AdaraNewborn Achieving the maternal and newborn survival targets in ten health facilities across (2020-2030)

Overview Adara Development (Adara) is seeking long-term support from 2020 to 2030, to expand our high-impact model of maternal and newborn care to ten health facilities across Uganda serving populations with very high numbers of newborn deaths. This model, pioneered at in central Uganda over the past twenty years, has delivered strong results. More than 90% of sick and vulnerable newborns now survive and maternal deaths as a proportion of hospital births have fallen by 20%. The model also incorporates a “Hospital to Home” (H2H) program to further improve maternal and newborn health up to six months post- discharge and the ABAaNA Early Intervention Program to better support babies with moderate to severe developmental disabilities and their caregivers.

Adara is seeking to demonstrate that introducing these three “arms” of the AdaraNewborn model - (1) Prenatal Care, (2) Delivery and Newborn Care, and (3) Community Care - can reduce health facility maternal and newborn deaths to the levels required by the Sustainable Development Goals (SDGs) in high-need settings across Uganda. The overarching goal of the program is to help Uganda “bend the curves” and reduce the national maternal mortality ratio to less than 70 maternal deaths per 100,000 live births and newborn deaths to less than 12 deaths per 1,000 live births by 2030. In addition, AdaraNewborn wants to show that 90% maternal and newborn vaccination rates, 90% exclusive breastmilk-feeding rates, and meeting 100% of the unmet need for modern contraception is achievable in Ugandan health facilities and the communities they serve, and will lay a strong foundation for the sustained low rates of maternal and newborn deaths required by the SDGs. Adara is also proposing an open- access, online “knowledge-sharing” platform to facilitate best practices among partners and encourage further replication of the model to other low resource settings.

The AdaraNewborn program will measure success in the ten communities against five Key Performance Targets:

1. Facility Maternal Mortality Ratio of less than 70 per 100,000 live births 2. Facility Neonatal Mortality Rate of less than 12 per 1,000 live births 3. Maternal and Newborn Vaccination Rates of at least 90% upon discharge and six months after birth 4. Early Breastmilk Initiation Rate of at least 90% in the hour after birth and Exclusive Breastfeeding Rate of at least 90% upon discharge and six months after birth for babies delivered and cared for in the maternity ward 5. 100% of Unmet Need for Modern Contraception met at one and six months after birth

The Challenge Uganda is not on track to achieve the SDGs for maternal and newborn mortality by 2030. In 2017, an estimated 375 women died in pregnancy or childbirth for every 100,000 live births and an estimated 20 newborns died for every 1,000 live births in 2018.1 In real numbers this means according to the latest available estimates, there are 6,000 maternal deaths and 32,000

1 WHO, UNICEF, UNFPA, World Bank Group, and the United Nations Population Division Trends in Maternal Mortality: 2000 to 2017 Geneva, World Health Organization, 2019 and UN Inter-agency Group for Child Mortality Estimation (UNICEF, WHO, World Bank, UN DESA Population Division), Levels and Trends in Child Mortality, 2019.

Page 1 of 10 newborn deaths in Uganda. Despite reductions in these deaths in recent years, at current rates of progress the Ugandan Maternal Mortality Ratio will be 325 per 100,000 live births and the Neonatal Mortality Rate will be 16 per 1,000 live births in 2030, above the SDG targets of 70 and 12 respectively. With Uganda’s rapid population growth, this means that in 2030 Uganda will still lose about 5,800 women in childbirth and pregnancy and 30,000 newborns every year, well above the SDG thresholds of 1,300 and 22,000 respectively. Over the next decade, Uganda needs to prevent the deaths of an additional 27,000 mothers and 60,000 newborns to achieve the SDGs.2

