Top Priorities for Maternal, Neonatal, and Child Health in Africa

Preamble

The African Academy of Sciences (AAS), the German Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung, BMBF) and the Bill & Melinda Gates Foundation have come together in a transformative partnership to support African investigators to accelerate MNCH targets towards the Sustainable Development Goals (SDGs) for health.

The first initiative of the partnership is to launch a new Grand Challenge: Focusing on top priorities for MNCH in Africa – solutions to meet the Sustainable Development Goal 3 targets for maternal, neonatal and child health.

The Challenge

This challenge focuses on the top priorities for MNCH in Africa 2019 and aligns with the findings of the MNCH research prioritization using The Child Health and Nutrition Research Initiative (CHNRI) process conducted in 2019 in Africa. CHNRI uses the principles of wisdom of the crowds to systematically collect and transparently score research options against important criteria in a particular field. In a three-stage democratic process lasting 7 months, the MNCH expert convening 2019, aggregated thoughts from MNCH experts working in Africa and showed that there is a need to concentrate on four areas of importance in MNCH that remain a grand challenge for Africa. These are:

• better health during pregnancy
• better care at birth
• better post-birth care for women and their newborns
• better hospital care of sick newborns

The aggregated research priorities are across the spectrum of health research and in all four domains of description (epidemiology), discovery (new interventions), development (improvement of existing interventions), and delivery (implementation research, including health systems).

This is, therefore, a call for proposals looking for big, bold, innovative ideas that can have the greatest impact on African maternal and neonatal health with the potential for future sustainability and scaling.

This will be the third maternal and neonatal child health call and the eighth call from GC Africa since its inception in 2016.

These grand challenges innovation grants will be issued and administered under the banner of Grand Challenges Africa (GC Africa), a program of the AAS implemented through the AAS funding and program management platform – the Alliance for Accelerating Excellence in Science in Africa (AESA), which was created in partnership with the African Union Development Agency (AUDA: formerly (NEPAD Agency) and global partners including the Bill & Melinda Gates Foundation.

Funding for this call

GC Africa and partners will fund African investigators through this GC Africa Innovation Seed Grants' (GCA-ISG) call (round 8). Subject to the eligibility requirements in the GCA Rules & Guidelines, African investigators are invited to apply, with the support of the primary organization where they are affiliated, and where the major part of the work will be undertaken. Applications MUST be submitted through the AAS Ishango Online Application Portal. Grants will go to institutions and investigators in African countries.

Though not a must, we encourage initiating South to South partnerships and partnerships between African lead PIs and co-investigators in Germany or other Northern countries especially where the opportunity exists to combine synergies and promote innovations in MNCH. New and existing collaborations will be welcomed.

Applicants can be at any level of experience and working in any discipline from organizations such as colleges and universities, government units, hospitals, research institutions, for-profit and non-profit organizations.

Funding levels

The GCA-ISG grants will fund projects up to USD $100,000 for 2 years. These awards are meant to provide an opportunity to test particularly bold, proof of concept ideas, including applying approaches from outside the fields indicated for this call. New approaches could be piloted as additions to ongoing projects. Winners of the GCA-ISG grants will have an opportunity to apply for follow-on, transition to scale funding in the future. Please note that support for phase II or transition to scale funding is NOT part of this call. Funded at up to $1 million per three-year project, phase II awards require substantial preliminary data and are meant to provide an opportunity to develop, refine, and rigorously test combinations of activities, including sets of interventions for which some or all have previously shown promise in controlled or limited settings. We expect that successful projects funded under this seed call, and which demonstrate promising results, will have the opportunity to apply for Phase II follow-on funding either to GC Africa or directly to our partners.

In all cases, individual project budgets should be representative of the scope and magnitude of the proposed studies and carefully designed to get the best possible value out of the award. The AAS does rigorous budget challenges during the due diligence process. The applicant’s recipient institution, organization or company will also be required to provide assurances on their capacity to manage the grant through detailed letters of support from the appropriate research or innovation support office, previous or current partners. The AAS reserves the right to undertake due diligence site visits to organizations hosting successful candidates before making final awards. Due diligence will include a request to fill out the Good Financial Grants Practice (GFGP) financial governance assessments to allow AAS to determine an institution's eligibility and capacities for managing the grant.

Background

While great strides have been made in reducing mortality in Africa, maternal and neonatal mortality rates remain unacceptably high. Estimates show that over half the global maternal deaths and over three-quarters of neonatal deaths occur in sub-Saharan Africa.

The WHO argues that "the major direct causes of maternal morbidity and mortality include hemorrhage, infection, high blood pressure, unsafe abortion, and obstructed labor. These complications may arise unexpectedly. Investing in health systems - especially in training midwives and in making emergency obstetric care available round-the-clock - is key to reducing maternal mortality".

