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. 2019 Mar 13;7(Suppl 1):S188-S206.
doi: 10.9745/GHSP-D-18-00265. Print 2019 Mar 11.

Sustainability and Scale of the Saving Mothers, Giving Life Approach in Uganda and Zambia

Jessica Healey  1 , Claudia Morrissey Conlon  2 , Kennedy Malama  3 , Reeti Hobson  4 , Frank Kaharuza  5 , Adeodata Kekitiinwa  6 , Marta Levitt  7 , Davy Wadula Zulu  3 , Lawrence Marum  8
Affiliations

Sustainability and Scale of the Saving Mothers, Giving Life Approach in Uganda and Zambia

Jessica Healey et al. Glob Health Sci Pract. .

Abstract

Background: 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.

Methods: 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.

Findings: 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.

Conclusion: 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.

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Figures

FIGURE 1
FIGURE 1
SMGL Theory of Change Model Abbreviations: EmONC, emergency obstetric and newborn care; MCH, maternal and child health; MDSR, maternal death surveillance and response; MMR, maternal mortality rate; NMR, neonatal mortality rate; SMGL, Saving Mothers, Giving Life; USG, U.S. government.
FIGURE 2
FIGURE 2
Scale-Up of SMGL Approach in Zambia, 2016–2021 Abbreviations: COC, continuum of care; RMNCAH/N, reproductive, maternal, newborn, child, adolescent health and nutrition; SMGL, Saving Mothers, Giving Life.
FIGURE 3
FIGURE 3
Scale-Up of SMGL Approach in Uganda Through World Bank Support, 2016–2021 Abbreviation: SMGL, Saving Mothers, Giving Life
FIGURE 4
FIGURE 4
Scale-Up of SMGL Approach in Uganda Through Regional Health Integration to Enhance Services, 2012–2022 Abbreviations: UBOS, Uganda Bureau of Statistics; URMNCAH, Uganda reproductive, maternal, newborn, child, and adolescent health.
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Mothers wait with Safe Motherhood Action Group member at Lundazi Urban Health Centre, Zambia. © Amy Fowler/USAID
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A service provider examines a client at the SMGL-supported Kakumiro Health Center in Uganda. © Amy Fowler/USAID
See this image and copyright information in PMC

References

    1. World Health Organization (WHO), United Nations Children's Fund (UNICEF), United Nations Population Fund (UNFPA), World Bank Group, United Nations. Trends in Maternal Mortality 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Groups and the United Nations Population Division. Geneva: WHO; 2015. http://apps.who.int/iris/bitstream/handle/10665/194254/9789241565141_eng... Accessed December 2, 2018.
    1. Conlon CM, Serbanescu F, Marum L, et al. ; Saving Mothers, Giving Life Working Group. Saving Mothers, Giving Life: it takes a system to save a mother. Glob Health Sci Pract. 2019;7(suppl 1):S6–S26. 10.9745/GHSP-D-18-00427 - DOI - PMC - PubMed
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    1. World Health Organization (WHO). Beginning with the End in Mind: Planning Pilot Projects and Other Programmatic Research for Successful Scaling Up. Geneva: WHO; 2014. http://www.who.int/reproductivehealth/publications/strategic_approach/97... Accessed June 18, 2018.
    1. The Kaiser Family Foundation. U.S. Global Health Initiative (GHI). Menlo Park, CA: The Kaiser Family Foundation; 2011. https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8116.pdf Accessed November 10, 2018.