A really big dream takes its first steps to reality

June 23, 2010

The World Health Organization (WHO) estimates that one million babies die each year from birth asphyxia (eg. inability to breathe immediately after delivery).  A few years ago a group of pediatricians affiliated with the American Academy of Pediatrics developed a neonatal resuscitation program that was evidence-based, easy to teach and easy to use in resource limited areas.  So they began to dream big and envision a world where no baby would die due to its inability to breathe at birth.

But big dreams need big partnerships. Enter into discussion with the American Academy of Pediatrics, the Laerdal Medical Company of Norway (one of the largest providers of CPR equipment and simulators in the world),  the U.S. Agency for International Development’s  (USAID)  Newborn and Maternal Health program, Save the Children , the U.S. National Institute of Child Health and Development (NICHD) and USAID’s Global Development Alliance program. With lots of outreach and dialogue,  a public-private-NGO sector alliance with these groups as its charter members was born.  The glue binding these groups together? A commitment to move forward Millennium Development Goal #4 (MDG4) : reduction of child mortality by two thirds from 1990 to 2015.

Last week in Washington D.C. over 150 policy makers and health care educators and trainers from 10 countries came together to launch Helping Babies Breathe. Also on the agenda was training new regional and local level master trainers in the program’s skills for birth attendants, and discuss country implementation plans and scale-up.

“Birthing” this new program was a bit like birthing a new baby:  lots of advance preparation, intensity and labor at the moments of birth, moments of pure joy, and then continued nurturing.   What are some of the things we’ve learned so far?  Effective partnerships require among other things:  (1) A clearly articulated common purpose; (2) Clarifying the roles and expectations for each partner; (3) Being willing to compromise and cede some control, allowing different partners to take the ‘lead’ at different times.  None of these are easy to do, especially with strong partners who are all used to leading.

There is much work ahead and challenges to come as this baby grows and continues to be nurtured. What do we think are some of the factors that will help this project to be an effective scale-up model? (1) A simple to teach and use educational curriculum that has a small number of core concepts with a lot of latitude for local and situational customization; (2) A partnership that has set the tone of a culture of learning as we go, sharing of ‘lessons learned’ and reflections on this learning.  [This was started from the very beginning with several pilot projects in Bangladesh, India, Kenya, Pakistan and Tanzania whose initial results were shared during last week’s kick-off.  The learning from these initial pilots will be incorporated into curriculum, training and process recommendations as the program expands to a projected 15-20 countries in the coming year to 18 months]; (3) A wide range of partners with a broad range of contacts and distribution networks.

So as this really big dream takes steps to reality and we learn about partnerships, scale-up and other areas as we go, I look forward to sharing some of these ‘lessons learned’ in this blog, and broadening the dialogue.

Categories: Global Health, Partnerships, Scale-up
Tags: , , ,

  • http://twitter.com/gaurisalokhe Gauri

    Hi Bonnie,

    Thanks for sharing this post on twitter. I didn’t know the number of babies dying of this problem was so high. This is very important work and I look forward to reading more about your lessons learned and how these lessons get incorporated into new trainings and new projects.

    All the best and thank you for doing this wonderful and important work.

    Gauri

    • http://www.goinginternational.com Bonnie Koenig

      Thanks for your kind words, Gauri. I hope you will share some of your experiences and ‘lessons learned’ here from time to time as well!

  • http://www.bloodandmilk.org Alanna

    One thing they talked about at Women Deliver was the need to “overcommunicate” in partnerships. Did you find that to be he case?

  • http://www.goinginternational.com Bonnie Koenig

    Definitely – communication among partners (especially geographic widespread ones) is a challenge. Before the roll-out there were numerous partner conference calls. The face to face meetings gave ‘country teams’ from different orgs a chance to get to know each other and discuss plans. It is anticipated that a communications plan will be a very important part of the effort going forward. Thanks for your comment, Alanna.

  • http://www.jsi.com Lauren

    You’re right on the mark with your points about scale-up. As was emphasized at both Women Deliver and Global Health Conference this year, the key to drawing nearer to the MDGs is going to be integration of different types of services, which, as you astutely point out, will require new and different partners to come together and collaborate. The rewards of such collaboration can be tremendous, if done effectively, as has been my experience working with both JSI and World Education on projects. I look forward to seeing this program grow.

