The Sustaining Health Outcomes through the Private Sector (SHOPS) Plus is USAID's flagship initiative in private sector health, awarded to Abt associates in September 2015. The new $150 million project builds on the highly successful Strengthening Health Outcomes through the Private Sector Project from 2010-2015.
The primary goal of the project is to improve health outcomes and contribute to the achievement of major global efforts, especially Ending Preventable Child and Maternal Deaths, AIDS-free Generation, and FP2020. The private sector is integral to the health system and an important provider of priority health care services. To improve health outcomes and meet these global commitments, SHOPS Plus will strategically engage the private sector. The project will capitalize on the unique capabilities of each of its partners to tackle pressing health issues with a flexible and comprehensive approach.
SHOPS Plus is implemented by Abt Associates in collaboration with the American College of Nurse-Midwives, Avenir Health, Broad Branch Associates, Banyan Global, Iris Group, Marie Stopes International, Population Services International, William Davidson Institute at the University of Michigan, and two African-based organizations, Insight Health Advisors and Praekelt Foundation.
Systems for Better Health (awarded 2015)
USAID has awarded Abt Associates the Systems for Better Health Program in Zambia (SBH), a five-year project to increase the quality, availability, and use of priority health services in Zambia. SBH, valued at $54 million, will build on Abt Associates' 17 years of successful health systems strengthening work in Zambia, and is a direct follow-on project to the Zambia Integrated Systems Strengthening Program (ZISSP), which ended in December 2014. ACNM also was a partner in ZISSP and is looking forward to further supporting the groundwork laid during the earlier project.
In keeping with the Zambia's National Health Strategic Plan and the US Government's Country Development Cooperation Strategy, Abt will support Zambia's Ministry of Health to provide equitable access to cost effective, high quality family planning, HIV and AIDS, maternal, newborn and child health, and nutrition services. The SBH project goal of improving health outcomes for Zambians will be achieved by strengthening the systems underpinning the delivery of high quality health services and increasing the utilization of these services at district and community levels.
SBH will be implemented in partnership with Save the Children, the American College of Nurse-Midwives, Akros Inc., Imperial Health Sciences, Initiatives, Inc. and the BroadReach Institute for Training and Education.
ACNM is directly involved with strengthening pre-service educational institutions for midwifery and Community Health Assistants with a focus on their simulation/skills laboratories and clinical practice systems.
Every Preemie SCALE (awarded 2014)
Every Preemie SCALE (Scaling, Catalyzing, Advocating, Learning, Evidence-Driven) is a five-year $9 million United States Agency for International Development (USAID) Cooperative Agreement designed to provide practical, catalytic, and scalable approaches for expanding uptake of preterm birth (PTB) and low birth weight (LBW) interventions in 24 USAID priority countries in Africa and Asia. Every Preemie SCALE is working with partners to identify and overcome bottlenecks to implementation and significantly increase coverage of PTB and LBW evidence-based interventions in order to increase newborn survival.The program is being implemented by a consortium comprised of Project Concern International (PCI), the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), and the American College of Nurse-Midwives (ACNM). PCI leads community capacity building and mobilization activities, GAPPS leads evidence and knowledge sharing, program learning, and implementation research activities, while ACNM leads health provider capacity building and performance improvement activities.
Health Service Delivery Activity Jordan (awarded 2016)
To help the Jordan address the influx of more than 1.3 million refugees which has threatened to overwhelm and weaken the nation's previously robust health system, USAID's new five-year, $51.7 million Health Service Delivery Activity (HSDA) is designed to expand the capacity of the health system by increasing its efficiency and effectiveness, enabling it to cope with the estimated 25% increase in the population. Simultaneously, the activity will protect and build on previous gains in maternal and child health by targeting both the public and private sectors to enhance the quality and responsiveness of health services. Through innovative and scalable interventions, the Health Service Delivery Activity will improve access to quality services through expanding health networks; promoting the integration of key reproductive, maternal, newborn and child health interventions; and fostering community ownership to increase health facility accountability. These efforts will focus on heavily populated, urban, and poor areas to meet the health needs of vulnerable Jordanian host communities and refugees outside camps.
USAID envisions that over the life of the activity, these investments will enable the Jordanian health system to deliver the right care at the right time for the right client, with measurable improvements in contraceptive prevalence rates, maternal and newborn mortality, women and children's nutrition and access to facilities providing integrated health services.
Abt Associates Inc. is the prime implementer for USAID's Health Service Delivery Activity and is supported by the Health Care Accreditation Council, Eastern Mediterranean Public Health Network, American College of Nurse-Midwives, and Population Council. In addition to these sub-partners, Abt is proud to collaborate with Jordan's public health authorities, including the Ministry of Health, Royal Medical Services, and Higher Population Council.
