Memorandum submitted by the DFID Funded
Research Programme Consortium on Maternal and Neonatal health
at the London School of Hygiene and Tropical Medicine and Institute
of Child Health (Towards 4+5)[134]
INTRODUCTION
(i1) This document is written from the perspective of
the academic communities at the London School of Hygiene and Tropical
Medicine (LSHTM) and the Institute of Child Health (ICH), and
their collaborators in Nepal, Ghana, Malawi, Burkina, and Bangladesh,
and the UK. We provide evidence only where we have good insight
from our experience and respond directly to the questions raised
in the International Development Committee News Release. We emphasize
research reflecting our role in finding or assessing solutions
to improve maternal health, but also discuss other issues, and
in particular donor financing for which we have new information.
(i2) From a research perspective, we believe
that DFID is generally very effective in its application of its
maternal and neonatal health strategy compared to other national
aid agencies. For example, DFID support to the research activities
in the Kintampo Health Research Centre in Ghana (KHRC) (a Ministry
of Health research unit which works mostly on maternal and neonatal
health in collaboration with LSHTM), has been outstanding in terms
of level of funding, the keen interest of staff in DFID headquarters
and the accompanying measures supported by DFID. In addition to
research funds, DFID sponsored the development of a business plan
to encourage the sustainability of the institution. In the UK,
DFID's long term support to the Maternal and Neonatal Health Group
at LSHTM since 1989 and to the Perinatal Health Unit at ICH since
1998 has enabled both institutions to nurture and retain staff
who have become recognised experts in the field.
(i3) One concern, however, relates to the
downsizing in the number of staff at head quarters. If health
advisors and other associated staff become over-stretched this
will adversely affect the depth and quality of the interactions
between DFID and the academic community in developing countries
and in the UK. A second concern is the informality and lack of
systematic links between DFID country programmes and advisers
and DFID research programme consortia. We believe that DFID country
work for maternal health would benefit greatly if the evaluation
skills of researchers were applied routinely to DFID's large scale
country work.
1. How donors can catalyse progress towards
MDG 5?
The following catalysts will be discussed in
our answer to this question:
a. Research
(1a1) From our perspective, donors can catalyse progress
towards MDG 5 in the short and medium term by supporting robustly
designed research which can disentangle (a) which interventions
work and do not work in very poor countries in Africa (including
Francophone Africa) and South East Asia, (b) how interventions
which work on their own can be combined together more effectively
to reduce maternal mortality, and (c) how to promote the implementation
of evidence-based interventions and policies. While it is often
said, that "we know what works" in maternal health,
this is true in terms of therapeutic interventions and in relation
to the central role played by midwives, obstetricians and emergency
obstetric services in the reduction of maternal mortality. There
are implementation questions for which we do not have good answers
(Sanders and Haines, 2006), for example in relation to the most
conducive policy environment to ensure changes, the financing
strategies to ensure equitable access, the best methods to promote
good quality of care, the policies which work best to retain health
staff in remote areas, the relative cost-effectiveness of interventions
and how to package safe motherhood and neonatal health interventions
into a coherent and efficient programme. There is also a need
for donors to finance long term efforts to develop new, innovative
interventions to reach women in need, especially those in remote
populations whose access to services is extremely limited.
(1a2) Where it concerns the question of
integration with child and neonatal health, and of health systems
approaches to maternal health, there is also a need for donors
to recognise, actively support and reward researchers for engaging
with interdisciplinary methods, non-experimental observational
epidemiology, and operations research. This is particularly important
because, for researchers, generating credible scientific evidence
for evaluation of horizontal initiatives is a major challenge,
since these require different research models than those used
to assess the efficacy and effectiveness of vertical initiatives
(Behague and Storeng, 2007).
(1a3) DFID is one of the biggest bilateral
donors (in terms of funds and visibility) for research activities
in maternal and neonatal health. Major research priorities for
DFID concern the effectiveness of current safe motherhood activities,
the scaling up of effective maternal health interventions within
existing health systems, and the integration of safe motherhood
with neonatal health interventions. A key concern of DFID is to
demonstrate that the research they have supported has influenced
policy, and there is a push to show changes. We believe that the
focus of DFID should not always be on change. Sometimes the current
policy is appropriate, and the focus should be on how research
has helped to produce rational policy decisions even if it does
not involve change.
