During the first phase it had become clear that programmes for maternal and newborn health did not have the data they needed to track progress in the delivery of high quality health care; that programme managers needed to be more agile in their use of data for decision-making to achieve the best quality of care from the health system; that innovations launched with donor funding were difficult to sustain; and that there was insufficient evidence about the mechanisms through which quality improvement interventions operated in different settings.
And so, six independent areas of research were developed by our multi-disciplinary team, with close attention paid to learning from one another and to learning with country partners.
Areas of research
Multiple actors working in the same geography may share the aim to improve health outcomes but lack the coordination needed to make progress. In particular, a failure to recognise dependencies between demand and supply-side issues can limit progress. In Gombe State, northeast Nigeria, the presence of multiple Bill & Melinda Gates foundation investments presented an opportunity to enhance synergy between actors so that the health system as a whole could be strengthened.
Data on the quality of facility-based care received by mothers and newborns was lacking: there was evidence that indicators from household surveys were not valid for some services, that definitions were not harmonised, that the methods to link data sources together needed development, as did the methods and indicators for respectful maternity care. The Partnership in Gombe State, Nigeria, presented an opportunity to dig deep into this topic.
Better data is essential to improve health outcomes, yet even where rich data sources are available there can be limited capacity to synthesise and use the data for decision-making.
Despite increasing popularity, there was little evidence to explain why quality improvement initiatives have varied results across settings, nor were there good theoretical models to explain the role of leadership, teamwork, supervision or health system context. A better understanding of the mechanisms through which quality improvement operates was needed.
The sustainability of health programmes is critical, but effective interventions may only last as long as donor funding is available.
Community-Based Newborn Care (CBNC) is a national Ethiopian initiative launched in 2013 as a means of bringing life-saving care to mothers and newborns at the community level within the Ethiopian health system. IDEAS and partners evaluated the programme over five years.