18 November, 2015

amdd partners with Ethiopian moh to conduct needs assessment

With support from the Bill and Melinda Gates Foundation, AMDD and the Ethiopian Federal Ministry of Health (FMOH) have launched Ethiopia’s 2015 national Emergency Obstetric and Newborn Care (EmONC) assessment. Over a period of 24 months, AMDD will provide continuous technical assistance – both remotely and in-country – to the FMOH as it carries out the assessment. AMDD will be involved in tool adaptation, tablet-based electronic data collection training, data analysis, report writing, mapping of national EmONC services, and evidence-based action planning. Upon completion of the assessment, the FMOH aims to use results from the assessment to finalize its newest health sector plan on reproductive, maternal, neonatal, child, adolescent and youth health.

1 July, 2015

New York Times publishes article on Disrespect and Abuse in Childbirth

On July 1st, 2015 the New York Times published an article entitled “Report Shows Widespread Mistreatment by Health Workers During Childbirth”. The article draws on recent research from a systematic review published by PLOS Medicine as well as a commentary in the Lancet written by AMDD to address the pressing concern of disrespect and abuse in childbirth. The article discusses the prevalence and types of disrespectful and abusive treatment that women encounter, explaining that such treatment is a global phenomenon that ranges from pinching and slapping to neglect and humiliation. The research outlined in the article emphasizes that disrespect and abuse can serve as a significant deterrent to seeking a hospital birth. The New York Times article argues that this deterrent effect may well undermine international goals of reducing deaths during childbirth. Disrespectful and abusive childbirth treatment is framed as a crisis deserving greater recognition and increased research and action. The article can be accessed at The New York Times

30 June, 2015

AMDD Discusses Saving Women’s Lives on Leonard Lopate Show

Lynn Freedman, director of AMDD, appeared on WNYC’s Leonard Lopate Show to talk about maternal mortality. She discussed the recent study on maternal mortality published in the April 2010 edition of the Lancet, barriers to life-saving maternal care, and the role of health systems in preventing maternal death.

Dr. Grace Kodindo, medical and advocacy adviser for the RAISE Initiative, a sister program of AMDD at the Mailman School of Public Health in the Department of Population & Family Health at Columbia University, was also a guest on the show. Listen to the podcast.

7 January, 2015

How can we Do Development Differently in global health?

AMDD recently signed a manifesto on Doing Development Differently (DDD).  The Manifesto laments the poor quality and outcomes that characterize some development interventions.  The authors put forward principles that they feel distinguish more successful initiatives.  These principles are quoted below (emphasis is ours): 

  • They focus on solving local problems that are debated, defined and refined by local people in an ongoing process.

  • They are legitimised at all levels (political, managerial and social), building ownership and momentum throughout the process to be ‘locally owned’ in reality (not just on paper).

  • They work through local conveners who mobilise all those with a stake in progress (in both formal and informal coalitions and teams) to tackle common problems and introduce relevant change.

  • They blend design and implementation through rapid cycles of planning, action, reflection and revision (drawing on local knowledge, feedback and energy) to foster learning from both success and failure.

  • They manage risks by making ‘small bets’: pursuing activities with promise and dropping others.

  • They foster real results – real solutions to real problems that have real impact: they build trust, empower people and promote sustainability.

This resonates with AMDD learning over the past decade, particularly with the ongoing Emergency Obstetric and Newborn Care (EmONC) Needs Assessments that we conduct in partnership with national ministries of health and UNFPA in low and middle income countries.  These assessments are censuses of all hospitals and clinics, and a sample of health centers conducting up to a certain number of deliveries per day. They provide a comprehensive picture of what services, equipment, and human resources are available where, resulting in valuable data on actual health system functioning at the local and national level.  The EmONC needs assessment tool is adapted by a multi-stakeholder team in each country, ensuring that priorities are defined by local people, and that the data collection process and follow-up is locally owned.  Depending on national priorities, the needs assessments may be enhanced by adding in qualitative enquiries, geographic information system (GIS) analyses, and other research.

Despite the potential utility of the assessment data, rigorous national and sub-national planning, implementation, and learning do not always follow.  This may be due to any number of reasons, including lack of financial and human resources, poor management capacity, insufficient technical capacity, lack of political will, and competing priorities.  Rather than rehearsing these well-worn explanations for implementation failure, AMDD seeks to work with partners and countries to do development differently.  To that end, we are initiating a multi-stakeholder process to design flexible implementation guidance. This guidance will acknowledge and accommodate the challenging and dynamic reality of the contexts where assessments are conducted.  It will aid countries to use EmONC assessment data as a planning tool, facilitating careful engagement with health system realities without being prescriptive or generic.  For example, informal practices and norms that often undercut best laid policies should be named and addressed, rather than ignored. 

This guidance will be one important step, though certainly not the whole puzzle, in supporting countries to make small bets that lead to real results. 

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