Bending the curves will require targeted action. This will be done Uganda needs to prevent the deaths of an in partnership with the Government of Uganda and the additional 27,000 mothers by 2030 communities where the largest numbers of women and newborns 7,000 face the greatest risk of death. The focus will be on childbirth and the week after as 82% of newborn deaths in Uganda occur during this critical window of time. With three- quarters of women in 5,375 3 Uganda now delivering their babies in hospitals, interventions to improve the quality of facility-based care around the time of birth and prior to discharge can have a major impact, especially when 3,750 they target the leading causes of maternal and newborn death in Maternal Deaths Uganda. According to the Global Burden of Disease (GBD), pre- SDG Target existing conditions, hypertension, hemorrhage, sepsis and 2,125 abortion/miscarriage caused three-quarters of all maternal deaths, while birth trauma, preterm birth complications, syphilis, sepsis and pneumonia caused three-quarters of newborn deaths in the six days after birth in Uganda in 2017. 2000 2010 2017 2030 It is also important that interventions target the leading risk Sources: WHO, UNICEF, UNFPA, World Bank Group, and the United factors for maternal and newborn death around the time of birth. Nations Population Division, 2018 and UN World Population Prospects, 2017 In Uganda, prematurity, low birth weight, household air pollution, lack of access to handwashing facilities and unsafe water are the leading risk factors for newborn death in the first week, and iron deficiency is the leading risk factor for maternal death, according to the GBD. In this context, prenatal care that prioritizes maternal nutrition as well as access to clean cooking fuels and technologies, safe water and handwashing during pregnancy is critical.

From day seven to 27 after birth, the leading causes of newborn death in Uganda are sepsis, malaria, syphilis, birth trauma and preterm birth complications, according to the GBD. Post-natal care that targets infection control (including malaria) in the home, exclusive breastmilk feeding and the proper care of sick and vulnerable newborns can have a major impact on reducing newborns death in the community. It will be important to implement programs that ensure a link between health facility and home, allowing for the quick referral of mothers and newborns who experience complications after discharge. In Uganda, 18% of newborn deaths occur between days seven and 27 after birth.

2 All calculations based on latest UN data. 3 Uganda, Demographic and Health Survey, 2016.

Page 2 of 10 Further, integrating modern contraceptive access into every stage of the maternal and newborn care continuum will save many Ugandan lives due to the current high fertility rate (5 children per woman),4 and the very low level of modern contraception coverage among Ugandan women (29%).5 As each one percentage point increase in the modern contraceptive coverage rate prevents an estimated 200 maternal deaths in Uganda, increasing coverage to 33% could prevent an additional 1,000 maternal deaths.6 Increases in modern contraception coverage also reduce newborn deaths, as babies spaced too closely together are at greater risk of death.7 Together, these interventions can lay a solid foundation for sustained low rates of maternal and newborn deaths in Uganda and may even trigger the “demographic dividend” - the rise in economic growth that occurs when the share of the working-age population (ages 15 to 64) is larger than the non-working- age population (ages 14 and younger, and 65 and older).

The Solution To help Uganda “bend the curves” and contribute to the prevention of an additional 27,000 maternal and 60,000 newborn deaths over the next decade, Adara is proposing to expand the high-impact maternal and newborn care model that we have pioneered at Kiwoko Hospital in central Uganda to ten other Ugandan health facilities. This model has shown that improvements in the quality of care provided at the time of childbirth, especially to sick and vulnerable newborns and their mothers, coupled with facility-linked but community-based pre- and postnatal care can dramatically improve maternal and newborn survival in the next decade.

In 1999, Adara began working with Kiwoko Hospital, a 204-bed non-profit community hospital in the District of Uganda which also acts as a referral hospital for the area.8 In the years following, with Adara support, the hospital introduced and significantly improved newborn care, integrating new components at appropriate times. In 2010, the NICU was remodeled to accommodate an increase in patients. In the eight years following, maternity ward admissions rose by 44% to 3,901 women and NICU admissions rose by 150% to 1,223 babies. This rise in NICU admissions included many babies born outside of the hospital who are at greater risk of death due to higher rates of preterm birth and/or low birth weight and delays in seeking care. Despite this rapid growth, maternal deaths as a proportion of births fell by 20% to 0.2% and NICU survival rates remained above 90% over the period. By 2018, babies born weighing less than 2.5kg had a 91% survival rate in the Kiwoko NICU. Over the same period, the hospital increased the number of antenatal appointments by 146%, the number of pregnant women immunised with the tetanus toxoid vaccine by 17%, and the number of infant BCG vaccinations by 94%.9 By 2018, 32% of women admitted to the maternity ward were discharged with contraception - a massive increase of 275% - and 91% of maternity ward babies were exclusively breastmilk-fed.

Uganda’s Ministry of Health now recognises Kiwoko Hospital as a National Center of Excellence in Newborn Care.

