1. GHI, BEST, SLB, DIV, NUVI,
CSHGP, STI, PPP:
MSotASfMCH@USAID
CORE Group Conference
October 14, 2011
1

2. Making Sense of the Alphabet
Soup for Maternal and Child
Health Programs at USAID
CORE Group Conference
October 14, 2011
2

3. There is a unique global opportunity to accelerate
progress in maternal, newborn and child health

4. Despite working in challenging environment…
Poverty Infrastructure
Status of Women Geography
4

5. Deaths Per 1000 Live Births
50
0
100
150
200
250
300
Angola 1990-2009
Afghanistan 2000-2006
Mali 1995-2006
Liberia 1986-2009
DR Congo 2001-07
Malawi 1995-2010
Nigeria 2003-2008
Zambia 1996-2007
Rwanda 2000-2007
Mozambique 1995-2008
Benin 1996-2006
Ethiopia 2000-05
Madagascar 1997-2009
in BEST countries (1995-2010)
Uganda 1995-2006
Senegal 1997-2009
Tanzania 1996-2010
India (UP) 1998-2005
Haiti 2000-2005
Nepal 1996-2006
Country, Two Survey Years
Pakistan 1990-2006
Progress - Changes in under-five mortality
Bangladesh 1996-2007
Kenya 1998-2008
(MICS); Sudan Household Survey 2006; Yemen: 2006 (MICS). Ghana 1998-2008
Earliest
Yemen 1997-2006
Sudan 2000-2007
Guatemala 1995-2008
Latest
Indonesia 1997-2007
Philippines 1998-2008
Source: Demographic and Health Surveys since 1995, except Angola, Pakistan and Liberia where
and 2009); DR Congo: 2001 (MICS); Guatemala (RHS), Malawi: 2006 (MICS); Mozambique
earlier datapoints are used. Exceptions are Afghanistan Health Survey; Angola (SOWC, 1990
5

6. Trends in Under-five Deaths, 1990-2009
With increasing
birth cohort, >5
million more
Millions of Deaths
deaths/year if no
U5MR reduction
UNICEF – “Levels & Trends in Child Mortality – Report 2010” 6

7. Maternal mortality has declined globally between 1990
& 2008; there has been considerable regional variation
MMR: maternal deaths per 100,000 live births
26%
53%
34%
37%
Source: Trends in Maternal Mortality: 1990 to 2008. UN Estimates, 2010 7

8. Despite progress, the lifetime chance of a woman dying as a result of pregnancy is
substantial and far greater in developing than in developed regions
1: 4,300
1: 260
1: 490
1: 31
Source: WHO, UNICEF, UNFPA, The World Bank. Trends in
Maternal Mortality: 1990 to 2008 pub 2010
8

9. Greater effort is needed in newborn survival
to accelerate progress
Changes in Neonatal and Post-Neonatal (1-11 months) Mortality Rate
USAID MCH priority countries - 2000-2009
Neonatal
mortality has
lagged post-
neonatal (and
child) mortality
Reflects limited
newborn
programs in
most countries
Source: 2009 data are from the State of the World’s Children (SOWC) 2011 Report.
2000 neonatal mortality data are from http://www.unicef.org/statistics 9
(SOWC 2008 Report), and 2000 infant data are from www.childinfo.org.

10. Advantages: We know the causes of newborn, infant and
child mortality in developing countries
• Diarrheal disease and
pneumonia still claim the
most lives among older
infants and children under
age five
• Among newborns, preterm
Undernutrition /Low birth complications, birth
birth weight asphyxia and infection
pose the greatest dangers
• Undernutrition / low birth
weight are major
contributors to
newborn, infant and child
deaths
Based on: Black RE et al. Global, regional, and national causes of child mortality in 2008:
a systematic analysis 10
www.thelancet.com, May 12, 2010 (DOI10.1016/50140-6736(10)60549-1

11. There are proven interventions to address the leading causes of
neonatal death
•Syphilis Control
•Folate
•Malaria control Supplementation
•Antenatal Corticosteroid •Tetanus toxoid
•Antibiotic for bacteriuria •Clean Delivery
•Kangaroo Mother Care •Cord Care
•Birth Spacing •Early & Exclusive
Breastfeeding
•Hand washing
•Antibiotics for
•Warming mother and baby
•Resuscitation
•Partograph
Sepsis
Pneumonia • Low birth weight is a
Diarrhea significant contributor in 40–
Tetanus 70% of neonatal deaths
• Neonatal death constitutes
41% of under 5 mortality
• Maternal nutrition is an
important factor
Source: Adapted from Black et al. for the CHERG of WHO and
UNICEF, 2010, “Global, Regional, and National Causes of Child Mortality in 2008: A Systematic 11
Analysis,” Lancet 2010