(1a4) Nevertheless, DFID is also willing
to take risks with research, by financing research on innovative
interventions, which take longer to impact policy, for example,
with the Vitamin A trial in Ghana and the women's group trials
in Nepal, Malawi, Bangladesh and India. DFID is also one of the
few donors supporting research on induced abortion.
b. Finance
(1b1) Worldwide Overseas Development Assistance (ODA)
for maternal, newborn and child health represented approximately
16 percent of ODA to health, and approximately 2.5 percent of
total ODA in 2004. The amount pales into insignificance when compared
against projected resources required to achieve MDGs 4 & 5.
It is also far less than resources committed to HIV/AIDS, which
accounts for a smaller burden of disease in many developing countries.
The majority of funds are provided by a small group of donors.
Fourteen donors contributed 90 percent of total ODA to maternal,
newborn and child health in 2004, and just four donors account
for 51 percent—World Bank, USAID, DFID and UNFPA.
(1b2) According to our study on tracking
donor assistance (Powell-Jackson 2006), DFID spent US$56 million
on maternal and neonatal health (equivalent to 8 percent of all-donor
expenditure) in 2003, and increased its contribution to US$62
million (12 percent of all-donor expenditure) the following year.
The following pie chart gives details on the distribution of DfID
funding to maternal and newborn health:
Figure 1
DFID funding to Maternal and Neonatal
health by sector of intervention (2004)
(1b3) Some attention has been paid to estimating
the amount of funds required to scale up maternal and neonatal
health to reach MDG 5 and comparing this against projected trends
in available resources (ie. to estimate the financing gap). Even
if donor countries fulfil their commitments to increase external
aid to developing countries, and developing countries' governments
implement their commitment to increase health expenditure, low
income countries will still lack adequate financial resources
to scale up maternal and newborn health interventions. We have
estimated that US$ 1 per capita additional to committed resources
would be required in 2015 to extend coverage of life-saving interventions
for mothers and children in Sub Saharan Africa (Greco et al, 2007).
If domestic and external health expenditures increase only in
line with past trends, the financing gap is estimated to be more
than US$ 4 per person. Lower and upper middle income groups are
likely to have sufficient funds to reach the MDG 5. Their domestic
policies for maternal and neonatal health fund allocation will
be therefore paramount. The implication is clear: donors, including
DFID, must focus on low-income countries first and foremost.
(1b4) Insufficient time has been spent on
how to raise additional resources and, equally importantly, how
to channel additional resources in the most efficient way possible.
As DFID is fully aware (more than any other donor), the aid architecture
for health is overly complex. A study on the health sector in
Rwanda (Foster 2006) illustrates this point well at the country
level.
c. Policy
(1c1) DFID is one of the more innovative funders where
it concerns efforts to promote horizontal policy-making and implementation—that
is, to integrate interventions from different subfields (such
as maternal/child health), to promote sector-wide approaches,
and to strengthen health systems. A recent research on evidence-based
policy-making has demonstrated how important support for a horizontal
approach to maternal health issues is for long-term sustainability
of programs developed to reduce maternal mortality and for improved,
cohesive policy-development (Behague and Storeng, 2007).
(1c2). Nevertheless, a number of social
and political factors, including most importantly the competition
for funds and international recognition between subgroups (eg
maternal, child, reproductive and neonatal health), operate to
persuade policy-makers and donors of the greater relative importance
of vertical interventions. The inclination to favour vertical
approaches also ensues from the demands of political and economic
accountability of professional activities at the international
level. Because vertical approaches tend to be more universally
applicable and standardized, and less context-specific, than horizontal
approaches, they lend themselves to becoming tools for monitoring
professional accountability (Béhague and Storeng, 2007).
(1c3) For international policy-makers and
donors, a major challenge in contributing to vertical-horizontal
collaboration lies in finding ways to make horizontal initiatives
a priority without losing the focus on the more immediate needs
of vertical initiatives and on achieving a direct, measurable,
and easily monitored impact on health outcomes. We feel DFID should
continue to embrace this challenge head-on. Rather than solely
support disease- and subfield- specific approaches, donors such
as DFID, together with researchers and policy-makers, urgently
need to engage in open dialogue regarding the larger international,
academic, and donor-driven forces that drive the public health
community towards a predominant interest in vertical programs.
2. How effectively DFID is working with recipient
countries to make emergency obstetric care available, ensure adequate
numbers of skilled birth attendants, and integration in health
system?
