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Saving Mothers, Giving Life
Description/achievement of initiative

Saving Mothers, Giving Life (SMGL) is a five-year initiative to rapidly reduce maternal and newborn mortality in low-resource, high-burden sub-Saharan Africa countries. Launched by Secretary of State Clinton in 2012, this public-private partnership strengthens health services by increasing demand, facilitating access to quality, lifesaving care for the most vulnerable women, and strengthening health systems at the district level. The initiative was given the ambitious goals of reducing maternal mortality by 50% and perinatal morality by 30% in 8 pilot districts in Uganda and Zambia, and then scaling-up nationally in both countries. SMGL also expanded to include Cross River State, Nigeria.

Implementation methodologies

• Saving Mothers, Giving Life builds on the existing structures and resources that have been invested in successful national and US Government-supported maternal health and HIV programs, guided by national strategies for maternal and newborn health. To that end, the partnership focuses on the three delays that prevent women from benefiting from lifesaving maternal health services: the delay in seeking services, the delay in reaching services, and the delay in receiving high-quality services. SMGL gains an understanding of the landscape of safe delivery services in a given area by conducting in depth health facility assessments at all health care facilities, public or private, providing delivery services. The SMGL principle that all women should have access to comprehensive emergency care within two hours of the onset of a complication, helps inform the financial and technical inputs in order to maximize coverage and quality of services. SMGL focuses its efforts on the labor, delivery and 48-hour postnatal period as this is the time that women and babies are most vulnerable and the majority of deaths occur. The SMGL approach also support the provision of integrated MNH and HIV care.• Saving Mothers, Giving Life is not a “one-size fits all” model, and these strategies and assessments help inform the most appropriate interventions for each district. SMGL uses rigorous monitoring and evaluation to not only count, analyze, and report all maternal and newborn deaths, but also to track programming and guide the expansion of SMGL. Some key evidence-based interventions include:o Increasing demand by training community health workers, mobilizing community leaders, and promoting services and healthy behaviors. o Enabling access by upgrading facilities, providing transportation vehicles and/or vouchers, and building/refurbishing maternity waiting homeso Improving quality by hiring health care workers and providing on the job training and mentoring.o Strengthening health systems by improving supply chain management of supplies, equipment, and essential medicines, and training in data reporting and M&E.

Arrangements for Capacity-Building and Technology Transfer

The Saving Mothers, Giving Life approach fosters host-country ownership, capacity-building and sustainability: • AGOC has been working with the Zambian Ministry of Health to incorporate Uterine Balloon Tamponade (UBT), a low cost and effective technology to treat post-partum hemorrhage (the number one cause of maternal deaths), into the nation guidelines for postpartum hemorrhage management. It also initiated the MOH-endorsed policy shift to allow mid-wives to provide this life-saving care. ACOG is building a network of local trainers who will facilitate the nation-wide roll-out of UBT training. Trainees are also taught how to make UBT kits with local products, should kits not be available. • Project C.U.R.E. provides shipments of customized donated medical supplies, equipment, and related program services to SMGL facilities. After completing comprehensive needs assessments, Project C.U.R.E. produces individualized manifest lists of items for each facility, which are then reviewed and approved by facility directors and ministry of health officials, to ensure that the content is appropriate and needed. After the shipment arrives, they conduct impact evaluations for each container that is delivered to ensure that all equipment is functioning properly and being utilized appropriately. Project C.U.R.E. also holds bio-medical trainings for local engineers in the maintenance and repair of the donated equipment. • Additionally, rosters of mentors who can provide supportive supervision have been established in SMGL districts; this facilitates collaboration, knowledge sharing, problem solving and skills training. Job aids and materials for various technologies and interventions have been distributed among healthcare professionals and facilities, including UBT, Helping Babies Breathe, Helping Mothers Survive, and the BABIES Matrix (a simple tool to capture and monitor perinatal deaths in facilities) among others. SMGL has also fostered south to south collaboration, sharing, and learning between SMGL countries, with SMGL team members traveling to other countries to support and train in data collection and analysis. • Through SMGL efforts, maternal and perinatal death reviews are now standard in SMGL facilities• MOH leaders from both Uganda and Zambia have endorsed the SMGL approach as the standard model for scaling out maternal and newborn services.

