This document discusses Concern Worldwide's initiative to generate innovative solutions for maternal, newborn and child health (MNCH) in Malawi, Sierra Leone and India. The initiative identifies barriers to MNCH services, generates ideas from diverse sources, and tests the most promising ideas through small pilots. Some innovative ideas currently being tested include using mobile phones to improve health facility access and creating community support groups for health workers. The initiative aims to expand the definition of innovation to include grassroots ideas and small improvements, not just radical changes. It stresses the importance of engaging diverse stakeholders and creating an environment where ideas can be nurtured and developed.

2. Listening to Unheard Voices, Exploring New PossibilitiesConcern Worldwide’s experiences inspiring & generating innovative MNCH solutions Presented by: Donna Espeut, Concern Worldwide US CORE Group Spring Meeting 11 May 2011

3. Innovations for MNCH Currently spans three countries: Malawi, Sierra Leone, India (State of Orissa) Involves moving beyond the status quo by engaging both traditional & non-traditional players in health to generate new & creative health solutions UNICEF and Ministries of Health are partners in the initiative.

4. The Foundation of the Innovations for MNCH Initiative Analyze, synthesize & actively disseminate the LEARNING from these ideas to influence POLICY, PRACTICE and SCALE UP SELECT and DEVELOP the best of these IDEAS into models that can be implemented at district level GENERATE hundreds of bold, new and creative IDEAS from diverse & non-traditional sources IDENTIFY the most serious & widespread BARRIERS to delivery of health services for mothers and children

5. Innovations is as much about the process of unearthing innovation as it is about the actual innovations we will be testing. 5

6. Our Process During the First Phase (2009-2010)

7. Our Working Definition of “Innovation” A new approach or practice A substantial transformation of an existing approach or practice An application and/or adaptation of a successful approach or practice from a different context

8. Based on research & consultation, we selected one priority MNCH service delivery challenge to serve as the basis for a nationwide Call for Ideas Solicited ideas via competition open to all members of the general public, and selected winning ideas to be pilot tested

9. Outcomes of the Process Almost 13,000 submissions across the 3 countries. (Not all of them were bona fide ideas/solutions.) Primarily in the categories of social ‘innovations’ (e.g., elevating the role of communities in health service delivery) –AND- systems ‘innovations’ (e.g., strengthening accountability mechanisms; facilitating the work of health workers; incentive schemes) Technological ‘innovations’ mostly entailed use of mobile phone technology & GIS/GPS

10. Innovative ideas we are currently testing in Malawi CLEMENT District AIDS Coordinator SOYAPI Software Developer His Idea : Create an SMS-based booking system to minimize waiting times in government health facilities. Also, use mobile technology to send personalized appointment reminders and health tips. His Idea : Create a 24 hour toll-free hotline. Families can call the hotline for advice based on recognized signs of common illnesses and conditions. For cases that can’t be managed at home, the hotline can facilitate referral.

11. Innovative ideas from Orissa DISHANTI Mother from a remote tribal village; works in road construction and forestry. DAKTAR Vocational student teacher from rural village Her Idea: Support Women’s Federations and Self Help Groups as focal entities to monitor and assess health worker performance in tribal areas, as well as facilitate linkages between tribal communities and district-level health facilities. His Idea: Recruit & train male health workers to work alongside female health workers in rural villages. This aims to increase the security of the female health workers, enabling them to travel at night to attend to MNCH emergencies. It will also help to engage husbands and fathers to promote MCNH household practices & timely care seeking.

12. Innovative ideas we are currently testing in Sierra Leone ISHMAEL Air traffic controller in Freetown MUSA Student from a rural district VICTOR Counsellor with Medecins Sans Frontieres His Idea: Form “Quality Circles” of health workers to provide peer learning, problem solving and support to one another His Idea: Provide group and individual counselling and training to health workers in order to help them cope with stress and trauma in their professional and personal lives His Idea: Use community scorecards to give communities a say in the assessment of health worker performance, and link this to rewards and incentives for health workers

13. What is “innovative?”

14. We anticipated this:

15. In reality, many innovations are more like this: OR EVEN:

17. It can be a small change that has the potential to make a radical difference.A seemingly unremarkable idea (or set of ideas) can be nurtured and developed into something quite remarkable.

18. What does it take to inspire & generate richer innovations?

19. Targeted, in-depth engagement + Diversity Be much more deliberate in who we engage and how we engage them. Create opportunities for the “gentle collision” of different people who represent different backgrounds, perspectives & skills 18

20. A safe space in which creativity can thrive Playful & fun methods can help people let their guard down & become more open to thinking “outside the box.” 19

21. Clarity re: what is currently being done/has been tried

22. Patience (& resources) to allow raw ideas to “incubate” Action/experimentation at the grassroots level Sharing between different groups (not necessarily bound by geography) 21

23. Getting a glimpse of Innovations in action 22