Socio-economic inequalities and the MDGs: building evidence to support equitable improvement in maternal and newborn health in Asia & Africa
Lead Research Organisation:
University College London
Department Name: Institute of Child Health
Abstract
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Organisations
Publications
Alcock G
(2015)
Examining inequalities in uptake of maternal health care and choice of provider in underserved urban areas of Mumbai, India: a mixed methods study.
in BMC pregnancy and childbirth
Bentley A
(2015)
Malnutrition and infant and young child feeding in informal settlements in Mumbai, India: findings from a census.
in Food science & nutrition
Bhim Prasad Shrestha (Author)
(2012)
Food security, food price and income trends in Dhanusha district, Nepal between 2005 and 2011
Bimala Manandhar
(2014)
Workshop about Maternal and Neonatal Health
Bimala Manandhar
(2014)
International Workshop has finished
Bimala Manandhar
(2014)
Workshop on Maternal and Neonatal Health
| Description | The EquiNaM project built evidence to support an equitable improvement in newborn and maternal health in Asia and Africa. The Millennium Development Goals have galvanized support to accelerate progress in human development, but improvements have been uneven and within-country inequalities between socioeconomic groups remain large. Little is known about (i) inequalities in outcomes that show the least progress, especially newborn mortality, and (ii) what works to reach the poor with interventions and reduce these inequalities. We addressed these evidence gaps using (i) data from a network of surveillance sites (Nepal, Bangladesh, rural and urban India, Malawi) with some of the largest population-bases of prospectively collected newborn mortality data in developing countries; (ii) randomized controlled trial data from these sites to assess the equity impact of community-based interventions; (iii) extensive qualitative research in the sites to explain our quantitative findings. We found that socioeconomic inequalities in neonatal mortality are large: the odds of dying in the first 28 days of life are about twice as high among poor compared with wealthier infants. Survival gains would be substantial if these within-country inequalities were reduced: if all groups had the mortality rate of wealthier infants, overall neonatal mortality would decline by around 40%. Underlying this problem are large inequalities in maternity and essential newborn care. Poor and illiterate women are far less likely to make at least three antenatal care visits, to deliver in a facility, and have access to emergency obstetric care. Socioeconomic inequalities in essential newborn care, like hygienic delivery practices, are largely explained by better care in facilities than at home. Governments in South Asia are introducing financial incentive programmes to improve access to institutional delivery care. Yet, our studies of the Safe Delivery Incentive programme in Nepal and the JSY program in India) show that poor and illiterate women are less likely to use these schemes. Our research in Nepal shows that financial concerns remain important barriers to institutional delivery among poorer women, despite the scheme. Community-based newborn health interventions are becoming increasingly popular. Randomised trials have shown that participatory learning and action (PLA) with women's groups can substantially reduce neonatal mortality. Our meta-analysis of the trial data shows that (i) PLA can address the exclusion of lower strata from interventions by reaching all socioeconomic groups; (ii) it is effective in improving health behaviours across socioeconomic groups in rural communities when simple changes can be implemented at home; (iii) by improving survival of all newborns, especially of disadvantaged infants, it can substantially contribute to an equitable improvement in newborn survival and towards targets set in the internationally agreed Every Newborn Action Plan. Our qualitative research shows that (i) soft targeting works to reach lower socioeconomic groups, among others by using engaging approaches that are easily understandable for the less educated; (ii) the social process of learning and action ¬¬-leading to increased knowledge, confidence to act, and acceptability of healthy practices- is important for behaviour change in all social layers in a context where newly-wed women have little decision-making power. |
| Exploitation Route | Our findings can be used for: - Advocacy: Using high quality data, we demonstrated the public health importance of addressing newborn mortality inequalities. The internationally agreed Every Newborn Action Plan envisages a world without preventable newborn deaths. Efforts to achieve this will fail if the poor are not reached with effective interventions. - Policy making, and developing maternal, newborn, and community health strategies: We have provided strong evidence that participatory learning and action with women's groups can substantially improve survival of all socioeconomic strata, especially of disadvantaged infants. This low-cost intervention is effective in rural communities for issues addressable with simple behavioural changes. It can be integrated into and scaled-up through government community health programs. Based on the work of our UCL-IGH research group, WHO in 2014 recommended the intervention to improve maternal and newborn health. - Program planning and implementation: We have provided strong, tangible evidence on what works to reach the poor and reduce mortality inequalities, which can contribute to operational change in development activities. We found that soft targeting works to reach the poor with health interventions. Furthermore, a social process of learning and action, with long-term community engagement, can ensure behaviour change across socioeconomic groups. |
| Sectors | Communities and Social Services/Policy,Education,Healthcare,Government, Democracy and Justice |
| URL | http://equinam.global-health-inequalities.info/ |
