Laaru Consulting sat down with Nicole Sirivansanti (former employee of Bill & Melinda Gates Foundation) and Claire-Helene Mershon to discuss Bill & Melinda Gates Foundation's approach and vision for their maternal newborn and child health. They also share some of the great projects the foundation has undertaken in the developing world. Here is an insight into how the foundation has managed to support and implement its’ strategies whilst positively impacting maternal and child mortality rates.
Can you share one of your projects that has positively impacted society with us?
Nicole: I would say trying to get ahead of the pandemic has been a significant undertaking across all of the teams at the Gates Foundation. You can get a high-level view into that if you check our website with the latest articles from our CEO. If we drill down to our team specifically, our partners have had to make pivots to respond to COVID and accommodate the new ways of working. For me, one of them is the Maternity Foundation. They are an organisation that develops the Safe Delivery App and supports the scale and use of this app, job aid and learning tool for skilled birth attendants across multiple countries. They have over 200,00 workers and are in 10 countries. Given COVID and the need to be socially distant, having this tool that enabled easy sharing and quick updates were instrumental in responding efficiently, and I think they were at the right place. Before, there were modules on what to do with birth deliveries and relevant modules for a midwife; before COVID hit, they created COVID modules to share the latest guidelines and practices. For example, topics like the proper use of PPEs with pregnant women, the complications and challenges of breastfeeding, and the latest research and updates regarding COVID-19. They have had to rethink their physical training to conduct them remotely. Another interesting dynamic and a positive aspect are that there has been less travelling and a lot more local response that has had the opportunity to step up and shine. We have many more local partners stepping in to do more training and research instead of having people from the global North flying in to conduct these sessions.
Claire: So, I work on a different part of the portfolio from Nicole. My work is centred around the measurement and monitoring of pregnancy services, emphasising vulnerable populations and how that applies across our strategy. Like Nicole, most of our teams have been affected by COVID-19. We are starting a couple of projects related to the measurement of essential health services. For example, I am working on a project in Kenya that is interviewing women who delivered a year ago, or less and soon after the lockdown, to find out what their experiences were delivering in the time of COVID, and specifically women who ended up delivering at home. Was this either by choice or because they couldn't make it to healthcare facilities? What were some of the influencing factors?
So essentially trying to help decision-makers and policymakers figure out the kind of things that go into decisions regarding lockdowns. Is there a need for better transportation systems in case of lockdowns?
Additionally, we have worked a lot on essential health services, ensuring that people get all the care they need. And we do this by working with global institutions creating guidelines and recommendations for country governments to use their health information system data to track, for example, knowledge on how institutional deliveries have been reduced. The institutions that we worked with were World Health Organization (WHO), UNICEF, UNFPA; they developed a preliminary guideline for countries to have all of this information coming from the health management information system. What are the key factors they need to know? What are the top indicators that countries need to know and regularly track to find out the health of their population aside from COVID, specifically related to MNCH? These finalised guidelines have been made available to countries to enable them to make decisions and figure out tracking indicators in terms of how well they are doing to get populations back on track.
What are some new strategies and innovative ideas recently designed specifically to tackle infant and pregnancy mortality?
Nicole: The good news is there are so many. Specifically for us, we have investments exploring how to facilitate risk stratification during pregnancies in underserved communities so that we can make sure women are getting the proper care at the right place and at the right time. We are also investing in the development and research of devices like handheld portable ultrasound. We are also thinking about the characteristics of a successful health system that we can highlight and bolster. For example, this concept, networks of care, the interconnection across the health system level and the concept of teamwork and collaborations and coordination it's not new, but it hasn't necessarily received the kind of emphasis that is warranted. We also invest in maternal and infant nutrition and quality of care in terms of improving pregnancy mortality. Our team has really zoomed in on how to improve the quality of care.
Claire: I can talk a little bit about the pieces of work that I am involved in and how our strategies work with other strategies across this foundation. For example, we're in the global development division, which focuses more on what we generally think of as public health approaches. There is also a division on global health, which is a little more the bench science in research and technical invention. We work closely with another team in the global health division who is charged with things like the ultrasound project Nicole was talking about. The idea is that they are testing out new innovations and the most promising ones come to us. We then do the effectiveness and implementation research associated with that and prepare to scale up.
Besides the pandemic, what have been some of the significant setbacks in achieving your goals this year? How have you managed to overcome them?
Nicole: As a whole, we can still reach our goals; we are thinking more broadly about our work ethics and how we can do our work differently. We haven't really had any setbacks, but overall an increasing awareness of what our blind spots have been; One is gender equality, making sure we integrate the gender lens in our strategy and investments, that is a working progress as we all know, it is a marathon and not a sprint, and there are many steps and learning for our team to go through as we undertake this journey.
Similarly to that, another journey we are taking is when we think about whom we partner with and whom we share our power with, and this is tied to a movement that has crossed the United States, at least when it comes to racial and social justice. For us, it connects to decolonisation and thinking through what our role is in that. These are things that we are increasingly turning our attention to and locking the journey that needs to happen. This is so that we can be more intentional in bringing sustainable impact, beyond just maternal and newborn health, by thinking about how we work with our partners in communities.
Any concerns for the future?
Claire: We have no significant concerns, really; however, we are concerned about the long-term potential generational impact COVID-19 will have, especially on women. Some of that is related to economic disruptions and health. That's something we're definitely interested in learning more about. Also, people have a desire to get back to normal, but normal was not really working for many people.
What criteria do you particularly look for in companies or individuals wishing to apply for your grants?
Nicole: Firstly, it needs to somehow fit with the strategies of the foundation. We hope to support learning; we are looking for local ownership, growth potential, and leadership in the work we support. Our advice is to be bold and come forward. Build your case and persevere. I know we have a lot of power, but hopefully, we can shift that. It's a big world, don't let us determine your path.
What do you miss the most about 2020 and hope that 2021 will be different?
Nicole: I miss hugs.
Claire: I hope to get to see my family soon. I miss the office and the people. We hope to get back to normality soon.