The Approach

The strategy for the HSSE project is driven by four key elements:

• Focus on the delivery of emergency obstetric and newborn health care (EmONC) by mid-level providers as a key entry point to assessing the use and effectiveness of mid-level providers more broadly;
• Unique and strategic collaborative partnership among research, policy and advocacy organizations;
• Action-oriented participatory approach to engaging policymakers in research and an emphasis on stakeholder engagement in all phases of the project, to ensure country level ownership and project sustainability, and
• Multi-country approach to enable in-country analyses and cross-country comparisons.

Malawi, Mozambique and Tanzania have been selected for in-depth research because each country has well established cadres of mid-level providers delivering the bulk of emergency obstetric care (including caesarian sections); there is documented political support to address the health worker problems in the countries; and there are lessons to be learnt from the different mechanisms each country has adopted to developing and supporting mid-level providers. The evidence generated from these three countries will be shared with, and would be of interest and benefit to many other African and developing countries.

Ultimately, the HSSE project believes that attention to expanding the use of mid-level providers to increase maternal and newborn health services at district level is the lynchpin on which to strengthen district health systems overall.