Innovating for Maternal and Child Health in Africa (IMCHA) / Innovation pour la santé des mères et des enfants d’Afrique (IMCHA)
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Item Improving access to emergency obstetric care in underserved rural Tanzania : a prospective cohort study(Springer Nature, 2022-08-17) Nyamtema, Angelo S.; Scott, Heather; LeBlanc, John C.; Kweyamba, Elias; Bulemela, Janet; Shayo, Allan; Kilume, Omary; Abel, Zabron; Mtey, GodfreyOne of the key strategies to reducing maternal mortality is provision of emergency obstetric care services. This paper describes the results of improving availability of, and access to emergency obstetric care services in underserved rural Tanzania using associate clinicians. A prospective cohort study of emergency obstetric care was implemented in seven health centres in Morogoro region, Tanzania from July 2016 to June 2019. In early 2016, forty-two associate clinicians from five health centres were trained in teams for three months in emergency obstetric care, newborn care and anaesthesia. Two health centres were unexposed to the intervention and served as controls. Following training, virtual teleconsultation, quarterly on-site supportive supervision and continuous mentorship were implemented to reinforce skills and knowledge. When emergency obstetric care services are made available the proportion of obstetric complications treated in the facilities increases. However, the effort to scale up emergency obstetric care services in underserved rural areas should be accompanied by strategies to reinforce skills and the referral system.Item Building leadership and managerial capacity for maternal and newborn health services(Springer Nature, 2022-09-07) Murphy, Gail Tomblin; Mtey, Godfrey; Nyamtema, Angelo; LeBlanc, John; Rigby, Janet; Abel, Zabron; Mselle, Lilian TeddyStrengthening leadership and management is important for building an effective and efficient health system. This paper presents the findings from a L&M capacity building initiative which was implemented as part of a larger study aimed at improving maternal and newborn outcomes within primary health facilities in the Morogoro, Tanzania. The initiative, involving 30 stakeholders from 20 primary health facilities, 4 council health management teams and the regional health management team in the Morogoro region, provided leadership and managerial training through two 5-day in-person workshops, onsite mentoring, and e-learning modules. The initiative was evaluated using a pre-post design. Quantitative instruments included the ‘Big Results Now’ star-rating assessments and a team developed survey for health providers/managers. The ‘Big Results Now’ star-rating assessments, conducted in 2018 (19 facilities) and 2021 (20 facilities), measured overall facility leadership and management capability, with comparisons of star-ratings from the two time-points providing indication of improvement. The survey was used to measure 3 key leadership indicators - team climate, role clarity/conflict and job satisfaction. The survey was completed by 97 respondents at baseline and 100 at follow up. Paired t-tests were used to examine mean score differences for each indicator. Triangulated findings from focus groups with 99 health providers and health management team members provided support and context for quantitative findings. Star-ratings increased in 15 (79%) of 19 facilities, with the number of facilities achieving the target of 3 plus stars increasing from 2 (10%) in 2018 to 10 (50%) in 2021, indicating improved organizational performance. From the survey, team climate, job satisfaction and role clarity improved across the facilities over the 3 project years. Focus group discussions related this improvement to the leadership and managerial capacity-building. Improved leadership and managerial capacity in the participating health facilities and enhanced communication between the health facility, council and regional health management teams created a more supportive workplace environment, leading to enhanced teamwork, job satisfaction, productivity, and improved services for mothers and newborns. Leadership and managerial training at all levels is important for ensuring efficient and effective health service provision.Item Innovating for maternal and child health in Africa initiative : final narrative report - March 14, 2014 - April 30, 2022(2022) IDRC; IMCHAThis final narrative report for the Innovating for Maternal and Child Health in Africa (IMCHA) initiative presents the story of IMCHA, our results, outcomes, and outputs from 2014 to 2022. IMCHA was launched in March 2014 as a CAD36 million, 7-year flagship initiative to improve maternal, newborn, and child health outcomes by strengthening health systems, using primary healthcare as an entry point. The IMCHA model used a novel approach to embed research and engage decision-makers in local and national health authorities, respond to national priorities, promote a multisectoral approach in participating countries, and build on African-Canadian research capacities and collaboration.Item IMCHA-funded projects in Nigeria : added-value for maternal, newborn and child health policy, practice and research(2022-02) Innovating for Maternal and Child Health in AfricaThe paper describes several initiatives from the programme for Innovating