Financing catalyses innovation for newborns

Dr Karlee Silver

Co-Chief Executive Officer, Grand Challenges Canada

Ms Jocelyn Mackie

Co-Chief Executive Officer, Grand Challenges Canada

Each year, 20,000 newborns die in Cameroon, primarily because they are born too early or are very small at birth. In response, a consortium of partners led by the Government of Cameroon sought to scale a simple, proven life-saving method nation-wide.

Kangaroo Mother Care (KMC) has proven to reduce newborn mortality in multiple countries through the promotion of skin-to-skin contact, exclusive breast feeding and close follow up with mother and baby.

While KMC is an approved practice endorsed by WHO, delivering it on a national scale requires considerable initial costs and new systems. A development impact bond (DIB) can catalyse these needed changes.

Grand Challenges Canada (GCC), alongside partners including the Government of Cameroon and Kangaroo Foundation Colombia, launched the first DIB globally focused on the health of newborns to address this need.

Investing where funding hasn’t, historically, been forthcoming

DIBs catalyse funding for needed social programs by creating the challenge into an investible opportunity with a strong focus on results. The investor, GCC with funding from the Government of Canada, has funded USD 800,000 dollars in upfront funding, which they stand to receive interest on providing agreed outcomes are achieved.

“The service provider gets funding, the outcomes funders [Government of Cameroon with funding from the Global Financing Facility and Nutrition International] only pays if the results they care about are achieved; and the investor is rewarded for enabling the success of the services provider,” explains Dr Karlee Silver, Co-Chief Executive Officer of GCC.

Outcomes are key measures of success

The word ‘outcomes’ is the significant one here. DIBs work because funding isn’t just tied to outputs, such as the number of hospital visits, but rather measurable results; in this case, the number of newborns receiving quality KMC and healthy weight gain in low birth weight and premature babies.

Giving the service provider, Fondation Kangourou Cameroun, flexibility in how they deliver the programme is key. In recent months, the number of women giving birth in hospital and the number attending scheduled check-ups has declined due to COVID-19.

Fondation Kangourou Cameroun, which is currently working with nine hospitals (out of the total 10 hospitals planned), responded by building closer links with community partners and harnessing technology to interact with mothers. “This has provided a window of opportunity for innovators to redefine care and reach people where they are,” says Silver.

Promising early results

So far, 1,100 low-birth weight and premature babies have received quality KMC and 2,200 newborns will receive quality KMC by 2021. Promising preliminary results show that after being discharged from the hospital, the majority of the babies receiving KMC who return for their 40-week follow up visit are thriving and have gained sufficient weight. In addition, there are plans to develop multiple centres of excellence where a “train-the-trainer” approach will extend Kangaroo Mother Care through hospitals across the nation.

The initiative is relatively small in development terms, but GCC hope it will inspire others. As funding becomes even more competitive, DIBs could help to ensure innovations in health care continue to reach the most vulnerable.

“There is insufficient funding going toward big challenges in maternal, newborn and child health,” says Co-Chief Executive, Jocelyn Mackie. “GCC has experimented with innovative funding tools to help crowd-in new funding and new partnerships that didn’t exist and that can be applied to other challenges.”