International Journal of Gynecology and Obstetrics 130 (2015) S1–S2 Contents lists available at ScienceDirect International Journal of Gynecology and Obstetrics journal homepage: www.elsevier.com/locate/ijgo EDITORIAL Advancing implementation in maternal and newborn health: Two decades of experience In the past 15 years, Jhpiego has had the privilege of working with who work in MNH must truly embrace task-shifting and community in- governments and other partners to implement interventions for mater- terventions, especially those delivered by community health workers, to nal and newborn health (MNH) in nearly 40 countries. This Supplement reach the unreachable and end preventable deaths in the last mile. to the International Journal of Gynecology and Obstetrics (IJGO) is our at- MNH champions, including the readers of IJGO, play an essential role tempt to share our analysis and learning from those experiences as the not only in modeling and echoing technical excellence but also in promot- global health community looks toward 2030 and beyond, and to ensure ing the responsible task-shifting and community-based delivery that is that implementation challenges, as well as the resources required to ad- required to facilitate sustainable impact at scale. dress them, are an important part of the post-Millennium Development The third and final section explores specific interventions that Goals conversation. have or should be considered for scale: core examples of the The new global paradigm for MNH envisioned by the UN Secretary “what” of MNH implementation. Jhpiego’s experiences in setting up General’s Sustainable Development Goals and the Global Strategy for programs for emergency obstetric and newborn care, postpartum Women’s, Children’s, and Adolescents’ Health aims to bring evidence- family planning, malaria in pregnancy, and prevention of maternal- based MNH interventions to national scale, setting ambitious targets to-child transmission of HIV show the wide range of implementation to reach the unreached in every country and end all preventable deaths factors and the reality that there is no single successful implementa- among women and children. Scale is not only about what works; it is tion strategy for all interventions. MNH interventions will go farther about how to make that which has been proven to work in small, con- with a focus on pre-service education, engaging learners as early as trolled areas apply equally well across all contexts. So we must ask our- possible. selves: What does it take for health systems to reach every woman, Going forward, we need to harness the power of unlike minds and every child, everywhere, every time? those of our beneficiaries to approach implementation with the kind The answer to this classic implementation science question is diffi- of design thinking and crowd-sourced inputs that has benefitted the cult to quantify, but we do have some evidence, and as with any scien- fields of business and engineering. MNH is at a critical crossroads as tific inquiry, we should start with the evidence that we have. The papers the era of the Millennium Development Goals ends and new goals are in the Supplement have been written by and for implementers, describ- set. It is time to set goals that are more precise than “skilled care at ing in detail what has been accomplished and highlighting lessons birth” so we can hold ourselves accountable to coverage at scale, such about what did and did not work. The lessons themselves will not be as use of uterotonics and immediate postpartum contraception. If we new to anyone who has worked in MNH as long as we have, but we be- are committed to eliminating preventable deaths among women and lieve that their thoughtful analysis and collective and inductive presen- children, we must convince nations to invest in strengthening systems tation is a unique illustration of the complexity of achieving—and then and in improving quality of care for mothers and newborns, and achieve reinforcing—implementation results. Implementation science for MNH quality at scale. Just as we found the resources to reach high immuniza- has a long road ahead. tion rates, we must find the resources and political will to implement The papers in the first section directly confront the “how” of im- other MNH interventions and measure that implementation to achieve plementation. Even if we have all the right interventions, we need impact at scale. In doing so, we will not only achieve greater maternal political commitment and partnerships to bring those interventions and newborn survival but start to reduce the morbidities that will re- to populations in need. Sometimes these elements are beyond the main an obstacle far beyond 2030. If we learn to implement better, control of implementers owing to contextual factors and prioritiza- women and children will receive more effective care and be more likely tions inherent in real-world public health environments, but there to return to their families safe and healthy. are common principles that can help