    • http://www.goinginternational.com Bonnie Koenig

      Thanks, Lauren. You highlight a very good point about the ‘integration’ of different types of services. The HBB program is working hard to integrate with other on-going maternal and newborn care programs. This is seen as important for a number of reasons including efficiency of training, and sustainability. Do you have any thoughts from your experiences with JSI and World Education vis a vis what makes a good partnership or particular challenges?

  • Jim

    What does “overcommunication” mean? Does that mean 20% feel like there’s too much talk, but only 15% feel behind the curve, with 65 feel like there’s enough?

    As opposed to 60% feeling there’s enough; & 40% confused/unclear/behind the curve?

    (I say this as someone who is friendlier to the first; though of course wishing that it would be communicated well and that all would listen “the first time”.

    • http://www.goinginternational.com Bonnie Koenig

      Jim – It’s a good question re: the working definition of “overcommunication”. One of those good practices, I find, to clarify how words/terms are being used. Alanna may have intended another meaning, but I was using “overcommunication” to mean that in collaborations you can never err on the side of ‘too much’ communication, and should thus make a point of communicating more than you think you might normally: hence “overcommunicate”.

  • http://www.hiyamaya.wordpress.com Maya Forstater

    Congratulations on the birth of your partnership. Like you say birthing a partnership is a bit like birthing a baby – lots of intense preparation and pain at the time, and then……well, a whole different kind of pain and conflict (and joy and learning) for the next 18 years or so.

    I would agree with your learning points 2 and 3 (clear roles and compromise) but I think you may find that point 1 (common purpose) is not quite right.

    My experience of multi-sector partnerships is that they bring together diverse organizations that each hold one part of the puzzle of the resources, skills and legitimacies needed to solve a problem. But the key thing, and what makes them potentially powerful is that these resources dont just happen be stuck in different organizations. Partnerships are hard work because they bring together organizations whose different purpose and accountabilities have stopped them working together effectively to apply their resources to the problem in the first place.

    So yes partnerships need a common purpose, if by that you mean an agreement on what they are there for and how they will measure success. But as hard as that is to negotiate and agree those foundations to get started with, its not the same thing as the kind of shared long-term vision that can drive a singular organization.

    Successful partnerships are not shaped around a common vision but around shared activities that deliver against the individual aims of each partner. This may sound like an academic distinction but it makes a real difference: it means that whatever is agreed in principle, everything is really up for renegotiation each time the partnership’s activities evolve and mature, changing the stakes for each partner (and bringing in new ones). Just as you want to speed up, scale up and get on with it, things can grind to a halt – partners compete or free ride, stakeholders raise grievances, decision making stalls, efficiency declines.

    With that in mind, be prepared to spend more time and effort in governance and learning than you thought possible! I look forward to you sharing more experiences and learning as you go.

    Some good resources on the topic:
    http://www.grsproadsafety.org/themes/default/pdfs/bpd_myths_and_truths.pdf

    http://www.accountability21.net/uploadedFiles/Conference/Governing%20Collaboration_Full%20report.pdf

    http://www.scalingimpact.net/gan

    • http://www.goinginternational.com Bonnie Koenig

      Thank you, Maya, for contributing to this discussion. I understand your short twitter comment much better now that you have more than 140 characters to expand on it! Yes, I did intend to say that the common purpose would be ‘what they are there for’, but I do agree with you that there is constant renegotiation needed as the interests of partners diverge and/or change. You write that “successful partnerships are not shaped around a common vision but around shared activities…” I wonder if some of what binds partners together may vary depending on their ‘common purpose? For example, is it harder to maintain cohesion when the agreement on why they are together is just activity specific (such as for a conference or workshop) as opposed to a broader vision, such as saving [newborn] lives?

      Thank you also for the resources you shared. I look forward to reading them, as well as continuing to discussion and learn together…

  • http://www.egroby.com czyszczenie nagrobków

    Just added your blog to my list of worth reading blogs

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