Dr. Wolfgang MunarResearch Professor

Milken Institute School of Public Health

Feb 28-2018

MMR (per 100k live births)

NMR (per 1k live births)

1990 2016 2035

Tension for change - the stagnation of

maternal survival in Honduras

Adapted from Hovmand et al. 2016 – Washington University in St Louis

Political decision to redesign MNCH

policy• SMI and System Dynamics simulation modeling

• Participatory redesign process

• Conventional strategic planning (SWOT, epi & institutional assessments)

• Scenario planning (Imagining plausible futures in the context of a very dynamic environment)

• Using system thinking tools for policy design

MMR (per 100k live births)

NMR (per 1k live births)

1990 2016 2035

Adapted from: Hovmand et al. 2016 – Washington University in St Louis

How can Honduras accelerate

maternal survival?

Confluence of domestic and external

factorsSMI’s focus on population-level

outcomes brought MNH issues to

evidence-informed policy dialogue

agenda

Photo credit: Janko Ferlic

Confluence of domestic and external

factorsSMI’s focus on population-level

outcomes brought MNH issues to

evidence-informed policy dialogue

agenda

Development of a System

Dynamics MNH Simulation Model

using group model-building (GMB)

Photo credit: Janko Ferlic

Photo credit: Peter Hovmand

Confluence of domestic and external

factorsSMI’s focus on population-level

outcomes brought MNH issues to

evidence-informed policy dialogue

agenda

Development of a System

Dynamics MNH Simulation Model

using group model-building (GMB)

Photo credit: Janko Ferlic

Photo credit: Peter Hovmand

At BMGF, a growing interest in

understanding how to achieve global

impact at scale

Group model building and system dynamics - “seeing” own system; negotiating meaning about system elements, inter-

relations, and system boundaries

Several high leverage points were identified

through the participatory modeling process

Mapping policy options and experimenting with high-leverage points

Leverage point in the model

Increasing accessibility

Increasing affordability

Quality improvement (QI)

Increasing quality improvement capabilities (QI+)

Increasing women’s health status

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Best case

All QI+

ID QI+

ID QI

All Aff. and Acc.

PPC QI

MCP QI

Base case

MMR NMRHovmand et al. 2016

Honduras - Simulation model scenarios for

MN survival

Peter Hovmand– Washington University in St Louis

InterventionsID: Institutional deliveryANC: Antenatal carePPC: Postpartum carePNC: Postnatal careQI: Quality improvementQI+: Continuous QI +System learning for QI

Page-3-

MaternalMortalityRatio

Year

Pe

r1

00

kliv

eb

irth

s

0

150

300

1990 2001 2013 2024 2035

1

2

3

4

51

23

45

12

3

4

5

1

2 34

5

Basecase1

AllQI+2

IDandPPCQI+3

IDandPPCQI+,IDAff.andPPCAcc.4

Bestcasescenario5

Scenarios

Hovmand et al. 2016

Peter Hovmand– Washington University in St Louis

InterventionsID: Institutional deliveryANC: Antenatal carePPC: Postpartum carePNC: Postnatal careQI: Quality improvementQI+: Continuous QI +System learning for QI

Page-3-

NeonatalMortalityRate

Year

Per

1kliv

eb

irth

s

0

20

40

1990 2001 2013 2024 2035

1

2

3

4

5

12

34

51

23

4

5

1

2 34 5

Basecase1

AllQI+2

IDandPPCQI+3

IDandPPCQI+,IDAff.andPPCAcc.4

Bestcasescenario5

Scenarios

Hovmand et al. 2016

Peter Hovmand– Washington University in St Louis

InterventionsID: Institutional deliveryANC: Antenatal carePPC: Postpartum carePNC: Postnatal careQI: Quality improvementQI+: Continuous QI +System learning for QI

Complementing evidence-informed policy design with SD models and GMB

System thinking-informed policy dialogue brought new perspectives: multi-sectorial approaches, adolescents and girls, improvement and system learning

The result: A new inter sectorial MNCH policy,with a strong focus on girls and adolescents

Promise and risks