title: 'Big push' to reduce maternal mortality in Uganda and Zambia enhanced health systems but lacked a sustainability plan.
abstract: In the past decade, "big push" global health initiatives financed by international donors have aimed to rapidly reach ambitious health targets in low-income countries. The health system impacts of these efforts are infrequently assessed. Saving Mothers, Giving Life is a global public-private partnership that aims to reduce maternal mortality dramatically in one year in eight districts in Uganda and Zambia. We evaluated the first six to twelve months of the program's implementation, its ownership by national ministries of health, and its effects on health systems. The project's impact on maternal mortality is not reported here. We found that the Saving Mothers, Giving Life initiative delivered a large "dose" of intervention quickly by capitalizing on existing US international health assistance platforms, such as the President's Emergency Plan for AIDS Relief. Early benefits to the broader health system included greater policy attention to maternal and child health, new health care infrastructure, and new models for collaborating with the private sector and communities. However, the rapid pace, external design, and lack of a long-term financing plan hindered integration into the health system and local ownership. Sustaining and scaling up early gains of similar big push initiatives requires longer-term commitments and a clear plan for transition to national control.
authors.affiliation: Margaret E. Kruk (mkruk@columbia.edu) is an assistant professor of health policy and management and director of the Better Health Systems Initiative at the Columbia University Mailman School of Public Health, in New York City.
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Kruk
authors.affiliation: Miriam Rabkin is an associate professor of epidemiology at the Columbia University Medical Center and director for health systems strategies at ICAP at Columbia University.
authors.forename: Miriam
authors.initials: M
authors.lastname: Rabkin
authors.affiliation: Karen Ann Grépin is an assistant professor of global health policy at the Robert F. Wagner Graduate School of Public Service, New York University, in New York City.
authors.forename: Karen Ann
authors.initials: KA
authors.lastname: Grépin
authors.affiliation: Katherine Austin-Evelyn is a researcher in the Department of Epidemiology, Columbia University Mailman School of Public Health.
authors.forename: Katherine
authors.initials: K
authors.lastname: Austin-Evelyn
authors.affiliation: Dana Greeson is a researcher in the Department of Epidemiology, Columbia University Mailman School of Public Health.
authors.forename: Dana
authors.initials: D
authors.lastname: Greeson
authors.affiliation: Tsitsi Beatrice Masvawure is a researcher in the Department of Epidemiology, Columbia University Mailman School of Public Health.
authors.forename: Tsitsi Beatrice
authors.initials: TB
authors.lastname: Masvawure
authors.affiliation: Emma Rose Sacks is a researcher in the Department of Epidemiology, Columbia University Mailman School of Public Health.
authors.forename: Emma Rose
authors.initials: ER
authors.lastname: Sacks
authors.affiliation: Daniel Vail is a researcher in the Department of Epidemiology, Columbia University Mailman School of Public Health.
authors.forename: Daniel
authors.initials: D
authors.lastname: Vail
authors.affiliation: Sandro Galea is chair of and the Gelman Professor of Epidemiology in the Department of Epidemiology, Columbia University Mailman School of Public Health.
authors.forename: Sandro
authors.initials: S
authors.lastname: Galea
mesh_terms: D018672:Community Health Planning / Q000191:economics / Q000458:organization & administration* / Q000639:trends*; D003362:Cost-Benefit Analysis / Q000639:trends; D003906:Developing Countries / Q000191:economics; D005260:Female; D005544:Forecasting; D014943:Global Health; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration / Q000639:trends; D006308:Health Systems Plans / Q000458:organization & administration* / Q000639:trends*; D006801:Humans; D007231:Infant, Newborn; D008428:Maternal Mortality / Q000208:ethnology* / Q000639:trends*; D011203:Poverty / Q000191:economics / Q000208:ethnology*; D011247:Pregnancy; D011787:Quality of Health Care / Q000191:economics / Q000458:organization & administration / Q000639:trends; D014454:Uganda; D015024:Zambia
keywords: Access To Care; Developing World < International/global health studies; Maternal And Child Health; Quality Of Care