Global Communities has worked to save mothers’ and children’s lives and improve their health and well-being since 1961. We implement integrated maternal, newborn, child health and nutrition (MNCHN) programs at the individual, family, community and institutional levels. On the supply side, we partner with governments, civil society, and frontline health workers to strengthen health systems, focusing on enhancing the accessibility, quality and equity of MNCHN services. On the demand side, we work with individuals, families and communities to increase uptake of these services; adopt improved health, nutrition and hygiene behaviors; and increase citizens’ participation in decision-making processes that shape MNCHN service delivery. We promote evidence-based interventions such as kangaroo mother care (KMC) for preterm and low birthweight babies, optimal breastfeeding and complementary feeding practices, community-based management of acute malnutrition (CMAM), growth monitoring, multiple micronutrient supplementation and anemia screening. Our solutions are community-driven, people-centered, and grounded in the principles of gender equality, universal access and accountability.

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In 2012, the United States Agency for International Development (USAID) partnered with the United Nations Children’s Fund (UNICEF) and the Governments of India and Ethiopia to convene the Child Survival Call to Action, which galvanized unprecedented commitments from governments and civil society around the world to end preventable maternal and child deaths. Three years later, UN Member States adopted the Agenda for Sustainable Development with ambitious targets to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030 and end preventable deaths of newborns and children under 5 years of age, also by 2030. Yet every two minutes a woman dies due to pregnancy or childbirth, and most of these deaths are entirely preventable.

New data released this February by several UN agencies shows significant progress in reducing maternal deaths between 2000 and 2015, but also reveals alarming setbacks for maternal health over recent years. According to the report, “The world must significantly accelerate progress to meet global targets for reducing maternal deaths, or else risk the lives of over 1 million more women by 2030.”

I recently chatted with Cara Endyke Doran, our Senior Director of Health, WASH and Nutrition, about these trends and about ways in which Global Communities is saving mothers’ and children’s lives.

This is the first conversation in our new series “Pass the Mic,” where staff from Global Communities share innovative ideas and in-depth insights on timely topics spanning the development, humanitarian and peace nexus. The interview was edited for length and clarity.

Paula: You recently traveled from Boston to Washington, D.C., to attend the global event Maternal and Child Survival: A Decade of Progress and Action for the Future, co-convened by USAID, UNICEF and the Governments of India, Senegal and the United Kingdom. A Hill Reception organized by the Global Health Council and co-sponsored by Global Communities followed. Why were these convenings important to you and what was your key takeaway?

Cara: These events were important because they provided an opportunity for global leaders, health experts, advocates and practitioners to come together to review progress made in maternal and child health since 2012 and to chart a course for future action. Despite significant improvements toward reducing maternal, newborn and child deaths since 2012, many populations around the globe do not have equitable access to high-quality care. Even when care is available and of quality, women and children still do not have access to and control over resources to attain a high standard of health and well-being. Furthermore, many health systems lack the ability to adapt to changing epidemiologic and demographic trends. During the event, USAID addressed these continued challenges and released a new strategic framework for preventing maternal and child deaths by 2030. The framework laid out a plan for improving maternal, newborn and child health outcomes through a renewed focus on coverage, quality and equity. 

Paula: While there were calls for a celebration, most experts acknowledged dramatic setbacks caused by the COVID-19 pandemic, ongoing conflicts and natural disasters. For example, Dr. Atul Gawande, Assistant Administrator at USAID, pointed out the first drop in life expectancy since World War II. What is needed to rebuild the momentum and get back on track for achieving related Sustainable Development Goals by 2030?        

Cara: Lessons from Ebola and other emergencies have taught us that women and children are often the first to suffer in a crisis. The impact of the COVID-19 pandemic on women and children is no different. Widespread disruptions in health services have impacted women’s access to lifesaving maternal health services, such as treatment for postpartum hemorrhage, infection and high blood pressure. These disruptions have also impacted children. For example, we saw major backsliding in childhood immunizations, leaving millions of children at increased risk of contracting vaccine-preventable diseases. Children have also been at risk of malnutrition due to disrupted food systems and decreased access to essential nutrition services.

