Building a Culture of Collaborating, Learning and Adapting in the Philippines
By telling the story of midwives in the Philippines, Panagora Group is helping improve the effectiveness of USAID health interventions
Panagora Group’s work in the Philippines has been a unique opportunity to support the United States Agency for International Development (USAID) and the Government of the Philippines in improving the health of the country’s underserved citizens, and helping change the way development work is done in the country and beyond.
Through USAID’s CLAimHealth (Collaborating, Learning and Adapting for Improved Health) project, Panagora is documenting good practices and promising interventions (GPPI) in the Philippines. Panagora is also disseminating this learning so that current and future health initiatives can be adapted, while empowering USAID and its partners to conduct similar learning and adaptive management efforts.
This type of third-party evaluation and documentation of USAID’s work, and dissemination of the findings, fosters the “virtuous cycle of continuous improvement,” says Panagora president and CEO Betsy Bassan, “where learning and adaptation helps ensure that every donor dollar is maximized for positive impact. This is the ideal we are all working toward in international development.”
Panagora and CLAimHealth’s role in the Philippines
This important element of CLAimHealth appears right in the project’s name—“collaborating, learning and adapting” (CLA)—which refers to a set of practices that improves the effectiveness of development work. By integrating CLA into its work around the world, USAID ensures that projects and implementing partners (IPs) are not operating in silos, and lessons learned are not lost after a project ends. Instead, USAID, governments, IPs, and communities collaborate to share knowledge and create efficiencies, evaluate the effectiveness of their efforts with an evidence-based rigor, and adapt their approaches to become more effective over time, ensuring lasting gains.
“This type of documentation of best practices can encourage local organizations to replicate models to bring interventions to scale,” says Michelle Lang-Alli, USAID/Philippines Director for the Office of Health.
As such, CLAimHealth’s role in the Philippines is to gather evidence on USAID-supported health interventions that are working, and document these innovative interventions. This brings together the USAID/Philippines Office of Health and its IPs to learn from these findings and ensures that these high-impact interventions are scaled up in ongoing and future health activities.
To maximize CLAimHealth’s effectiveness and long-term impact, Panagora filled 90 percent of the project’s staff positions with local residents, including the Chief of Party position. “This is a priceless aspect of the project that allows our team to operate in a deeply engaged, collaborative way with USAID,” notes Bassan. Additionally, being a third-party monitoring and evaluation platform enabled Panagora to hire expert staff who bring depth and rigor to the effort.
USAID’s Community Maternal, Neonatal, Child Health, and Nutrition Scale-up project (CMSU2) midwives from Leyte during an OSCE.
Good practices and promising interventions: uncovering the evolution of the midwife profession through USAID support
One important GPPI that CLAimHealth studied was USAID’s support of an association of midwives, called the Integrated Midwives Association of the Philippines (IMAP), in its journey to professionalize midwives’ work and become self-reliant.
Midwives play a critical role in reducing maternal and neonatal deaths and providing access to affordable maternal, neonatal, and child health and nutrition (MNCHN) care and family planning (FP) services. They are also crucial to managing health emergencies: for example, during the COVID-19 pandemic, midwives were on the frontlines of the country’s response, providing services to citizens in need.
To support the growth of these lifesaving health services, IMAP has worked to enhance the competencies and reach of its midwife members through decades of sustained collaboration and partnership with local and international partners, including USAID.
To evaluate and document IMAP’s metamorphosis, CLAimHealth collaborated with IMAP in late 2018 and early 2019 to study the organization’s journey to self-reliance through observation, desk review of documents and reports, key informant interviews, and focus group discussions. What CLAimHealth uncovered was the compelling story of how IMAP and the midwife profession evolved over several decades, with USAID’s support, transforming into a stable, resilient, and self-reliant organization.
After IMAP was founded in 1975, USAID provided technical assistance (TA) to the individual midwives who were members of IMAP. Though not yet directly supporting IMAP, this TA helped build and strengthen the profession by increasing the capacity of midwives to grow and sustain their businesses in a way that allowed them to support themselves and continue providing midwife services, as well as expand into FP and maternal and child health (MCH) services.
In the next phase of USAID support, from 1993 to 2011, USAID worked with various organizations in the Philippines, including IMAP, to provide technical assistance to individual private practice midwives (PPMs) with birthing homes. This support helped increase the number of PPMs with successful practices and get them accredited through the country’s Department of Health (DOH) so they could expand local partnerships and broaden their FP and MNCHN services.
