Evidence for action to reduce maternal & neonatal mortality project review

The Issue

Evidence for Action (E4A) was a £17m five-year programme (2012-2016) to improve maternal and newborn survival in Ethiopia, Ghana, Malawi, Nigeria, Sierra Leone and Tanzania. It was implemented through a consortium of partners led by Options Consultancy Services Ltd and attracted complementary funding from the Bill and Melinda Gates Foundation for continuation and extension of programme activities.

DFID commissioned Tropical Health in partnership with Montrose International from the midpoint of the E4A programme period (2014) to assess programme results of the programme and draw lessons, focusing on quality of care, capacity building and regional alignment in the context of the programme’s theory of change.

Our Approach

The Tropical Health and Montrose team applied a mix of methods and sources to analyse E4A’s Theory of Change and answer the review questions. The team analysed a variety of reports and other secondary data sources and conducted primary research including two online surveys, key informant interviews and field visits. Primary research focused on Ghana, Malawi and Tanzania.

Tropical Health and Montrose delivered a comprehensive analysis of the E4A programme’s relating to the following criteria: relevance, effectiveness, efficiency and sustainability.  The analysis included a set of lessons learned in the areas of evidence, advocacy, accountability, regional programming and others, which should be useful in future programming and in the extension of the E4A programme.

Our Findings

Tropical Health and Montrose found that the Theory of Change worked comparatively well at the outcome level, but many expected changes have not become institutionalised. The availability and use of evidence for policy, planning, and decisionmaking were noticeable at all levels while quality of care improvements were only effective sporadically. The timeframe for implementation was short, thus results may take time to emerge at the systemic level.