At Global Communities, we understand the critical need to advocate for and maintain essential services in an emergency to avoid preventable mortality as well as improve data access and quality to support timely decision-making. We aim to reinforce stronger, more resilient and adaptable health systems that put the needs of women, children and other vulnerable people at the center of programming. This includes holistic, locally led programs that support sustained political will, adequate investment and financing of health systems. We also believe in the power of equitable partnerships and multisectoral approaches to address health and well-being. Ensuring meaningful participation of women and overlooked groups in the design and implantation of programs is of key importance. So is accountability to the people we serve.  

Paula: The speakers consistently mentioned the need to invest in primary healthcare and integrated services for moms and babies. In fact, some talked about a radical reorientation of health systems towards primary health. What is your perspective on this issue? Is Global Communities well-positioned to support this effort? 

Cara: Global Communities advances opportunity, well-being and resilience among vulnerable groups and across all ages. We believe that maternal and child health services are most effective when they are integrated across the continuum of care for mothers, newborns and children. We work with local health structures to bundle services within existing platforms, especially primary healthcare, to improve access, address multiple health needs at once and increase cost-efficiency. Our approaches are locally driven and grounded in systems-thinking, gender equality, social inclusion, evidence and ingenuity.

With our community-driven systems approaches, we are optimally placed to strengthen primary healthcare systems to improve maternal and child health. By involving community members in the planning, implementation and evaluation of primary healthcare projects, we can ensure that the healthcare services are tailored to the specific needs of the community. By leveraging the local knowledge and tapping into the existing networks and resources within the community, we can increase the effectiveness and sustainability of primary healthcare projects. And by making an effort to understand local contexts and include community members in the decision-making process, we can build trust and relationships between healthcare providers and community members. Through our partnerships with communities, we can ensure that the delivery of high-quality healthcare services can continue even after external funding ends.

Paula: I very much appreciated the focus on equity during the event. Dr. Omar Abdi from UNICEF remarked that 10 years ago equity was an ‘innovation’ in the maternal and child health space, but now everyone is talking about it. The speakers emphasized the importance of using equity data to understand who is left behind and then ensuring that health interventions reach the poorest and most marginalized populations. Advancing equity is one of the cornerstones of Global Communities’ mission. What tools and approaches do we use to promote equitable and gender-responsive access to health services?  

Cara: Global Communities uses a multipronged approach to ensure equitable and gender-responsive programs. Where appropriate, we start our programs with gender analyses that examine how gender roles, norms and relations affect access to health services and health outcomes. These analyses help us identify barriers and opportunities for addressing gender disparities and improving women’s and children’s access to care. We also embed metrics to assess health equity in our data systems. This involves tracking health outcomes and health service utilization by gender and other social determinants of health to identify gaps and monitor progress toward health equity.

Paula: At the event USAID Administrator Samantha Power launched a new strategy, Preventing Child and Maternal Deaths: A Framework for Action in a Changing World. The strategy lays out an action plan to improve health outcomes for women and children by 2030. What is your vision for Global Communities’ maternal and child health programming in the next 5-10 years?

Cara: Over the next five years, I hope to strengthen and expand our ability to support primary health systems to be able to protect women, children and adolescents in a world affected by climate change. The goal is to ensure that people we serve have access to quality health services and can achieve the highest possible level of health and well-being. That children not only survive but thrive, and that we transform systems to meet their needs. And that health systems are well-managed with the ability to adapt and respond to changing needs of the community, including in times of crisis.

Paula: Climate change and its impact on maternal and child health were also mentioned by multiple speakers. Youare representing Global Communities as a co-chair of the USAID-funded Child Health Task Force, which is exploring this issue. Can you share a few thoughts on this subject?