Adara is proposing to expand the AdaraNewborn model to ten health facilities serving communities with large numbers of newborn deaths across Uganda, in partnership with the Government of Uganda and other stakeholders. Target health facilities will be supported to strengthen the quality of prenatal, delivery and postnatal care, especially for women with high-risk pregnancies and sick and vulnerable newborns. Support will include refurbishment of the maternity ward, the establishment of a best practice, tailored neonatal unit, staff training, and the expansion of a community healthcare program that provides pre- and postnatal care directly linked to the health facility. The specific services offered will be Special care for a sick and vulnerable newborn at the Kiwoko Hospital NICU.

4 United Nations Population Division. World Population Prospects: 2019 Revision. 5 2019 estimate from Track20 which monitors progress towards achieving the goals of the FP2020 initiative http://www.track20.org/Uganda. 6 ibid. 7 Guttmacher Institute. Adding It Up: Investing in Contraception and Maternal and Newborn Health, 2017. 8 Kiwoko Hospital serves as a referral center for three rural districts and is approximately 80 kilometers (49 miles) north-west of . 9 Recommended maternal and newborn vaccines include two doses of the tetanus toxoid (TT) vaccine during pregnancy and one dose each of the BCG (TB) and Hepatitis B vaccine to the newborn immediately following birth.

Page 3 of 10 adapted to suit local conditions, resources, risk factors and causes of maternal and newborn deaths and barriers to care. Based on these assessments, the ten health facilities will be supported to introduce a range of programs to suit the requirements of the region. These could include:

(1) AdaraNewborn Prenatal Care: Participating health facilities will establish Safe Motherhood Clinics to service surrounding communities and provide a range of services including pregnancy tests, antenatal checkups, diagnostic tests for major infections (e.g. syphilis, HIV/AIDS, malaria etc) and hypertension, vaccinations, identification and referral of pregnancy complications and access to modern contraception. These clinics will educate mothers and their families about the leading risks for maternal and newborn death including preexisting conditions (diabetes, heart disease, HIV/AIDS etc),10 poor diet, exposure to air pollution, smoking and alcohol and infections, and how to recognize danger signs. The clinics will encourage mothers to deliver their babies at the health facility. There will be special outreach to adolescents regarding sexual and reproductive health including school programs that encourage and support female students to complete their education, delay pregnancy, and receive all recommended vaccinations (e.g. HPV).

(2) AdaraNewborn Delivery and Newborn Care: Participating health facilities will undertake maternity ward and newborn care upgrades to ensure that both are equipped with the right technologies and staffed with adequate numbers of trained personnel to diagnose and respond to the major threats to maternal and newborn survival, and to maintain an environment that reduces the risks of death. The extent of the upgrade will be customized based on a needs assessment of the facility. Health facilities will also be supported to increase maternal and newborn vaccination rates to above 90% and rates of early initiation of breastmilk feeding and exclusive breastfeeding upon discharge to above 90%, and to meet all unmet need for modern contraception upon discharge. Each facility will introduce the ABAaNA Early Intervention Program to provide social and emotional support and guidance for mothers of newborns with moderate to severe developmental disabilities aged between six months and two years.

The goal is to ensure that every health facility can provide the range of services consistent with best practices as defined by the WHO and UNICEF, including:11

• neonatal resuscitation • respiratory complications therapy • jaundice treatment • sepsis treatment • premature and sick infant feeding • fluid and electrolyte management/intravenous hydration • care of low-birthweight infants • thermoregulation • safe oxygen provision • continuous positive airway pressure (CPAP) • intravenous therapy • family-centred care • neurodevelopmentally supportive care • biomedical engineering installation and maintenance Respiratory therapy at the Kiwoko Hospital NICU. (3) AdaraNewborn Community Care: Participating health facilities will establish Hospital to Home (H2H) teams of community health workers. These specially trained health workers will visit mothers and babies discharged from the health facility within 48 hours after returning home and at regular intervals thereafter. Community health workers will be trained and equipped to help families care for newborns, improve hygiene in the home, and support breastmilk feeding. They will be able to recognize the danger signs of maternal and/or newborn illness, and refer sick mothers and/or newborns to the health facility if needed. They will be responsible for ensuring that infants complete the recommended vaccination schedule for the

10 Note pre-existing conditions is now the leading cause of maternal death in Uganda rising 45% since 2000, according to the GBD. 11See WHO and UNICEF, Survive and Thrive: Transforming care for every small and sick newborn, 2019, and other guidelines here: https:// www.who.int/maternal_child_adolescent/newborns/en/

Page 4 of 10 first six months after birth and meeting the needs of all mothers with respect to modern contraception. Community health workers and expert parent facilitators will also participate in the ABAaNA Early Intervention Program to support the health and development of newborns with moderate to severe developmental disabilities aged between six months and two years.

