Learnings from the Monami feasibility study

Source: Calouste Gulbenkian Foundation website A 4M USD development impact bond (DIB) [ii] can scale and improve Monami to serve 400,000 pregnant and postpartum women in Angola over the next four years. For a year, in partnership with Appy People, the Calouste Gulbenkian Foundation, and the Maternity Hospital Lucrécia Paim, maze’s team has been conducting feasibility work on funding a maternal health intervention in Angola - Monami - through outcomes-based commissioning (OBC) [i] to improve and scale Monami's intervention and therefore contribute to better maternal health outcomes in Angola.

The problem

Globally, 800 women die of pregnancy-related causes every day. Additionally, 6,400 newborns die daily. Most maternal and child deaths are preventable. Angola is among the countries off track to achieve target 3.1. and 3.2. [iii] of the SDGs, and the increase in maternal health literacy of pregnant and postpartum women can help to get Angola on track.

The World Health Organization (WHO) points out that maternal health literacy is deeply connected with increased uptake of available healthcare services, such as antenatal care (ANC), postnatal care (PNC), and skilled birth attendance (SBA), which are key determinants in preventing maternal and neonatal deaths.

Monami’s service

Monami is a free mobile-based maternal health literacy intervention targeting pregnant and postpartum women in Angola.

It is designed to promote education on maternal health topics and empower women to make informed health decisions during pregnancy and the early postpartum period by providing regular educational content on maternal and neonatal healthcare.

This intervention model has been implemented in Luanda since 2022, reaching over 37,000 pregnant women and sending more than 400,000 text messages. It has the potential to be scaled nationwide.

The first Impact Bond in Angola

Dr. Manuela Mendes, General Director of the Manuel Pedro Azancot de Menezes Maternal and Child Hospital Emerging financing instruments that tie funding to outcomes, such as development impact bonds, play a growing role in fostering the impact of innovative and scalable interventions. 292 impact bonds have been launched around the world and 16 in Africa, but not yet in Angola.

Deploying a DIB to fund the scaling of Monami’s intervention could allow for:

Assessing the adequacy of the intervention to achieve relevant outcomes - which, in a Monami DIB, would be a substiantial increase in maternal health literacy.
Collect relevant data - to inform health policy and the provision of maternal health services in Angola.
Inform health policy in Angola - as a rigorous evaluation model contributes to informing Angola’s health sector regarding adequate measures to reduce maternal and neonatal deaths.

Lessons from the feasibility work

The Monami Programme was represented at the "Mobilizing Maternal Health: A Transformative Vision" forum. This extensive work helped us gather 3 main lessons that we will take away for future feasibility work:

1) Trust your local partners

While working abroad, it is essential to build and maintain a close relationship with partners in the field who have a deeper understanding of the cultural context and local maternal health issues and opportunities. Trusting in the expertise and intuition of local partners, rather than relying too heavily on desk-based research, can yield a more accurate and timely understanding of the local context.

ℹ️

In the design phase of the evaluation model for the DIB, which at first relied on clinical data collected at the healthcare facilities, project partners got more clarity on how data was collected in practice at healthcare facilities in Angola through a few conversations with Angolan practitioners than in several days of desk-based research. These insights informed a leaner and more effective evaluation model of a future DIB.

2) Be fully open to adaptation

In the design phase of improvements to the intervention model, it is tempting to be attached to your first idea or insight. One must be capable of leaving behind its first or even (apparently) best solutions to embrace or accommodate new insights. It is essential to keep conversations open, check regularly with local partners and leave space for the concerns and priorities of potential investors and outcome funders.

ℹ️

One example of decisive adaptation was the revisiting of maze’s plan for the trip to Angola - with the purpose of capacity-building on outcomes-based commissioning- to accommodate for the specificities of the Angolan impact ecosystem, as the ecosystem players were seeking not only deeper knowledge about OBC but also opportunities to network and build partnerships.

3) In fundraising, the earlier, the better and the more the merrier

A timely approach to potential investors and funders is essential to measuring the appetite in the territory, sector, and social issue, identifying potential obstacles, and aligning the project's objectives with the expectations and requirements of funders, thereby increasing the chances of securing the necessary support.

Furthermore, although intros and connections are important, a robust fundraising strategy must be bold enough to reach entities not yet connected to our network. Opening and following as many leads as possible is the best way to secure funding, as the right lead might be just around the corner.

ℹ️

During our interactions with investors and outcome funders, important questions were raised that provided us with relevant insights into the DIB’s structure. These inputs were critical in refining our approach, ultimately leading to a more robust structure appealing to a wider and more diverse range of investors.

Get involved

Monami is in the exciting phase of scaling its operations to other regions in Angola, facilitated by new strategic partnerships. Project partners will continue refining and expanding Monami through appropriate financing mechanisms. Looking into the future, a Monami DIB will allow us to strengthen Monami’s role as a critical intervention in the Angolan maternal health ecosystem by enhancing maternal health literacy and other maternal health outcomes in Angola.

If you wish to partner in this project and contribute to better maternal and neonatal health outcomes in Angola, email margarida@maze-impact.com.

This project is supported by the Outcomes Accelerator, a multi-donor initiative, as part of its first cohort of outcomes-based financing projects.