(2.1) Nepal (Dr Dharma Manandhar): DFID
made substantial contributions to the provision of emergency obstetric
care, training and making available skilled birth attendants,
and integrating safe motherhood policy with the national health
programme. Initially in 1997, it helped through the Nepal Safer
Motherhood Project by developing infrastructure, training of health
personnel and providing equipment in 10 district and zonal hospitals
and some primary health care units in Nepal for providing quality
emergency obstetric care. In 2005, this project was converted
to the Support to Safe Motherhood Program (SSMP) so as to integrate
safe motherhood policy into the national health programme. SSMP
has substantially helped by providing training for skilled birth
attendants and starting maternity financial incentive scheme to
promote delivery in a health facility and to promote the presence
of a skilled birth attendant at home delivery. DFID's support
to SSMP has also helped in other activities related to improving
women's health particularly in reducing maternal mortality eg
legalisation of abortion, family planning, gender equity etc.
The latest maternal mortality ratio according to DHS 2006 is 281/100000
live births which is substantially less compared to 539/100000
live births as reported by NFHS 1996.
(2.2) Malawi (Dr Charles Mwamsambo): DFID
is a major contributor to the Sector Wide Approach (SWAp) funds
in Malawi. These funds are being used to fund, among other things,
the Human Resource Emergency Plan which involves supporting training
institutions to train health workers such as midwives, and enrolled
nurse/midwife technicians. SWAp funds are also being used to strengthen
the health system where these health workers will be deployed
after training. The support is in the form of drugs, equipment
and infrastructural development with the ultimate goal of achieving
MDG 5 by 2015. Unfortunately we can not see the direct impact
of this now. It will take another 2 to 3 years before we can see
the results. Previously, DFID supported the Safe Motherhood project
for 6 years. When I visit the supported facilities I can see the
obvious difference in organization, emergency handling and also
the attitude of the staff: generally they are better organized
and better prepared to handle emergency obstetric cases
3. The steps DFID is taking to mainstreaming
maternal health across related policies?
(a) Maternal health and health systems
(3a1) Health systems include
anything related to infrastructure and equipment, human resources,
financing and the various processes which enable staff to work
with a system, such as communication (Sanders and Haines, 2006).
DFID has been instrumental in putting the strengthening of health
systems on the international agenda, and in making the case for
maternal health as a health system issue.
(3a2) Health system issues which are particularly
significant for maternal health all relate to how the coverage
of skilled birth attendance at delivery and emergency obstetric
care can be best improved. There are areas where services are
available but underused, and where most of the problems relate
to poor quality of care and women's or families reluctance to
use services. But the most difficult issues relate to increasing
the availability of human resources in areas where services are
unavailable, as midwives are trained in insufficient numbers,
their willingness to live in remote areas is limited and many
leave their home countries for rich nations. In the Lancet maternal
health series, we argue that, in the context of integration of
maternal and neonatal health, the current lack of human resources
should not be a reason for encouraging quick fix solutions, for
example by financing programmes using community health workers
at the expense of training more midwives or mid-level workers
when there is insufficient doctors. It is important that every
effort is made for women to receive care from providers working
in pairs (as a minimum) in health services settings, and that
the international community understand that this is a long term
effort. We think that staff at DFID can play a key role in promoting
this message, and we would like to encourage DFID as well, to
continue supporting action towards the abolition or reduction
of user fees for pregnant women. As user fees often represent
a sizeable proportion of facility budgets, governments must be
supported and encouraged to make the substantial commitment of
replenishing the lost revenue through additional tax, donor contributions
and/or cross-subsidies. The effectiveness of methods of reducing
transport costs (such as vouchers and cash transfers) must also
be explored, especially in rural areas where these can be substantial.
(3a3) We would like to add however, that
while without a doubt, maternal health would greatly benefit from
a general improvement in health systems, it is as much as health
system issue as other conditions or public health problems such
as HIV or Malaria. There are other broader particularities which
make maternal health difficult to improve including those embedded
in gender issues.
(b) Integration of maternal health with neonatal
and child health
(3b1) Newborn survival interventions are potentially
the most cost-effective approach to achieving the Millennium Development
Goal 4 given the failure in reducing the neonatal deaths and the
increasing proportion of child deaths occurring in the newborn
period. Newborn interventions depend heavily upon functional maternal
care services and the dual benefits need to be emphasised. There
is encouraging progress at international level to create partnerships
and data collection systems which monitor both maternal and newborn
care coverage and mortality outcomes. At national and district
level there remains greater separation, and a high priority for
health systems is to emphasise the importance of integration of
prenatal, delivery and postnatal care interventions which will
benefit BOTH mothers and newborn infants.