AdaraNewborn Knowledge-Sharing To facilitate the spread of best practices across the ten sites and to encourage the uptake of the AdaraNewborn model to other health facilities, an open-access online knowledge-sharing platform will be maintained for the duration of the program. The platform will be managed by a dedicated officer at Adara and maintained by an officer at each of the ten sites. The platform will host real-time performance data from each of the sites, maternal and newborn care training materials (with topics on antibiotics, infection, Helping Babies Breathe, hyperglycemia, hypoglycemia, jaundice, Kangaroo Mother Care, nasogastric tube placement, oxygen therapy, physical assessment, prematurity and many others). It will also include links to related programs such as Helping Babies Breathe and other reports, videos and interviews, including how to introduce new technologies.12 The site will have webinar-hosting and email newsletter functions and direct links to social media platforms. The ultimate goal of the platform is to inspire and facilitate replication of the AdaraNewborn model beyond the ten sites to other nations struggling with heavy burdens of maternal and newborn mortality.

Target Health Facilities To maximize the impact of the program on maternal and newborn survival in Uganda, priority areas and target facilities from the public, private and non-profit sectors will be identified in partnership with the Government of Uganda and the Ministry of Health. This will be informed by data on the communities with the greatest numbers and rates of newborn deaths, coupled with a needs and feasibility assessment of the facilities in the area. For example, according to the latest GBD estimates of sub-national newborn deaths in Uganda in 2017,13 the following ten counties14 experienced the largest numbers of newborn deaths:

1. Kampala Capital City (Kampala District), 1114 newborn deaths 2. Dodoth County (Kaabong District), 735 newborn deaths 3. Bukoto County (Masaka District), 697 newborn deaths 4. Kyadondo County (Wakiso District), 621 newborn deaths 5. Busiiro County (Wakiso District) 521 newborn deaths 6. Buikwe County (Buikwe District), 507 newborn deaths 7. Bukooli County (Bugiri District), 486 newborn deaths 8. Mwenge County (Kyenjojo District), 447 newborn deaths 9. Buwekula County (Mubende District), 430 newborn deaths 10. Aringa County (Yumbe District), 428 newborn deaths

12 For example, Adara is planning to test a new bubble CPAP “blender” technology that delivers safe levels of oxygen to newborns in partnership with PATH and the University of Washington. 13 See Local Burden of Disease Under-5 Mortality, 2017: https://vizhub.healthdata.org/lbd/under5# 14 Uganda has 134 districts and 167 counties.

Page 5 of 10 By working with health facilities serving communities with high numbers of newborn deaths, AdaraNewborn can make a major contribution to Uganda’s newborn survival goals. For example, if half of the estimated 6,000 newborn deaths in these ten counties each year were prevented, over ten years 30,000 newborn lives would be saved, which is about half of Uganda’s target of 64,500. Other possible sites include Nakaseke Hospital in , a 120-bed public hospital 30 miles south from Kiwoko Hospital where Adara is already supporting a Special Care Nursery, and the Kawempe General Referral Hospital in Kampala.

The final selection of facilities will be made by the Government of Uganda and each of the ten selected sites will be invited to become an AdaraNewborn site. Selected facilities will sign a Memorandum of Understanding with Adara and the Government of Uganda. If the site achieves the Key Performance Indicators during the specified period, Adara will begin handing over operational oversight to the Government of Uganda, which would continue to fund the program, with support from other stakeholders if required. During this handover period, Adara will continue to provide clinical mentorship.

Kiwoko Hospital Center of Excellence Throughout the program, Kiwoko Hospital will continue to be supported as a Center of Excellence and a source of expertise and training for the ten participating sites. For example, clinicians from the ten sites will spend time at Kiwoko shadowing clinicians in a best-practice setting, and receive mentored hands-on practical training. Kiwoko Hospital is critical to the success of the program as it will serve as the primary teaching hospital. To play this role, Kiwoko will require additional capacity to ensure that the teaching of clinicians from the AdaraNewborn sites does not negatively impact the quality of care at Kiwoko. This will require the employment of additional staff, increasing the capacity of the existing NICU and the construction of a Skills Laboratory at Kiwoko. Adara is also committed to developing other newborn care Centres of Excellence in Uganda that could act as future teaching facilities.