12. There is a core set of proven interventions to address the leading
causes of maternal death
• Magnesium Sulfate
• Aspirin
• Anti-hypertensives
• Cesarean section
• Active management of
Preeclampsia the third stage of labor
• Family planning
• Post-abortion care Eclampsia • Uterotonics: oxytocin &
misoprostol
18% Hemorrhage
Abortion •Blood transfusion
9% 35%
• Tetanus toxoid Sepsis
• Clean delivery
• Antibiotics 8% Indirect and Other
Direct
• Iron folate supplements 30%
• De-worming Underlying causes:
• Malaria intermittent treatment
• Anti-retrovirals
• Unintended pregnancy
• Under-nutrition
Source for Causes: Countdown to 2015 12

13. The central strategic approaches of USAID’s MNCH Programs
• Supporting development and
implementation at scale
of evidence-based high-impact
interventions
• Developing and evaluating
delivery approaches to reach
underserved families
• Strengthening key elements of
health systems to promote
effectiveness & sustainability
13

14. USAID’s MNCHprogram uses a research-to-
implementation pathway approach
PRIORITY SETTING PRODUCT FIELD
INTRODUCTION
DEVELOPMENT IMPLEMENTATION
Strategic Applied research creates Catalytic activities to Multi-country program
planning, problem new interventions & facilitate introduction roll-out /diffusion into
identification, priority approaches regular use
setting
Developing GMP &
Continued diarrhea Zinc tablets, improved manufacturing capacity; Support for zinc
deaths ORS formula policy development; pilot introduction with ORT
testing in countries in 14 countries
GLOBAL HEALTH MISSIONS 14

15. E.g. Developing interventions, technologies & approaches
to address critical needs in child health
(Examples)
Prior achievements Current activities Planned activities
• Community-based
• Oral Rehydration treatment of severe • Research on family
Therapy (ORT); pneumonia recognition of
improved ORS, zinc • Simplified treatment newborn
for suspected illness, care- Increasing
adjunctive treatment seeking, and health
newborn sepsis emphasis on
• Vitamin A service response
• Research on
• Early work on integrated community • Evaluation of implementation
case management integrated services (vs.
Hib, rotavirus, pneumoc
occal vaccines • Adaptation of quality • Simplified vitamin A
intervention)
improvement for
• Community treatment of CHW performance blood level assay research
pneumonia • Anemia diagnostic
• Behavioral
• Essential newborn care interventions on tool
indoor air pollution
• Non-reusable syringes
• Antibiotics in
• Vaccine Vial Monitors Uniject for
newborn
• Safe birth kits treatment
• Uniject (e.g. Tetanus • Chlorhexidine
Toxoid) for newborn
umbilical cord
Technologies 15

16. Scale-up of high impact interventions– PPH example
National Strategic Program Implementation Sustainability /
Global Actions
Choices Institutionalization
Introduction Early Mature
Health system governance: Community
Proactive financing of mobilization:
maternal health services Awareness raising of
PPH; Training programs:
Birth preparedness Government
budgeted training
PPH Policy: National advocacy:
Global advocacy programs on PPH;
AMTSL/misoprostol use; Pilot programs: Expansion of
and partnerships: PPH competencies
Expanded job descriptions Phase 1 national program
Global action to in pre-service and
for skilled birth attendant implementation of and highlight work
support work on in-service curricula
cadres managing PPH; PPH misoprostol and/or of champions
reduction of PPH AMTSL for all skilled
service delivery guidelines
birth attendant REDUCTION
cadres Standardization: OF PPH AND
Quality of care Clinical coverage: IMPROVED
Service delivery capacity at approaches; High coverage use MATERNAL
Program initiatives in
sites: Reliable Government led of a uterotonic; HEALTH
obstetric and
Global clinical and infrastructure, personnel, an training expansion Public and private
postpartum STATUS
program d systems to deliver services implementation
management:
approaches: Quality of care;
Evidence-based Clinical training; Drug & equipment
interventions for Health workers training Programmatic
Supervision growth: availability:
prevention and systems:
Adding districts, Drugs and supplies
management of PPH For PPH prevention and
partners, financing in government
demonstrated management Pharmaceutical
,
routine
systems: procurement
Uterotonics on mechanisms
Essential Drug List
Drugs & equipment and in Drug
Oxytocin/ misoprostol Registration; Supply
procurement, logistics, distri chain management
bution
Readiness Pilot project Indicators in
M&E Survey data Routine monitoring
assessment data HMIS
Source: MCHIP, 2011. 16

