Sustainability and Scale of the Saving Mothers, Giving Life Approach in Uganda and Zambia
Identifieur interne : 000001 ( Pmc/Checkpoint ); précédent : 000000; suivant : 000002Sustainability and Scale of the Saving Mothers, Giving Life Approach in Uganda and Zambia
Auteurs : Jessica Healey ; Claudia Morrissey Conlon ; Kennedy Malama ; Reeti Hobson ; Frank Kaharuza ; Adeodata Kekitiinwa ; Marta Levitt ; Davy Wadula Zulu ; Lawrence MarumSource :
- Global Health: Science and Practice [ 2169-575X ] ; 2019.
Abstract
The Saving Mothers, Giving Life district health systems strengthening approach provides a sustainable model for reducing maternal mortality at scale. Lessons from the learning districts demonstrated increased efficiency in allocation of resources for maternal and newborn health, better use of strategic information, improved management capacities, and increased community engagement.
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DOI: 10.9745/GHSP-D-18-00265
PubMed: 30867217
PubMed Central: 6519672
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Sustainability and Scale of the Saving Mothers, Giving Life Approach in Uganda and Zambia</title><author><name sortKey="Healey, Jessica" sort="Healey, Jessica" uniqKey="Healey J" first="Jessica" last="Healey">Jessica Healey</name><affiliation><nlm:aff id="aff1"><institution>U.S. Agency for International Development</institution>,<addr-line>Lusaka, Zambia</addr-line>.<addr-line>Now based in Monrovia, Liberia</addr-line>.</nlm:aff></affiliation></author><author><name sortKey="Conlon, Claudia Morrissey" sort="Conlon, Claudia Morrissey" uniqKey="Conlon C" first="Claudia Morrissey" last="Conlon">Claudia Morrissey Conlon</name><affiliation><nlm:aff id="aff2"><institution>Bureau for Global Health, U.S. Agency for International Development</institution>,<addr-line>Washington, DC, USA</addr-line>.</nlm:aff></affiliation></author><author><name sortKey="Malama, Kennedy" sort="Malama, Kennedy" uniqKey="Malama K" first="Kennedy" last="Malama">Kennedy Malama</name><affiliation><nlm:aff id="aff3"><institution>Ministry of Health, Government of the Republic of Zambia</institution>,<addr-line>Lusaka, Zambia</addr-line>.</nlm:aff></affiliation></author><author><name sortKey="Hobson, Reeti" sort="Hobson, Reeti" uniqKey="Hobson R" first="Reeti" last="Hobson">Reeti Hobson</name><affiliation><nlm:aff id="aff4"><institution>ICF</institution>,<addr-line>Rockville, Maryland, USA</addr-line>.</nlm:aff></affiliation></author><author><name sortKey="Kaharuza, Frank" sort="Kaharuza, Frank" uniqKey="Kaharuza F" first="Frank" last="Kaharuza">Frank Kaharuza</name><affiliation><nlm:aff id="aff5"><institution>HIV Health Office, U.S. Agency for International Development</institution>,<addr-line>Kampala, Uganda</addr-line>.</nlm:aff></affiliation></author><author><name sortKey="Kekitiinwa, Adeodata" sort="Kekitiinwa, Adeodata" uniqKey="Kekitiinwa A" first="Adeodata" last="Kekitiinwa">Adeodata Kekitiinwa</name><affiliation><nlm:aff id="aff6"><institution>Baylor College of Medicine Children's Foundation-Uganda, Kampala</institution>,<addr-line>Uganda</addr-line>.</nlm:aff></affiliation></author><author><name sortKey="Levitt, Marta" sort="Levitt, Marta" uniqKey="Levitt M" first="Marta" last="Levitt">Marta Levitt</name><affiliation><nlm:aff id="aff7"><institution>Bureau for Global Health, U.S. Agency for International Development and RTI</institution>,<addr-line>Washington, DC, USA</addr-line>. Now with<institution>Palladium</institution>,<addr-line>Abuja, Nigeria</addr-line>.</nlm:aff></affiliation></author><author><name sortKey="Zulu, Davy Wadula" sort="Zulu, Davy Wadula" uniqKey="Zulu D" first="Davy Wadula" last="Zulu">Davy Wadula Zulu</name><affiliation><nlm:aff id="aff3"><institution>Ministry of Health, Government of the Republic of Zambia</institution>,<addr-line>Lusaka, Zambia</addr-line>.