Cara: Through the Child Health Task Force we are unpacking the effects that changing climate has on children and exploring system-level approaches that health systems can take to adapt to changing conditions. According to the Children’s Climate Risk Index, climate change is already significantly affecting children globally, with approximately 1 billion children at ‘extremely high risk’ of experiencing the negative impacts of climate change. While research and literature linking climate change and environmental degradation to ecological and social outcomes have been rapidly proliferating, there is a noticeable lack of data on the intersection of climate, environment and health. We seek to address this information gap through a webinar series “Adapting Health Systems to Protect Children from the Impact of Climate Change.” These events foster greater discussion on under-represented but important child health themes. Please join the series here. We also promote collaboration across sectors and organizations to advocate for greater global investment in adapting child health systems to become more resilient in the face of climate change going forward.

Paula: Global Communities has worked to save mothers’ and children’s lives and improve their health and well-being for six decades. What is, in your opinion, our greatest contribution or achievement thus far? What are you most proud of?

Cara: One of the hallmarks of Global Communities’ approach is training and mentoring community health workers (CHW) to deliver high-quality maternal and child health services. We work to ensure that these frontline health workers are motivated and equipped with knowledge and skills to employ global best practices, such as kangaroo mother care, community-based management of acute malnutrition and emergency obstetric and newborn care. It is very exciting and rewarding work. My colleagues and I recently published a paper in the Journal of Social Science and Medicine titled “Effects of Engaging Fathers and Bundling Nutrition and Parenting Interventions on Household Gender Equality and Women’s Empowerment in Rural Tanzania.” EFFECTS was a cluster-randomized controlled trial co-designed and implemented by Global Communities. The study generated novel evidence that, with the right approach and resources, CHWs can deliver gender-transformative nutrition and parenting interventions to couples in low-resource community settings with potentially synergistic positive effects on household gender relations and maternal and child well-being.

Paula: Very exciting, congratulations! Empowering CHWs is so important. This was also a recurring theme of the events we talked about. One speaker, Millicent Miruka — a CHW Supervisor from Kenya — made an impassioned plea to recognize CHWs’ contributions, listen to their voices and ensure they are well-trained and supervised. I am also proud we are doing this work.

Thank you for your time! How can our readers reach you to learn more?

Cara: To learn more about Global Communities’ work in promoting maternal and child health please visit our website and read our most recent technical factsheet. If you have questions about our programs, please email us at hello@globalcommunities.org. You can also find me on LinkedIn.

Cara Endyke-Doran

Senior Director, Health, Nutrition & WASH

Cara Endyke-Doran, MPH, MSN, RN, is an advanced practice nurse with nearly 25 years of experience leading large international health programs focused on women’s, children’s, and adolescent’s health. Her technical areas of expertise include maternal, newborn, child and adolescent health, gender, and HIV prevention, care, and treatment. She is a thought leader who sits on global task forces and advisory groups. Cara is an innovative and effective problem-solver who adapts and responds to evolving program needs. She has held long-term assignments in Mozambique, Zambia, and Nicaragua and provided technical support to programs in Guatemala, Haiti, Honduras, India, Kenya, Liberia, Malawi, Tanzania, Uganda, and South Africa. She has her master’s degrees in Public Health and Nursing from Johns Hopkins University. She speaks Spanish and Portuguese.

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The January 12, 2010 earthquake in Haiti was the largest natural disaster in the country’s history. Residents were confronted with a tragedy of monumental scale and the daunting task of building back. Among the hundreds of projects implemented in response to the disaster was the KATYE Project. Named for the Haitian Creole word for “neighborhood,” the KATYE Project was implemented by Project Concern International (PCI), CHF International (now Global Communities) and USAID’s Office of U.S. Foreign Disaster Assistance (OFDA) to support a community-led, sustainable approach to recovery. The project’s goal was to develop and demonstrate replicable strategies for neighborhood-based humanitarian assistance in heavily impacted urban areas, such as downtown Port-au-Prince, that would meet the humanitarian needs of earthquake-affected households and create the conditions for longer-term recovery and rebuilding.

The post Humanitarian Assistance, Resilience, and Rebuilding: The Long-term Impact of the Neighborhood Approach on Post Earthquake Haiti appeared first on Global Communities.

