Getting It Right: Using Consensus-Building and a Regional Approach to Successfully Scale Up Integrated Health Services in West Africa

The three-year Action for West Africa Region ( AWARE II) Project, funded by the United States Agency for International Development, is using an innovative, comprehensive approach to scale up integrated best practices in family planning/reproductive health, HIV & AIDS, and maternal, newborn, and child health in 21 countries in West Africa. MSH is managing AWARE II in partnership with EngenderHealth and the Futures Group.

MSH interviewed Dr. Issakha Diallo, the project’s director, on the importance of scale up, why it’s so difficult, and what the project is doing to help countries make their efforts successful and sustainable.

[Issakha Diallo]Issakha DialloWhy is scale up important?
Scale up is the implementation of best practices that are replicated in a country or region. Best practices are defined as evidence-based activities or sets of activities that are proven to work and likely to achieve the best results possible in a given context.“Going to scale” is the only way to make a significant impact on the health of a population.

Why does scale up often not succeed?
Although there are many best practices available for scaling up—again, interventions that we know do work and can be replicated—scale up can be difficult to implement. Governments, donors, and partners are frequently not aligned and do not or aren’t able to stay aligned over the course of a project’s implementation for various reasons—competing priorities, conflicts of interest, competition among partners, earmarked funds, lack of communication, and many others.

At the same time, supportive factors such as building the capacity of individuals and institutions, advocating for government policies, and securing funding to institutionalize scale up and make it sustainable are not thought about until a project is well underway or not at all. 

What is unique about the AWARE II approach?
AWARE II approach recognizes that scale up is only sustainable if all parties are in agreement—governments, donors, and partners—and there are supporting policies, capable institutions, and leveraged funding in place. We also recognize that integrating best practices increases access to services, lowers costs, and contributes to the strengthening of the overall health system.

The cornerstone of the AWARE II approach is to use consensus-building based on the best available technical information to develop an integrated package of a few high-impact best practices in each of four areas: family planning/reproductive health; HIV & AIDS; maternal health; and newborn/child health. This key intervention package (KIP) includes policies that enable the interventions, activities to build and strengthen institutions that drive replication and expansion of these interventions, as well as leveraging funding that sustains the interventions.

How were you able to bring all parties together and come to an agreement on this approach?
All the partners and governments we met and shared the approach with were very supportive and engaged to work collaboratively with the project toward promoting the KIP approach. Most said that this evidently is what should have been developed and used a long time ago.

How was it possible to develop the KIPs in so many health areas over such a large region?
When developing the KIPs, the first goal was to build a regional consensus to unify efforts. We did this by holding a regional conference attended by country delegates from across West Africa. Together they reviewed and improved a proposed vision and mission for the project, as well as a limited number of key interventions to focus on in each health area to address the top-most regional priorities. The selection of the priorities was based on the identified major killers in pregnant women, newborn, and under-five children in the region. Country delegates also decided on the order of countries in which implementation would occur over the next three years.

An important part of the project was employing regional public health experts to review all the existing literature and conduct a thorough assessment of the current status of each health area that was then submitted to the country delegates. The experts also drafted the proposed vision and mission. As a result, the country delegates were able to have the best understanding possible of the technical priorities and options to inform their decision.

How will these decisions be translated when implemented in individual countries? And what is the role of the regional institutions?
Countries are asked to develop actions plans from the decisions of the regional consensus-building conference using a framework, also developed at the conference, to identify needed policies, capacity-building, and leveraged funding that will support the integrated implementation at scale of the best-practices in their country.

We will be increasing the capacity of regional institutions so they can assist countries by offering training and other needed technical assistance. Our goal is to create a regional system through the West African Health Organization (WAHO) that will coordinate and support all country health systems by linking regional institutions with implementing government structures and establishing a regional monitoring system.

Why is advocacy such an important part of the AWARE II approach and to successful scale up?
Everyone needs to participate for scale up to be successful and advocacy wakes everyone up.

Advocacy encourages the government to adopt important policies and legislation to institutionalize activities being scaled up, establishing accountability for and a means to sustain those activities. At the same time, advocacy raises public awareness so that people are encouraged to take personal responsibility and understand their importance in helping the country reach its goals in a health area.

In the case of AWARE II, we are using consensus-building to create messages to highlight the various economical, demographic, social, and health benefits of family planning that will be integrated in all maternal, newborn, and child health, and HIV & AIDS activities.

For 28 years, Dr. Diallo has worked extensively with the international donor community on a variety of major national and international public health programs in sub-Saharan Africa and elsewhere. As a clinician, a senior public health official in Senegal, and former director of large, complex donor-funded assistance programs, Dr. Diallo has inspired teams, built the capacity of African institutions, coordinated decision-makers to prioritize and address health problems, and mobilized resources to apply best practices.


Related Links:

AWARE II website

Fact Sheet: West Africa

Fact Sheet: Integrating Family Planning with Other Services




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