| Description | Our project addressed the demand from policy makers and implementers for evidence to support equitable achievement of the Millennium Development Goals (MDGs), in particular with regards to maternal and newborn health in South Asia and Africa. Our project was designed to have short, medium and long-term impacts at 3 levels: (1) data & evidence, (2) policy & implementation, and (3) research capacity. (1) DATA & EVIDENCE Using the most robust data available, our project addressed the paucity of evidence on (i) socio-economic inequalities in maternal and newborn mortality (ii) how to reach the poor in efforts to achieve the MDGs, and (iii) how to reduce socio-economic inequalities in newborn and maternal mortality. For details on this, see our Key Finding report. The methods for quantitative equity impact evaluation that we have developed in our project are now being applied in other studies - notably in a new large randomised controlled trial of an intervention to reduce maternal and newborn mortality. Also, in observational studies that our colleagues are doing, the methods for equity impact evaluation that we have developed are being applied (see also below under 'capacity building'). Our project has supported that such analyses can be done more systematically in impact evaluations so that gradually a body of evidence is being developed on how to how to reduce health inequalities. Our work on the equity impact of participatory women's groups (for example our 2013 paper in the International Journal of Epidemiology, a top 5% journal in our field - Houweling et al 2013, Int J. Epi.) has also been cited and/or used by others in the fields of equity research and newborn health research. A systematic review paper referred to our work as follows: "This kind of intervention [i.e. participatory women's groups] was also verified by strong evidence [i.e. Houweling, 2013, Int. J. Epi.] to have stronger effectiveness on reduction of neonatal mortality rate among the most marginalized women." (Yuan 2014 BMC Public Health). An editorial in the Int. J. Epidemiology by Prof. Cesar Victora, an eminent professor in the field of health inequalities research, was dedicated to the same paper [Houweling, 2013, Int J Epi.] Our response to this commentary was also published in the same journal. (2) POLICY & IMPLEMENTATION THROUGH STAKEHOLDER ENGAGEMENT Through targeted dissemination of our findings and ongoing interaction with policy makers, we increased awareness among those in power, of the problem of large inequalities in maternal and newborn mortality and how best to address this. By providing tangible evidence on what works to reach the poor and reduce mortality inequalities, we sought to contribute to operational change in development activities, such that they reach those most in need, thus increasing the effectiveness of efforts to reach the MDGs and contributing to an equitable achievement of the MDGs. From the start of the project onwards we built up a basis for engagement with policy and practitioner stakeholders, by giving our project a clear identity (a project name (EquiNaM, which stands for Equity in Newborn and Maternal Health), developing a logo, communication templates (for presentations, policy briefs etc), and a professional website that serves as a platform for dissemination (http://equinam.global-health-inequalities.info/). The website provides easy access to project information and outputs; it is very frequently visited, and our project outputs are downloaded on a daily basis by people from across the world. Through the website, we also sought to raise awareness among stakeholders about the possibility to actively engage with our project (see: http://equinam.global-health-inequalities.info/index.php/stakeholder-engagement/). We developed project information leaflets (in English, Hindi, Nepali and Chichewa), introduction presentations about the project and about the problem of socioeconomic inequalities in maternal and newborn health. And the study was announced on websites of each of the project partners, including the UCL website. As the project developed, presentations with the latest evidence from the project, policy briefs, project updates, reports and international publications were added to the website. All the above facilitated project leaders and other team members within the study countries to act as advocates for equity in maternal and newborn health, and to raise awareness about the importance of addressing inequalities in maternal and newborn health. Numerous presentations were given, not only in academic fora, but in particular also to professionals and policy makers, at the Bangladesh Neonatal Health Forum, the Nepal Paediatric Society Annual Conference, and a conference by the College of Medicine and Malawi National Aids Commission. We distributed our project information leaflet to hundreds of participants at these and other meetings and at international conferences. Our project activities have received interest of the national and international media, including Nepali daily newspapers and The Huffington Post. From the start of the project, we actively engaged with and learned from stakeholders, drawing on their experiential evidence regarding what works to ensure an equitable improvement in newborn and maternal health. We were able to obtain additional funding for dedicated start-up consultations with stakeholders from a DSA-DFID New Ideas Initiative grant. The premise of this work was that policy-makers and practitioners have valuable experience of what does and does not work to reduce health inequalities. Unfortunately, this tacit knowledge is rarely written up and shared. We therefore collected, synthesized, and shared experiential evidence of a large group of stakeholders with real-life experience in policy-making and implementation. We conducted seven roundtable discussions in India, Nepal, Bangladesh, and Malawi, and 11 in-depth interviews with international stakeholders, including health policy analysts, medical experts, funders, national and international NGO heads, and government representatives. The key findings of these round table discussions have been reported in a policy brief, an interview report, and a round table discussions report which can be downloaded from our project website. The findings of these stakeholder engagement activities have also been submitted for publication to an international peer reviewed journal. In the third year of the project, we invited many of the stakeholders involved in the round table discussions and in-depth interviews mentioned above to our two-day international workshop in Kathmandu. We also invited several other stakeholders from each of the partner countries (India, Nepal, Bangladesh, UK) who were considered important to include after a second stakeholder mapping exercise by each of the project partners. The 80 stakeholders who participated in the workshop included practitioners (medical doctors, District Health Officers) and representatives of practitioner organisations (e.g. Nepal Paediatric Society; Director General BIRDEM hospital Bangladesh - the largest diabetic hospital in the world; director of Sravanga hospital Nepal), government