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“Having lived in Haiti for the first 20 years of my life and visited many times after that, I was able to gauge at first sight the magnitude of the devastation,” said Pascale Wagner, a senior PCI staff member who was on the ground in 2010. “All my bearings and references were gone, lost, turned into mounds of rubble. The human losses and suffering were unbearable. Rebuilding Port-au-Prince was going to be a huge challenge, and there was no time to be wasted.”

Even before the earthquake, the families living in Ravine Pintade near downtown Port-au-Prince were vulnerable, with much of the community living in poverty without access to safe sanitation. The earthquake’s destruction in this area was unimaginable, instantly rendering 75% of houses uninhabitable. Over 3,000 neighbors were killed, and the survivors moved in to tents on nearby roads and into camps. These temporary shelters tore at the fabric of the community, undermining livelihoods and social networks of trust, putting Ravine Pintade’s recovery at risk.

“Part of the problem for humanitarian aid organizations was that a lot of our technical strategies and best practices were crafted in rural disasters in Africa. There simply was no way to use those strategies in a situation like downtown Port-au-Prince,” said Jim DiFrancesca, PCI’s Senior Director of Humanitarian Assistance and Resilience. “People didn’t know how to remove large scale rubble. They didn’t have access to heavy machinery. They didn’t know how to put shelters down for all of the people who lost houses. It required that we generate a whole new way of responding to crises.”

With the support of the U.S. government, PCI offered another way. Instead of traditional disaster relief, our team partnered with community leaders to create the conditions for sustainable recovery and rebuilding. We believed that with the right voices at the table, we could meet immediate humanitarian needs while addressing the deeper challenges of pre-existing vulnerabilities, laying the foundation for a safer, healthier, and more resilient neighborhood for years to come.

So, PCI partnered with community leaders to determine what it would take to get families out of tents and camps and back into their communities. This included removing rubble and addressing immediate shelter and sanitation needs, but it also accounted for deeper challenges, from settling land disputes, reducing vulnerability to future disasters, and improving lighting, to installing walkways, roads, and water and sanitation systems. This methodology, known as the Neighborhood Approach, worked to build long-term solutions to enhance livelihoods, build community trust through safe gathering spaces, and leave a platform where recovery could take place.

“We took a huge risk, but we were right in thinking that the emergency was the right time to address long-term vulnerabilities,” DiFrancesca said. “To get people set up so they could recover versus only putting a shelter down wherever you can find space.”

A look back at PCI’s response to the 2010 earthquake in Port Au Prince, Haiti, including a follow-up visit to see the impact of the neighborhood approach in Ravine Pintade almost a decade later (photos 17-20).

In 2019, nine years after the earthquake, PCI returned to Ravine Pintade to conduct a rigorous follow-up study and analysis of the program. The results were remarkable.

The Neighborhood Approach increased the value of land and housing, increased the presence of small businesses and implemented drainage systems that significantly decreased flooding and mud that was common before the earthquake, which reduced vectors for disease. The temporary shelters erected by the project had been formalized into more permanent houses and had outlived their original intended lifespan by 5 years. The project’s retaining walls, pathways, stairs and much of the water system continue to be maintained and appreciated.

“What we did clearly worked,” DiFrancesca said. “I don’t think people realize how difficult it was for our team to be there and the significance of seeing those structures still in place years later. It made me realize just how important good work is after a crisis.”

The installation of walkways, lighting and creation of public space promoted safety and encouraged community gathering places. Residents reported strengthened relationships, an improved health environment and a better neighborhood for the elderly, children, and those with disabilities. Most importantly, local residents voted with their feet: Ravine Pintade saw a population increase of 25% over pre-earthquake levels.

After a natural disaster of unthinkable proportions, this community built back better than before through a collaborative effort using an innovative, bold approach that centered around people, families and communities, strengthening the beating heart of this previously devastated Haitian neighborhood.

“I was very fortunate to be part of the PCI team in Haiti,” Wagner said. “The partnerships that we developed then, and the innovative and sound interventions that we implemented in difficult conditions and in a context where so many had lost hope are a reminder that everything is possible.”

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