navigate politics and partner- ships more strategically and systematically to reach goals more rap- Harshad Sanghvi, Jeffrey Michael Smith, Koki Agarwal, Blami Dao, idly and with longer-lasting efforts. We should not, however, Ronald Magarick Jhpiego sacrifice quality for speed; quality improvement, particularly the linkages between quality and health outcomes, remains a critical Acknowledgments but under-funded area of our work. The second section examines the “who” of implementation, The Guest Editors of this supplement thank Rehana Gubin and Judith documenting ways to empower all cadres of frontline health workers Fullerton for their editorial support during the preparation of manu- with appropriate competencies to deliver evidence-based interventions, scripts and acknowledge additional editorial contributions from Karen wherever women and children need them. It is our belief that those Kirk, Sarah Ju, and members of the Jhpiego Publications Department. http://dx.doi.org/10.1016/j.ijgo.2015.04.018 0020-7292/© 2015 Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). S2 Editorial The Guest Editors also thank the donors that funded the many programs Jeffrey Michael Smith described in this supplement, including the United States Agency for Jhpiego, Baltimore, MD, USA International Development. Koki Agarwal Conflict of interest Jhpiego, Washington, DC, USA The authors have no conflicts of interest. Blami Dao Jhpiego, Baltimore, MD, USA Harshad Sanghvi⁎ Jhpiego, Baltimore, MD, USA Ronald Magarick Corresponding author at: 1615 Thames Street, Baltimore, Jhpiego, Baltimore, MD, USA MD 21231-3492, USA. Tel.: +1 410 537 1800. E-mail address: [email protected] (H. Sanghvi). International Journal of Gynecology and Obstetrics 130 (2015) S3 Contents lists available at ScienceDirect International Journal of Gynecology and Obstetrics journal homepage: www.elsevier.com/locate/ijgo INVITED EDITORIAL Jhpiego: Model supporter of implementation science As Editor of the International Journal of Gynecology and Obstetrics show that policy and national and local factors must be considered in (IJGO) it was my pleasure to shepherd this Supplement and, as Editor the transfer of scientific information to practice. Emeritus, it is my pleasure to thank the authors and guest editors for Jhpiego has long focused on “training the trainers” and, as an early their contributions. Jhpiego, an affiliate of Johns Hopkins University, adopter of pre-service education at the medical and nursing school was founded in 1974 by Doctor Theodore M. King, Director of the levels, is developing lifelong learners engaged in important work that Department of Gynecology and Obstetrics at Hopkins, realizing the remains in maternal and neonatal health. The readers of IJGO will find need to introduce reproductive health breakthroughs to low-income much to learn from the examples and lessons in this Supplement: the countries to save the lives of women and improve the health of “how,” the “who,” and the “what.” I thank Jhpiego not only for its families worldwide. Since its inception, Jhpiego has been providing many contributions to our shared vision and goals, but for the partner- education and capacity building for physicians, nurses, administrators, ship that it, as a nongovernmental organization, has shown to FIGO and and other pre-service providers, and supporting programs to make other professional organizations in achieving our mutual goals of a bet- these lifesaving skills and services available and accessible. In this ter world through improved women’s health worldwide. Supplement, the experience of Jhpiego in implementing maternal and I also thank the guest editors, Harshad Sanghvi, Jeffrey M. Smith, newborn health is described in order to provide a way forward to ad- Koki Agarwal, and Blami Dao, and especially the managing editors of dress the Sustainable Development Goals (SDGs) and achieve and attain the Supplement, Rehana Gubin and Judith Fullerton, for their efforts the maternal and newborn development goals of the post-Millennium and contributions in making it possible. Development Goals (MDGs) era. Implementation science promotes the uptake of research findings Conflict of interest into routine health care in both clinical and policy contexts [1,2].Itisa new concept and discipline that is the natural extension of translational research, clinical research, outcomes research, and health services re- Dr Johnson is the Editor Emeritus of IJGO. search, and melds translational research and health technologies devel- opment with health services science, public health, and policy. It is an References interdisciplinary science that is of the times and whose time has come. This is complex interdisciplinary work and Jhpiego has consistently [1] Peterson HB, Haidar J, Merialdi M, Say L, Gülmezoglu AM, Fajans PJ, et al. Preventing ma- evidenced, through its educational programs and demonstration pro- ternal and newborn deaths globally: using innovation and science to address challenges in implementing life-saving interventions.