17. Applying the financial “lever” is bringing more women
into life saving services
Rwanda
Key Financing
Approaches • There is a correlation between increased
enrollment in health insurance and
increased institutional deliveries
• Health Insurance • National scale-up efforts have
increased coverage from 7% in
2003 to 91% in 2010
• Conditional cash
• Institutional deliveries have
transfers increased from 31% in 2000 to
52.10% in 2008
• Vouchers
• Recent research has shown a correlation
between pay for performance (P4P)
• Free services and an increase in institutional
deliveries by 21.1%
Sources: Rajkotia and Charles/USAID; Soucat/WB
17

18. Strategic integration of FP, MNCH, nutrition, infectious diseases
and water and sanitation interventions is essential
EMERGENCY NEWBORN AND CHILD CARE
REPRODUCTIVE
Clinical
CHILDBIRTH CARE • Hospital care of newborn and childhood illness,
• Post-abortion
• Emergency obstetric care including HIV care
care
• Skilled obstetric care, immediate newborn care •Extra care of preterm babies, including Kangaroo
• STI case
(hygiene, warmth, breastfeeding) & resuscitation Mother Care
management
• Emergency care of sick newborns
REPRODUCTIVE POSTNATAL CARE
HEALTH CARE ANTENATAL CARE • Promotion of healthy CHILD HEALTH CARE
Outpatient
Outreach/
• Family planning • 4-visit focused • Immunizations & nutrition e.g.
behaviors
Vitamin A supplementation &
• Prevention and package • Early detection of and
growth monitoring
management of • IPTp and bednets referral for illness
•IPTp and bednets for malaria
STIs and HIV for malaria • Extra care of LBW • Care of children with
• Peri-conceptual • PMTCT babies HIV, including cotrimoxazole
folic acid • PMTCT
FAMILY & COMMUNITY HEALTHY HOME CARE, including:
• Newborn care (hygiene, warmth)
Community
• Counseling & • Nutrition, including exclusive breastfeeding & appropriate
• Adolescent & pre- preparation for • Where skilled care is not
Family/
available, consider clean complementary feeding
pregnancy nutrition newborn • Seeking appropriate preventative care
delivery & immediate
• Education care, breastfeeding Danger sign recognition & care seeking for illness
newborn care, including
• Prevention of STIs , birth & hygiene, warmth, and early • ORS & zinc for treatment of diarrhea
and HIV emergency initiation of breastfeeding • Where referral is not available, consider case management for
preparedness pneumonia, malaria, & neonatal sepsis
Intersectoral Improved living and working conditions– housing, water, sanitation & nutrition
Pre-pregnancy Pregnancy Newborn/post-natal Childhood
BIRTH
Adapted from K.J. Kerber, et al., Continuum of Care for Maternal, Newborn, and
Child Health: From Slogan to Service Delivery, 370 Lancet 1358 (2007). 18

19. Program Progress: Bangladesh
Maternal deaths have declined by 40% in last 9 years
More needs to be done:
• Continue fertility reduction
to replacement level
• Increase women’s
education
• Improve referral systems
3,870 and referral level care
• Focus on PPH and PE/E
— still the biggest killers
• Expand access to care at
upazilla and union level
19

20. Global Health Initiative (GHI): Context and Rationale
Objectives
• Achieve major improvements in health outcomes in 8
health areas, aligned with the health-related MDGs
• Progress along 7 principles, including country ownership
and HSS
Approach
• Multi-year initiative
• Coordinates and integrates all U.S. global health efforts
through a whole of government approach
• Do more of what works, including better alignment, smart
integration, and reform
• Led by U.S. Ambassador and includes all U.S agencies in
health to promote and achieve sustainable health
outcomes
20

21. MCH-relevant GHI Goals
Maternal Health
• Reduce maternal mortality by 30 percent across assisted
countries
Child Health • Reduce under-5 mortality rates by 35 percent across assisted
countries
Nutrition • Reduce child under-nutrition by 30 percent across assisted food
insecure countries in conjunction with the President’s Feed the
Future Initiative
Family Planning
& Reproductive • Prevent 54 million unintended pregnancies
Health
21

22. BEST:
Best Practices at Scale in the Home, Community and Facilities
An Action Plan for Smart Integrated
Programming in Family Planning,
Maternal and Child Health,
and Nutrition
under the Global Health Initiative
22

