Giving Compass' Take:

• Michael Igoe recounts how the Surgo Foundation identified a gap in maternal care caused not by lack of training, but by a healthcare system that misidentified and rewarded priorities. 

• How can foundations better understand the true barriers to development work? How can private sector understanding of consumer behavior be leveraged for social benefit? 

• Learn about information and communications technology trends for development. 

The challenge rings tragically commonplace to global health and development professionals: A mother in Uttar Pradesh, India, pregnant for the fourth time and having lost one child already, needs adequate medical care to ensure a safe pregnancy and birth.

“How do we save [this mother] and her baby during this pregnancy?” asked Sema Sgaier, co-founder and executive director of the Surgo Foundation.

The answer is straightforward — three antenatal visits to a government hospital; the right medical supplies at the right time; health care professionals who know the steps to keeping pregnant mothers and their babies healthy.

But in Uttar Pradesh, an Indian state that has proven stubbornly dangerous for pregnant mothers and their babies, those steps didn’t seem to be adding up. Though the nurses had adequate training, they simply weren’t using it. Instead of completing the 25-step checklist that she had been trained to complete, the patient’s nurse only completed three steps, the Surgo Foundation discovered.

Surgo’s employees are behavioral psychologists, data scientists, and machine learning experts. In Uttar Pradesh, the organization wanted to find out why the nurse had not followed through — what, from her perspective, was preventing health care professionals from providing patients with the full range of health services that might save their lives.

The nurses working environment was stressful and characterized by “punitive supervision,” which would see them blamed if anything went wrong. Their first instinct was not, “how do I deliver a comprehensive suite of care to this pregnant mother?” — but instead, “how do I save myself from being blamed?” Sgaier explained.

The gap was not training — though training remains critical — but a dysfunction in the accountability system that was distorting incentive structures inside Uttar Pradesh’s healthcare facilities.

Read the full article about identifying gaps by Michael Igoe at Devex International Development.