied to health services research. Although the methodology has been widely used in the commercial and political sectors, and to some extent in academic research, its potential in clinical medicine and public health has yet to be fully explored. This study ccould mark the beginning of the permanent inclusion of direct healthcare providers in the decision-making process at all levels of the health service. The technology is already available for such direct participation. This strong message from the direct providers must be taken very seriously; without addressing the current ‘disconnect’ between decision makers and frontline healthcare staff, it is unlikely that further progress will be made.

For more information on the project, read a blog post about Global Voices.

Partnership for Maternal Newborn and Child Health
Mapping of Knowledge Resources in Maternal Health

Under its three-year strategic framework, the Partnership for Maternal, Newborn and Child Health (PMNCH) is building a state-of-the-art knowledge management system for the maternal-newborn-child health continuum, and the MHTF supported the mapping of knowledge resources for the maternal health component. Conducted by Management Sciences for Health (MSH), the comprehensive map was the result of extensive electronic searches, focus group analyses, email surveys and individual interviews. MSH also provided recommendations on creating a knowledge management system that responds to the needs of relevant stakeholders. The Partnership and the MHTF will integrate this information into their respective management systems to ensure maximum value to users.

Population Action International
Integrating Maternal Health Supplies into the Reproductive Health Supplies Coalition

The MHTF supported Population Action International (PAI) to apply the lessons learned from the reproductive health supplies movement to the maternal health field in order to ensure that women throughout the world have access to all the reproductive and maternal health supplies they need. PAI facilitated the inclusion and engagement of maternal health groups as active members of the Reproductive Health Supplies Coalition (RHSC), promoted the adoption of maternal health supplies as a priority issue of the RHSC, and promoted the adoption of the supply issue into maternal health organizations’ technical and advocacy priorities. Two critical outputs from this project were: 1) a report of two country case studies that highlight supplies needed beyond contraceptives, 2) a fact sheet, checklist or toolkit on maternal health supplies that can be used with policy makers and partners.

PAI also convened a group of key stakeholders from the maternal and reproductive health communities. PAI facilitated draft recommendations to increase access to maternal health supplies, with an eye toward leveraging national, regional and global level commitments to reduce maternal mortality.

Click here for Roy Jacobstein’s blog post that presents his observations on the “Linking Reproductive and Maternal Health Supplies” meeting at PAI held in December 2009.

For more information, check out the report of Maternal Health Supplies in (pdf) Uganda and (pdf) Bangladesh.

Public Health Foundation of India
Quality Roadmap for Institutional Births in India

Public Health Foundation of India (PHFI) has recognized that poor quality of care may act as an obstacle to women considering institutional births. In order to address quality of care issues, PHFI produced a roadmap for improving quality of care at delivery. This roadmap consists of a Quality Assessment Package, which includes a “menu” of options for interventions, as well as a decision guide to assist policy makers in their choice of interventions. Through this initiative supported by the MHTF, PHFI hoped to embed quality improvement interventions at the facility level throughout the Indian health system. A list of indicators for the roadmap was developed and translated into Hindi for piloting in two districts in Uttar Pradesh to determine its feasibility, usefulness and acceptability as a tool for health care workers.

Rajarata University Department of Community Medicine
Measuring Economic Impact of Maternal Morbidity

The Department of Community Medicine at Rajarata University aimed to improve available data on maternal death and morbidity through an adapted IMMPACT toolkit productivity questionnaire through field tests throughout Sri Lanka. With MHTF support, the team collected data on the prevalence of post-partum depression in two-thirds of Sri Lanka’s districts while training field teams of medical students in data collections methods. Their leading paper from this project, “Productivity Loss Due to Maternal Ill Health,” was accepted for publication in summer 2012 in PLoS One. Papers on prevalence and screening of gestational diabetes and prevalence of post partum depression have been published in the Ceylon Medical Journal.

For more information on the project, read the Department of Community Medicine’s blog posts.

