*Y.C.* Better Information can Save Lives: Improving Maternal Health Information Quality in Mesoamerica
This project aims to improve the quality of maternal and reproductive health information in Central America and southeastern Mexico by first compiling and then standardizing key process and impact indicators. The ultimate goal of saving the lives of mothers and newborns is predicated on the ability to target at-risk populations and implement programs and actions that have the most impact, and this cannot be carried out without having high quality, reliable, and accurate information.
A major finding of the maternal, neonatal and reproductive health working group of the Mesoamerican Health Initiative was the identification of severe limitations in information as it currently exists in the region. This need was cross cutting for all indicators in all three areas and for all countries in the region, and thus a major challenge to implementing interventions. Strengthening of health information systems to ensure the availability of reliable information on the existence and performance of maternal and reproductive services will be of great help for the planning of specific interventions in each country and for the region as a whole.
In each of the countries in the region, despite some progress observed in recent years, there are severe deficiencies in information systems. This is especially evident in some areas such as maternal mortality, where the sub-registry of cases can be substantial. This explains why maternal mortality ratios calculated by scientific groups using sophisticated corrective methods are usually higher than the official rates reported by individual countries. The same is likely true for early neonatal mortality rates.
There is a great need to improve mechanisms of evaluation, monitoring and supervision of programs and interventions. We found that the program implementation is usually poorly monitored, precisely due to the lack of available information on program results, both expected and achieved. Supervision systems are frequently listed in the structure of services but usually these services are never actually implemented. Where supervision systems do exist, they are usually administrative and do not contribute either to the maintenance or assurance of the quality of the interventions or to their sustainability.
I propose to continue our working group’s efforts to compile, consolidate and compare information with the goal of having a standardized dataset available for further analysis. Our statistical annexes have many gaps due to missing information, especially for time trends, and these gaps make it extremely difficult to propose evidence-based and cost-effective interventions targeting key population groups.
About You
Section 1: About You
First Name
Sarah
Last Name
Lewis
Website
Organization
Instituto Nacional de Salud Publica
Country
Mexico, MOR
Are you an individual between the ages of 18 and 35 who would like to apply for a nine month Young Champions Program mentored by an Ashoka Fellow?
Yes
Section 2: About Your Organization
Organization Name
Sistema Mesoamericano de Salud Publica
Organization Website
Organization Phone
(503) 2261-5444
Organization Address
Blvd. de los Héroes, Edificio Torre Roble, Piso No. 8
Organization Country
El Salvador, SS
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Your idea
Name Your Project
*Y.C.* Better Information can Save Lives: Improving Maternal Health Information Quality in Mesoamerica
Country your work focuses on
Describe Your Idea
This project aims to improve the quality of maternal and reproductive health information in Central America and southeastern Mexico by first compiling and then standardizing key process and impact indicators. The ultimate goal of saving the lives of mothers and newborns is predicated on the ability to target at-risk populations and implement programs and actions that have the most impact, and this cannot be carried out without having high quality, reliable, and accurate information.
A major finding of the maternal, neonatal and reproductive health working group of the Mesoamerican Health Initiative was the identification of severe limitations in information as it currently exists in the region. This need was cross cutting for all indicators in all three areas and for all countries in the region, and thus a major challenge to implementing interventions. Strengthening of health information systems to ensure the availability of reliable information on the existence and performance of maternal and reproductive services will be of great help for the planning of specific interventions in each country and for the region as a whole.
In each of the countries in the region, despite some progress observed in recent years, there are severe deficiencies in information systems. This is especially evident in some areas such as maternal mortality, where the sub-registry of cases can be substantial. This explains why maternal mortality ratios calculated by scientific groups using sophisticated corrective methods are usually higher than the official rates reported by individual countries. The same is likely true for early neonatal mortality rates.
