The Making It Happen Programme - Outcomes

Working in Partnership

The MiH Programme is implemented with, and highly respected by all participating country Governments and Partners.  CMNH additionally worked with a network of over 300 volunteer Obstetricians and Midwives from the United Kingdom, who worked together with colleagues in-country to deliver the EmOC&NC training across the 11 countries. 

We wish to thank all who so sincerely contributed and continue to Make it Happen.  

Making it Happen in participating countries

MiH was implemented and evaluated in 11 countries between January 2012 and December 2015: eight in Sub-Saharan Africa (Kenya, Tanzania, Malawi, Zimbabwe, Republic of South Africa, Sierra Leone, Ghana and Nigeria) and three in Asia (India, Bangladesh and Pakistan).

Innovative Interventions

CMNH developed three new approaches:

1)      Designing and delivering a ‘skills and drills’ EmOC&NC training package that comprises a short (max five days) multi-disciplinary training (nurses, midwives, doctors and specialists training as a team), training critical numbers (80% or more) of health care providers working in the maternity areas in health care facilities and using expert volunteers to build in-country capacity (all 11 countries) 

2)      Designing and delivering a MiH with Data workshop package (one day) that helps health care providers to better collect, understand and use routine data on maternal and newborn healthcare provision and health outcomes (all countries except India and South Africa). 

3)      Designing and delivering a comprehensive workshop package (two workshops of three days each) to strengthen quality improvement methodology (maternal and perinatal death audit and standards-based audit) at health care facility level (in Malawi, Kenya, Zimbabwe and Sierra Leone).

Evaluation of Making it Happen

A new, innovative 5-level M&E framework to evaluate the effectiveness of the MiH programme training was developed.  This informed the MiH programme logical framework which has five outputs:

Output 1: Increased healthcare provider capacity to provide EmOC&NC

Output 2: Increased availability of EmOC&NC for mothers and babies

Output 3: Strengthened accountability for results with increased transparency

Output 4: Strengthened capacity to sustain improvements in MNH service delivery

Output 5: Evidence generated by programme disseminated in order to inform national, regional and global agendas

 

Results of Making it Happen - Outputs

By May 2016 we are able to share the preliminary results of the MiH programme

Output 1:

• 18,628 health care providers trained in EmOC&NC
• 84.1% of health care providers demonstrating improved knowledge
• 99.5% of healthcare providers demonstrating improved skills 

Output 2:

• 70% of healthcare facilities increased the availability of EmOC&NC by 12 months after the MiH Programme started and there was a 123% increase in healthcare facilities able to provide all the required components (signal functions) of EmOC
• Assisted vaginal delivery (ventouse delivery) was only available in 48% of healthcare facilities at the start of the programme and increased to 69%
• Neonatal resuscitation was available at 87% of healthcare facilities and increased to 98% by 12 months. 

Output 3:

• 1,487 health care providers completed MiH with Data workshops
• Quality Improvement was a component of the Making it Happen Programme in Zimbabwe, Sierra Leone and Malawi
• 696 healthcare providers completed the Quality Improvement workshops and worked together to improve maternal and perinatal death audit (review) at their healthcare facility and to introduce standards-based audit.
• By 12 months 51% more healthcare facilities had active quality improvement committees in place, there was a 134% increase in the number of healthcare facilities where >80% of all maternal deaths were reviewed.
• 88% of all healthcare facilities had documented evidence of actions taken to reduce maternal and newborn deaths and stillbirths. 

Output 4:

• 1,681 enthusiastic Master Trainers for EmOC&NC available in-country to sustain EmOC&NC “skills and drills” training
• 20 Skills labs and 274 training rooms have been supported 

Output 5: Evidence generated by programme disseminated in order to inform national, regional and global agendas

• 27 peer reviewed publications arising from MiH Programme by 2016
• Quarterly newsletters
• Four films of MiH available online www.cmnh.lstmed.ac.uk  

Results of Making it Happen - Outcomes

Across 830 healthcare facilities in MiH implementation countries

• 8% increase in the number of women giving birth at health facility level
• 20% increase in the number of women who received Emergency Obstetric Care
• In 7 out of 9 countries a 23% decrease in maternal case facility rate and in an additional two countries the case facility rate for obstetric haemorrhage decreased by 45% and 62%
• In 8 out of 9 countries a 8% decrease in stillbirth rates
• In 6 out of 9 countries a 24% reduction in newborn death before discharge
• An estimated 5,624 stillbirths avoided and 1,252 mothers’ lives saved during the life time of the MiH programme

Beneficiary Feedback

Health Care Provider, Malawi “The knowledge and skills that I gained during the training helps me to detect and diagnose obstetric emergencies and act promptly.  I have been able to conduct assisted vaginal deliveries, manage shoulder dystocia and many other obstetric complications with less difficulty.”

UK Volunteer “MiH has helped re-shape the mentality of health workers…that maternal death is not an inevitable consequence of pregnancy and labour.  The training has assisted team working and empowered workers to speak up about substandard practice and to be confident about how they themselves practice.”

NGO Partner, Bangladesh “The skills based, short nature of the course, compared to much longer theoretical courses available in country, is very attractive to healthcare providers in Bangladesh.”

Ministry of Health, Kenya “MiH is the best thing that has ever happened to Kenya in MNH.  It is highly valued and has succeeded in demystifying MNH.”

Ministry of Health, Tanzania “We own this programme. We would like to scale this up to other areas so that we can work towards the new global targets of ending preventable maternal deaths in Tanzania”

Reproductive Health Coordinator “In my region alone over 400 health care providers were trained in the (CMNH-LSTM) EmOC training package of which 90% are still in post”  

DFID In-country “CMNH-LSTM are really well known for working in partnership with the MOH and all partners – this has been noted and is very much appreciated – also unlike others – CMNH-LSTM has taken sustainability into account from the start of the programme and not just at the end  - Well Done! – this is really a great programme - Keep saving lives!”

Funding

Funding for this Programme was from:

•     Department for International Development (DFID/UK Aid) – United Kingdom
•     DFID/UK Aid - Republic of South Africa
•     DFID/UK Aid - Kenya
•     UNICEF Sierra Leone
•     Johnson and Johnson 

All country Governments contributed financially or in kind. 

All volunteers provided their time and expertise for free acting as Facilitators or Master Trainers for the EmOC&NC workshops.