Survive and Thrive Global Development Alliance (awarded 2012)
ACNM is in year three of its engagement as a professional partner in the Survive and Thrive GDA. With ACOG and the American Academy of pediatrics (AAP), ACNM is engaged in a variety of initiatives related to maternal and newborn health and strengthening professional associations.
Activities for 2017 have included:
- The Professional Association Strengthening Manual is a series of modules that will assist health professional association to become stronger, better governed and more effective. The modules were developed as a simple, easy-to-understand series for use with or without a consultant. Unlike materials used in a training, with these modules the goal is for associations to self-diagnose their developmental level and move forward with use of selected materials that meet their unique needs. These modules were launched at the recent Women Deliver conference in Copenhagen.
- Myanmar Nurses and Midwives Association (MNMA). The country office of USAID requested that ACNM provide support to MNMA in professional association strengthening and in promoting MNMA's capacity to participate in collaborative clinical initiatives. ACNM will be using the manual developed under the GDA to support association strengthening efforts. In conjunction with the Maternal Child Survival Program (MCSP)/Jhpiego, ACNM will be working with MNMA to develop clinical skills that take place within the national skills lab which Jhpiego has supported. These trainings are planned to be interdisciplinary with the Ob/Gyn society of the Myanmar Medical Association.
- Midwifery education in Tanzania. ACNM is collaborating with MCSP/Tanzania to strengthen pre-service education of midwives. We were first asked to conduct a thorough assessment of the new midwifery curriculum. Based upon that assessment, the partners prioritized the strengthening of the skills labs at the schools in order to build capacity among faculty and to facilitate the integration of simulation with the curriculum.
- Strengthening Midwifery Education in Comprehensive Family Planning. In June 2011, ACNM was awarded a multi-million dollar grant by a private foundation to scale up their pre-service education program in comprehensive family planning to 2 more midwifery schools after the successful pilot at the Kumasi Nurses and Midwifery Training College in Kumasi, Ghana from 2009-2011. The project focuses on strengthening 4 core areas: 1) program standards and regulation 2)curricula development and teaching methodologies 3) clinical and teaching skills of teachers (tutors) and preceptors 4) infrastructure, equipment and supplies. An exciting part of this project is the development of an electronic Learning Package in Comprehensive Family Planning being undertake in collaboration with the Center for International Medicine at University of California Los Angeles to be piloted at Kumasi Nurses and Midwifery Training College in 2012. Theproject addresses the core areas in three learning environments: 1) didactic learning in the classroom 2) skills practice area on models and 3) hands-on clinical practice with patients. It is expected that activities undertaken to strengthen these areas will also improve professional satisfaction and thus improve recruitment and retainment of both teachers and preceptors.
- Zambia Integrated Systems Strengthening Program (ZISSP). ZISSPis a USAID program led by Abt Associates that builds on the successes of the previous USAID funded Zambia Health Services and Systems Program (HSSP).ZISSP is designed to increase utilization of high-impact public health interventions in HIV/AIDS, malaria, family planning, maternal, newborn and child health and nutrition at district and community levels, through a health systems strengthening approach. ACNM is contracted to provide technical support and direction to the maternal health components of ZISSP's projects. Key areas include: supporting the national emergency obstetric and neonatal care (EmONC) training system; development of a post natal home visiting program; pre-service strengthening within the new direct entry midwifery programs; and strengthening community preparation and response to EmONC via Home Based Life Saving Skills (HBLSS).
- Human Resources for Maternal Survival: Facilitating a Community of Practice for Non-Physician Clinicians (NPCs). The Averting Maternal Death and Disability (AMDD) program at Columbia University contracts with ACNM in the development of a community of practice (CoP) among non-physician clinicians in 6 African countries where their scope and training includes emergency obstetric care. ACNM is the acting secretariat for this CoP. As formative reseach for the CoP and in anticipation of scale up across the region, ACNM designed and implemented a survey regarding training, practice, and regulatory standards in each participating country. Although non-physician clinicians exist in many countries,this cadre of health care workers is just beginning to develop their professional identity. ACNM draws on its extensive experience developing core competencies, regulatory frameworks, and a professional identity for midwives to assist non-physician clinicians with this process.
- Developing a National Training Program for Life-Saving Skills in Namibia. The Namibian Government is committed to ensure quality maternal and child health. In their last DHS of 2006/2007, progress was found to be hampered by a number of challenges. There is a slight upward trend in infant mortality. The maternal mortality ratio also increased and major causes identified were related to emergency obstetric care services. However, increased numbers of births (81%) were found to occur in facilities by skilled birth attendants. In moving forward the government identified interventions to improve these services, in 2010 Namibia's Ministry of Health and Social Services and some of their donor partners (WHO, UNFPA, UNICEF and the CDC) requested ACNM provide assistance in designing and establishing a national Life Saving Skills program (LSS)training program. This program provides updates in emergency obstetric care knowledge, skills, and attitudes for health care providers such as midwives, doctors and nurses. As with other LSS programs, a systems approach has been used so critical elements including assessment, up-grading of training facilities, curriculum adaptation, preparation of trainers and target participants and monitoring and evaluation are addressed. ACNM's technical assistance to this program is ongoing.
