Learning from health systems strengthening in maternal and newborn health in China to accelerate progress for saving lives in Africa. (360G-Wellcome-106472_Z_14_Z)

The aim of this project is to examine China's progress in reducing maternal and neonatal mortality to draw lessonsapplicable to the MNH context in sub-Saharan Africa. The focus will be on understanding the health systems inputs andoutputs that have enabled progress towards comprehensive obstetric care in health facilities, particularly for the rural poor and those living in remote areas, and the financing mechanisms that facilitated reimbursement of hospital delivery charges. We will contribute knowledge in three areas: 1. We will assess implementation strength, an emerging approach to programme evaluation which aims to characterise the intensity of programme effort required to achieving programme goals. This will be done through a quantitative analysis of the relationship between health system inputs/outputs, contextual factors and maternal and neonatal mortality across all 3255 counties in China between 1996 and 2013, using routinely available data. Multilevel statistical models will identify thresholds for MNH health systems indicators, incorporating time varying covariates where possible. 2. A case study in eight counties in Western China will provide an in depth understanding of the relationship between MNH inputs that are more difficult to capture through routine data, including the mix and levels of the midwifery workforce, referrals, levels and allocation of health care financing, and selected service coverage and outcome indicators. Eight counties will be selected purposively to reflect various levels of maternal and neonatal mortality, matching counties as far as possible within provinces on contextual factors. Data will be collected at province, county and facility levels and methods will include document review, in-depth interviews with key stakeholders and facility and patient surveys. 3. We will adapt lessons from China's experience in MNH to low income countries, by analysing the transferability of policy lessons from China to Tanzania.