Koki Agarwal, DirectorRebecca Levine, Program Officer

Maternal and Child Health Integrated Program

Lives Saved Tool: Using LiST for Maternal, Newborn, and Child

Health Advocacy

The Maternal and Child Health Integrated Program (MCHIP)

•USAID Bureau for Global Health’s flagship maternal, newborn and child health program

•Working in well over 30 countries worldwide

•MCHIP supports programming and opportunities for integration in:

• Maternal, Newborn and Child Health•Immunization, Family Planning, Malaria, HIV/AIDS•Wat/San, Urban Health, Health Systems Strengthening

Session Outline

•Advocacy Tools for Global Health•Overview of Lives Saved Tool (LiST)•Benefits & Limitations of LiST•How LiST has been used for Global Health Advocacy•How MCHIP has used LiST for Advocacy•Recommendations based on Experience

GLOBAL HEALTH ADVOCACY

TOOLS

What Tools Exist for Global Health Advocacy?• REDUCE

An advocacy model for reducing maternal mortality, morbidity, and disability. Developed by the SARA Project. Safe Motherhood Model

A computer program to examine the impact of maternal health services on the maternal mortality ratio

• ALIVE An advocacy model for saving newborn lives

• Marginal Budgeting for Bottlenecking (MBB) Aims at estimating the potential impact,

resources needs, costs and budgeting implications of country strategies to remove implementation constraints of the health system.

WHAT IS THE LIVES SAVED

TOOL?

7

Goal of LiST To promote evidence-based decision making and aid in the planning for expansion of maternal, neonatal and child health interventions

ObjectivesTo estimate potential lives saved when introducing or scaling up key MNCH interventions

The Lives Saved Tool - LiST

The Lives Saved Tool - LiST The Lives Saved Tool

A computer-based software that models multi-causes of mortality

Predicts changes in Under-five and neonatal mortality rates and deaths Maternal mortality ratios and deaths Causes of death

Based on changes in health intervention coverage levels

Using Country specific fertility and HIV information and

trends Country specific health status information Effect sizes of interventions (based on RCT studies) Baseline intervention coverage values (60+)

Which Interventions Are Included? Proximal factors

Not distal (being equal) Work through health programs

Not included: income, education and crowding, etc. Water and sanitation are the exceptions

Feasible in a low income country 68 priority countries with highest MNCH mortality

Cause-specific evidence of effect Research studies or systematic reviews Delphi method if research is impossible (i.e. CEmOC) Updated as new evidence is published Several published International Journal of Epidemiology

(Apr 2010)

Intervention Types Maternal, neonatal, child

ex. AMTSL, Neonatal Resuscitation, Rotavirus vaccine

Periconceptional, antenatal, birth, immediate postnatal, childex. Folic acid supplementation, IPTp malaria, delivery care, routine postnatal care, antimalarials

Preventive, curativeex. Vitamin A, Pneumonia case management

Immediate, time-laggedex. ORS, breastfeeding

What’s NOT Calculated in LiST? Education Motivation Gender issues Economic status Emergencies (i.e. famine, flooding) Delivery mechanism Quality of care

What Information Can LiST Provide?

Number of deaths Total, by cause, by age group

Mortality rates/ratios (NMR, U5MR, MMR) Deaths averted (Lives Saved)

Total, by cause, by intervention, by age group

Intermediate outcomes Stunting, breastfeeding

Displays (over a chosen period of time) Tables, graphs, pie charts Single country, multiple scenarios within

one country Multiple countries, single or multiple

scenarios

Some Limitations of LiST Data availability

• If no baseline, can’t evaluate impact accurately

Data quality User Friendliness Sensible scale up targets

• Feasible, acceptable, funds available Interventions included in software Costing/budgeting considerations*

* Links to existing costing tools including MBB and the WHO supported costing tool for child survival are being developed

Using LiST for Advocacy

The Lancet South Africa series –

August 2009 The Lancet, Volume 374, Issue 9692, Pages 835 - 846, 5 September

2009

PMTCT-Dual therapy-Appropriate feeding

NEONATAL -Obstetric care packages-Resuscitation-Kangaroo mother care-Facility case mx of neonatal illness