The close relationship between mothers and their infants results in shared aetiologies and as a result, around half of the newborn deaths are due to mother transmitted infections, including tetanus. Critically, the risk of dying during the first day of life in Africa is close to 1% with the top three causes being infections, birth asphyxia and complications of preterm birth which together account for 88% of the newborn deaths. Effective interventions to help reduce this mortality would target the management of labor and delivery, preterm births, timely diagnosis and treatment of serious infectious diseases, malnutrition and non-communicable diseases in both mothers and children.

Addressing the barriers to the use of care and creating an environment within households and communities that support women in seeking the needed care is also key.

Program Goal

This call is focused on the SDG3 targets with the overall objective of focusing African scientists to work in local and global partnerships on the ambitious but achievable goals of accelerating knowledge generation, developing and deploying interventions and innovations. These should advance the prevention of maternal deaths, preterm birth, and neonatal deaths and improve the implementation of policies and innovations that will improve care for the mother and child in the first 1000 days of life. The ultimate goal of this challenge is to determine what packages of interventions should be delivered to which group of individuals (mother or infant or both) to reduce the burden of maternal and neonatal deaths in Africa. While new innovations and interventions are required, much progress can be made if we find innovative approaches to deliver already available interventions i.e., we will also be looking for proposals that focus on innovative approaches to deliver existing life-saving innovations.

This joint initiative of GC Africa partners (AAS, BMBF, and Gates foundation) also aims to nurture and strengthen the innovation ecosystem in Africa by supporting the development of sustainable research networks that will contribute to solving Africa's challenges in Global Health. We want to develop a community of African leaders in MNCH research and innovation; strengthen the development of innovative solutions facilitating the resolution of challenges in global health and development that Africa is facing; reinforce research and training capacity, and equitable partnerships in African institutions through skills transfer between international networks and organizations hosting the grand challenges projects; and facilitate sustainable multidisciplinary partnerships between research groups in Africa. Enable the adoption of new technologies, innovations and policies to prevent maternal and neonatal deaths.

Program Objectives

We are looking for innovations that:

1. Package known interventions in a way that ensures they are delivered efficiently and cost-effectively and or promote MNCH in otherwise excluded communities.
2. Apply new technologies to enable rapid identification of risks or management of conditions (communicable and non-communicable) that lead to poor outcomes in pregnancy, birth and in the first month of life.
3. Apply precision medicine techniques to identify or manage common exposures in Africa that may increase susceptibility to communicable and non-communicable diseases in mothers and children under 5 years of age.

What We are Looking for

To reach these objectives, we are looking for projects that propose innovation in the following areas:

• Delivery tools: Innovative approaches or new ways to deliver already available interventions i.e., proposals that focus on packages / innovative approaches to deliver existing proven life-saving innovations
• Measurement tools: Pilot tests of new measurement tools, such as those based on a new technology or new biomarkers to enable the timely diagnosis, monitoring or management of maternal conditions that can lead to significant improvement of fetal and neonatal outcomes as well as prevent maternal mortality and morbidity.
• Analytical tools: Pilot tests of new analytical tools that use existing biorepositories or existing health and development databases for retrospective analysis.

We will give the highest priority to projects that:

• Build on ongoing work in some way, and that address well-identified barriers and constraints to delivery of interventions and to implementation of locally-relevant programs.
• Incorporate multiple areas of innovation listed above, e.g., developing and/or testing new, single or multiple products or candidates, especially sets of interventions targeting combinations of outcomes spanning the spectrum of objectives outlined above for this call.
• Clearly incorporate measures of success reasonable for the time span of the grant (18-24 months).
• Have a project plan where after two years- the end of phase I grant period- grantees will be in a position to explore how the results from their project could inform the design of a more extensive collaborative package of work that can be submitted for Phase II funding.
• Could contribute to a portfolio of funded projects that address a country’s key priorities or regional challenges
• Explain how proposed innovations and interventions will eventually be tested in communities so that they have the highest likelihood of being relevant for implementation more broadly in the country’s public health system.
• Respect diversity as well as gender equity and address the need to provide health equity for diverse vulnerable populations as captured by the SDG targets.
• Promote the career of young scientists.