23. Focus on countries and populations with greatest need…
Integrated programming in family planning, maternal
and child health, and nutrition
 28 countries are very high need
Asia/Middle East: Afghanistan, Bangladesh, India
(UP), Indonesia, Nepal, Pakistan, Philippines, Ye
men
Africa: Angola, Benin, DR
Congo, Ethiopia, Ghana, Kenya, Liberia, Madagas
car, Malawi, Mali, Mozambique, Nigeria, Rwanda,
Senegal, (southern)
Sudan, Tanzania, Uganda, Zambia
Latin America and the Caribbean:
Guatemala, Haiti
 Focus on vulnerable populations: urban as well
as rural; poor; harder-to-reach and disadvantaged
tribal, racial, ethnic and caste groups
23

24. BEST applies the GHI principles…
• Woman and girl-centered approach: with special attention to
compassionate and dignified care; status and working conditions of
midwives and nurses; female leadership in health policy; the role of men in
improved health; and gender inequities.
• Strategic coordination and integration: across the 3 program areas and
with other sectors to maximize benefits and increase impact.
• Partnerships: with multilaterals, other donors and private sector – in
particular, drug merchants, private providers and social marketing
programs.
• Country ownership: with government, communities and civil society to
support national plans for family planning, maternal and child health, and
nutrition.
• Sustainability through health systems strengthening: with special
attention to human resources and removal of financial barriers to care.
• Metrics, monitoring and evaluation: with strong baseline measurement in
place and support to monitor programs and measure impact.
• Research and innovation: with emphasis on feasible, community-based
approaches; information technologies; and research to practice.
24

25. New initiatives & partnerships
To improve health outcomes of mothers and newborns and
reduce mortality
Underway…
• Helping Babies Breathe to expand access to and use of low-
cost resuscitation devices
• Saving Lives at Birth – Grand Challenges for Development --
innovation
• MAMA
…and others
25

26. Harnessing the power of innovation: “Saving Lives at Birth: A
Grand Challenge for Development”
Goal: Dramatically and sustainably reduce stillbirth, newborn and maternal death
Challenge: To develop groundbreaking prevention and treatment approaches for
pregnant women and newborns in rural, low-resource settings around the
time of delivery
Partners: USAID, Government of Norway, the Bill & Melinda Gates
Foundation, Grand Challenges Canada, and The World Bank
What We are Sustainable, scalable, and innovative technologies, service delivery
Looking For: models, and "demand side" innovations that empower women and their
families to be aware of and access health care at the time of birth and
adopt healthy behaviors.
Grants: $14M to support grants in the first round
(1) Seed Grants ($250k) to demonstrate proof of concept
(2) Transition Grants ($2 Million) to transition successful innovations
toward scale up

27. Founding Partners:
• Strategic vision
• Funding • Strategic vision
• Link to • Funding
governments • In-kind resources
• M&E Support
Supporting Partners:
• Content advisors • Global Knowledge • Link to UN
Exchange programs
• Expertise in
localization • Capacity building • Communications

28. Launched on May 3, 2011

29. MAMA: Mission DRAFT
MAMA will harness the power of mobile
technology to empower expectant and
new mothers to make healthy
decisions.
Target Audience: low income mothers and their
household decision-makers with access to mobile
phones

30. MAMA Bangladesh Partners as of July 2011
Lead Partners
Implementing Partners Supporting Partners
TECHNOLOGY COORDINATION
CORPORATE
SPONSORS
OUTREACH - NGO
CONTENT
MOBILE
OPERATORS
OUTREACH -
GOVERNMENT
ICDDR, B
MEDIA RESEARCH

31. GHCS MCH funding (including nutrition) – 2000-2011
?
31

32. GHCS MCH Funding – 2000-2010
549
495
451
356
Constant 2000 dollars
32

33. USAID has focused funding on the field,
principally on priority countries
Allocation of MCH funds (excluding nutrition)
(GHCS, FY 2010 Enacted)
Total = $474 million
“BEST” Countries
Millions of Dollars
$276 million (58%)
USAID’s MCH
program is highly
Other MCH Countries decentralized
$51 million (11%)
Central & Regional
$69 million (15%)
GAVI
$78 million (16%)
33

34. Allocation of MCH funds is also focused on
key technical / program areas
Health
systems, governan
ce & finance
We will take a
closer look at the
main child health
technical focus
areas in the
following slides
Derived from 2010 Operational Plan Reports –
includes all MCH including nutrition 34

35. Thank You!
35