Concern Worldwide and John Snow, Inc. (JSI) hosted a forum this month in Washington, D.C. to spotlight new and promising innovations and strategies to improve the health and survival of women and children. Think Differently: Fresh Evidence on Innovations for Healthy Women, Newborns and Children marked the culmination of Concern Worldwide’s Innovations for Maternal, Newborn & Child Health. This eight-year initiative, funded by the Bill & Melinda Gates Foundation, launched nine pilots in Africa and South Asia. With the goal of collectively advancing the field, Concern Worldwide and JSI revealed evidence, experiences and lessons learned, as did other experts working on the frontlines of delivery and design from Save the Children, PSI, PATH, FHI 360 and Philips, Jhpiego and USAID.
Here are some insights from the forum:
“Innovations are not standard,” said Soumya Alva, senior evaluation advisor with JSI. “So we needed to be creative about how we measured things. We couldn’t be passive observers and wait until the very end.”
In evaluating Concern Worldwide’s Innovations pilots, JSI repeatedly collected both quantitative and qualitative data, interviewing pregnant women, health workers and government officials, and shared its analysis along the way to see if changes in implementation were needed. “This was a more comprehensive approach than what is customary,” Alva said.
One example was a smartphone app called CHN on the Go for frontline nurses in Ghana. JSI and Concern agreed that the needs of the nurses’ supervisors should be probed more in-depth; JSI gathered additional data and an app was created for them. “There was an adjustment process that went on more than once,” Alva said.
Walk in your users’ shoes
For CHN on the Go, Ledia Andrawes of the design firm ThinkPlace said she walked with the community health nurses, known as CHNS, on their arduous routes to bring care to mothers and babies. Learning about their daily challenges, including experiencing sexual harassment, snakebites and isolation, reframed her understanding of their problems. Interviews and focus groups that solicited their stories further deepened the empathy of the implementers and designers, who co-created the app with the nurses, using human-centered design thinking.
Similarly, in designing a program with the users to increase teen uptake of contraceptives in three African counties, PSI focused intently on understanding the girls, said Beth Skorochod, PSI’s social and behavior change senior advisor. “It’s really important to get the stories, emotions, feelings of the teens to supplement the research,” she said. “Design thinking forces you to go in solution-agnostic,” she added. “It has been game-changing for PSI.”
Anne LaFond, Director of JSI’s Center for Health Information, Monitoring & Evaluation, described her work exploring how design thinking has influenced the Innovations pilots’ fit, uptake and buy-in. She said CHN on the Go’s fit was positively influenced by design thinking, resulting in implementation with a much higher commitment to iteration.
Put the community in the driver’s seat
Take advantage of a community’s “huge pool of ‘social capital,’” said Eric Sarriot, senior health systems advisor at Save the Children, by engaging community members to improve health outcomes. After all, he said, they’re trusted by the community and are extremely motivated to prevent mother and child deaths.
That point was amplified by Concern Worldwide’s research director Jean Christophe Fotso, who shared results from Concern’s program in Sierra Leone that harnesses the community’s trust of former traditional birth attendants to help mothers access health care.
The program, Essential Newborn Care Corps, trained these senior women who used to assist home births to instead go door-to-door educating women about healthy childbirth, selling health products and linking them to health centers for care and delivery. And it’s working, Fotso said, with an increase in antenatal care visits, facility deliveries, postnatal care and breastfeeding initiation. “They’re so committed,” he added, “that not a single one has dropped out.”
Tapping social capital must also include teens, especially for maternal and newborn health programs, said Donna McCarraher, FHI 360’s Director of Reproductive, Maternal, Newborn and Child Health Division.
Stress process not just product
Adoption and scale-up requires focusing not only on the product itself, but also on the process. Patricia Coffey, PATH’s Program Advisor for Health Technologies for Women and Children, and Koki Agarwal, Director of USAID’s Maternal and Child Survival Program, emphasized the importance of planning for scale from the start and throughout the entire cycle.
Another essential ingredient for sustainability and scale is cross-sector collaboration, said Will Center, Director of International Funding Organizations with Philips. He noted a “remarkable convergence” of priorities between the world of non-governmental organizations and corporations like Philips that serve developing markets.
Invest in innovation
As we in global health continue to advance ambitious goals around halting preventable mother and child deaths, “we won’t achieve them unless we keep investing in innovations,” Wendy Taylor, Director of USAID’s Center for Accelerating Innovation and Impact, said in closing remarks. “I’m confident that if we double down, think differently, and continue to learn and be on the front end of the curve with how we scale innovations, we will continue to accelerate impact.”
Read more about Concern Worldwide’s work to improve global maternal health
Learn about other mhealth innovations for maternal health.