Request for Proposals: MSD for Mothers: Research on maternity waiting homes in Zambia

JANUARY 2013 – MSD for Mothers is soliciting proposals from eligible organizations to help answer the following question in Zambia: “Is there a way for maternity waiting homes (MWHs) to provide a high quality service that is responsive to community needs in a financially self‐sustaining way?”

Maternity waiting homes (MWHs) have been established in numerous contexts around the world as a strategy to increase access to facility‐based deliveries for women living in remote areas or those who lack adequate transportation options. Maternity waiting homes take many forms, but are typically residential facilities located near emergency obstetric care facilities where women, often with high‐risk pregnancies, can await their delivery in close proximity to care. Some are simple shelters where women must provide their own supplies, while others have antenatal care services and medical staff available. While a number of studies have been conducted on MWHs, including a 2012 Cochrane systematic review, there is insufficient evidence to determine their impact in improving maternal and neonatal health outcomes.2,3,4 Some studies have found decreased mortality,5,6 fewer fetal deaths,7 and lower proportions of children with low birth weights8 among mothers using MWHs, while others observed no effect after controlling for maternal risk factors.9 One study conducted in rural Zambia concluded that MWHs can reduce perinatal mortality when a proper functioning referral system is in place.10 However, existing studies lack the rigor necessary to fully tease out any direct causal relationship between MWHs and health outcomes.

To further explore these gaps, challenges and opportunities, MSD for Mothers seeks proposals for a program along with a plan for formative and implementation research that addresses the question: “Is there a way for maternity waiting homes to provide a high quality service that is responsive to community needs in a financially self‐sustaining way?”

MSD for Mothers will provide program support in two phases. Phase 1 will focus on program planning, including formative research to determine the feasibility of an intervention and to further inform the design of the proposed program model(s). If Phase 1 determines that a proposed program is feasible, MSD for Mothers will consider funding a more robust second phase focusing on implementation of the program model as part of an implementation research project to answer key questions.13 Considering there is currently insufficient evidence on whether MWHs increase access in an equitable manner or have an impact on maternal and neonatal health outcomes, should this initial assessment indicate that the proposed approach(es) would not be feasible, this project would still be considered a success and the MSD for Mothers team would support dissemination of findings in the second phase. Funding available through this RFP will be for Phase 1.

Proposals will be accepted from all types of organizations with the capacity, competence and experience to accomplish program goals and objectives. Proposals may be submitted from individual organizations or groups of collaborating organizations with the complementary expertise/experience that may be required to design and implement the program.

MSD for Mothers anticipates supporting 2‐3 planning projects with budgets in the range of $200,000‐ $250,000 over six to nine‐months. Projects will be selected for Phase 2 based on results and a second proposal. Approximately $3 million will be available for Phase 2.

Deadline for RFP: 31 January 2013