(3b2) DFID has also been instrumental in
promoting the integration at international level of implementation
agendas for maternal, neonatal, and child health, in order to
facilitate work at country level. With respect to research, this
translated into an RPC on maternal and neonatal health, whose
main focus is to look at integration.
(c) Maternal health and infectious diseases (HIV,
malaria)
(3c1) There is a real need in countries and at programme
level (but also possibly at international level) for better integration
of the activities for the prevention of mother to child transmission
(PMTCT) of HIV and malaria programmes into antenatal, delivery
and postnatal services, and this has been a key concern for DFID.
For example, PMTCT programmes often act in parallel to existing
maternity services and do not address the family planning needs
of women, or their antenatal care needs. There are examples of
settings in which HIV programmes take money out of maternal health
and the best midwives are taken from maternity care to do PMTCT,
for example South Africa. On the other hand, we know from our
work in Ivory Coast, that integration can be beneficial for both
programmes. A national programme in Cote d'Ivoire integrating
PMTCT programmes into regular maternity services has shown that
the strengthening of maternity services that accompanied the PMTCT
(including additional equipment and drugs and staff training)
has resulted in notable improvements in the quality of antenatal
and delivery care. While HIV testing and PMTCT uptake increased
dramatically after implementation of PMTCT, many quality indicators
of maternity care services also improved. The most dramatic changes
were seen in the areas of communication and health promotion,
but effects were also seen at the technical level (eg staff were
more likely to monitor foetal heart sounds or to measure blood
pressure).
(3c2) Intermittent Preventive Treatment
in pregnancy (IPTp) is less likely to be implemented as a separate
vertical programme in the same way as PMTCT. However, there are
issues of drug safety in pregnancy which are not being addressed
by the research community. Chloroquine and sulphadoxine-pyrimethamine
(SP) that commonly used drugs for treatment of malaria in pregancy
and IPTp need to be replaced with other antimalarials because
of wide spread resistance. Although there are several new antimalarials
available there is no or very limited data on the safety of these
drugs during pregnancy because pregnant women are systematically
excluded from clinical trials due to fear of fetal toxicity. The
consequence of this situation is that pregnant women are either
getting ineffective or drugs of unknown safety records for treatment
of malaria.
(d) Maternal health and human rights
(3d1) DFID headquarters has been particularly active
in encouraging mainstreaming of maternal health on the human rights
agenda, by preparing for example a document on human rights approaches
to maternal health.
(3d2) It may be important to write here
than there is more to maternal health than mortality only. There
are many women who survive in extremis severe obstetric complications
and who suffer long term economic, health and other consequences
and are not looked after suitably by health services in the postpartum.
A paper is forthcoming in the Lancet, but we would be happy to
provide evidence on this to the committee.
4. How effectively DFID works with others
(a) Research community in developing countries
and the UK
(4a1) Our experience in working
with DFID headquarters has been excellent, but interaction with
country offices has sometimes been less satisfactory. Feedback
from some country offices on what are identified as important
research topics in their country could be improved. Sometimes
it is hard to engage DFID country offices in following the progress
of DFID funded maternal health research in the country they are
working in. DFID headquarters has tried to facilitate these links,
but even when forged, the links can be hard to maintain. For example,
links were first forged in 2002 between the Ghana DFID country
office and KHRC with repect to the Vitamin A trial to reduce maternal
mortality, and a country office representative accompanied the
Parliamentary Select Committee visit to KHRC in March 2002. At
the suggestion of HQ staff, a representative attended the 2004
annual technical steering committee meeting of the trial. It was
intended that this should be a regular occurrence. However, this
person was then replaced by a new staff member, who did not have
a particular interest in health or in research, and who did not
see this as a priority amongst the wide range of ongoing development
projects within Ghana. The wide remit and high turnover of staff
in DFID country offices make forging long term links difficult.
The number of health advisors at central level has been greatly
reduced, and it might be beneficial to have additional health
advisors, with expertise in maternal health.
(4a2) That said, as mentioned previously,
the long term support of DFID for research institutions in developing
countries is greatly appreciated. MIRA in Nepal is an organisation
which now employs 800 research staff. It was started in 1992 in
collaboration between Professor Dharma Manandhar and Professor
Anthony Costello with seed money from DFID (formerly ODA) to start
research activity in perinatal health in Nepal. This seed money
enabled Mira to start its first study on perinatal health. Mira
got another grant in 1993 (ODA) for a trial on postnatal health
education for mothers on infant care and family planning. DFID
was also the major funder for the Makwanpur study on women's groups.