As there are several multi-stakeholder newborn survival programs currently active in Uganda it will be important to select sites that complement and do not duplicate existing efforts, including:

• Saving Mothers, Giving Life, which launched in 2012 with funding from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), supported hospitals in 21 districts15 to successfully reduce maternal mortality ratios, newborn mortality rates and stillbirth rates.16

• Quality of Care Network, a partnership between WHO, UNICEF, UNFPA, the World Bank, and four government development agencies17, is supporting six districts18 in Uganda with high rates of maternal and newborn deaths and high volume maternity facilities to halve their maternal and newborn mortality and stillbirths by 2022.19

• East Africa Preterm Birth Initiative, a research partnership led by the University of California San Francisco, Kenya Medical Research Institute (KEMRI), University of Rwanda, Rwanda Biomedical Center, and Makerere University, is

15Kyenjojo, Kamwenge, Kabarole, Kibaaleto, Nwoya, Gulu, Omoro, Pader, Lira, Dokolo, Apac, Oyam, Alebtong, Amolatar, Kitgum, Agago, Amur, Lamwo, Kole, and Otuke. 16Between by 20%, from 138 to 109 maternal deaths per 100,000 live births between December 2014 and December 2016. The hospital neonatal mortality rate was reduced by 30%, while the fresh stillbirth rate declined by 47% During this period, over 90% of pregnant women were screened for hypertension and 70% for syphilis during antenatal care services. —between 17 USAID, the Japanese International Cooperation Agency (JICA), the Korean International Cooperation Agency (KOICA), and the Belgian Developmental Agency Enabel. 18 Hoima, Kamuli, Kasese, Kiryandongo, Nwoya and Sheema. 19 11 countries Bangladesh, India, Sierra Leone, Cote d’Ivoire, Ethiopia, Ghana, Kenya, Malawi, Nigeria, Tanzania.

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supporting six health facilities in the districts of Bugiri, Buluba, Iganga, Kamuli Government, Kamuli Mission and Jinja to reduce facility deaths due to preterm birth complications.

• NEST360°, aiming to halve newborn mortality rates in hospitals by optimizing a bundle of effective and affordable devices, training clinicians and biomedical engineers, developing locally-owned data to drive quality of care, and shaping a marketplace that connects device manufacturers with health systems. Phase 1 will launch in Malawi, Kenya, Tanzania, and Nigeria over the next four years and phase 2 will expand the initiative to Ethiopia, Ghana, Côte d’Ivoire and Uganda from 2025.

• Global Financing Facility, hosted by the World Bank, began working with Uganda in 2015 on a “sharpened RMNCAH Plan” emphasizing evidence-based high-impact solutions, access by high-burden populations, a particular focus on adolescent health, and strengthening data systems, including civil registration and vital statistics.

In the development of AdaraNewborn, we will liaise will all of these initiatives to ensure that our efforts are complementary and connected. For example, the Knowledge-Sharing Platform can provide direct links to each of these initiatives.

Evaluation An independent agency/ies would be selected via competitive tender to evaluate the impact of AdaraNewborn in each of the ten sites. Each facility would be required to gather and upload the following data to the Knowledge-Sharing Platform prior to the introduction of the program and quarterly for the duration of the program:

1. % women delivering at the health facility, by number and location of prenatal consultations 2. # maternal deaths during pregnancy, delivery, post-delivery and at one month and six months after birth, by cause 3. # newborn deaths, by weight, location of birth (e.g. born in the facility), timing (delivery, post-delivery and at one month after and six months after birth, by cause 4. Ratio health facility maternal deaths to live births 5. Ratio health facility newborn deaths to live births 6. # health facility stillbirths 7. Ratio stillbirths to live births 8. % increase in facility deliveries 9. % increase NICU admissions 10. % women and newborns receiving all WHO-recommended vaccinations upon discharge and at one month and six months after birth (e.g. TT, BCG, DPT/Hepatitis B/Hib, polio, IPV, PCV, rotavirus) 11. % adolescents receiving HPV vaccine 12. % adolescents pregnancy rate 13. % newborns fed breastmilk within an hour of birth, maternity ward and NICU 14. % newborns breastfeeding exclusively upon discharge, maternity and NICU, and at one month and six months after birth 15. % women discharged with modern contraception and using modern contraception one month and six months after birth

The independent evaluator/s will issue annual reports, a final report per site, and a final report for all sites after ten years. Several publications in peer-reviewed journals are expected.