- Partnership for Transforming Health Systems (PATHS2) in Nigeria. PATHS2is a project funded by the UK Department for International Development (DFID) and led by Abt Associates for whom ACNM is subcontracted to implement their signature Life Saving Skills program (LSS). PATHS2 is assisting the Nigerian government to improve the access of impoverished communities to quality health care particularly at the community level. One component of PATHS2's health system strengthening is in-service training for Community Health Extension Workers (CHEWs) in essential obstetric skills. ACNM is designing and implementing the Master's training and CHEW training program in essential obstetric care through ACNM's competency-based Life Saving Skills training program. ACNM is also working closely with PATHS2 to design and implement a supportive supervision system for the Master Trainers who will train all senior level CHEWs in 5 different states of Nigeria.
- ACNM/CORE Group Healthy Moms, Healthy Babies Initiative. CORE Group is a network of more than 50 member organizations working in community health. One of its functions is to "develop and diffuse innovative cross-cutting community health program strategies, tools and best practices in order to overcome barriers to program coverage, quality, equity, and sustainability." This network includes many of the organizations who have implemented ACNM's pioneering community maternal and neonatal health program,Home Based Life Saving Skills (HBLSS). ACNM and CORE Group have partnered to leverage the experience of HBLSS implementing organizations to promote program learning, improve field implementation, and integrate HBLSS into existing programs. Other objectives include addressing the need for more Master Trainers, updating curriculum materials, and streamlining monitoring and evaluation. To date, a training of trainers for HBLSSwas conductedwith CORE Group members and the curriculum materials have been updated and finalized into a second edition. Future work will focus on creating a field-friendly implementation and facilitation guide.
- HBLSS Guatemala. In 2012, ACNM began partnering with Curamericas to implement Home-Based Life Saving Skills (HBLSS) in rural northwest Guatemala in order to reduce pregnancy- and birth-related mortality in the region that locals of San Sebastian Coatan call "The Triangle of Death." With a rate of 584 maternal deaths per 100,000 live births, these women face a 1-in-20 lifetime chance of dying in childbirth. At the root of this high mortality is a lack of timely access to adequate healthcare. Using ACNM's HBLSS curriculum, training was conducted to increase the knowledge and skills of local communities in the early recognition of maternal and neonatal problems and appropriate referral; the goal is to reduce maternal and newborn mortality in this area. Following the HBLSS Master Trainer Training, ACNM is working with Curamericas to develop a sustainable and effective training cascade and supportive supervision system for HBLSS in 12 communities.
- Scaling Up Family Planning Zambia. Beginning in 2012, ACNM was awarded a four-year grant to partner with Abt Associates on their Scaling Up Family Planning Program (SUFP) in Zambia project, funded by the Department for International Development of the UK. Zambia has one of the highest rates of maternal mortality in the world. The need for family planning and fertility are the highest in rural areas and among the poorest, least educated, and the youngest women. With this in mind, in collaboration with the local ministries of health and development, SUFP will launch their program in 26 districts of Zambia. ACNM will be working to build the capacity of the public sector to deliver quality family planning services through in-service programs for family planning providers, focusing on areas with the highest fertility rates and the most unmet need. Emphasis will be given to expanding availability of long-term reversible contraception methods and providing family planning services, with focus on adolescent girls and the poorest women. The program will also engage community health workers to sensitize men and others who influence family planning and will provide accurate information to address popular myths and misconceptions. To ensure sustainability of the project, outreach services as well as training and mentoring to public health workers will be carried out. Read more from DFID here.
- SHaRP: Strengthening Human Resources in Partnership, Zambia & Kenya. An award was made in November 2012 to the Averting Maternal Death and Disability (AMDD) Program at Columbia University, to study the implementation of task shifting of cesarean sections (C-sections) from physicians to associate clinicians (previously known as non-physician clinicians) in Zambia and Kenya. The goal of the research is to develop guidance for low-income countries seeking to implement and improve task shifting programs. The research aims to understand the process of moving from policy adoption of task shifting to actual implementation on the ground. Partners on the project include Chainama College of Health Sciences (Zambia), the American College of Nurse Midwives, Community Health Promotion Kenya (CHPK), and the Africa Network for Associate Clinicians (ANAC). Read more here.