American Academy of Pediatrics – Helping Babies Breathe

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.  They knew it was being used in different parts of the world but they knew much more could be done. So they began to dream big and envision a world where no baby would die due to its inability to breathe at birth.

Those big dreams needed 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.

After much planning, in June 2010 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 learned in the initial stages?  Effective partnershipsrequire 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.

Factors that could 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.

After four months some additional learning:

(1)   Communication and coordination: There needs to be continued and effective mechanisms for communication and coordination.  In the case of HBB a coordinating group has been set up with a representative from each member of the alliance  Each representative in the group needs to take seriously this responsibility and allocate the time to communicate with others within the organization they are representing.  When they don’t, their own organization loses an opportunity for increasing their knowledge base, and the group misses information that might be useful to others.

(2)   Cross-border information exchange (especially ‘headquarters vis a vis field’): There is always a natural gap between those who work in offices, headquarters or in some ways are responsible for coordinating the ‘global picture’, and those who are implementing a program locally.  There needs to be additional effort placed on getting information from the field to headquarters and from one field project to another.

Eight months after  the original launch another face-to-face partners meeting was held.  Some of the major process issues discussed at that  meeting included:

How fast to move?

The original plan was to have the partnership focus on scale-up, evaluation and feedback in approximately 10 countries.  This number fairly quickly grew to 20 and then over 30.  Even with numerous new volunteers (often well versed in the program’s content) how effectively can a program be implemented in different locations, while still keeping a focus on sharing implementation and evaluation lessons?  There is a trade-off between tapping into the momentum and enthusiasm, and taking the time to develop mechanisms for sharing information that will improve the program.  For example, for HBB, through the initial field roll-out it was discovered that some of the equipment could be adapted in ways that would make it easier to maintain cleanliness, an important health component.  With a faster roll-out, the existing equipment would need to be sent as is; with a slower roll-out there would be time for the equipment to be re-tooled, tested and be ready for use.  Additionally there would be more time for translations, and logistics such as equipment clearing customs or local procurement.

What should be core?

This question is closely linked to the speed of roll-out.   The more different locations, the larger the increase in possible permutations in how the program is implemented.  The partnership needs to decide what is core to keep the fidelity of the program, which becomes clearer as the roll-out proceeds.  If the roll-out is slower, this information can be fed back into a ‘global’ discussion.  If the roll-out is moving very quickly there is less time to have this exchange of information and more adjustments are made de facto which can lead to programs getting ‘off track’ in potentially negative ways.

Coordinating information flow

The more organizations that come into a partnership or alliance, the more challenging communication becomes, at the same time that is becoming increasingly important.  In the focus on program implementation it can be easy to neglect the time it takes to create and use effective communication processes and mechanisms.

Several factors have helped the HBB Global Development Alliance to deal with these challenges including: (1) The commitment among key stakeholders  to create communication mechanisms and allocate time to use them; (2) Designating key people to be ‘in charge’ of facilitating this communication and (3) Scheduling regular ‘check in’ calls and meetings.  This experience as well as previous ones have underscored to me the critical importance of communication systems – creating them and nurturing them through a commitment of time. (4) Creating online sharing mechanisms.

This 3rd anniversary video (April 2013) talks more about some of the factors that have helped HBB to be successful.