Improving maternal and newborn health is a priority for Ethiopian government policy as we enter the new era of achieving the Sustainable Development Goals by 2030. Launched in 2008, the Saving Newborn Lives project—led by the Ethiopian Ministry of Health’s Health Extension Programme, implemented by Save the Children, and funded by the Bill and Melinda Gates Foundation—is a community-based innovation that works with Health Extension Workers treating neonatal sepsis with antibiotics.
A team based at the London School of Hygiene & Tropical Medicine has studied the critical steps that were taken to help scale up the Saving Newborn Lives neonatal sepsis management innovation, as part of Ethiopia’s flagship Community Based Newborn Care programme with the overall aim of improving maternal and newborn health outcomes. What lessons can our analysis hold for other countries?
1. Keep it simple and robust.
When designing innovations for improving maternal and newborn care, it is vital to consider the challenges of implementation across large and diverse geographical areas. Innovations need to be adaptable to different settings and simple for frontline health workers to use.
Innovations need to be highly cost-effective and affordable, especially when local administrations are constrained by financial and human resources. They must also be closely aligned across the priorities, programmes and infrastructure of the national Ministry of Health, as well as all the regional health administrations where they are being scaled-up.
“It builds on the system, it isn’t parallel to the system.”
2. Collect strong data from the field.
One of our critical findings was that the Saving Newborn Lives implementers generated relevant and robust randomised control trial data that helped the government make informed decisions about where to spend money on innovation at scale.
“What our intervention provided is how effective the intervention was.”
The implementation team also collected qualitative data, documenting stories about what worked and why, as well as estimates on the costs of scaling innovations. These data helped identify which components of the innovations could be used best at scale.
3. Leverage a collective effort.
Working in isolation is not conducive to scaling up innovations in maternal and newborn health. The success of innovation scale-up depends on long term engagement and good working relationships between all the partners. This project was successful because the Ethiopian government had a sense of ownership.
A strong partnership was also developed between the government, the funder of the innovation (the Bill & Melinda Gates Foundation), and development partners – especially UNICEF – together with professional associations such as the Ethiopian Paediatric Society, the Ethiopian Society of Obstetricians and Gynaecologists and the Ethiopian Midwives Association, whose support for the innovation was crucial.
“It’s a collective effort – one agency’s voice would be very thin and low.”
With all these players, the government-led national and regional technical working groups were vital facilitators in the whole process of scaling up.
4. Take advantage of pivotal moments.
The Ethiopian government was initially hesitant to allow Health Extension Workers to administer antibiotics to newborn babies. However, a ‘policy window’ emerged with the publication of a demographic and health survey showing maternal and newborn deaths remained high as well as field visits to other countries where similar innovations were already being trialled successfully.
With lessons learned from implementation, all the factors were in place to support change at the right time in Ethiopia.
5. Position yourself at the table.
Sustainable shifts in policy are rarely the result of pressure from the outside. Even when maternal newborn health was a government priority and the pivotal moment had come about, there was still a need, and some room, for negotiation between all the partners. The ability of the implementing partner to work well with and support the Ethiopian government was vital in this process.
This support came in the form of technical assistance including sharing implementation lessons (both from Ethiopia and elsewhere), together with project resources including health communications and training materials, and also strengthening government capacity, particularly at the sub-national level.
To learn more, read the IDEAS Research Brief, ‘Catalysing scale-up of maternal and newborn health innovations in Ethiopia‘