Coordination mechanisms/governance structure

Saving Mothers, Giving Life employs a systems approach to addressing maternal and newborn morality by working with both public and private sectors to build on existing national, state, and local platforms. SMGL is coordinated through a secretariat, housed in USAID’s Bureau for Global Health, under the direction of the initiative’s Leadership Council, comprised of representatives from each of the founding partners of the initiative. Each partner of the Leadership Council plays an integral role, outlined below: The United States Government, through USAID, manages SMGL in partnership with CDC, OGAC, the Department of Defense, and the Peace Corps. Together, USAID and CDC lead implementation and monitoring and evaluation (M&E) activities for the initiative with oversight from the Operations Committee and the M&E Committee. The Government of Norway has supported efforts to access donated hospital supplies and equipment through support of Project C.U.R.E. Every Mother Counts leads efforts to strengthen emergency transportation and referral systems in Uganda and advocate for increased support for maternal mortality reduction globally.The American College of Obstetricians and Gynecologists lends scientific, technical, and clinical expertise. ACOG has established networks of trainers and mentors for specific clinical skills, such as use of Uterine Balloon Tamponade for postpartum hemorrhage, and has successfully advocated for national task shifting policies.Merck for Mothers leads programs to strengthen local private health providers through social franchising models in Uganda and Nigeria, and programs to develop entrepreneurial models for maternity waiting homes in Zambia. Project C.U.R.E. provides containers of customized donated medical supplies, equipment to SMGL facilities. Project C.U.R.E. completes on-site needs assessments in all selected SMGL facilities, generates manifests that are signed-off on by district health leaders, oversees door to door delivery, and completes impact evaluations for each container. SMGL operations include a rigorous M&E component that examines not only outputs and program outcomes, but health outcomes—such as the maternal mortality ratio and the perinatal morality rate--with the goal to count every maternal and newborn death and to understand its cause. A comprehensive baseline was undertaken at the inception of the initiative, with regular monitoring and quarterly reporting of 31 district, community and facility level indicators. Indicators are collected and analysed by implementing partners, and cleaned and analysed by CDC and USAID teams in country and headquarters. The M&E committee is also responsible for oversight of external evaluations.


Founding partners: USG (USAID, CDC, OGAC, DoD, Peace Corps), Government of Norway, Government of Zambia, Government of Uganda, Government of Nigeria, American College of Obstetricians and Gynecologists, Every Mother Counts, Merck for Mothers, Project C.U.R.E.

Other stakeholders: Swedish Sida, Lafarge Foundation Zambia Zamnet, ELMA Philanthropies
Progress reports
Goal 3
3.1 - By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births
3.2 - By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births
3.3 - By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases
3.7 - By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes
3.c - Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States
Goal 4
4.4 - By 2030, substantially increase the number of youth and adults who have relevant skills, including technical and vocational skills, for employment, decent jobs and entrepreneurship
Goal 5
5.6 - Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences
Goal 17
17.3 - Mobilize additional financial resources for developing countries from multiple sources
17.6 - Enhance North-South, South-South and triangular regional and international cooperation on and access to science, technology and innovation and enhance knowledge sharing on mutually agreed terms, including through improved coordination among existing mechanisms, in particular at the United Nations level, and through a global technology facilitation mechanism
17.8 - Fully operationalize the technology bank and science, technology and innovation capacity-building mechanism for least developed countries by 2017 and enhance the use of enabling technology, in particular information and communications technology
17.9 - Enhance international support for implementing effective and targeted capacity-building in developing countries to support national plans to implement all the sustainable development goals, including through North-South, South-South and triangular cooperation
17.16 - Enhance the global partnership for sustainable development, complemented by multi-stakeholder partnerships that mobilize and share knowledge, expertise, technology and financial resources, to support the achievement of the sustainable development goals in all countries, in particular developing countries
17.17 - Encourage and promote effective public, public-private and civil society partnerships, building on the experience and resourcing strategies of partnerships

Data, monitoring and accountability
Reduction of maternal mortality ratio by 50% in target facilities
Reduction of newborn mortality rate by 30% in target facilities
Distribution of 30 shipping containers of donated medical supplies and equipment to target facilities across the 3 SMGL countries by Project CURE
Increase in use of PMTCT services by 50% in target facilities
Financing (in USD)
107,000,000 USD
In-kind contribution
Approximately $6M USD in-kind have been contributed to SMGL, including more than $4.2M USD worth of donated in-kind medical supplies and equipment which have been distributed to Uganda and Zambia.
Staff / Technical expertise
USAID and CDC provide in-kind staff and technical advisors for programming and M&E, Peace Corps provides volunteer support, ACOG provides technical expertise and trainings, and Merck for Mothers provides global health fellows.

Basic information
Time-frame: 06/2012 - 09/2017
Founding partners: USG (USAID, CDC, OGAC, DoD, Peace Corps), Government of Norway, Government of Zambia, Government of Uganda, Government of Nigeria, American College of Obstetricians and Gynecologists, Every Mother Counts, Merck for Mothers, Project C.U.R.E.

Other stakeholders: Swedish Sida, Lafarge Foundation Zambia Zamnet, ELMA Philanthropies
Contact information
Kate Cassidy, Saving Mothers, Giving Life Initiative Manager, kcassidy@usaid.gov
United Nations