for Maternal and Child Health in Africa (IMCHA). Innovations stemmed from project design, strategies for community engagement, and policy makers’ involvement early in the project. Over 500 health workers, researchers, and policymakers across the country were trained on various topics: Universal Home Visits, communication, perinatal depression, adolescent parenting, group psychotherapy, gender-based violence, use of tablets for data collection, implementation research, social media skills, and knowledge translation. Collaborations were developed with policymakers, non-governmental organizations and other researchers working in the field.Item Case study report on IMCHA’s research and policy engagement work in Tanzania 2015-2022(2022-04) Lomofsky, Dena; Wessels-Ziervogel, Wilma; Bhebe, Brilliant; Ncube, Petronella; Davids, Shu-aat; Innovating for Maternal and Child Health in AfricaThe Innovating for Maternal and Child Health in Africa (IMCHA) project tackles health systems issues by focusing on ensuring that research is designed, presented, and packaged to influence policy. In Tanzania, most projects had at least two innovations leading to positive outcomes across the different categories, showing there were multiple pathways for impacts to scale. The Tanzanian case study demonstrates sustainability of project results. Impact stemmed from the conscious effort to coordinate teams and to create the conditions for cooperation. Between 2014-2022, the initiative was implemented in 11 countries across Sub-Saharan Africa, with Tanzania hosting the largest number of projects.Item Insights from IMCHA’s research and policy engagement work in Tanzania(2022-04) Lomofsky, Dena; Kern, Carolina; Innovating for Maternal and Child Health in AfricaThe design of the Innovating for Maternal and Child Health in Africa (IMCHA) initiative prioritized knowledge translation and research uptake as key objectives in all projects. The project design insisted using ‘implementation research’ – an approach that puts heavy emphasis on testing innovations in real-life settings. It also encouraged uptake by embedding decisionmakers in research teams. The case study reviewed in this brief, identifies benefits of having multiple teams working in one country, which stemmed from the initiative’s conscious efforts to coordinate researchers and create the conditions for cooperation.Item Timeline of the IMCHA initiative’s research and policy engagement work with Tanzanian research teams(2022) Innovating for Maternal and Child Health in AfricaThis graphic portrays a timeline (2014-2020), breaking down steps and activities in training and planning towards improved health care for women and children, through the Innovating for Maternal and Child Health in Africa (IMCHA) project. Policy influence and uptake is an outcome of the initiatives.Item Project synopsis : Tanzanian research project supported under the IMCHA initiative [part 1](2022) Innovating for Maternal and Child Health in AfricaThis two-page poster type brief provides details of six Core grants, their goals and results, as well as four “Synergy” grant components which outline particular activities that enhance the core grant projects. The synergy grants were used to address gender and equity issues in projects. All of the grants are used in support of Innovating for Maternal and Child Health in Africa (IMCHA) to improve the quality of antenatal, postnatal, and neonatal care as well as access to health care services.Item Added value of multiple IMCHA research projects on maternal, newborn and child health policy and practice in Nigeria(2022-02) Johnson, Ermel; Sombié, IssiakaThe Innovating for Maternal and Child Health in Africa (IMCHA) initiative was designed to generate findings that could influence policies and practices at national and subnational levels. This case study documents the added value of IMCHA projects on maternal, newborn and child health policy and practice in Nigeria. Three research teams implemented five research projects representative of different country contexts, allowing analysis of different facets of MNCH problems including barriers to service utilisation and perinatal depression, as well as impacts of the projects. Future research funding could build on the IMCHA model to ensure political involvement and ownership at national level.Item Impact brief : using research evidence for national and regional decision-making(2022) Innovating for Maternal and Child Health in AfricaDeveloping evidence-informed policies was at the heart of the Innovating for Maternal and Child Health in Africa (IMCHA) initiative. IMCHA projects have informed the adoption or revision of more than 20 policies and practices across sub-Saharan Africa. Between 2014 and 2022, IMCHA made important strides toward improving the lives of women and children in 11 countries. This 3-page policy brief reviews outcomes and impacts of the IMCHA initiative. It demonstrates to decision-makers and researchers that they need each other, even if they do not have the same vision.Item Synthèse sur les répercussions : utiliser les résultats de la recherche pour la prise de décision à l’échelle nationale et régionale(2022) Innovation pour la santé des mères et des enfants d’AfriqueItem Synthèse des répercussions : mobiliser les hommes pour une meilleure santé des mères et des enfants en