Thursday, October 6, 2022

NANCY LOWENTHAL: Thank you for inviting me to join you today! I recently arrived back in Washington, DC to assume the position of Office Director of the Office of Maternal and Child Health and Nutrition in USAID’s Bureau for Global Health. I look forward to working with all of you in this new role!

Let me also congratulate the CORE Group on your 25th anniversary! I know this organization and its members have achieved quite a legacy of community-based global health programming.

As a Foreign Service Officer, I am especially proud of USAID’s recent commitment to expanding the Agency’s commitment to working with local partners.

As Administrator Power has stated time and again, if we truly want to make development aid inclusive, local voices need to be at the center of everything that we do. 

But localization is not a new idea. In fact, many of you here today have been at the forefront of championing community and stakeholder engagement to solve one of the greatest global health challenges of our time – ending preventable child and maternal deaths.  

Together with many of our partners and with the commitment of countries and the generosity of the American people, USAID has contributed to significant reductions in maternal, newborn, and child mortality. In 2020 alone, USAID helped more than 92 million women and children access essential—and often lifesaving—care. 

Question 1:  How have each of your organizations contributed to moving localization of country-based partners forward and what has been one success, and one challenge that you would like to share? 

Localization is the set of internal reforms, actions, and behavior changes that USAID is undertaking to ensure our work puts local actors in the lead, strengthens local systems, and is responsive to local communities. 

Equitable, inclusive, and sustainable responses to development challenges must be built upon the priorities, knowledge, lived experiences, aspirations, and expertise of the people who live them every day.

I have seen firsthand how critical community collaboration is to not only to developing local solutions, but to also prioritizing the problems that need to be solved. For example, in my most recent position in Cote d’Ivoire, USAID supported youth, women, and elders to determine their community’s most significant health challenges and enabled them to advocate to government officials to secure the necessary resources to address them – from fixing pumps for potable water to ensuring the local hospitals could provide safe births. 

Another example, comes from our Office’s work to address postpartum hemorrhage. Through efforts to elevate and listen to the voices of local health care providers, the USAID heard loud and clear that lack of access to and availability of safe blood was a fundamental challenge to preventing maternal death and disability due to postpartum hemorrhage. This led USAID to develop the Safe Blood Starter Kit – a practical resource that supports the evaluation of national blood systems and provides actionable steps on how to address critical barriers at each level within the health system. 

Lastly, in terms of successes, many of you are likely familiar with USAID’s suite of MOMENTUM awards – the Global Health Bureau’s flagship maternal, newborn, child health and family planning program. 

MOMENTUM truly marks a strategic and intentional programming shift with an increased focus on building the capacity, sustainability, and resilience of ministries of health and local partner institutions. 

MOMENTUM also works to ensure that state institutions and local partners are the primary implementers of service delivery activities. 

Across the MOMENTUM awards, there are currently over 130 subawards to local entities ranging from civil society and faith-based organizations to academic institutions. Over time, these sub-awards have the ability to become transition awards where the local partners receive funding directly from USAID. 

In terms of challenges to achieving USAID’s localization vision, perhaps the greatest challenge is understanding that a focus on organizational capacity building may initially slow-down the achievement of improved health outcomes. 

We believe this requires greater recognition in terms of setting expectations for health results, particularly with the deadline for the 2030 Sustainable Development Goals quickly approaching.

Ultimately, this kind of partnership will require us to emphasize trust-building, mutual accountability, and long-term commitments to a shared vision. 

Localization is not a quick-win, but as we look to what is needed in the next 25 years, ensuring that local voices are heard and prioritizing local leadership will be critical to future global health successes. 

Question 2: What are the two top ways that the partners working on global health issues need to do immediately to shift power, enable agency and ensure localization occurs?

First, intentionally center local voices in the design of local interventions and programs. For example in Mozambique, USAID partners used a human-centered design approach to work with community stakeholders, health workers and families in two provinces with high rates of children who have never received vaccines. The communities themselves identified barriers such as religious beliefs and proposed solutions to address these barriers such as having community leaders be the ones to disseminate accurate vaccination content to their constituents.

As another example of making sure local voices are heard, our Office of Maternal and Child Health and Nutrition recently held a “listening session” with CORE Group members to ensure the child survival community’s recommendations for our revised Framework for Preventing Child and Maternal Deaths (PCMD) were taken into consideration as we refine and updated the Framework. As the new Office Director, I commit to listening to your concerns, suggestions, and perspectives and I personally look forward to an ongoing dialogue.

Second, large international global health partners need to reimagine and redefine their roles in development. As opposed to serving as large scale service-delivery implementers and technical assistance providers, international global health partners should continue focusing on empowering country change agents and local partners to become direct recipients of USAID and other donor funding. This necessitates supporting organizational capacity-building not just technical capacity-building. 

I wanted to close by underscoring that USAID does not have all the answers. That is why it is so critical for us to partner with all of you. To learn from your expertise and experience in working with local organizations and centering communities in programming. I want to thank you for your past insights as well as for those sure to come that will strengthen USAID’s localization goals


Nancy Lowenthal Localization MOMENTUM Maternal and Child Health News
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