Their evaluation of women's groups in improving demand for better
care suggests that the neonatal survival benefits will be substantial,
and the possibility of a direct effect on maternal survival. Replication
and scalability trials of a women's group intervention are being
conducted in Bangladesh, India, Pakistan, Nepal and Malawi. The
MIRA studies continue with an emphasis shifting to the links between
demand and improved quality of care, and how to increase skilled
birth attendance in remote areas.
(4a3) DFID support has been instrumental
in the capacity building of individuals and other organizations
in Nepal. Many from Nepal have completed postgraduate studies
and received a Master's degree or PhD or MD from the UK. Many
were supported for short courses and to participate and to present
papers in international conferences. The Perinatal Society of
Nepal was established in 1997 following the DFID sponsorship of
a leading Nepalese paediatrician and obstetrician (Dr D. S. Mandandhar
and Dr Malla) to a conference. In 1997 MIRA in collaboration with
ICH conducted an international workshop on improving newborn infant
health in developing countries. This was attended by a large number
of leading perinatologists from other countries. Proceedings of
this workshop were published as a book. This workshop as well
as post conference workshops which were held during each PESON
conference (so far five conferences have been held) has been supported
by DFID through ICH.
(4a4) Although DFID has been generous in
its repeated support for research work by the ICH-MIRA collaboration,
there has been something of a disconnection between funding and
dialogue. Given DFID's appetite for communication and linking
research with policy, there is sometimes a perceived lack of ownership
of DFID-funded projects by country offices, a limited interest
within some parts of DFID about project progress and findings
(related in part to staff shortages), and insufficient dialogue
about the rigor, and policy relevance of research findings.
(b) Partnership and Global funds
(4b1) There appears to be a tension between the need
to raise new, additional funds for MNCH and the reluctance to
create a new fund (whether it be a global fund for maternal, newborn
and child health or a fund in an alternative guise). This was
apparent at a meeting in Norway (March 2007) on the Global Business
Plan. More resources are needed but how do we find them without
creating a new fund or a new initiative that will potentially
complicate the aid architecture further? Many donors who would
like to support maternal and child health need a way to channel
their funds to districts and communities in developing countries.
For the moment, the modalities for an effective channelling of
the funding are unclear. The Global Business Plan for MDGs 4 and
5 will develop details of how additional funding can be raised
and channelled, the Fast Track Initiative Catalytic Fund could
serve as example. Aid coordination is an area where DFID is a
leader and well respected. It is hoped even greater focus is given
to this issue by DFID, particularly at the country level where
ultimately the effects of poor coordination and duplication are
felt. Basket funding may have long term benefits but there is
a paucity of evidence to show that a sector wide approach has
actually led to increased expenditure on maternal and newborn
care.
5. What leadership the UN is providing and
how well coordinated its agencies are
(5.1) Multiple UN agencies have remits which
include maternal health (WHO, UNFPA, UNICEF). In recent years,
staff at WHO have worked very hard to bring maternal, neonatal
and child health together. Nevertheless, WHO has two departments
with a focus on maternal health: Reproductive Health and Research
(HRP) and Making Pregnancy Safer. HRP has experienced financial
problems recently which have been detrimental to the ranges of
research activities which could be funded in maternal health and
reproductive health. The recent formation of the Partnership for
Maternal, Newborn and Child Health (PMNCH) represents an attempt
to improve co-ordination across various agencies involved in maternal
and child health work at country level. However, PMNCH does not
disburse funds and has very limited financial support itself.
The latter is probably appropriate as PMNCH should not be competing
with other international institutions such as WHO and Unicef.
Nevertheless, if substantially increased funds for maternal (and
neonatal/child) health are generated, there must be mechanisms
to ensure that some of these are used to reinforce WHO and other
UN agencies in their efforts to reduce maternal mortality and
that they are disbursed in a co-ordinated and rational way.
6. Socio economic barriers to women's empowerment
and the low status of women
(6.1) DFID funding has been central to the
development of a new international discussion on the effectiveness
of community mobilization activities for maternal and newborn
health. Specifically, DFID support for research in Nepal has allowed
us to test the effectiveness, potential scalability and sustainability,
and possibilities for integration of community women's groups
as a lever for demand-led improvements in maternity care. This
work is now going forward into areas that cross research disciplines:
the evaluation of empowerment, the relationships between economic
status and health vulnerability, and the creation and maintenance
of poverty.