</nlm:aff></affiliation></author><author><name sortKey="Marum, Lawrence" sort="Marum, Lawrence" uniqKey="Marum L" first="Lawrence" last="Marum">Lawrence Marum</name><affiliation><nlm:aff id="aff8"><institution>U.S. Centers for Disease Control and Prevention</institution>,<addr-line>Lusaka, Zambia</addr-line>. Now retired.</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">30867217</idno><idno type="pmc">6519672</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6519672</idno><idno type="RBID">PMC:6519672</idno><idno type="doi">10.9745/GHSP-D-18-00265</idno><date when="2019">2019</date><idno type="wicri:Area/Pmc/Corpus">000188</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000188</idno><idno type="wicri:Area/Pmc/Curation">000188</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000188</idno><idno type="wicri:Area/Pmc/Checkpoint">000001</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000001</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Sustainability and Scale of the Saving Mothers, Giving Life Approach in Uganda and Zambia</title><author><name sortKey="Healey, Jessica" sort="Healey, Jessica" uniqKey="Healey J" first="Jessica" last="Healey">Jessica Healey</name><affiliation><nlm:aff id="aff1"><institution>U.S. Agency for International Development</institution>,<addr-line>Lusaka, Zambia</addr-line>.<addr-line>Now based in Monrovia, Liberia</addr-line>.</nlm:aff></affiliation></author><author><name sortKey="Conlon, Claudia Morrissey" sort="Conlon, Claudia Morrissey" uniqKey="Conlon C" first="Claudia Morrissey" last="Conlon">Claudia Morrissey Conlon</name><affiliation><nlm:aff id="aff2"><institution>Bureau for Global Health, U.S. Agency for International Development</institution>,<addr-line>Washington, DC, USA</addr-line>.</nlm:aff></affiliation></author><author><name sortKey="Malama, Kennedy" sort="Malama, Kennedy" uniqKey="Malama K" first="Kennedy" last="Malama">Kennedy Malama</name><affiliation><nlm:aff id="aff3"><institution>Ministry of Health, Government of the Republic of Zambia</institution>,<addr-line>Lusaka, Zambia</addr-line>.</nlm:aff></affiliation></author><author><name sortKey="Hobson, Reeti" sort="Hobson, Reeti" uniqKey="Hobson R" first="Reeti" last="Hobson">Reeti Hobson</name><affiliation><nlm:aff id="aff4"><institution>ICF</institution>,<addr-line>Rockville, Maryland, USA</addr-line>.</nlm:aff></affiliation></author><author><name sortKey="Kaharuza, Frank" sort="Kaharuza, Frank" uniqKey="Kaharuza F" first="Frank" last="Kaharuza">Frank Kaharuza</name><affiliation><nlm:aff id="aff5"><institution>HIV Health Office, U.S. Agency for International Development</institution>,<addr-line>Kampala, Uganda</addr-line>.</nlm:aff></affiliation></author><author><name sortKey="Kekitiinwa, Adeodata" sort="Kekitiinwa, Adeodata" uniqKey="Kekitiinwa A" first="Adeodata" last="Kekitiinwa">Adeodata Kekitiinwa</name><affiliation><nlm:aff id="aff6"><institution>Baylor College of Medicine Children's Foundation-Uganda, Kampala</institution>,<addr-line>Uganda</addr-line>.</nlm:aff></affiliation></author><author><name sortKey="Levitt, Marta" sort="Levitt, Marta" uniqKey="Levitt M" first="Marta" last="Levitt">Marta Levitt</name><affiliation><nlm:aff id="aff7"><institution>Bureau for Global Health, U.S. Agency for International Development and RTI</institution>,<addr-line>Washington, DC, USA</addr-line>. Now with<institution>Palladium</institution>,<addr-line>Abuja, Nigeria</addr-line>.</nlm:aff></affiliation></author><author><name sortKey="Zulu, Davy Wadula" sort="Zulu, Davy Wadula" uniqKey="Zulu D" first="Davy Wadula" last="Zulu">Davy Wadula Zulu</name><affiliation><nlm:aff id="aff3"><institution>Ministry of Health, Government of the Republic of Zambia</institution>,<addr-line>Lusaka, Zambia</addr-line>.