There is a great need to improve mechanisms of evaluation, monitoring and supervision of programs and interventions. We found that the program implementation is usually poorly monitored, precisely due to the lack of available information on program results, both expected and achieved. Supervision systems are frequently listed in the structure of services but usually these services are never actually implemented. Where supervision systems do exist, they are usually administrative and do not contribute either to the maintenance or assurance of the quality of the interventions or to their sustainability.
I propose to continue our working group’s efforts to compile, consolidate and compare information with the goal of having a standardized dataset available for further analysis. Our statistical annexes have many gaps due to missing information, especially for time trends, and these gaps make it extremely difficult to propose evidence-based and cost-effective interventions targeting key population groups.
Website URL
Innovation
What makes your idea unique?
In recent years, many international organizations such as the WHO, the Disease Control Priorities Project and the Institute for Health Metrics and Evaluation have made the need for high quality information a major priority in the improvement of population health in developing countries. However, efforts to obtain reliable information and standardize data often confront major difficulties in poor countries due to deficiencies in reporting deaths and cases as well as program information. Thus the key national indicators — let alone state or local-level information — necessary to make projections and allocate resources severely inhibit health improvement and system performance goals.
In the Mesoamerican region, consisting of seven countries of Central America (Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama) and the nine states of the Southeastern region of Mexico (Campeche, Chiapas, Guerrero, Morelos Oaxaca, Puebla, Quintana Roo, Tabasco, Veracruz, and Yucatan), there is a pressing need for strengthening the evaluation component of programs and interventions. As a consequence of the weakness of existing systems, there are very few programs evaluated and the official statistics may be inaccurate and unreliable.
Our working group’s Strategic Assessment was the first attempt to present a full set of comparable and standardized maternal health indicators and program information for the Mesoamerican region in order to have a basis on which to propose sets of interventions as part of a regional Master Plan.
Our research found no similar report or extensive compilation of this type of data. Completing the consolidation and standardization of this information would serve not only the Mesoamerican region but also could be applied to other regions with similar information deficiencies as well as organizations that require global information.
Do you have a patent for this idea?
Impact
This Entry is about (Issues)
What impact have you had?
The Mesoamerican Health Initiative was launched last year and is still in the intervention proposal stage, thus there has not yet been a health impact. However, another type of impact has been the gathering together of leaders from all the countries in the region to address maternal health and commit to making this area a priority, as individual countries and as a region. Funding and political support have been leveraged.
Problem
Despite significant improvements in basic maternal, neonatal, and sexual and reproductive health indicators in the Mesoamerican region during the past 10 years, on average unacceptably high maternal mortality ratios and neonatal mortality rates persist. If reductions in maternal and neonatal mortality continue at the same pace observed in recent years, it is likely that most countries in the region will fail to meet the MDGs, especially Goals 4 and 5. All national governments in the region have recognized the great importance of improving the quality of reproductive health care and have designed policies and programs to reduce maternal and neonatal mortality. However, these programs have not been fully implemented and the limited evaluations that do exist indicate that in many cases, programs have not achieved the desired impact. The lack of effective implementation of programs and interventions is due, fundamentally, to deficiencies within the systems of service and resource provision which fail to make interventions fully accessible to the whole population. These deficiencies are due largely to the existence of poor quality information.
Actions
To make the overall initiative successful, this project will identify the main problems, needs, and gaps in maternal, neonatal and reproductive health throughout the region, and interventions or strategies that have been implemented with the aim of addressing these issues by:
-Documenting the current situation of maternal, neonatal, and reproductive health and, when possible, trends over time, by examining key indicators, scientific literature and expert statements.
-Documenting the implementation of strategies, programs, projects, and other activities (completed and underway), from the past 10 years.
-Identifying regional and national needs and gaps in the topic areas.
Results
The major objectives of the initiative, to be achieved with the help of this project, are:
To increase the access to childbirth care provided by qualified and competent personnel, especially in rural and marginalized urban areas.
To increase the access to basic emergency obstetric care, especially in rural and marginalized urban areas.
To reduce the gap in the proportion of women giving birth with skilled personnel between women in the poorest and richest income quintiles in all countries in the region.
