The Making It Happen Programme (MiH) is implemented by the Centre for Maternal and Newborn Health at the Liverpool School of Tropical Medicine (CMNH-LSTM). CMNH serves as the global coordinating centre for the programme working in close partnership with the Ministry of Health in each participating country, the UN technical agencies and professional organisations.
The MiH programme aims to reduce maternal and newborn mortality and morbidity (MDG4 and MDG5) by increasing the availability and improving the quality of Skilled Birth Attendance (SBA) and Emergency Obstetric and Newborn Care (EmONC). MiH is currently being delivered in 11 countries: 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).
CMNH has developed three new approaches:
1) Designing and delivering a ‘skills and drills’ EmONC training package that comprises a short (max 6 days) multi-disciplinary training (nurses, midwives, doctors and specialists train as a team), training critical numbers (80% or more) of health care workers providing maternity care in or close to 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 (1 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 (4 days) to strengthen quality improvement methodologies (maternal and perinatal death audit and standards based audit) at health care facility level (in Malawi, Kenya, Zimbabwe and Sierra Leone)
Evaluation of MiH.
A comprehensive, innovative 5-level M&E framework to evaluate the effectiveness of EmONC training was developed with inputs from the Royal College of Obstetricians and Gynaecologists and the World Health Organisation. This informed the MiH programme logframe which has 5 Outputs.
Output 1: Increased healthcare provider capacity to provide EmONC: Score A
• 11,837 healthcare providers trained in EmONC between Jan 2012 and October 2014 (of which 1,586 involved in pre-service training).
• 84.3% health care providers demonstrated improved knowledge and 93.8% improved skills (n= 6,627 tested before and after training)
Output 2: Increased availability of EmONC for mothers and babies: Score A+
• 1,617 health care facilities have staff trained in EmONC by MiH programme; 323 designated to provide Comprehensive, and 819 Basic EmONC
• 58% of CEmONC and 47% of BEmONC increased the availability of signal functions at six months.
• 35.5% more CEmONC health care facilities fully functional (all 9 signal functions) and 54.5% more BEmONC facilities ( all 7 signal functions)
Output 3: Strengthened accountability for results with increased transparency: Score A
• 100% of healthcare facilities have labour ward register, 75.2% have postnatal register and 94.6% of CEMONC facilities have theatre register in place.
• 1,219 health care providers trained in the collection and use of routine MNH data
• 192 health care providers completed quality improvement workshop package
• 100% of participating healthcare facilities conduct maternal death audit in Zimbabwe and 83.3% in Kenya.
• 81.8% of all maternal deaths have been reviewed by Quality Improvement team in healthcare facilities.
Output 4: Strengthened capacity to sustain improvements in MNH service delivery: Score A+
• 1,488 in-country Facilitators (Master Trainers) for EmONC established
• South Africa, Kenya and Zimbabwe able to run EmONC training independently; Sierra Leone, Ghana, Nigeria, Malawi, Tanzania, Bangladesh, Pakistan and India able to deliver training with quality assurance from CMNH-LSTM
• 20 skills laboratories and 265 training rooms equipped
Output 5: Evidence generated by programme disseminated in order to inform national, regional and global agendas: Score A+
• Evidence arising from MiH programme shared at international and national conferences and meetings, via news bulletins and via peer reviewed publications.
• All quarterly reports completed and Key Performance Indicators (KPIs) developed and on track.
For the second year running, the DFID Annual Review 2014 scored the overall MiH programme as: A+ (outputs exceeded expectations).
Interim Outcome level results
Outcome measures are obtained for a subsample of health care facilities with at least 100 deliveries per three months. Before and after data are collected at baseline, 3, 6 and 12 months.
By September 2014, for 82 health care facilities with 80% or more maternity staff trained in EmONC, at six months after the intervention:
- The number of women recognised to need and receiving emergency obstetric care increased from 680 to 781 per month - an overall increase of 14.9%. In addition, a 67% reduction in postpartum haemorrhage (PPH).
- The maternal direct obstetric case fatality rate decreased by 27.6% from 4.36% overall to 3.16% with no deaths occurring at BEmONC level (attributed to more timely referral to CEmONC level). This equates to 5 fewer maternal deaths per month.
- A 4.5% reduction in still birth rates from 3.8% to 3.6% or 16 fewer stillbirths per month.
- For health care facilities that have a newborn care unit/area (n= 30/82) a 36.6% reduction in the number of babies admitted for asphyxia or 15 fewer babies per month