Research Triangle Institute

(in collaboration with the Global Alliance for the Prevention of Prematurity and Stillbirth, Global Network for Women’s and Children’s Health, Harvard School of Public Health, and the MHTF)

Pilot Study of an Indicator to Measure Intrapartum Stillbirth and Immediate Neonatal Death. The Intrapartum Stillbirth and Early Neonatal Death Indicator (ISINDI) was intended to monitor improvements in the quality of obstetric and newborn care provided at birth by skilled attendants in health facilities. As it is currently defined, ISINDI was constructed with (1) a numerator comprising the sum of intrapartum stillbirths (with fetal heart beats perceived at admission in labor ward) and very early newborn death (within the first 24 hours of life) (all above 2,500 grams) in a given facility in a given year; and (2) a denominator comprising all births (above 2,500 grams) in the same facility. The objectives of this pilot study in 4-5 hospitals were: 1) to develop and evaluate a practical and feasible method for prospective, standardized measurement of intrapartum stillbirth and immediate neonatal death rates at health facilities performing deliveries on a routine basis; 2) to refine the indicator by analyzing its components; 3) to assess the potential cost (both human and financial) and acceptability of monitoring the indicator routinely.

Stanton-Hill Research and Harvard Medical School
Validating Women’s Self Reports of Indications for Caesarean Delivery

Currently, cesarean delivery is the only surgery for which we have nearly global population-based data. This is thanks primarily to the Demographic and Health Surveys (DHS) and UNICEF’s Multiple Indicator Clusters Survey (MICS). However, few surveys of reproductive aged women in low income countries have incorporated questions related to cesarean that go beyond mode of delivery. Given that routine health information will not be sufficiently available for years into the future, it is likely that large-scale surveys will continue to be conducted and may be able to provide an invaluable source of valid information on cesarean delivery. This study aimed to validate self-reported data on the classification of cesarean deliveries among women delivering in Korle Bu Teaching Hospital in Ghana and Altagracia Maternity Hospital in the Dominican Republic, using two different approaches.

White Ribbon Alliance
The Maternal Mortality Campaign

The White Ribbon Alliance’s Global Patron, Sarah Brown, founded a global Maternal Mortality Campaign with the support of a wide range of actors within the maternal health community. With general support from the MHTF and others, the Maternal Mortality Campaign aimed to establish and deliver an advocacy initiative that will contribute to significantly increasing funding for maternal and newborn health and mortality, by involving powerful advocacy voices not traditionally associated with maternal heath and new, influential supporters. Developing country advocates and their campaigns were engaged with their international counterparts and a unified global campaign will influence policy and funding decisions made at key gatherings of the G20, European Union, African Union and United Nations.

Women Deliver
Mapping Maternal Health Organizations in Six Priority Countries

By tapping their network of over 8000 members and stakeholders, Women Deliver mapped nearly 1,500 organizations working on maternal health in a number of priority countries, including India, Brazil, Nigeria, Pakistan, Peru, Ghana and Indonesia. The interactive map resides on the MHTF website where users are able to provide more details about each organization, add new organizations and download existing information for a variety of uses. The MHTF expanded this mapping exercise to cover additional high-burden countries identified by Countdown to 2015 so that users and observers can easily learn who is working on various aspects of maternal health, where they are located and where there are gaps in maternal health services.

To learn more about the project and Women Deliver, read updates on the MHTF blog.

Women’s Refugee Commission
Promoting the Minimum Initial Services Package for Reproductive Health in Disaster Risk Reduction

With the documented increase in natural disasters as a result of climate change, international policy makers have turned their attention to creating disaster risk reduction and emergency preparedness policies. However, interventions in post-disaster relief efforts notoriously neglect women’s reproductive health. With funding from the MHTF, the Women’s Refugee Commission (WRC) advocated for global policies on disaster risk reduction that include maternal and reproductive healthcare and worked at the country-level with government ministries and first responders to design disaster risk reduction plans that include activities known to reduce maternal mortality and promote access and quality reproductive healthcare. Using their expert Minimum Initial Services Package for Reproductive Health in Disaster Risk Reduction, the WRC met with and provided technical assistance to key global and regional disaster risk reduction and natural disaster policy-making bodies, focusing their technical assistance and training efforts in northern Uganda and southern Sudan where the needs are greatest and where the WRC has already established relationships with country officials.

As a founding member, the WRC coordinated the International Secretariat of Disaster Reduction Reproductive Health sub-working Group; and collaborate to develop and promote global policy and guidance on reproductive health and disaster risk reduction and emergency preparedness. The WRC also developed monitoring and evaluation criteria on incorporating reproductive health into health mitigation and preparedness activities, while also publishing a report containing lessons learned and best practices on reproductive health in emergency preparedness efforts in South Sudan, Uganda, Haiti, the Philippines and Indonesia.