Introduction
More than 26 million women and girls of reproductive age live in emergency situations, all of whom need and deserve high-quality health services. And yet, the global community is failing on reaching those in need with life-saving maternal and newborn health (MNH) services, as seen by the fact that the 25 countries that have a 2024 international humanitarian appeal are responsible for 58% of global maternal deaths, 38% of newborn deaths, and 36% of stillbirths.
Acknowledging the need for accelerated progress, the Newborn Roadmap was developed in 2019 to set a five-year workplan for strengthening MNH within the sector. To coordinate efforts and advanced agendas, a secretariat was established in 2020 and housed within IAWG. The IAWG Newborn Initiative (INI) had a dual mandate: 1) to provide sustained and directed support to the global agenda for newborn health in humanitarian settings, as delineated in the Newborn Roadmap; and 2) to ensure global progress that reflects the intentional efforts to integrate MNH programming across the development and humanitarian sectors.
With the end of 2024 approaching and the sunsetting of the INI, a program evaluation was conducted to examine successes and challenges, to capture key stakeholder insights, and to better understand priorities for the MNH in humanitarian settings community moving forward. A desk review examined documented achievements from the previous four years, including resources, tools, and advocacy work, and then mapped them across the nine objectives of the Newborn Roadmap. A short survey capturing stakeholder perspectives on global progress and the unfinished agenda was distributed through global MNH listservs across both humanitarian and development initiatives and received 85 responses. Finally, in-depth interviews were held with 19 key informants from 13 organizations inclusive of UN, donors, INGOs, and one local organization.
Presented here are overarching top-line findings from both survey respondents and KII respondents to help inform future agenda setting discussions both within the humanitarian and MNH communities. While these findings are from a snapshot of the sector, they offer important insights into perceived progress over the past four years and suggestions on where the global humanitarian community, donors, and development actors should focus efforts moving forward.
- 74% of survey respondents felt that the prominence of MNH in humanitarian settings had increased since 2020, and that global actors – including those traditionally outside of the humanitarian sector – are now much more aware of specific needs and considerations for women and newborns affected by crisis. However, 13% believed that attention granted to MNH had decreased since 2020, proving more work is needed.
- Respondents noted increased integration of humanitarian considerations within global guidance, clinical and technical resources, and more. Examples of such documents include guidance around new EmONC signal functions, WHO’s KMC practice guide, the Postpartum Hemorrhage Roadmap, and several MPDSR implementation documents.
- While not directly an achievement of INI, respondents felt training resources for and professionalism of midwifery improved over the past five years, globally, inclusive of humanitarian settings. They specifically mentioned that useful pre-packaged curricula like HMBS and EENC were simple enough for in-service training in humanitarian settings as well as noting an increase in engagement between midwifery associations and humanitarian actors in responses and crises.
- Respondents believe these simple, clear, modular and competency/practice-based training packages allowed for easier adaptation in humanitarian contexts and increased emphasis on capacity building for humanitarian actors. However, they also noted that the challenge now is getting qualified trainers these trainings in more remote or difficult to access areas and that there should be a focus on capacitating a cadre of master trainers who are available in humanitarian and fragile settings.
- Respondents noted a growing interest at the global-level in expanding and investing in community-based MNH approaches within humanitarian settings to expand reach and access to care.
When reflecting upon the many global achievements undertaken in just a few short years for MNH in humanitarian settings, respondents consistently attributed these achievements to having dedicated staffing provided by the INI, which allowed the humanitarian sector the ability to have stronger and more consistent representation in a breadth of working groups and task teams that may usually get passed over by stakeholders with too many competing priorities. That said, while not all respondents were familiar with the INI as an independent entity within IAWG, for the two-thirds of survey respondents who were, 44% felt the biggest value add was linked to global coordination to accelerate the Newborn Roadmap and humanitarian MNH agendas, 19% said the biggest value-add was the global advocacy around newborn health in humanitarian settings, and 17% responded the biggest value add was the production and dissemination of technical resources and learning.
Remaining Gaps, Unfinished Agendas and Recommendations
- Despite progress, respondents emphasized that there is a need to better understand what is happening (and not happening) for MNH programming at the field level during preparedness, response, and recovery phases.
- Implementing partners requested improved guidance from global stakeholders on how to integrate across programs, noting that existing guidance is too vertical and siloed compared to their implementation plans.
