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– Health inequalities are still affecting women and children in many areas of the word. The MASCOT project aimed at enhancing understanding and dissemination of strategies for addressing these inequalities through international co-operation.
– MASCOT brought together 11 partners and 3 world regions (Europe, Africa, and Latin America) to work towards selected targets. These included mapping the current status of maternal and child health inequalities in selected countries, identifying the best practices that should be implemented for tackling inequalities, and fostering multilateral collaboration and knowledge transfer.
– Among the many results/outcomes produced, an open source, freely searchable webDatabase has been developed that covers research on maternal health in low- middle- and high-income countries.
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Health equity for the vulnerable ones
Building a better future for women and children is a universal must. Yet, in many countries, notably low- and middle-income countries (LMIC), inequalities in maternal, newborn, and child health interventions are a persistent reality, and progress towards the achievement of Millennium Development Goals (MDGs) 4 (reduce child mortality) and 5 (improve maternal health) remarkably slow. While some countries have made advances, these advances remain unknown to other countries which could still benefit from their experience.
The firm belief that international collaboration can help addressing health inequalities was the starting point for MASCOT (“Multilateral Association for Studying Health Inequalities and Enhancing North-South and South-South Cooperation”), a project that took place between October 2011 and March 2014 and was supported by the European Union’s Seventh Framework Programme. Co-ordinated by COHRED (Council on Health Research for Development), MASCOT gathered 11 partners and a number of experts from Africa, Latin America and Europe, to identify research being conducted on maternal and child health, and adequate and efficient strategies for tackling health inequalities affecting children, adolescents and mothers. This was in perfect line with COHRED’s focus on supporting research and innovation systems for health, equity and development.
In a nutshell, MASCOT aimed to create links between North-South and South-South efforts in addressing maternal and child health (MCH) and health inequalities, and to provide research-based evidence on best practice and policy advice for the development of future public health and health systems interventions.
MASCOT at work
Reduce health inequalities, enhance efficiency of national health research systems (NHRS), enhance collaboration. This was the pole star of MASCOT action. Around these guiding objectives, the work was organized as work-packages intending to reach 6 specific targets:
• To select relevant countries for the studies and to standardise the procedures.
• To describe inequalities concerning MCH as well as strategies and activities currently put into practice to reduce these inequalities at national scale.
• To describe NHRS and detect dedicated projects and research teams working on MCH inequalities.
• To identify the best practices and evaluate their roles in the development of measures (policies or recommendations) that are and/or that should be implemented for tackling MCH inequalities.
• To develop and suggest country-specific strategies derived from best practices and best policy advice for strengthening NHRS, the use of research results for decision-making and the capacity to address MCH inequalities.
• To implement specific activities to stimulate the multi-lateral collaboration between countries and institutions in Africa, Latin America and Europe, enabling countries to make better use of research in addressing health inequalities in maternal and child health.
Seeding the future now
MASCOT has developed a variety of results/outcomes that will be extremely useful for health professionals and other stakeholders working in the maternal and child health area. Much of the value of these results will become manifest in the future, as the guidelines and recommendations developed under the MASCOT vision will be applied and implemented.
Both national and regional reports were drafted, presenting the results of investigation on health inequality status, national research for health systems and their role in MCH research, and the impact of health research on development of policies and programmes.
An online platform to access MCH data collected from different sources and gathered, selected and analyzed through the MASCOT project has been put in place. This decision-support tool includes analyses of MCH inequalities gaps by country according to selected health indicators and PROGRESS categories (indicators of the social determinants of health), qualitative data on health research systems and MCH research by country, and qualitative data on research use strategies for tackling MCH inequalities by country. The following countries are included in the platform: Ghana, Guinea Bissau, Malawi, Mozambique, Tunisia, Bolivia, Chile, Costa Rica, Mexico.
Promoting the contact and knowledge transfer regarding MCH strategies between countries was one of the declared MASCOT objectives. Collaboration activities between Ghana and Mozambique and Costa Rica and Guatemala were supported and fostered under this framework. Ghana learned from Mozambique’s policy and experience with Maternity Waiting Homes as an effective approach to provide women the same access to quality and in-time basic and emergency obstetric care services. Costa Rica drew out key elements from ‘Hospitals without Walls’, an integrated health care strategy based on the provision of prevention, promotion and care with a community access and empowerment component, to assist Guatemala in their efforts to combat infant malnutrition.
Another tangible result of MASCOT is the webDatabase on maternal health in low- middle- and high-income countries. The product of a systematic mapping of the maternal health primary research and systematic reviews published in the period 2000-2012, the database stems from a collaboration between partners in the MASCOT and WOTRO projects, from more than a dozen countries. The database includes research that examines maternal health interventional research in LMIC, dealing with health systems interventions, interventions in community settings, health promotion interventions, and interventions on five tracer clinical conditions (antepartum and postpartum haemorrhage, HIV and other sexually transmitted infections, hypertension and malaria). Also, research on maternal health interventions in high-income countries that occurred outside the health facility is included.
The webDatabase is open source and supports a variety of functions. Users can run searches and make reports. Searches can be carried out using key words and free-text terms. Reports enable visual mapping and analysis of the search results. Reports on the database work as “question” reports, whereby one can select a ‘parent’ code, such as HIV codes, and the results will give all the studies included on that topic.
COHRED was proud to co-ordinate this project, serving as it did as a clear reminder that the desire to address the gaps in maternal and child health outcomes between groups in society cuts across borders. This is a fantastic opportunity to give a heartfelt thanks to not only the European Commission for supporting this initiative, but also to all of our partners in this effort. The collaborative effort in the project was strong, and we believe that the outputs will continue serve as useful tools for researchers and policy makers in the future as they seek to identify and implement strategies to address the maternal and child health inequalities in their countries.
Danny Edwards (Mascot Project Coordinator)