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WOTRO funding for health system research on maternal health

13 JUNE 2012

NICHE collaborates with AIGHD and institutes in South Africa and Rwanda on the WOTRO funded project 'Mainstreaming a health systems’ approach to maternal health programming: transdisciplinary research in Rwanda and South Africa'. The project runs from 2012-2016.

Too many women in low- and middle-income countries (LMICs) still die as a direct result of pregnancy and childbirth and we know from experiences in high-income countries that the vast majority of these deaths are preventable. Most experts believe that strengthening various aspects of the health system (as conceptualized in the WHO building blocks) is the solution, but it is not yet clear which building blocks are most important. There is also uncertainty about which interventions within the building blocks have been most successful and are best value for money, and how interventions in different building blocks influence one another. In addition, one other aspect that is critical for improving maternal health but is not sufficiently emphasised in the WHO building blocks is increasing patient demand for good access to high quality services.

We hypothesize that the key steps needed to improve services in pregnancy include encouraging community participation to thus increase patient demand for good-quality services and to hold maternal health managers accountable for these services. Moreover, much more is needed to improve the skills of managers and how they function in teams that work to improve these services. Finally, we hold that services would be improved through better use of information routinely collected by maternal health services, especially learning from instances of maternal death.

To test this hypothesis, we will thoroughly review the available knowledge on these topics in the academic literature (for all low- and middle-income countries) and in the grey literature (for South Africa, Rwanda and up to three additional, carefully selected African countries). Furthermore, in Rwanda and South Africa, we will document illustrative cases of successes and failures in maternal health services, to identify opportunities to improve the way these services are provided, and to enhance workers‟ motivation and leadership. We will study services for treatment of HIV disease in pregnant women and for providing care during emergencies that happen during pregnancy or childbirth. Through working closely with policy leaders and civil society, throughout the project, we will take joint actions to improve maternal services. Practically, this means that teams of policy makers and researchers in Rwanda and South Africa will apply knowledge learnt in the project and attempt to alter the way maternal services are organised in Rwanda and South Africa.

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