1. An Advocacy-Research Partnership: A Successful Knowledge-Translation Platform?
McAuliffe, E, DePinho, H., Clark, P, Sawyer, A, Shehu, D, Masanja, H, Kamwendo, F, Sidat, M, & Bradley, S.

2. Knowledge translation
knowledge translation (KT) methodologies are an integral part of the health policymaking process.
KT methodologies or platforms are mechanisms designed to use evidence to improve the safety and effectiveness of health policies and policy implementation interventions.
Not just disseminating evidence but encouraging the use of evidence

3. Inadequate long-term human resource planning and domestic production of health workers, coupled with ageing populations in developed countries, will continue to fuel recruitment from resource-poor countries unless there is a significant commitment to address this global inequity.”
EU HRH Strategy 2005

4. Rationale for Project focus
midlevel providers are already providing a significant share of maternal health services including the bulk of emergency obstetrical surgery (EmOC), in at least three countries in Africa: Malawi, Mozambique, and Tanzania. But they receive little attention.
clearly defined tasks and standards of care for the provision of maternal health and in particular emergency obstetric care that can be used to assess midlevel providers
interventions to reduce maternal and newborn deaths depend on the presence of a functioning health system that enables health worker performance.
existing data indicate that of all the MDGs, MDG 5, reducing maternal mortality ratios, is the one least likely to be achieved by 2015
Requires change in all building blocks in WHO Health Systems framework: Governance and Leadership, Health Workforce, Financing, Information, Supplies and Infrastructure, Service Delivery.

5. Supported by Irish Aid and Ministry of Foreign Affairs Denmark

6. Project aims
four-year, multi-country research project in Malawi, Tanzania and Mozambique
to expand the evidence base in support of the effective use of mid-level providers (MLPs) in maternal and newborn health and promote greater political leadership and critical policy action on their use.
The focus on the delivery of the Emergency Obstetric Care signal functions seen as a strategic entry point to assessing the use and effectiveness of MLPs more broadly.

7. Partners Ministries of Health HR Directorates
Reproductive Health programmes
Global Advocacy – Realizing Rights (Mary Robinson)
Research partners
Ifakara, Tanzania
College of Medicine, Malawi.
EM University, Mozambique
AMDD, Columbia University
CGH, Trinity College
Regional & Local Advocacy –
Regional Prevention of Maternal Mortality Network

8. Advocacy activities - examples
Before
During
After
Global
Discussions with key actors in Maternal Health e.g. White Ribbon Alliance, Donors etc.
Conference presentations making case for research through evidence to date (from previous research)
Roundtables with critical actors
Policy briefs issued
Strategic conference presentations
Advocacy with country presidents and vice-presidents
National & Local
Discussion with MoH stakeholders
Workshops for professional networks
Interviews with professional associations, training bodies and district health mgt staff
Dissemination to ministry staff
Workshops with professional networks

9. Challenges What is advocacy? Who should be doing it?
Timing and integration of research and advocacy elements
Communication challenges (Bradley et al. poster)
Complexity overwhelming at times
Managing and targeting outputs

10. Lessons
Preparing intended audience for research outputs is a valuable activity that increases the utility of research findings.
Having a champion makes it more likely that message will be heard.
Preparation time to plan specific strengths and contributions of each partner would help to manage expectations and reduce tensions.
Complex multi-stranded project - a phased approach with responsibility for specific phases being assigned to individual partners.
Integration of the advocacy elements of the project into these phases would also have ensured that the data analysis and advocacy were better aligned.
A more strategic, streamlined approach to planning the outputs from the project.

11. Some evidence that visibility and use of MLPs has increased
EU projects recently funded
STEM – Support train and empower managers. Improving HRM and supervision of MLPs providing obstetric care in Tanzania and Mozambique (CGH)
PERFORM- strengthening HRM in Tanzania (Liverpool School of Tropical Medicine)
Training programme for Clinical Officers in Malawi (RCSI)

12. With Thanks
HSSE Team:
Centre for Global Health, Trinity College, University of Dublin
AMDD, Mailman School of Public Health, Columbia University, USA
Centre for Reproductive Health, College of Medicine, Malawi
Ifakara Health Institute, Tanzania
Dept. of Community Health, Eduardo Mondlane University, Mozambique
Realizing Rights: Ethical Globalization Initiative, USA
Regional Prevention of Maternal Mortality Network, Ghana
Funders:
IrishAid & Ministry of Foreign Affairs, Denmark