“Have you ever been surprised when you get to the maternal and newborn sector and you find that you don’t really have any field based, sanctioned, global guidance on measurement?”
It was with this pointed fact that John Grove, Deputy Director for Evidence and Policy at the Bill & Melinda Gates Foundation (BMGF) opened the satellite session organized by the IDEAS project at the Fourth Global Symposium on Health Systems Research in November 2016.
IDEAS, a project based at the London School of Hygiene & Tropical Medicine, aims to improve the health and survival of mothers and babies by generating evidence to inform maternal and newborn health policy and practice. In collaboration with partners in Nigeria, Ethiopia and India, the IDEAS team focus on actionable measurement for change and take an independent evaluation approach to answer a series of questions about the BMGF’s Maternal and Newborn Health Strategy. The packed satellite session titled “Measurement, learning and evaluation for maternal and newborn health” provided an opportunity for the IDEAS team to share their key findings and highlight the importance of learning for maternal and newborn health innovation.
Describing the intervention
IDEAS’ Krystyna Makowiecka started the session with the simple assertion that the first step in actionable measurement is describing the intervention, a process called “characterization.” Krystyna summarized IDEAS’ experience with characterization in Northeastern Nigeria. She emphasized the need for researchers, project implementers, funders and policymakers to be clear and purposeful in describing the intended outcomes of an intervention and what change is expected to occur.
Understanding the mechanisms
Building on Krystyna’s analysis, IDEAS’ Tanya Marchant turned everyone’s attention to the magnitude and mechanisms of change. When measuring change in targeted outcomes, understanding why changes did or did not occur is essential.
Take the example of postnatal care in Ethiopia: Frequent high quality contacts between families and frontline workers are critical to ensuring that every woman and every child receive the interventions they need, and between 2012 and 2015 some positive changes were observed. Yet the demand for high quality services was not satisfied equally across the continuum of care from pregnancy through the postpartum period. Exploring the mechanisms of change revealed issues around equity, motivation and social norms as key barriers.
“System ready” scale-up
The second half of the session focused on how to scale-up successful maternal and newborn health innovations. Neil Spicer’s presentation focused on how and why scale-up happens. He outlined a set of six critical actions for donors and implementers in scaling-up maternal and newborn innovations.
Six critical actions for implementers include:
– Building a strong evidence base
– Backing well-connected advocates and government personalities
– Being prepared, responsive and flexible
– Supporting transition
– Aligning to principles of aid effectiveness
– Designing innovations that are scalable
Six critical actions for donors include:
– Supporting implementers to build a strong evidence base
– Allowing flexibility
– Incentivizing scale-up
– Supporting continuity and transition to the scale-up
– Embracing government-led donor coordination platforms
– Actively fostering country ownership and harmonization
Neil closed with a quote from a recent qualitative study published by IDEAS that reinforced the key message that scale-up is “an art, not a science”:
“The policy breakthrough is never the data, the findings themselves… it’s the trust, the relevance, it’s being at the table, being able to show you support implementation… you also need the right time. You cannot push a policy breakthrough when the system is not ready.”
Interaction, coordination, capacity, data and decisions
Carrying forward the discussion on scale-up, the final IDEAS presentation from Bilal Avan highlighted the centrality of health systems readiness and responsiveness. In practice, this means using local evidence for effective decision-making at the district level. Thus, understanding local context and having access to local data is critical.
Bilal outlined an exciting new approach currently being piloted in West Bengal, India: The Data-Informed Platform for Health (DIPH). This platform attempts to enhance the interactions among district level health personnel, link databases and build capacity to strengthen coordinated decision-making and planning.
The importance of learning
Closing the session, John Grove reminded the audience that the “soft” methods of evaluation—i.e. analyzing the political economy of how services are delivered at the district level and documenting anecdotal evidence about the current context—is just as important as monitoring progress through data, graphs and spreadsheets. In other words, the learning from implementation and evaluation is just as vital as the monitoring itself.
All of these presentations will be uploaded to IDEAS TV shortly.
Learn more about IDEAS and access additional resources.