7. How the international community can improve
maternal health in crisis and conflict settings[135]
(7.1) To improve maternal health in crisis
and conflict settings a comprehensive approach to sexual and reproductive
health services is required. The critical importance of sexual
and reproductive health (SRH) care to reducing maternal mortality
and morbidity is well documented and recognized by the international
community. Yet, lack of access to comprehensive reproductive health
services, in particular family planning, skilled birth attendance
and emergency obstetric care continue to lead to many unnecessary
deaths, in particular in conflict settings in the developing world.
(7.2) Experience from Afghanistan, 5 years
on from the start of the contracting out of health services, has
shown that it is of crucial importance to start investing in training
of female health services providers at a very early phase of health
services rehabilitation and/or reform. This is true especially
for countries where cultural barriers do not allow male health
staff to provide care to female patients. Wherever possible, the
provision of technical assistance to an (interim) health ministry
with the specific aim of developing a strategy for human resources
development for the maternal health sector—with a focus
on recruitment and training of staff from rural areas—could
prove to be a valuable foundation for the improvement of maternal
health in countries emerging from periods of instability and conflict.
Technical assistance for the development of appropriate curriculums
for female doctors, midwives and nurses is another potential area
of early investment.
(7.3) As a global leader in women's health
and gender issues and a major humanitarian actor, DFID is best
placed to draw attention to the pressing comprehensive sexual
and reproductive health services needs of affected populations
in crisis and conflict settings, and to use its influence at both
national and international levels to ensure the incorporation
of SRH as integral part of humanitarian policy and action. DFID
is well placed to use its influence to pressure UN agencies (such
as WHO, UNAIDS, UNHCR, OCHA, UNICEF, UNFPA) to include SRH (including
emergency obstetrics) as an integral part of humanitarian policies
and guidelines developed by the Inter-Agency Standing Committee
(IASC). In particular, DFID should work with the humanitarian
coordination system to ensure more attention is devoted to SRH
needs, including by ensuring there is an appointed comprehensive
RH sub-cluster coordinator under the Humanitarian Coordinator
and the WHO-led Health Cluster. DFID should encourage humanitarian
agencies, including the UN and NGOs, to develop the human resources
necessary to set up and run effective comprehensive SRH programmes
in emergency settings. We understand that DFID is particularly
well placed to do this, because the approach it has taken for
the fragile states is admired on the global stage.
(7.4) DFID could also work towards a better
acknowledgement of skills and expertise that exist in the community
afflicted by crisis and conflict. Before the "international
community' is ready to intervene, the conflict-affected communities
may well have developed their own coping strategies. The international
community should look for those strategies, acknowledge locally
available skills and experience, and help members of the local
community who have initiated and fostered these coping mechanisms to
use them even more effectively. This could happen by officially
acknowledging the important role they have played, and by ensuring
that they benefit adequately from the financial and technical
resources the international community will mobilise.
References:
Behague DP, Storeng KT. Collapsing the vertical-horizontal
divide in public health: lessons from an ethnographic study of
evidence-based policy making in maternal health. American Journal
of Public Health Accepted pending revisions. 2007.
Foster M and Killick T 2006. What would doubling
aid do for macroeconomic management in Africa? Working Paper,
No. 264. London: Overseas Development Institute.
Sanders D, Haines A. Implementation Research is Needed
to Achieve International Health Goals. PloS Medicine 2006; 3:
e186. DOI: 10.1371/journal.pmed.0030186
Powell-Jackson T, Borghi J, Mueller D, Patouillard
E, Mills A. Countdown to 2015: tracking donor assistance to maternal,
newborn, and child health. Lancet 2006 Sep 23;368(9541):1077-87.
Greco G, Powell-Jackson T, Borghi J, Mills A. Finding
the Money: The Financing Gap for Child, Newborn and Maternal Health.
2007
12 September 2007
134 Contributors: Dr Véronique Filippi, Professor
Simon Cousens, Professor Betty Kirkwood, Dr Dharma Mandandhar,
Ms Giulia Greco, Professor Anthony Costello, Dr Charles Mwansambo,
Dr David Osrin, Dr Carine Ronsmans, Ms Annemarie Terveen, Dr Dominique
Behague, Mr Tom Marshall, Mr Timothy Powell-Jackson, Dr Daniel
Chandramohan, Dr Oona Campbell and Dr Matthias Borchert (section
7). Back
135
With inputs from Samantha Guy (Marie Stopes) and Anna Von Roenne
(GTZ). Back
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