</nlm:aff></affiliation></author><author><name sortKey="Marum, Lawrence" sort="Marum, Lawrence" uniqKey="Marum L" first="Lawrence" last="Marum">Lawrence Marum</name><affiliation><nlm:aff id="aff8"><institution>U.S. Centers for Disease Control and Prevention</institution>,<addr-line>Lusaka, Zambia</addr-line>. Now retired.</nlm:aff></affiliation></author></analytic><series><title level="j">Global Health: Science and Practice</title><idno type="eISSN">2169-575X</idno><imprint><date when="2019">2019</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>The Saving Mothers, Giving Life district health systems strengthening approach provides a sustainable model for reducing maternal mortality at scale. Lessons from the learning districts demonstrated increased efficiency in allocation of resources for maternal and newborn health, better use of strategic information, improved management capacities, and increased community engagement.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Conlon, Cm" uniqKey="Conlon C">CM Conlon</name></author><author><name sortKey="Serbanescu, F" uniqKey="Serbanescu F">F Serbanescu</name></author><author><name sortKey="Marum, L" uniqKey="Marum L">L Marum</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Thaddeus, S" uniqKey="Thaddeus S">S Thaddeus</name></author><author><name sortKey="Maine, D" uniqKey="Maine D">D Maine</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Palaia, A" uniqKey="Palaia A">A 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Glob Health Sci Pract</journal-id><journal-id journal-id-type="iso-abbrev">Glob Health Sci Pract</journal-id><journal-id journal-id-type="hwp">ghsp</journal-id><journal-id journal-id-type="publisher-id">ghsp</journal-id><journal-title-group><journal-title>Global Health: Science and Practice</journal-title></journal-title-group><issn pub-type="epub">2169-575X</issn><publisher><publisher-name>Global Health: Science and Practice</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">30867217</article-id><article-id pub-id-type="pmc">6519672</article-id><article-id pub-id-type="publisher-id">GHSP-D-18-00265</article-id><article-id pub-id-type="doi">10.9745/GHSP-D-18-00265</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Articles</subject></subj-group></article-categories><title-group><article-title>Sustainability and Scale of the Saving Mothers, Giving Life Approach in Uganda and Zambia</article-title><alt-title alt-title-type="right-running-head">Sustainability and Scale of Saving Mothers, Giving Life</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Healey</surname><given-names>Jessica</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Conlon</surname><given-names>Claudia Morrissey</given-names></name><xref ref-type="aff" rid="aff2"><sup>b</sup></xref></contrib><contrib contrib-type="author"><name><surname>Malama</surname><given-names>Kennedy</given-names></name><xref ref-type="aff" rid="aff3"><sup>c</sup></xref></contrib><contrib contrib-type="author"><name><surname>Hobson</surname><given-names>Reeti</given-names></name><xref ref-type="aff" rid="aff4"><sup>d</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kaharuza</surname><given-names>Frank</given-names></name><xref ref-type="aff" rid="aff5"><sup>e</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kekitiinwa</surname><given-names>Adeodata</given-names></name><xref ref-type="aff" rid="aff6"><sup>f</sup></xref></contrib><contrib contrib-type="author"><name><surname>Levitt</surname><given-names>Marta</given-names></name><xref ref-type="aff" rid="aff7"><sup>g</sup></xref></contrib><contrib contrib-type="author"><name><surname>Zulu</surname><given-names>Davy Wadula</given-names></name><xref ref-type="aff" rid="aff3"><sup>c</sup></xref></contrib><contrib contrib-type="author"><name><surname>Marum</surname><given-names>Lawrence</given-names></name><xref ref-type="aff" rid="aff8"><sup>h</sup></xref></contrib><on-behalf-of>on behalf of the Saving Mothers,Giving Life Working Group</on-behalf-of><aff id="aff1"><label>a</label><institution>U.S. Agency for International Development</institution>,<addr-line>Lusaka, Zambia</addr-line>.