representatives (e.g. Director General Dept. of Health Nepal; Assistant Director of Dir. Gen. of Health Services Bangladesh; Deputy Executive Health Officer from the Municipal Coorporation of Greater Mumbai; project director Community Clinics Bangladesh), academia (Director of the Institute for Global Health, University College London (UCL); global health researchers from UCL; Indian Institute of Public Health), and representatives from international (Save the Children, Action Aid, Plan international) and national NGOs (BRAC, ICDDR,B). In the workshop we presented and debated the findings of the stakeholder round table discussions and in-depth interviews and other evidence generated in the EquiNaM project. The workshop program included presentations and discussions on (i) setting evidence-based priorities to address inequalities in newborn & maternal health, (ii) how to partner with communities to reach the most in need, and (iii) the role of government incentive schemes and the private sector in addressing newborn health inequalities. Each session consisted of one or two brief EquiNaM presentations and at least two presentations by stakeholders, followed by a panel discussion including stakeholder and EquiNaM panellists. Using this set-up, we were able to actively debate not just the evidence generated in the project, but also compare and contrast it with and put it in the context of evidence and experience of our stakeholders. In the process, the evidence was not only translated to a broad non-research stakeholder audience, the workshop also strengthened a network of people and organisations who can make a difference around the issue of inequalities in maternal and newborn health. In working groups organised during the workshop, participants formulated recommendations for the Every Newborn Action Plan (the post-MDG international agenda for newborn health) on how to reduce inequalities in maternal and newborn health on the basis of the evidence heard at the workshop. These recommendations were published in the Lancet Global Health (http://download.thelancet.com/pdfs/journals/langl o/PIIS2214109X14702712.pdf). The Secretary of Health and Population of the Government of Nepal, Dr. Praveen Mishra, gave a speech at the closing ceremony of the workshop. He emphasized the importance of addressing health inequalities between different socio-economic groups and regions, through investment in health systems and through intersectoral action and by working closely with communities to reach the most in need. Many stakeholders at the workshop indicated their interest in further engagement. For instance one of the International NGOs based in India expressed interest in having a similar workshop around inequalities organised at the local level in India. As part of our broader ongoing work, all project partners sought to impact on policy making and practice for maternal and newborn health. For example, one of the project partners (SNEHA) has made an impact on policy for maternal and newborn health by organizing a major dissemination event of their ongoing work. The Maharashtra State Government Health Minister and some of his colleagues, chiefly the Health Secretary, attended the event. This was followed by the Municipal Corporation of Greater Mumbai releasing a circular, officially adopting the clinical protocols for maternal and newborn health whose development was facilitated by SNEHA. The protocols fix the responsibility for holding regular referral meetings across levels of maternal and newborn health facilities. Effective engagement with policy makers in India, by our project partner Ekjut, has led to the start of a large initiative by the state government to scale-up participatory women's groups throughout the state of Jharkhand in order to reduce neonatal mortality and inequalities in neonatal mortality. Effective engagement by various project partners with WHO has led to WHO's recommendation on community mobilization through participatory learning and action cycles with women's groups for maternal and newborn health (https://www.google.nl/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0ahUKEwih4ebnj7bLAhUhDZoKHcmGCzkQFggkMAA&url=http%3A%2F%2Fapps.who.int%2Firis%2Fbitstream%2F10665%2F127939%2F1%2F9789241507271_eng.pdf&usg=AFQjCNHtoInDKjiFR-e1CKUYkSfAqJ8_7A&cad=rja). One of the CO-I's of the project (Prof. Anthony Costello) has, taken up a new position as Director, WHO Department of Maternal, Newborn, Child and Adolescent Health, taking forward the lessons learned through the EquiNaM project and his broader, extensive, work on participatory women's groups (http://www.who.int/life-course/news/new-mca-director/en/). (3) RESEARCH CAPACITY Our project enhanced research capacity of our local partners, in particular capacity for health equity research, thus building a sustainable basis for in-country evidence building for policy making. Capacity building has taken place in the following areas: (i) Quantitative analyses & Stata software: Capacity has been substantially increased in EquiNaM's Quantitative Working Group, which contains members from all partner sites. The local researchers have been working with the PI of the project to analyse large quantitative datasets of randomised controlled trials for a broad range of papers. The local researchers in the trial sites have analysed their own trial data under the supervision of the PI of the project. The EquiNaM project, with co-funding from the Wellcome Trust, has organized three Stata (statistical software) equity analysis training workshops for researchers across the partner sites. The training included the use of simple and sophisticated regression techniques for equity analysis. (ii) Qualitative data collection and analysis methods: Members of our Qualitative Working group from all sites have received distance-based training, in the form of manuals, PPT presentations and online and Skype-based discussions, in the use of qualitative data collection and analysis methods, and in the use of the Nvivo statistical software. These skills have been put to practice through the actual data collection, analysis, and publication of findings in international journals. These trainings have allowed local researches to become local leaders in their own right in terms of equity analysis. |
| First Year Of Impact | 2011 |
| Sector | Healthcare,Government, Democracy and Justice |
| Impact Types | Societal,Policy & public services |
| Description | EquiNaM Stata and equity analysis training I |
| Geographic Reach | Europe |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | The training increased capacity of local researchers in the Asia region to work with the statistical program Stata and to conduct equity impact analyses. |