Examples of what we will consider funding:

Innovations that:

• address the handling of emergency obstetric and neonatal complications and or including the detection of danger signs by caregivers
• enhance the quality of care for sick newborns through early identification, monitoring and appropriate therapeutic measures for the management of neonatal sepsis
• provide rapid diagnosis of infectious pathogens that lead to preterm births
• determine the relationship between long term exposure to microbes (pathogens or not) and maternal and neonatal mortality
• encourage high coverage of known effective interventions to reduce maternal and neonatal mortality such as tetanus vaccination, antibiotic therapy to treat infections in mothers, screening for diabetes and hypertension
• use a systems approach to identify predictors of poor outcome in mothers and babies to allow for targeted interventions
• are aimed at understanding vaginal and neonatal microbiomes in relation to the burden of preterm birth sequelae, stunted postnatal growth, and impaired cognitive development as a result of alterations to the neonatal microbiomes
• improve training results and skills retention on obstetricians, GPs, and midwives
• feasible methods of delivery of the package for postpartum care at the community level
• determine the relation between the long-term treatment of chronic diseases such as HIV and poor neonatal outcomes
• improve maternal nutrition including micronutrients during pregnancy and its impact on intrauterine growth development and other neonatal outcomes
• design and test new algorithms, and point of care diagnostic tests for sepsis, including postnatal sepsis, for mothers and babies, care of sick newborns and children, in the face of new epidemic emergencies
• develop and test innovative and affordable means of monitoring labor progress including during contraction augmentation
• propose the most effective and more affordable tools to be deployed in the lowest level of health facilities to provide lifesaving care to sick neonates in African countries (e.g., availability of oxygen, functional newborn units)
• attract and retain skilled birth attendants in remote, rural areas
• improve the quality of care during labor in a cost-effective manner
• mitigate hypoxic ischemic encephalopathy and builds indicators predictive for long term neurodevelopmental outcomes
• improve the understanding between undiagnosed NCDs in pregnant women and complicated births and low birth weight
• enhance the effectiveness of task shifting and its impact on the quality of intrapartum care
• improve the attendance of women to ANC clinics especially in marginalized communities
• evaluate common metabolic disruptors/predictors such as glucose, acidosis, electrolytes
• utilize new strategies including biomarkers and point of care screening tools for comprehensive antenatal care and early detection of high-risk pregnancies (pre-eclampsia, prematurity, infections), and optimize preventive measures
• develop predictors of occurrence and severity of encephalopathies in Africa
• detect or manage the contributors to common problems that afford a treatment/prevention option like ABO/Rh blood typing, apnea/oxygen etc.
• measure fetal and sickle hemoglobin or early interventions to manage various aspects of the disease
• wearable sensors for Heart Rate /Respiratory Rate/BP/EEG/Temperature etc.
• improve timely second stages of delivery on pregnancy outcomes (PPH and birth asphyxia, obstetric fistula) and or proposes new ways of dealing with the conditions
• deliver solutions to underlying infections in pregnancy on pregnancy outcomes (abortions, Anemia, Preterm labor) and neonatal outcomes (Asphyxia, IUGR, prematurity, sepsis, mortality)

This call is not intended to support projects that focus on:

• Basic research that does not provide a clear path to development and testing of prevention, diagnosis and treatment strategies
• Projects without the potential to expand in scale to provide solutions to a greater number or diversity of people
• Projects lacking metrics to determine success or failure and to allow decisions about the appropriateness of follow-on/phase II funding
• Solutions that are only variations of existing approaches e.g., replication of an approach in new geography in the absence of added innovation
• Projects that cannot be implemented in LMIC countries in Africa

Promoting Intra-African and global collaborations

We will promote scientific collaborations between African researchers, and between different organizations across the continent. Though not compulsory the call will encourage partnerships between African, German and by extension researchers in other parts of the globe. We will hold expert workshops in MNCH and encourage skills and data sharing between individually funded projects. We expect that such sharing will help to ensure that the goals of the innovative approaches in individual projects are ultimately integrated with each other. Furthermore, we expect that sharing experimental methods, data, and resources will ultimately improve the ability to compare and validate local research findings and to develop innovations, interventions, and products that can have an impact on a greater scale. The reviewers to this call will evaluate how well applications address these requirements and how well collaborations between researchers meet the basic criteria of equitable, sustainable partnerships that benefit all parties including benefits to communities most affected by the challenges in MNCH.

Collaborative efforts could include:

• Short visits: Where a team organizes to visit another for the sake of knowledge sharing and technology transfer. The costs for this should be included in the budget.
• Cohort harmonization: when collaborating with projects with existing cohorts or establishing new cohorts, investigators will be expected to participate, whenever possible, in cohort harmonization. Study sites will be expected to develop and follow standard operating procedures and quality control protocols for specimen collections and participate in the establishment of a minimum common set of data and specimens to be collected across the program.

Data sharing: Projects will submit a data sharing plan that is equitable, ethical, and efficient.