To reduce neonatal mortality by improving obstetric care and by implementing actions to improve the quality of immediate care provided to the newborn, especially in communities removed from large metropolitan areas.
To increase access to and quality of services that offer permanent and reversible methods for both men and women, and to implement actions that promote the reduction of the barriers to contraceptive access common in rural areas and among indigenous women, adolescents and youth.
What will it take for your project to be successful over the next three years? Please address each year separately, if possible.
Year 1: A clear plan of action for gathering data. Continuous communication with country representatives.
Year 2: Continuous communication with country representatives.
Year 3: Systems and statistical techniques to fully integrate and systematize all data obtained.
What would prevent your project from being a success?
A lack of cooperation to contribute information or otherwise make obtaining data difficult. Losing communication with country representatives due to staff turnover or lack of political will.
How many people will your project serve annually?
More than 10,000
What is the average monthly household income in your target community, in US Dollars?
$50 - 100
Does your project seek to have an impact on public policy?
Yes
Sustainability
What stage is your project in?
Operating for less than a year
Is your organization a
Non‐profit/NGO/citizen sector organization
Is your initiative connected to an established organization?
Yes
If yes, provide organization name.
Proyecto Mesoamerica, Sistema Mesoamericano de Salud Publica
How long has this organization been operating?
More than 5 years
Does your organization have a Board of Directors or an Advisory Board?
Yes
Does your organization have a non-monetary partnerships with NGOs?
Yes
Does your organization have a non-monetary partnerships with businesses?
Does your organization have a non-monetary partnerships with government?
Yes
Please tell us more about how these partnerships are critical to the success of your innovation.
The governments of the eight Mesoamerican countries have committed to the initiative, as well as the Council of Central American Ministries of Health (COMISCA). Thus our working group has a representative of the Ministry of Health of each country in addition to a COMISCA represenative. The Gates Foundation and the Carso Health Institute are funders, and we have technical experts from EngenderHealth, PAHO, the CDC and USAID in our working group, among others.
What are the three most important actions needed to grow your initiative or organization?
The three most important actions are:
1. Continued political will on behalf of governments and international organizations.
2. Continued financial and technical support from funders.
3. The implementation of progressive health policies that support activities dedicated to improving maternal health.
The Story
What was the defining moment that you led to this innovation?
I first realized the importance of being able to find and analyze good health information during my master's program research project in Mexico. I realized how spoiled we are in the U.S. where so much updated and standardized health information is available! This was further confirmed when I worked for the Observatorio initiative at the Mexican Health Foundation, whose premise is to compile and standardize information for health conditions in LAC. It would take me ages to find information for the different countries, but luckily I was prepared for the Mesoamerican project because of this. I have become quite familiar with sources of health data in the LAC region, but there is much to be improved. Without good data, the brilliant interventions proposed will not be able to be monitord and evaluated.
Tell us about the social innovator behind this idea.
I love working in Latin America and have an innate love for statistics. When I entered my international health master's program, I didn't know I'd eventually be working and living in Mexico, which has made incredible progress in the availability of health information. Having high quality, comparable health information is extremely important to improving maternal health.
How did you first hear about Changemakers?
Web Search (e.g., Google or Yahoo)
If through another, please provide the name of the organization or company
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Comments
Hi Sarah,
I think your work is fantastic in that it is a very large scale effort to create important indicators and set up a system that ultimately can provide a more cohesive tracking, monitoring, and coordination system among various government, donor and NGO- led interventions in maternal health. I am curious to your thoughts on creating demand/ incentives for all of the organizations to systematically use the indicators, continue to report information, and to use it to coordinate among efforts.
Dear Sarah,
I think this link is not irrelevant to your idea.
www.euro.who.int/document/e73494.pdf
Best Wishes,
Faatemeh.
Dear Sarah,
I think this link is not irrelevant to your idea.
www.euro.who.int/document/e73494.pdf
Best Wishes,
Faatemeh.
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