| Description | EquiNaM Stata and equity analysis training II |
| Geographic Reach | Europe |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | This second training further increased capacity of local health researchers in the Asia region to work with the statistical program Stata and to conduct health equity impact analyses. |
| Description | EquiNaM Stata and equity analysis training III |
| Geographic Reach | Asia |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | This third training further increased capacity of local health researchers in the Asia region to work with the statistical program Stata and to conduct health equity impact analyses. |
| Description | Cordaid Grant |
| Amount | € 124,136 (EUR) |
| Organisation | Catholic Organisation for Relief and Development Aid (CORDAID) |
| Sector | Charity/Non Profit |
| Country | Netherlands |
| Start | 12/2012 |
| End | 03/2015 |
| Description | Evidence Measurement and Evaluation |
| Amount | £970,929 (GBP) |
| Organisation | Children's Investment Fund Foundation |
| Sector | Charity/Non Profit |
| Country | United Kingdom |
| Start | 10/2015 |
| End | 09/2020 |
| Description | New ideas grant |
| Amount | £8,000 (GBP) |
| Organisation | Government of the UK |
| Department | Department for International Development (DfID) |
| Sector | Public |
| Country | United Kingdom |
| Start | 04/2012 |
| End | 06/2012 |
| Description | Research Excellence Initiative grant |
| Amount | € 1,000,000 (EUR) |
| Organisation | Erasmus University Rotterdam |
| Sector | Academic/University |
| Country | Netherlands |
| Start | 01/2015 |
| End | 12/2019 |
| Description | Rotterdam global health initiative grant |
| Amount | € 50,000 (EUR) |
| Organisation | Erasmus University Rotterdam |
| Sector | Academic/University |
| Country | Netherlands |
| Start | 10/2012 |
| End | 03/2015 |
| Title | equity impact analyses |
| Description | We have developed methods for quantitative equity impact evaluation. Using these regression-based methods, one can estimate the impact of interventions on lower and higher socio-economic groups separately, and test for differences in effect, adjusting for baseline differences in each of these groups, using random effect modelling to adjust for a clustered sampling design. We have built capacity across the research team and local partners to use these methods. |
| Type Of Material | Model of mechanisms or symptoms - human |
| Year Produced | 2012 |
| Provided To Others? | Yes |
| Impact | The methods for quantitative equity impact evaluation that we have developed in our project are now being applied in other studies - notably in a new large randomised controlled trial of an intervention to reduce maternal and newborn mortality. Also, in observational studies that our colleagues are doing, the methods for equity impact evaluation that we have developed are being applied. Our project has supported that such analyses can be done more systematically in impact evaluations so that gradually a body of evidence is being developed on how to how to reduce health inequalities. |
| Description | "Improving Newborn Care in Nepal: Need to Focus on Inequalities", NEPAS (Nepal Paediatric Society) Annual Conference (Kathmandu, Nepal, 22 March 2012) |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | The presentation stimulated discussion afterwards Received requests for further information |
| Year(s) Of Engagement Activity | 2012 |
| Description | ''Improving maternal health for the poorest at Mumbai's municipal health facilities by promoting access to basic quality health services'. Global Maternal Health Conference 2013 Tanzania. Presentation. |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Other academic audiences (collaborators, peers etc.) |
| Results and Impact | Disseminated information about the project |
| Year(s) Of Engagement Activity | 2013 |
| URL | http://wordpress.sph.harvard.edu/mhtf/wp-content/uploads/sites/17/2013/12/GMHC2013_program_web.pdf |
| Description | 'Are there inequalities in community-based interventions for maternal health? The case study of women groups in Mchinji district, Malawi'. Third Global Symposium on Health Systems Research Conference. Poster presentation. |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Other academic audiences (collaborators, peers etc.) |
| Results and Impact | Disseminated activities |
| Year(s) Of Engagement Activity | 2014 |
| URL | http://hsr2014.healthsystemsresearch.org/sites/default/files/ProgrammeFinal.pdf |
| Description | 'Engaging policy makers in research on inequalities in maternal and newborn health.' IHEA Conference Presentation |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Disseminated findings from the project to health economists. Disseminated information about the project to health economists. Increased awareness about the importance of addressing inequalities in maternal and newborn health and increased awareness about what works to address these inequalities. |
| Year(s) Of Engagement Activity | 2013 |
| URL | http://equinam.global-health-inequalities.info/files/8713/7390/0662/2013_IHEA_presentation_-_stakeho... |
| Description | 'EquiNaM: building evidence to support equitable improvement in newborn and maternal health.' EquiNaM project introduction presentation. |
| Form Of Engagement Activity | A magazine, newsletter or online publication |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Information shared about the EquiNaM project and awareness raised about the importance of addressing inequalities in maternal and newborn health. Project information downloads from EquiNaM project website. |
| Year(s) Of Engagement Activity | 2011,2012,2013,2014 |
| URL | http://equinam.global-health-inequalities.info/ |
| Description | 'Facilitating supply side-Strengthening systems along with randomized control trial in communities '. Urban Health Symposium 2013 (Dhaka, Bangladesh). Presentation. |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | Disseminated information |
| Year(s) Of Engagement Activity | 2013 |
| Description | 'The equity impact of community based interventions to reduce neonatal mortality: a secondary analysis of four cluster-randomised trials' |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | The presentation stimulated discussion afterwards Received requests for further information |
| Year(s) Of Engagement Activity | 2014 |
| URL | http://www.faops.org/events-conferences/22-events-conferences/faops-conferences/ |