<addr-line>Now based in Monrovia, Liberia</addr-line>.</aff><aff id="aff2"><label>b</label><institution>Bureau for Global Health, U.S. Agency for International Development</institution>,<addr-line>Washington, DC, USA</addr-line>.</aff><aff id="aff3"><label>c</label><institution>Ministry of Health, Government of the Republic of Zambia</institution>,<addr-line>Lusaka, Zambia</addr-line>.</aff><aff id="aff4"><label>d</label><institution>ICF</institution>,<addr-line>Rockville, Maryland, USA</addr-line>.</aff><aff id="aff5"><label>e</label><institution>HIV Health Office, U.S. Agency for International Development</institution>,<addr-line>Kampala, Uganda</addr-line>.</aff><aff id="aff6"><label>f</label><institution>Baylor College of Medicine Children's Foundation-Uganda, Kampala</institution>,<addr-line>Uganda</addr-line>.</aff><aff id="aff7"><label>g</label><institution>Bureau for Global Health, U.S. Agency for International Development and RTI</institution>,<addr-line>Washington, DC, USA</addr-line>. Now with<institution>Palladium</institution>,<addr-line>Abuja, Nigeria</addr-line>.</aff><aff id="aff8"><label>h</label><institution>U.S. Centers for Disease Control and Prevention</institution>,<addr-line>Lusaka, Zambia</addr-line>. Now retired.</aff></contrib-group><author-notes><corresp id="cor1">Correspondence to Jessica Healey (<email>jhealey@usaid.gov</email>).</corresp></author-notes><pub-date pub-type="collection"><day>11</day><month>3</month><year>2019</year></pub-date><pub-date pub-type="epub"><day>11</day><month>3</month><year>2019</year></pub-date><volume>7</volume><issue>Suppl 1</issue><issue-title>Saving Mothers, Giving Life: A Systems Approach to Reducing Maternal and Perinatal Deaths in Uganda and Zambia</issue-title><fpage>S188</fpage><lpage>S206</lpage><history><date date-type="received"><day>17</day><month>7</month><year>2018</year></date><date date-type="accepted"><day>8</day><month>11</month><year>2018</year></date></history><permissions><copyright-statement>© Healey et al.</copyright-statement><copyright-year>2019</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>. When linking to this article, please use the following permanent link: <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.9745/GHSP-D-18-00265">https://doi.org/10.9745/GHSP-D-18-00265</ext-link></license-p></license></permissions><self-uri content-type="pdf" xlink:type="simple" xlink:href="S188.pdf"></self-uri><abstract abstract-type="precis"><p>The Saving Mothers, Giving Life district health systems strengthening approach provides a sustainable model for reducing maternal mortality at scale. Lessons from the learning districts demonstrated increased efficiency in allocation of resources for maternal and newborn health, better use of strategic information, improved management capacities, and increased community engagement.</p></abstract><abstract abstract-type="teaser"><p>The Saving Mothers, Giving Life district health systems strengthening approach provides a sustainable model for reducing maternal mortality at scale. Lessons from the learning districts demonstrated increased efficiency in allocation of resources for maternal and newborn health, better use of strategic information, improved management capacities, and increased community engagement.