Afrique subsaharienne(2022) Innovation pour la santé des mères et des enfants d’AfriqueItem Impact brief : engaging men for better maternal and child health in sub-Saharan Africa(2022) Innovating for Maternal and Child Health in AfricaLow participation of men in Maternal and Child Health (MCH) care negatively impacts the lives and health pf women and children. Because men are often the main providers and decision-makers for the entire family for example, they determine women’s access to resources and health care. The policy brief outlines the challenges in, and strategies towards increased male involvement in the care of their families. When men are engaged as “male champions” to deliver key messages to villages, in turn engaging male gatekeepers of information, this approach impacts behavioural change among men.Item Innovation pour la Santé des Mères et des Enfants d’Afrique : évaluation formative de mi-parcours(2018-10-21) Thorsteinsdóttir, Halla; Bell, Jennifer Mary; Bandyopadhyay, NandineeItem Innovating for Maternal and Child Health in Africa : a mid-term formative evaluation(2018-10-21) Thorsteinsdóttir, Halla; Bell, Jennifer Mary; Bandyopadhyay, NandineeThe initiative supports 19 research teams (13 in East Africa; 6 in West Africa) to encourage Africa-Canada collaboration in projects to improve maternal and child health (MCH). This mid-term formative evaluation identifies strategies that can inform and strengthen IMCHA’s implementation until the end of the initiative, as well as speak to related future activities. There was a wide range of types of collaboration, with some involving capacity-building efforts, and others involving complementary expertise and bi-directional knowledge flow. Over 80% of survey recipients said that the relationship between the African principal investigators (PI) and Canadian co-PIs was a collaboration of equals.Item Issue brief : working with decision-makers : findings from the mid-term evaluation of the Innovating for Maternal and Child Health in Africa (IMCHA) initiative(2018-10) Thorsteinsdóttir, Halla; Bell, Jennifer M.Involving decision-makers from the beginning of research projects is the most conducive model for project implementation processes. Maternal and Child Health in Africa (IMCHA) incorporates decision-makers as co-Principal Investigators (co-PIs) from the design stage and throughout the project. Collaboration with the decisionmaker co-PIs was generally viewed as a success by the research team. However, a main challenge for collaborations with decision-maker co-PIs was their frequent turnover, especially if they were already working in a position of influence, such as at the national level.Item Issue brief : equity in the IMCHA initiative : findings from the mid-term evaluation of the Innovating for Maternal and Child Health in Africa (IMCHA) initiative(2018-10) Bell, Jennifer M.; Thorsteinsdóttir, HallaThe analysis combines document review, online surveys, in-depth interviews with donor representatives, fieldwork in Africa and Canada, and focus group discussions with stakeholders. Innovating for Maternal and Child Health in Africa (IMCHA) projects emphasize incorporating health equity considerations. The report and findings of the evaluation underline scope for more deliberate incorporation of an equity lens in IMCHA projects; data indicates some confusion around the concepts of equity and gender equity. It would be useful to further the grantees’ understanding of inequities, and develop their capacity to identify social, racial, economic, or age-related barriers as well as geographic ones.Item Synthèse sur les répercussions : renforcer la motivation et l’impact des agents de santé communautaire pour une meilleure santé maternelle et infantile(2021) Innovation pour la santé des mères et des enfants d’AfriqueItem Impact brief : enhancing community health workers’ motivation and impact for better maternal and child health(2021) Innovating for Maternal and Child Health in AfricaCommunity Health Workers (CHW) have contributed to universal health coverage by ensuring access to care for the hardest to reach. They are vital to building strong health systems moving towards achieving the United Nations Sustainable Development Goals (SDG-3 Good Health and Wellbeing). This 2-page policy brief reviews the successes of the Innovating for Maternal and Child Health in Africa initiative (IMCHA) and the impact of CHW’s. There has been a 90% increase in the number of women attending four or more antenatal visits (2017-2018).Item Maternal and child health implementation research in Mozambique : effective community interventions to promote sexual and reproductive health(2021) Pires, PHNM; Mupueleque M,; Zakus D,; Mucufo J,; Abdirazak AThe article/study assesses the impact of community participation on improving sexual and reproductive health. Comparing changes between 2016 and 2019, the number of health committees operating in Natikiri (Nampula, Mozambique) rose from 7 to 20. Population access to contraceptives was facilitated, rising from 42% to 91% in women and 65% to 90% in men. At Marrere General Hospital (Nampula) maternity deliveries rose by 60%. The article reviews a baseline study, strategies designed to improve health services, and empowerment in sexual and reproductive health and rights, as well as enhancing maternal and child health.