| Description | 'Who participates? Examining socio-demographic and socio-economic differences in a community mobilisation intervention to improve maternal and newborn survival in Dhanusha and Makwanpur Districts.' Conference presentation. Social Science Baha. |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | The presentation sparked discussion with colleagues. Increased interest in EquiNaM work. |
| Year(s) Of Engagement Activity | 2013 |
| URL | http://soscbaha.org/conference-2013.html |
| Description | EquiNaM Project Website |
| Form Of Engagement Activity | A magazine, newsletter or online publication |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Through the website, we raise awareness about the importance of addressing inequalities in maternal and newborn health and provide information about how these inequalities can be addressed. Our project outputs are shared on the website. The EquiNaM project website is very frequently visited by people from around the world. |
| Year(s) Of Engagement Activity | 2012,2013,2014 |
| URL | http://equinam.global-health-inequalities.info/ |
| Description | EquiNam Project Information Sheet |
| Form Of Engagement Activity | A magazine, newsletter or online publication |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | International stakeholders (researchers, policy makers, practitioners) made aware of the EquiNaM project and the importance of adressing inequalities in maternal and newborn health Engagement with international stakeholders in the project. Increased awareness among policy makers, practitioners and researchers of the problem of large inequalities in maternal and newborn mortality. |
| Year(s) Of Engagement Activity | 2012,2013,2014 |
| URL | http://equinam.global-health-inequalities.info/index.php/output/ |
| Description | EquiNam Project Information Sheet - Chichewa translation |
| Form Of Engagement Activity | A magazine, newsletter or online publication |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Disseminated information about the project in Malawi (in local language) Engagement with local stakeholders and prospective research participants |
| Year(s) Of Engagement Activity | 2013,2014 |
| URL | http://equinam.global-health-inequalities.info/files/5613/5763/6522/M7.0-d1.1_EquiNaM_Project_Inform... |
| Description | EquiNam Project Information Sheet - Hindi translation |
| Form Of Engagement Activity | A magazine, newsletter or online publication |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Local stakeholders informed about the EquiNaM project and the importance of addressing health inequalities Engagement with local stakeholders and prospective research participants |
| Year(s) Of Engagement Activity | 2012,2013,2014 |
| Description | EquiNam Project Information Sheet - Nepali translation |
| Form Of Engagement Activity | A magazine, newsletter or online publication |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Local stakeholders informed about the EquiNaM project and the importance of addressing health inequalities Engagement with local stakeholders and future reserach participants |
| Year(s) Of Engagement Activity | 2012,2013,2014 |
| URL | http://equinam.global-health-inequalities.info/index.php/output/ |
| Description | Equinam Year 1 Project Update |
| Form Of Engagement Activity | A magazine, newsletter or online publication |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Other academic audiences (collaborators, peers etc.) |
| Results and Impact | Disseminated the year 1 activities and findings of the project. Year 1 project outputs were disseminated. |
| Year(s) Of Engagement Activity | 2012 |
| URL | http://equinam.global-health-inequalities.info/files/7413/5033/0023/EquiNaM_Project_Update_Year_1.pd... |
| Description | Generating evidence to support an equitable improvement in newborn survival in Asia and Africa. INRICH [International Network for Research on Inequalities in Child Health] 4th Annual Workshop. |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Other academic audiences (collaborators, peers etc.) |
| Results and Impact | the presentation stimulated discussion afterwards received requests for further information |
| Year(s) Of Engagement Activity | 2015 |
| Description | International Workshop: New Evidence Supporting Equity in Newborn and Maternal Health in South Asia |
| Form Of Engagement Activity | Scientific meeting (conference/symposium etc.) |
| Part Of Official Scheme? | No |
| Type Of Presentation | paper presentation |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Our two-day workshop brought together policy makers, practitioners and researchers from the South Asian region and the UK to share and discuss the latest evidence on how to address inequalities in newborn and maternal health. A consortium of partners from India, Bangladesh, Nepal and the UK, under the banner of the EquiNaM project (http://equinam.global-health-inequalities.info/), presented new evidence from their randomized trials of women's group interventions that have shown impressive impacts on newborn outcomes. Representatives of international, national and civil society organisations shared their experience on equitable approaches in newborn and maternal health. The program included presentations and discussions on (i) setting evidence-based priorities to address inequalities in newborn & maternal health, (ii) how to partner with communities to reach the most in need, and (iii) the role of government incentive schemes and the private sector in addressing newborn health inequalities. For details about the workshop, including the program, participants and worskhop outputs, please visit: http://equinam.global-health-inequalities.info/index.php/stakeholder-engagement/#International%20Workshop%20Kathmandu Conclusions from the workshop and recommendations for the Every Newborn Action Plan have been published in the Lancet Global Health (http://download.thelancet.com/pdfs/journals/langlo/PIIS2214109X14702712.pdf). The Secretary of Health and Population of the Government of Nepal, Dr. Praveen Mishra, gave a speech at the closing ceremony of the workshop. He emphasized the importance of addressing health inequalities between different socio-economic groups and regions, through investment in health systems and through intersectoral action and by working closely with communities to reach the most in need. |
| Year(s) Of Engagement Activity | 2014 |
| URL | http://equinam.global-health-inequalities.info/index.php/stakeholder-engagement/#International%20Wor... |
| Description | International workshop: MaiMwana regional dissemination on inequalities in newborn and maternal health (EquiNaM) |
| Form Of Engagement Activity | Scientific meeting (conference/symposium etc.) |
| Part Of Official Scheme? | No |
| Type Of Presentation | keynote/invited speaker |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | This workshop brought together policy makers, practitioners and researchers from the African region to share and discuss the latest evidence on how to address inequalities in newborn and maternal health. MaiMwana, the Malawi-based partner that ran the women's group randomised trial in this country, presented new evidence from their trial. Representatives from, among others, the Ministry of Health, NGOs, and central and district hospitals, shared their experience on equitable approaches in newborn and maternal health. We have increased awareness among key decision makers, including from the Ministry of Health, about the importance of reducing inequalities in maternal and newborn health, and the role that participatory women's groups can play to reduce these inequalities. |
| Year(s) Of Engagement Activity | 2015 |
| URL | http://equinam.global-health-inequalities.info/index.php/stakeholder-engagement/ |
| Description | Media Interest (Nepal)-Round Table Discussions with Stakeholders |
| Form Of Engagement Activity | A magazine, newsletter or online publication |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Media (as a channel to the public) |
| Results and Impact | Disseminated information about the project. Disseminated information about the project and results of the round table discussions with stakeholders about inequalities in maternal and newborn health. Raised awairness about the importance of addressing inequalities in maternal and newborn health and about what works to reduce these inequalities. |
| Year(s) Of Engagement Activity | 2012 |
| URL | http://equinam.global-health-inequalities.info/files/6613/5032/9752/MIRA_Makwanpur_Hetauda_Sandesh_d... |
| Description | Media Interest for EquiNaM health inequalities presentation at IHEA conference |
| Form Of Engagement Activity | A magazine, newsletter or online publication |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Media (as a channel to the public) |
| Results and Impact | Media interest in the global health projects including EquiNam being conducted by UCL. Increase interest from the public about the project. |
| Year(s) Of Engagement Activity | 2013 |
| URL | http://www.huffingtonpost.co.uk/bidisha/from-mosquito-nets-to-lif_b_3592193.html |
| Description | Newsletter |
| Form Of Engagement Activity | A magazine, newsletter or online publication |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Public/other audiences |
| Results and Impact | SNEHA (MUMBAI, India) newsletter talking about the results of the EquiNam Project Public is informed about the progress of the project. |
| Year(s) Of Engagement Activity | 2012 |
| URL | http://www.snehamumbai.org/events/sneha-newsletters.aspx |
| Description | Partners Meeting - Engagement with Decision makers, Providers and Policy makers to improve the maternal and newborn care in Eight cities in Maharashtra |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Policymakers/politicians |
| Results and Impact | SNEHA organized two Partners Meetings at Thane and Mira Bhyandar , hosted by the respective Municipal Commissioners with invitees from 8 municipal corporations including Kalyan Dombivali , Mira Bhyander , Greater Mumbai and corporations of Navi Mumbai, Vasai-Virar, Ulhasnagar and Bhiwandi- Nizampur. The agenda was to discuss emergency obstetric services and referral system in its present form, the challenges faced and systemic solutions to improve maternal and newborn survival. SNEHA involved the former chief secretary of Maharashtra to elicit greater participation from the corporations. From the discussions that ensued an action plan was drawn up for every corporation by the former chief secretary that included action items such as a situational analysis of the health resource gaps in each corporation, organizing trainings for health functionaries, planning the existing health services such as ensuring evening outpatient clinics at hospitals, availability of adequate blood banks, etc This Partners meet was highly successful and provided SNEHA a very effective platform to take further the agenda of better health for mothers and babies. SNEHA has been receiving requests from these corporations to support in taking this agenda further and assisting them in carrying out the situational analysis, planning the urban health services, etc. This provides SNEHA with an enormous opportunity to work with these health systems and enable the provision of essential care to every pregnant woman, regardless of municipal boundaries. |
| Year(s) Of Engagement Activity | 2015 |
| URL | http://equinam.global-health-inequalities.info/index.php/stakeholder-engagement/ |
| Description | Policy Brief. Learning from stakeholders for health equity |
| Form Of Engagement Activity | A magazine, newsletter or online publication |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Newsletter received positive reactions from stakeholders in the field, and increased interest in our work. Increased awareness about how to address inequalities in maternal and newborn health |
| Year(s) Of Engagement Activity | 2012 |
| URL | http://equinam.global-health-inequalities.info/index.php/stakeholder-engagement/ |
| Description | Policy Brief: Community health interventions in informal settlements: reaching the most vulnerable |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Policymakers/politicians |
| Results and Impact | This policy brief describes the findings of a programme incidence analysis of a cluster randomised controlled trial of participatory women's groups aimed at improving perinatal health in informal urban settlements in Mumbai. The trial was conducted by the Society for Nutrition, Education, and Health Action (SNEHA) and University College London (UCL) [6]. It was one of seven similar trials conducted in South Asia and Africa: an urban site in India (Mumbai) and sites in rural India, Nepal, Bangladesh and Malawi. The documents provides detailed recommendations to policy makers on improving impact of community-based perinatal health programs in urban settings. |
| Year(s) Of Engagement Activity | 2015 |
| URL | http://equinam.global-health-inequalities.info/files/3214/3740/6074/Policy_brief_A_final_25042015_SN... |
| Description | Policy Brief: Determinants and reasons for choice of maternity care provider in Mumbai's informal urban settlements |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Policymakers/politicians |
| Results and Impact | This policy brief makes recommendations based on the findings of a study conducted by researchers from the Society for Nutrition, Education, and Health Action (SNEHA) and University College London (UCL) to quantify the pattern, determinants, and choice of maternity care provider in Mumbai's urban slums, and to explore the reasons underlying these choices. The study contributes to an understanding of how families in underserved urban communities with inequitable access to health services choose their health care. This important aspect of health service utilisation has received limited attention. Future health policies will benefit from a greater understanding of how vulnerable groups decide in a context of uncertain health care choices. The policy brief discussed recommendations which can help address inequalities in access to maternal health care and to improve the experiences of the urban poor. |
| Year(s) Of Engagement Activity | 2015 |
| URL | http://equinam.global-health-inequalities.info/files/7314/3740/6144/Policy_brief_B_final_SNEHA140715... |
| Description | Scaling up maternity referral systems in three cities of Maharashtra, India, to promote access to quality health services for poor urban communities |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | Yes |
| Geographic Reach | International |
| Primary Audience | Other academic audiences (collaborators, peers etc.) |
| Results and Impact | Many people were interested in the work. The presentation stimulated questions and discussion afterwards. see below |
| Year(s) Of Engagement Activity | 2015 |
| URL | http://www.globalmnh2015.org/program/ |
| Description | Socio-demographic and socio-economic differences in attendance at community women's groups to improve maternal and newborn survival |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Other academic audiences (collaborators, peers etc.) |
| Results and Impact | Poster presented sparked discussion and shared information about the study. Disseminated activities |
| Year(s) Of Engagement Activity | 2013 |
| URL | http://www.healthsystemsasia.com/index.html |
| Description | Socio-economic inequalities in health in low and middle income countries. Presentation in the special programme for personnel of the planning buro of the Ministry of Health, Master's in Health Policy & Management. |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Policymakers/politicians |
| Results and Impact | the presentation stimulated questions afterwards Policy makers of planning buro of Ministry of Health made aware of the importance of the social determinants of health |
| Year(s) Of Engagement Activity | 2012 |
| Description | The Equity Impact of Community Women's Groups to Reduce Neonatal Mortality: A Meta-Analysis of Four Cluster Randomized Trials |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | the presentation stimulated discussion afterwards received requests for further information |
| Year(s) Of Engagement Activity | 2015 |
| Description | The Equity Impact of Community Women's Groups to Reduce Neonatal Mortality: A Meta-Analysis of Four Cluster Randomized Trials |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Many people were interested in the women's group work. The presentation stimulated questions and discussion afterwards. More people are now informed about the equity impact of participatory women's groups. They are aware that, when set up well, women's groups can help reduce socioeconomic inequalities in neonatal mortality. |
| Year(s) Of Engagement Activity | 2015 |
| Description | The Social Determinants of Health. Presentation in the special programme for personnel of the planning buro of the Ministry of Health, Master's in Health Policy & Management. |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Policymakers/politicians |
| Results and Impact | the presentation stimulated questions afterwards Policy makers of planning buro of Ministry of Health made aware of the importance of the social determinants of health |
| Year(s) Of Engagement Activity | 2012 |
| Description | The equity impact of community based interventions to reduce neonatal mortality: a secondary analysis of four cluster randomised trial. Presentation at Nepal Pediatric Conference |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | the presentation stimulated discussion afterwards received requests for further information |
| Year(s) Of Engagement Activity | 2014 |
| URL | http://www.nepas.org.np/ |
| Description | The equity impact of community based interventions to reduce neonatal mortality: a secondary analysis of four cluster randomised trial |
| Form Of Engagement Activity | Scientific meeting (conference/symposium etc.) |
| Part Of Official Scheme? | No |
| Type Of Presentation | paper presentation |
| Geographic Reach | International |
| Primary Audience | Health professionals |
| Results and Impact | Abstract printed in the proceedings of the Nepal Pediatric Conference (NEPCON) 2014, March 27-29, 2014, Kathmandu, Nepal Discussions were made with particpants. |
| Year(s) Of Engagement Activity | 2015 |
| Description | Who participates? Socio-demographic and socio-economic differences in a women's group intervention to improve maternal and newborn survival. International Health Economics Association Conference. Poster presentation. |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Public/other audiences |
| Results and Impact | Media interest in our work. Media coverage of the poster presentation and oral presentation at this conference. http://equinam.global-health-inequalities.info/files/3813/7847/3586/From_Mosquito_Nets_to_Life-saving_Moisturiser__The_London_Team_Tackling_Global_Health_and_Development___Bidisha.pdf |
| Year(s) Of Engagement Activity | 2013 |
| URL | http://equinam.global-health-inequalities.info/ |
| Description | • Azad K, Houweling TA. Reaching young primigravida women in community interventions. EquiNaM International Workshop "New Evidence Supporting Equity in Newborn & Maternal Health in South Asia". 8-9 May 2014, Kathmandu, Nepal. |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | We presented new evidence from randomized trials of women's group interventions that have shown impressive impacts on newborn outcomes. This included presentations and discussions on (i) setting evidence-based priorities to address inequalities in newborn & maternal health, (ii) how to partner with communities to reach the most in need, and (iii) the role of government incentive schemes and the private sector in addressing newborn health inequalities. Conclusions from the presentations and workshop, and our recommendations for the Every Newborn Action Plan, have been published in the Lancet Global Health (http://download.thelancet.com/pdfs/journals/langl o/PIIS2214109X14702712.pdf). The Secretary of Health and Population of the Government of Nepal, Dr. Praveen Mishra, gave a speech at the closing ceremony of the workshop. He emphasized the importance of addressing health inequalities between different socio-economic groups and regions, through investment in health systems and through intersectoral action and by working closely with communities to reach the most in need. |
| Year(s) Of Engagement Activity | 2015 |
| Description | • Houweling TA. What works to reduce inequalities. EquiNaM International Workshop "New Evidence Supporting Equity in Newborn & Maternal Health in South Asia". |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | We presented new evidence from randomized trials of women's group interventions that have shown impressive impacts on newborn outcomes. This included presentations and discussions on (i) setting evidence-based priorities to address inequalities in newborn & maternal health, (ii) how to partner with communities to reach the most in need, and (iii) the role of government incentive schemes and the private sector in addressing newborn health inequalities. Conclusions from the presentations and workshop, and our recommendations for the Every Newborn Action Plan, have been published in the Lancet Global Health (http://download.thelancet.com/pdfs/journals/langl o/PIIS2214109X14702712.pdf). The Secretary of Health and Population of the Government of Nepal, Dr. Praveen Mishra, gave a speech at the closing ceremony of the workshop. He emphasized the importance of addressing health inequalities between different socio-economic groups and regions, through investment in health systems and through intersectoral action and by working closely with communities to reach the most in need. |
| Year(s) Of Engagement Activity | 2015 |
| URL | http://equinam.global-health-inequalities.info/index.php/stakeholder-engagement/ |
| Description | • Manandhar DS, Houweling TA. Setting priorities in addressing inequalities in newborn & maternal health: new evidence from the EquiNaM project. EquiNaM International Workshop "New Evidence Supporting Equity in Newborn & Maternal Health in South Asia". |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | We presented new evidence from randomized trials of women's group interventions that have shown impressive impacts on newborn outcomes. This included presentations and discussions on (i) setting evidence-based priorities to address inequalities in newborn & maternal health, (ii) how to partner with communities to reach the most in need, and (iii) the role of government incentive schemes and the private sector in addressing newborn health inequalities. Conclusions from the presentations and workshop, and our recommendations for the Every Newborn Action Plan, have been published in the Lancet Global Health (http://download.thelancet.com/pdfs/journals/langl o/PIIS2214109X14702712.pdf). The Secretary of Health and Population of the Government of Nepal, Dr. Praveen Mishra, gave a speech at the closing ceremony of the workshop. He emphasized the importance of addressing health inequalities between different socio-economic groups and regions, through investment in health systems and through intersectoral action and by working closely with communities to reach the most in need. |
| Year(s) Of Engagement Activity | 2015 |
| URL | http://equinam.global-health-inequalities.info/index.php/stakeholder-engagement/ |
| Description | • Morrison J, Alcock G, Josson P, Houweling TA.Experiential evidence from policy makers and practitioners. EquiNaM International Workshop "New Evidence Supporting Equity in Newborn & Maternal Health in South Asia". |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | We presented new evidence from randomized trials of women's group interventions that have shown impressive impacts on newborn outcomes. This included presentations and discussions on (i) setting evidence-based priorities to address inequalities in newborn & maternal health, (ii) how to partner with communities to reach the most in need, and (iii) the role of government incentive schemes and the private sector in addressing newborn health inequalities. Conclusions from the presentations and workshop, and our recommendations for the Every Newborn Action Plan, have been published in the Lancet Global Health (http://download.thelancet.com/pdfs/journals/langl o/PIIS2214109X14702712.pdf). The Secretary of Health and Population of the Government of Nepal, Dr. Praveen Mishra, gave a speech at the closing ceremony of the workshop. He emphasized the importance of addressing health inequalities between different socio-economic groups and regions, through investment in health systems and through intersectoral action and by working closely with communities to reach the most in need. |
| Year(s) Of Engagement Activity | 2015 |
| URL | http://equinam.global-health-inequalities.info/index.php/stakeholder-engagement/ |
| Description | • Tripathy T, Houweling TA. Reaching lower socio-economic groups in community interventions. EquiNaM International Workshop "New Evidence Supporting Equity in Newborn & Maternal Health in South Asia". |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | We presented new evidence from randomized trials of women's group interventions that have shown impressive impacts on newborn outcomes. This included presentations and discussions on (i) setting evidence-based priorities to address inequalities in newborn & maternal health, (ii) how to partner with communities to reach the most in need, and (iii) the role of government incentive schemes and the private sector in addressing newborn health inequalities. Conclusions from the presentations and workshop, and our recommendations for the Every Newborn Action Plan, have been published in the Lancet Global Health (http://download.thelancet.com/pdfs/journals/langl o/PIIS2214109X14702712.pdf). The Secretary of Health and Population of the Government of Nepal, Dr. Praveen Mishra, gave a speech at the closing ceremony of the workshop. He emphasized the importance of addressing health inequalities between different socio-economic groups and regions, through investment in health systems and through intersectoral action and by working closely with communities to reach the most in need. |
| Year(s) Of Engagement Activity | 2015 |
| URL | http://equinam.global-health-inequalities.info/index.php/stakeholder-engagement/ |