Improving Local Governance for Maternal and Newborn Health Gains

Greg Olson

Communications Senior Associate

On July 22nd, 2015, I attended the Saving Lives at Birth: A Grand Challenge for Development fifth round DevelopmentXChange. Saving Lives at Birth is a public-private partnership between: the United States Agency for International Development (USAID), the Government of Norway, the Bill & Melinda Gates Foundation, Grand Challenges Canada, the United Kingdom’s Department for International Development (DFID) and the Korea International Cooperation Agency (KOICA) that aims to build a community and spirit of innovation within public health and development.

Photo of mothers and children. (Photo credit: MSH staff)

Since 2011, the Saving Lives at Birth partnership has aimed to improve maternal and infant health by identifying and supporting new solutions for impact, research, and service delivery. At this year’s DevelopmentXChange, 17 award nominees were chosen for grant awards from the 53 finalists. I enjoyed learning about the nominees’ innovative approaches that leverage new technologies and ideas for lowering maternal and infant mortality; however, I would also like to highlight one finalist that was not selected this year.

The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) presented a research proposal on the “Integration of a Community Based Management of Severe Pre-eclampsia and Eclampsia with Improved Governance of Local Government in Rural Bangladesh.” Generating enthusiasm for improving health system governance can be challenging on its own, but it can be even more difficult for a governance research proposal standing in a field alongside mHealth, eHealth, and tech-for-health tools.

However, icddr,b’s proposal warrants recognition. Poor health system governance—especially in rural settings—often proves to be a large hindrance for those same mHealth, eHealth, and tech-for-health projects bringing their solutions to scale. When it comes to maternal and newborn health in Bangladesh, icddr,b identified the weak governance capacity of Union Parishad Education Health and Family Planning Standing Committees (UPEHFPSC)—local committees responsible for maternal health service delivery—as a key obstacle to improved health outcomes.

As I spoke with Dr. Nafisa Lira, the icddr,b representative at the exchange, she identified a specific factor that limited UPEHFPSC institutional capacity for maternal and newborn health services: accountability. Accountability is a two-way street. Since there was neither oversight pressure from a regional governing body, nor social pressure from citizens, members of the UPEHFPSCs lacked an incentive to improve services. As a result, low accountability impacted the institution's ability to address health challenges. Although icddr,b’s research proposal was not selected this year for a Saving Lives at Birth award, their proposed research into local governance capacity has the potential to inform and catalyze institutional development and the organization’s ability to address maternal and newborn health challenges.

For example, in Afghanistan, improved local-ownership and governance led to improved health outcomes in rural villages that faced similar challenges to the challenges iccdr,b identified in Bangladesh. Members of shuras in Afghanistan—local community health councils—participated in governance trainings that included methods for cultivating accountability, one of the four main practices of good governance.

Good governance enables health service delivery, and when communities take collective action and ownership over their health outcomes, health systems become more resilient.

Learn more about good governance in health, and check out the four governance guides to: Cultivating Accountability, Engaging Stakeholders, Setting a Shared Direction, and Stewarding Resources.

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