12,200 lives saved

in 2015

37,000 lives saved

in 2015

Source: Chopra M, Lawn et al Lancet 2009

"We cannot allow a single…neonate to die because of our negligence...it will be criminal for us to allow any of these things to happen. “Minister of Health Dr Aaron Motsoaledi, South Africa

National situation analyses for newborn health in Africa

National as well as sub-national analysise.g. 36 states in Nigeria, 3 regions in Mali, South Sudan

“Science in Action” African Science Academies Development Initiative

http://www.nationalacademies.org/asadi/2009_Conference/PDFs/ScienceInActionFullReport.pdf

Coverage of skilled attendance at birth <30% 31-60% >61% TOTAL

9 example countriesEthiopiaNorthern Nigeria

Ghana, KenyaSenegal, Uganda,Tanzania

CameroonSouth AfricaSouthern Nigeria

    

Total maternal, neonatal, and child lives saved 903,400 606,000 310,200

1,819,700

Percentage reduction in deaths with 90% coverage 79% 90% 59% 78%

Country specific lives saved and cost for:- Births in facilities – achievable missed opportunities to save lives- Outreach or community interventions – achievable increases (20%)- For Ethiopia, Kenya, Nigeria, Uganda, Tanzania, Senegal, Cameroon, South Africa

MCHIP & LiST

How LiST is being used at MCHIP

20

Strategic PlanningStrategic Planning for country workplans Which interventions are necessary to reduce

mortality? (maternal, neonatal, under-5)

Based on feasible targets, what potential reduction in mortality will our program have?

Can counteract current emphasis on one-size-fits-all intervention packages, by suggesting which specific interventions are more likely to have an impact in different contexts

Helping to Reach MDG 4 in Zimbabwe:

Under 5 Mortality Rate

Implementation begins in 2010

Zimbabwe Current Trend Zimbabwe MCHIP Package

Zimbabwe MDG 4 Target

Zimbabwe 90% Maternal Health Coverage

Helping to Reach MDG 5 in Zimbabwe:

Maternal Mortality Ratio

MDG Goal for Maternal MortalityZimbabwe Current Trend Zimbabwe MCHIP Package

Zimbabwe MDG 5 Target

Zimbabwe 90% Maternal Health Coverage

Decreased Child Deaths in Zimbabwe

How LiST is being used at MCHIP con’t

24

Advocacy and Planning

InterventionMost Recent

Survey Target Coverage by

2015

Maternal Lives Saved Cumulatively

2010-2015

Newborn Lives Saved Cumulatively 2010-

2015

MATERNAL & NEWBORN

Antenatal Care 47% 67% 0 100

Skilled Birth Attendance 44% 64%70 2,000

Clean Practices & ENC (Home)* 3.9% 24%

Facility-Based Births 40.1% 60%

4,000 24,000

Essential Care for All Women & Newborns** 20.1% 15%

BeMONC** (Essential Care +) 12.0% 9%

CeMONC** (Essential, BeMONC +) 8.0% 36%

Combined Maternal/Newborn Interventions     4,000 24,000

MCHIP Lessons Learned

& Recommendations

What LiST Is, What LiST Isn’t

26

Is Multi-cause mortality

model Mathematic model Models coverage

impacts Potential impact

assessment National or sub-

national planning tool

Discussion points Evidence-based Effective advocacy

tool

Isn’t Truth Probabilistic model Natural history

model Detailed costing or

planning tool Bottlenecks,

budgeting Exhaustive

Food for Thought

Maternal Health Intervention Assumptions: Because of the much smaller numbers of

maternal deaths & the continuing work to determine the impact that some interventions have on maternal survival, LiST may not be the best tool to weigh the relative value of different investments in maternal survival

MH interventions included in LiST are packages that are only effective in reducing mortality if all services are provided at quality

Food for Thought

It is often just as important to show the impact of scaling back interventions that already have high coverage levels (ie. Lives LOST due to roll-back in coverage)

Particularly important for mature interventions (i.e. Immunization, Vit A coverage)

We do not want projections to inadvertently make the case for decreasing funding/coverage for these interventions

Thank you!

wwww.mchip.net

Follow us on: