Futures Group works at national and local levels to improve the health and well-being of women and children in developing countries. Our maternal and child health (MCH) efforts encompass a wide range of services, including strengthening the policy environment, building the capacity of civil society to encourage advocacy and community mobilization, social marketing and public-private partnership development, and computer modeling for policy development and resource allocation. Futures Group also works to strengthen and monitor the progress of national responses to orphans and vulnerable children (OVC). We highlight selected aspects of our MCH work below.
Applied models and tools. Our work in analytic models and tools has improved the evidence base and related decisionmaking for MCH policies and programs. The Maternal and Neonatal Program Index (MNPI), first conducted in 1999 to assess program efforts to improve the policy environment for safe motherhood issues, has now been applied in over 60 countries. In addition, Futures Group’s renowned SPECTRUM suite of policy models has components applicable to MCH.
• Safe Motherhood Model. Estimates impact of various scores from the MNPI on a country’s maternal mortality ratio.
• Lives Saved Tool (LiST- Child Survival). Projects changes in child survival in accordance with changes in coverage of different child health interventions.
• PMTCT: Prevention of Mother-to-Child Transmission. Evaluates costs and benefits of intervention programs to reduce transmission of HIV from mother to child.
• Allocate. Examines linkages and interactions among three areas of a representative reproductive health action plan: family planning, safe motherhood, and postabortion care.
Adding to its set of available tools, Futures Group developed and tested the Child Status Index, which assists service providers in monitoring the impact of their programs on individual children’s lives in relation to the resources they receive. We are currently conducting targeted evaluation studies of five existing OVC programs in Kenya and Tanzania to examine what works in terms of child outcomes and program effectiveness.
Targeted policy development and advocacy. Futures Group’s expertise in policy and advocacy has helped increase political and financial support for client-focused MCH policies and programs. As a partner on the Access to Clinical and Community Maternal, Neonatal and Women’s Health Services (ACCESS) Project, Futures Group helps stimulate policy dialogue and strategic planning and supplies technical leadership in advocacy and community mobilization. In Afghanistan, we conducted a review of the maternal and newborn health strategy and policy and are supporting the new strategy’s development. In Tanzania, Futures Group has supported the White Ribbon Alliance for Safe Motherhood (WRA) in advocating for changes and updates in policies, protocols, and guidelines; increased funding for maternal health; and building political will for reducing maternal and newborn mortality and morbidity. A key partner on various projects, Futures Group has supported WRA’s efforts around the globe.
In Guatemala, Futures Group provided data to a congresswoman on the country’s reproductive health situation and related policy environment as an evidence base, and she collaborated with political groups to secure their approval of a safe motherhood resolution. The resolution demands that the MOH promote effective and immediate actions to reduce maternal mortality.
In Mali, Futures Group works with religious leaders and uses a “Grandmother Strategy” to encourage pregnant women to get their prenatal visits and for couples to discuss pregnancy openly, plan together for delivery, and use bednets. In Uzbekistan and Tajikistan, Futures Group used small grants and capacity building to help NGOs advance critical MCH work. In Ukraine, we developed a referral structure, health personnel job descriptions, and components of outpatient maternal health care to help remove operational policy barriers to providing quality care. Futures Group also worked to strengthen the policy and institutional framework for safe motherhood, identified relevant priorities and strategies, and developed national leadership capacity to guide and monitor safe motherhood efforts in six Asian countries.
Innovations in OVC monitoring and evaluation. The HIV epidemic is fuelling the crisis of rapidly increasing numbers of OVC around the world. OVC are often excluded in designing or monitoring responsive strategies on their behalf. Futures Group has extensive experience working with multiple sectors and at multiple levels to strengthen and monitor the progress of national responses to OVC.
Under MEASURE Evaluation, Futures Group helped conduct a cost-effectiveness analysis of OVC programs in Tanzania and Kenya as part of a set of OVC program-targeted evaluations. In Rwanda and Zambia, Futures Group conducted a secondary analysis of expenditure data from select OVC service delivery NGOs to evaluate resource needs for developing scaled-up and sustainable OVC programs. Futures Group has used data demand and information use (DDIU) to develop a series of GIS databases for OVC in 12 countries to conduct palliative care public health evaluation in Africa and to inform the design of adherence programs and understand how to integrate tuberculosis and HIV/AIDS treatment programs effectively.
Social marketing and public-private partnerships. Futures Group has designed and implemented programs to increase awareness and use of products to improve MCH. We have successfully marketed a range of healthcare products and have used supplier networks for optimal consumer reach.
MCH-related Health Products Experience
• Family planning: Condoms, oral contraceptive pills, injectable contraceptives, intrauterine devices, and Moon Beads
• Micronutrients: Zinc, iron folate, and iodized salt
• Other products: Safe home birth kits, oral rehydration salts, insecticide-treated bed nets, and point-of-use water treatment
In Uganda, Futures Group is marketing and distributing anti-malarial, zinc, water solution, and reproductive health products, and promoting positive health behavior practices among key target groups. In Afghanistan, Futures Group is scaling up existing social marketing efforts to reach more women and children, primarily in rural areas, and bring about sustained behavior change. To do so, Futures Group developed and implemented a social marketing and an integrated information, education, and communication (IEC) and detailing (training) strategy targeting the general population as well as vulnerable groups, including women and children under five. In Nigeria, Futures Group worked to decrease morbidity and mortality due to malaria in pregnant women and children under five by promoting the use of insecticide-treated bednets.
Futures Group recognizes that human resource development is integral to increasing access to MCH services and products. In Kenya, Futures Group trained selected midwives in managing client data, quality-of-care issues, syndromic management of sexually transmitted infections, and social marketing skills. The midwives were then provided with kiosks to provide essential healthcare advice and products on market days. In Uganda, Futures Group has trained over 2,000 private practitioners on artemisinin-based combination therapies (ACTs) under the Ugandan Ministry of Health’s new malaria treatment policy.
In India, Futures Group is working to build public-private partnerships and has carried out several background studies that informed the design of a voucher scheme through which poverty-line families can receive affordable, accessible and high-quality reproductive and child health and family planning services through accredited private facilities. Futures Group supported the design and testing of various voucher scheme models in three states (Uttar Pradesh, Uttarakhand, and Jharkhand) in India. In Uttar Pradesh, a successfully piloted voucher scheme for slum dwellers and rural poor led to scaling up of the system at the state level and inclusion and accreditation of 50 private sector hospitals. After two years of implementation, policymakers, service providers, and clients have readily accepted Uttarakhand’s voucher system. As a result, the government decided to scale up and implement the scheme in five districts, which will encompass nearly 60 percent of the state’s total rural poor population.