Path to Impact Adara envisages a five step path to impact, beginning with (1) securing the support of donors and the Government of Uganda and progressing to the selection of the ten health facility sites. (2) Once these are agreed, Adara and the Ugandan Ministry of Health can select appropriate implementation partners to support each facility. (3) Adara will then provide the training and support to these agencies so they can work with the health facilities, beginning with two in 2021 and two more each year thereafter, with each facility receiving full support for at least five years and a phase-down period of two years. (4) Throughout the entire project, Adara will manage the Knowledge-Sharing Platform to encourage the replication of the AdaraNewborn model beyond the ten sites. (5) Finally, the independent evaluation agency will be continually collecting site- specific impact data for the final report after 2030 and several peer-reviewed journal publications.

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These steps are summarized below:

AdaraNewborn PATH TO IMPACT 2020-30

Stakeholders 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031

Donors Engage 4-6 donors

Government of Select 10 health facilities Uganda

Implementing Select non-Adara Partners implementing partners

Facility #1 Phase Down

Facility # 2 Phase Down

Facility #3 Phase Down

Facility #4 Phase Down

Facility #5 Phase Down

Facility #6 Phase Down

Facility #7 Phase Down

Facility #8 Phase Down

Facility #9 Phase Down

Facility #10 Phase Down

Adara Manage entire program and continue to support Kiwoko Hospital as Center of Excellence in Newborn Care Management (includes Kiwoko Support)

Knowledge- Maintain an online, openMaintain an online, open-access repository for all materials relating to implementation Sharing Platform and assessment at each site-access repository for all materials relating to implementation and assessment at each site

Evaluations Continuous baseline, midline and endline monitoring and evaluation of ten sites and the Knowledge-Platform and Final Report

Page 8 of 10 Governance To manage the program and ensure accountability, Adara will build upon its strong Ugandan team to oversee operations. This team will be based in Uganda and travel to the ten sites as necessary. It will be responsible for the selection and oversight of the agencies supporting each of the ten health facilities and for maintaining the Knowledge-Sharing Platform. The Uganda team will be supported by an AdaraNewborn Panel of stakeholders and experts essential to the success of the project. This Panel will be co-chaired by Adara and the Ugandan Ministry of Health and will include representatives from government, the Ugandan National Newborn Steering Committee, implementing partners, donors and Adara. For example, the Panel would include representatives from the Ugandan Ministry of Health, the Uganda National Newborn Steering Committee, implementing partners, donors, other newborn programs in Uganda, and other experts as needed. The Panel could also include family representatives. The Panel will sit at least twice a year and will report to Adara.

The chart below depicts:

Adara Development Board

Uganda Newborn Panel Adara (co-chair Adara Development and Uganda MoH) Development

Adara Uganda Government Partners Donors Experts

Adara + Implementing Agencies

Kiwoko Center of Excellence

10 Health Facilities

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About Adara Development The Adara Group was founded in 1998 by Audette Exel to bridge the worlds of business and international development with a special focus on serving the most vulnerable communities. Today the group comprises two different parts, an international development organization called Adara Development and two corporate advisory businesses - Adara Advisors Pty Limited and Adara Partners (Australia) Pty Limited. The sole objective of the businesses is to help support Adara Development’s administration and emergency project costs. This allows 100% of all other donations received by Adara Development to go directly to project-related costs.

Since 1998, the Adara businesses have donated over $US12 million to Adara Development for administration and infrastructure and emergency project costs, with a further $US24 million contributed by donors and partners. In 2019, Adara's direct staff of more than 60 and partner staff of over 165 delivered services to 50,000 people living in extreme poverty. The Adara businesses are certified BCorp®, a member of the UN Global Compact and the UN Secretary-General’s Every Woman Every Child movement.

Adara Group

Pty Ltd (est. 2000) Adara 100% overhead 100% program costs Donors (non-profit) Adara Partners Pty Ltd (est. 2015)

Adara Programs

Our Partners & Associates Adara has partnered and worked with the following organizations and alliances to advance its maternal and newborn health mission:

Deloitte University of Washington Every Woman, Every Child Seattle Children’s Hospital EY Makerere University Uganda Federal Ministry of Health, Ethiopia London School of Hygiene & Tropical Medicine (LHSTM) Federal Ministry of Health, Uganda The MRC/UVRI and LSHTM Uganda Research Unit MinterEllison Nakaseke Hospital National Newborn Steering Committee, Uganda Saving Brains, Grand Challenges Canada PATH

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