- Improved data and indicators to monitor MNH needs and care in humanitarian settings was also highlighted, noting that national level statistics often mask the realities of crisis-affected areas. Alternatively, when humanitarian data is available, it can be limited, looking only at access and coverage without providing any information on monitoring quality of care.
- Unsurprisingly, the primary barrier cited to the lack of progress for MNH in humanitarian settings were challenges related to funding. Sufficient and sustained funding and dedicated resources for MNH in humanitarian settings are lacking, especially for delivery care and EmONC.
Finally, to learn from survey respondents about their ideal vision and goals for the MNH in humanitarian settings agenda moving forward, the question was posed: If you had $1 million USD of funding and the only restriction is to spend it on MNH in humanitarian settings efforts, how would you dedicate the money? The responses primarily fell into four categories: advocacy efforts, preparedness efforts, humanitarian response efforts, and recovery/resilience efforts. More detailed suggestions can be found in the infographic.
The recommendations below are a snapshot of the plethora of ideas that emerged from both the global survey and the interviews. More recommendations can be found in the report.
Recommendations for Donors
- Donors need to fund global coordination. The small investment in the INI was able drive momentum to advance the Newborn Roadmap but this type of work relies on staff to move it forward.
- These global grants and funding mechanism also need to include funds that allow for meaningful reach at the country level to ensure global coordination work is complemented with robust investments directed to implementing, informing, and refining global guidance at the field level.
- More funding is necessary to create a resilient foundation for quality MNH care before, during, and after a crisis. This includes infrastructure and rehabilitation, workforce development, basic clinical competencies, and referral pathways.
In addition to making BEmONC more prominent in a primary health package, donors should invest in community-based MNH service delivery as well as secondary level care (CEmONC and SSNC) in humanitarian settings. - Data collection and research should be funded alongside robust implementation rather than on its own. Funding robust M&E systems will get donors better data and information that they are currently requesting from humanitarian partners to make the case for MNH investment.
"We would like to see more commitment, coordination, and leadership among donors. Donors want to leverage each other's investments, but no one is stepping up for MNH."
Recommendations for humanitarian partners
- On the global stage, the humanitarian MNH community needs to articulate how to prioritize MNH within the movements for localization and climate change. Respondents felt that it was important that MNH experts lead the MNH work within these cross-sectoral trends.
- Implementing partners stressed that guidance should be accessible (with language translations as well as technical translations for more generalist practitioners) and operational guidance should consider feasibility or adaptability for various typologies, given diversity of crises and responses. There should be recommendations for how to integrate new guidance and best practices into broader primary health and multi-sector humanitarian responses.
- In addition to packages that strengthen EmONC and PHC services, respondents also called for more vertical investments in High Impact Practices such as MPDSR, Safe Abortion Care, and Kangaroo Mother Care. To do this, the humanitarian MNH community needs to find ways to better integrate these initiatives into broader primary health programming as well as orient and train generalist humanitarian practitioners to become MNH champions.
Recommendations for governments and development partners
- Governments and development partners need to prioritize fragile, crisis-prone sub-national settings to ensure progress towards meeting the SDGs.
- Development partners do not need to become humanitarian responders, but rather focus on building more equitable and resilient health systems that will provide a stronger foundation for humanitarian responders when a crisis occurs.
- In addition to infrastructure development for MNH, robust investment in workforce development should be a priority. It can be particularly challenging to conduct clinical training amid crisis, and the availability of qualified master trainers in humanitarian settings is insufficient.
- Humanitarian respondents want to see more resources and engagement going to preparedness and resilience from governments and development partners, extending to marginalized areas of countries where crises are more prevalent.
Conclusion
The overarching takeaway from this evaluation is that investments from donors, like the one made to fund the INI, are effective at creating momentum and traction to advance issues like MNH in humanitarian settings on a global stage. However, these initiatives must be complemented by much larger investments directed to the field level to implement global guidance and provide feedback from implementers on what is needed from global technical working groups. While much work is being done at the field level to advance MNH in humanitarian settings, it is not feeding up into these global level discussions and efforts should be made to improve communication channels and representation. Robust and sustained funding for implementation of high impact practices for MNH in addition to EmONC infrastructure development needs to be directed at humanitarian settings to make progress for the SDGs. This must engage humanitarian, development, and government actors.
To learn more, read the INI Program Evaluation Report.