Time to Deliver on Maternal Health and Family Planning Best Practices: White Ribbon Alliances in Asia and the Middle East Make it Happen

This 12-page publication examines White Ribbon Alliances (WRAs), which have been established across Asia and the Middle East as advocates for evidence-based strategies to reduce maternal mortality. "Time to Deliver" details efforts on the part of the United States Agency for international Development (USAID) | Health Policy Initiative, Task Order 1 - a consortium that includes the WRA Global Secretariat as an implementing partner - to form alliances and support WRA efforts to scale up family planning (FP) and maternal, neonatal, and child health (MNCH) best practices in the region. This brief highlights the achievements of alliances from Bangladesh, India (Orissa), Indonesia, Pakistan, and Yemen.

As detailed here, the WRA action plans supported by the Health Policy Initiative focus on policy dialogue, advocacy, and networking. The 5 stories demonstrate the alliances' strategies for strengthening commitment to and active promotion of maternal and child health, as well as for designing country-specific action plans to scale up evidenced-based FP/MNCH best practices.

Bangladesh: Key strategies include registering midwives and providing training to upgrade their skills, expanding essential immunisation packages, delaying first pregnancy for adolescents, and promoting healthy timing and spacing of pregnancies. To translate these practices into action, WRA Bangladesh and MotherNewborNet organised 8 regional workshops in April and May 2008. The Director General of Health Services and Director General for Family Planning were also co-organisers, demonstrating the ownership and commitment of the government. About 675 district health authorities and service providers attended the workshops. As part of the process, participants met in teams to set district-specific priority interventions, assess feasibility of each approach, and outline next steps. The workshops were coupled with media outreach, resulting in 42 newspaper articles. Moreover, through the district planning process, WRA Bangladesh gained 350 new members, bringing its total membership to 799; according to organisers, expanding the membership of the alliance into the districts and widening its scope to include faith-based groups, professional associations, community organisations, and the media will contribute to a broadening of its advocacy and policy development efforts.

India: Recognising that "lack of accurate data has been a constant challenge for safe motherhood advocates in developing countries", WRA Orissa conducted "verbal autopsies" in the state's 30 districts. To foster sustainability, the alliance trained district coordinators and block-level partners in each district to conduct the qualitative research, which took place from January-August 2008. WRA Orissa began by identifying maternal deaths that occurred over the previous 3 months and randomly selected a case to investigate in each of the 30 districts. For each case, the team obtained permission from the woman's family and then visited the communities of the women, gathering information from families and any community members who were present during her pregnancy, delivery, and/or postpartum complications. Next, the team interviewed community-based health workers. Where relevant, the teams also gathered information from service providers and health facilities. The case studies were prepared with the agreement and observation of all the team members, and then shared with the families, health workers and service providers, district health authorities, and local media. "The case studies provide rich data on which to base evidence-driven advocacy, policy dialogue, and program planning..." WRA Orissa presented the findings of the verbal autopsies at hearings organised as part of the nationwide "Deliver Now for Women + Children" campaign. "The hearings, which are covered by the local media, have generated excitement and lively debates in communities, with anywhere from 500 to 1,300 women taking part in each event." The hearings have led to changes. For example, in Koraput, district authorities issued a circular to all service providers, including auxiliary nurse-midwives (ANMs), calling for health facilities to remain open 24 hours a day.

Indonesia: WRA Indonesia has promoted the creation of "alert villages" (desa siaga) and other best practices to improve birth preparedness and complication readiness at the community level. As part of this process, in March 2008 WRA Indonesia conducted a workshop for 60 participants from 22 provinces. Each province prepared a draft action plan. Then, working with the Indonesia Midwives Association, WRA trained 30 facilitators on the formation of alert villages with a focus on birth preparedness, community savings plans, transport plans, tracking of pregnant women, and setting up blood donor systems. Six new alert villages were formed in Banten and West Java Provinces. In addition, 30 midwives in these villages participated in a 3-day training to increase their knowledge and skills in practices such as Kangaroo Mother Care, care for low birthweight babies, and the standard days method. In alert villages, WRA Indonesia supports midwives to identify pregnant women, provide antenatal care, encourage savings for maternal and child healthcare, and map and advocate for local resources. The model has been replicated in 12 additional villages in West Java. Indonesia's First Lady is a patron of WRA Indonesia. In December 2008, she hosted a competition for the Best Alert Village; representatives from the winning village participated in a national event for Indonesia's Mothers' Day Celebration on December 22 2008.

Pakistan: On August 23 2007, representatives from various groups and sectors came together to form a national alliance. The Health Policy Initiative has assisted the alliance with network formation and organisational development. WRA Pakistan convened 2 planning meetings in 2008 to finalise an action plan comprising recommended interventions for MNCH, family planning, integration of services, and crosscutting issues, such as involvement of Islamic leaders. To help disseminate the best practices and encourage policy dialogue, the alliance developed an advocacy toolkit that contains user-friendly policy briefs on each proposed best practice. The alliance has also established a critical mass of champions for best practices who are moving forward with implementation and dissemination of high-impact best practices.

Yemen: Yemen's National Safe Motherhood Alliance (NSMA) was registered with the Ministry of Social Affairs in October 2007. The alliance had its official launch at a high-visibility event to commemorate International Women's Day on March 8 2008; more than 400 people, including members of Parliament and the Ministers of Social Affairs and Education, attended. In March 2008, the Health Policy Initiative facilitated an advocacy workshop for NSMA executive committee members and key partners (25 participants). The country team finalised an advocacy action plan with a focus on encouraging Parliament to adopt the national safe motherhood policy currently under review, which includes the provision of free services for facility-based deliveries. Country team members also prepared a detailed action and training plan for the roll-out of 5 selected best practices: Kangaroo Mother Care, postpartum family planning, early and immediate breastfeeding, neonatal infection prevention, and postpartum vitamin A supplementation. As part of the dissemination activities, the national alliance conducted a 3-day workshop on best practices for its executive committee members and a member of Parliament from the Health Committee. In turn, the executive committee held 3 trainings in August, each with 30 participants from the general membership, to educate them on the best practices and to expand the promotion of best practices into the members' organisations. In 2008, NSMA held orientation meetings on best practices with stakeholders in Aden, Amran, Ibb, Lahj, and Taiz. NSMA also organised trainings emphasising these topics: communication skills, MNCH best practices, networking and advocacy, resource mobilisation and management, and negotiation skills.