Finally, between 2012 and 2019, USAID focused on capacitating IMAP directly, helping to further develop IMAP’s clinical, mentoring, and organizational capacity, which enabled the association to develop leaders, trainers, and mentors. This improved the quality of midwifery care through hands-on peer mentoring and monitoring, and expanded midwives’ reach further through public-private partnerships.
Joint training on the family planning minimum initial service package for CMSU2 midwives from Negros Occidental and Iloilo.
Today, as CLAimHealth’s research and documentation validated, IMAP has matured into a self-reliant organization for midwives who are well trained in the skills of midwifery and FP/MNCHN services, as well as the skills to operate a business. It has a well-defined organizational structure and a stable source of funding from membership and training fees. IMAP’s leaders and members have the capacity and commitment to sustain the organization and overcome unforeseen challenges, and the government provides a supportive landscape for IMAP and its members to continue to grow and thrive.
CLAimHealth’s rigorous evaluation and documentation of GPPIs demonstrated to USAID the results of its long-term investment in IMAP and the midwife profession. “USAID’s strategic investment strengthened IMAP’s organizational capacity in health service delivery, policy engagement, and partnership development, which, in return, led to IMAP—in collaboration with regional and provincial DOH offices and the Commission on Population and Development (POPCOM)—training more than 950 midwives on mentoring and basic FP skills,” reflects USAID’s Lang-Alli. “IMAP also trained these midwives to mobilize FP providers in the community, who then served more than 94,000 clients, especially in hard-to-reach areas.”
IMAP chapters remain active in national and subnational Responsible Parenthood and Reproductive Health (RPRH) implementation teams and other health policy-making bodies, adds Lang-Alli.
Supportive supervision visit monitoring in Leyte.
Sharing GPPI findings for learning and replication
In August 2019, CLAimHealth convened representatives of USAID, the Government of the Philippines, and IPs to disseminate the GPPI report on IMAP and discuss how the findings on IMAP’s evolution and USAID’s support can inform adaptation of current and follow-on health interventions.
Additionally, CLAimHealth began collaborating with these stakeholders to empower them to replicate this cycle of evaluation, documentation, and learning in their own USAID projects and in other countries that USAID supports. Through this process, CLAimHealth equips them with the capacity to think through their initiatives, define what evidence is needed, and develop well-documented interventions that inform adaptive management.
CLAimHealth also developed a four-page briefer on IMAP that has been useful for advocacy purposes, helping to spread the word about IMAP and ensure the knowledge gained through our documentation is applied in other USAID projects.
Mentor midwife Mary Christine Molejona from CMSU2 explains the insertion process for a progestin subdermal implant (a family planning method) to a client in Iloilo during Family Planning day.
Panagora’s leadership provides the foundation for CLAimHealth’s success
An essential element of CLAimHealth’s impactful implementation is Panagora staff member and CLAimHealth Chief of Party Mary Ann Lansang, a Filipino medical doctor with more than 30 years of experience in global health across a wide range of initiatives and disciplines. Lansang provides the technical expertise and leadership that is crucial to the success of this type of CLA project. While managing CLAimHealth’s work, Lansang has also been contributing to the Philippines’ COVID-19 response as an infectious disease specialist and advocate of evidence-based clinical practice guidelines for prevention and management of the virus.
Panagora’s Bassan explains that without Lansang’s leadership of CLAimHealth, IMAP’s story would not have been told. “This type of documentation is sometimes shied away from, because turning interventions into evidence—the kind of deep-dive evidence to tell this kind of story—takes skilled, experienced leadership. And that is what Mary Ann provides.”
The fact that Panagora was selected to implement CLAimHealth is indicative of our reputation for innovative, effective approaches to CLA to support the virtuous cycle of continuous improvement in all of USAID’s work, adds Bassan.
CLAimHealth, led by Lansang, will continue working to evaluate and document GPPIs and ensure the learning has the fullest impact on other USAID initiatives. “Generating evidence through careful quantitative and qualitative assessments over time is essential to the adoption and rollout of good practices and promising interventions,” says Lansang. “We will continue to work with USAID to document GPPIs and share these widely for even greater impact.”