</p></abstract><abstract><title>ABSTRACT</title><sec><title>Background:</title><p>Saving Mothers, Giving Life (SMGL) significantly reduced maternal and perinatal mortality in Uganda and Zambia by using a district health systems strengthening approach to address the key delays women and newborns face in receiving quality, timely, and appropriate medical care. This article documents the transition of SMGL from pilot to scale in Uganda and Zambia and analyzes the sustainability of the approach, examining the likelihood of maintaining positive trends in maternal and newborn health in both countries.</p></sec><sec><title>Methods:</title><p>We analyzed the potential sustainment of SMGL achievements using a tool adapted from the HIV-focused domains and elements of the U.S. President's Emergency Plan for AIDS Relief Sustainability Index and Dashboard for maternal and neonatal health pro-gramming adding a domain on community normative change. Information for each of the 5 resulting domains was drawn from SMGL and non-SMGL reports, individual stakeholder interviews, and group discussions.</p></sec><sec><title>Findings:</title><p>In both Uganda and Zambia, the SMGL proof-of-concept phase catalyzed commitment to saving mothers and newborns and a renewed belief that significant change is possible. Increased leadership and accountability for maternal and newborn health, particularly at the district and facility levels, was bolstered by routine maternal death surveillance reviews that engaged a wide range of local leadership. The SMGL district-strengthening model was found to be cost-effective with cost of death averted estimated at US$177-206 per year of life gained. When further considering the ripple effect that saving a mother has on child survival and the household economy, the value of SMGL increases. Ministries of health and donor agencies have already demonstrated a willingness to pay this amount per year of life for other programs, such as HIV and AIDS.</p></sec><sec><title>Conclusion:</title><p>As SMGL scaled up in both Uganda and Zambia, the intentional integration of SMGL interventions into host country systems, alignment with other large-scale programs, and planned reductions in annual SMGL funding all contributed to increasing host government ownership of the interventions and set the SMGL approach on a path more likely to be sustained following the close of the initiative. Lessons from the learning districts resulted in increased efficiency in allocation of resources for maternal and newborn health, better use of strategic information, improved management capacities, and increased community engagement.</p></sec></abstract></article-meta></front></pmc><affiliations><list></list><tree><noCountry><name sortKey="Conlon, Claudia Morrissey" sort="Conlon, Claudia Morrissey" uniqKey="Conlon C" first="Claudia Morrissey" last="Conlon">Claudia Morrissey Conlon</name><name sortKey="Healey, Jessica" sort="Healey, Jessica" uniqKey="Healey J" first="Jessica" last="Healey">Jessica Healey</name><name sortKey="Hobson, Reeti" sort="Hobson, Reeti" uniqKey="Hobson R" first="Reeti" last="Hobson">Reeti Hobson</name><name sortKey="Kaharuza, Frank" sort="Kaharuza, Frank" uniqKey="Kaharuza F" first="Frank" last="Kaharuza">Frank Kaharuza</name><name sortKey="Kekitiinwa, Adeodata" sort="Kekitiinwa, Adeodata" uniqKey="Kekitiinwa A" first="Adeodata" last="Kekitiinwa">Adeodata Kekitiinwa</name><name sortKey="Levitt, Marta" sort="Levitt, Marta" uniqKey="Levitt M" first="Marta" last="Levitt">Marta Levitt</name><name sortKey="Malama, Kennedy" sort="Malama, Kennedy" uniqKey="Malama K" first="Kennedy" last="Malama">Kennedy Malama</name><name sortKey="Marum, Lawrence" sort="Marum, Lawrence" uniqKey="Marum L" first="Lawrence" last="Marum">Lawrence Marum</name><name sortKey="Zulu, Davy Wadula" sort="Zulu, Davy Wadula" uniqKey="Zulu D" first="Davy Wadula" last="Zulu">Davy Wadula Zulu</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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