Grand Challenges Canada

Secondary health crisis expected with the loss of primary care for reproductive, maternal, newborn and child health

Toronto, November 17, 2020Grand Challenges Canada (GCC), with funding from the Government of Canada, is increasing its investments in 14 innovative health and international development projects. Our support allows innovators to adapt their product to also provide novel, affordable and locally sourced resources, ideas and solutions to acquire critical COVID-19 supplies and services for low-resource countries during the global pandemic. Together with this supplementary funding, the 14 innovations will have received total Grand Challenges Canada support of $12.9 million.

Experts predict a secondary health crisis if effects on access to essential to primary care are not mitigated during COVID-19, with particularly devastating consequences for women and girls. The United Nations Population Fund suggests that six months of COVID-19-related disruptions to health services could leave 47 million women in 114 low- and middle-income countries without access to contraception1. As, well modelling by public health researchers at Johns Hopkins University suggests that pandemic-related disruptions in access to primary care could also result in over 1 million additional child deaths and nearly 60,000 additional maternal deaths in low- and middle-income countries over 6 months2.

“Amid the emergency COVID-19 response, the world cannot afford to ignore broader health needs,” said Grand Challenges Canada Co-CEO Dr. Karlee Silver. “A secondary health crisis is unfolding in the shadow of the pandemic: people are not able to access quality primary health care. When a person’s first point of contact with health services is threatened, it’s a sign that overall health systems are failing; and mothers and children are usually first and most impacted.”

In this light, these projects ensure primary care services are widely accessible. More specifically, supplements for the selected innovations focus on bolstering infection control and prevention while ensuring continuity of reproductive, maternal, newborn and child health care.

Spotlight on five projects ensuring primary care is widely accessible for reproductive, maternal, newborn and child health

Scaling Health Systems Innovation: Proactive Community Case Management
Innovator: Muso/Université des Sciences, des Techniques et des Technologies de Bamako
Location: Mali

Proactive and preventive community-based care

Whereas conventional models of community-level primary care are reactive and reliant on patients to seek out care from health workers, Muso’s Proactive Community Case Management (ProCCM) system is the first proactive delivery model for reproductive, maternal, newborn and child health services. ProCCM turns the current standard of care on its head: paid professional community health workers search for patients via door-to-door home visits, provide care at home and connect patients to clinics. By addressing illness early and removing barriers to care for underserved women and children, this intervention model has been proven to significantly reduce rates of mortality in children under the age of 5 years.

GCC funding has supported Muso and the Université des Sciences, des Techniques et des Technologies de Bamako in conducting a randomized control trial, generating evidence on the impact of ProCCM community health workers’ workflows that is influencing how the Malian government approaches primary care. To date, more than 35,000 lives have been improved using the ProCCM model.

COVID-19 supplemental funding: Activities will include training frontline health workers in COVID-19 curricula and protocols and providing personal protective equipment (PPE) to protect community health workers and primary care providers at partner health facilities, so that they may safely provide their routine proactive care visits, as well as COVID-19 education and screening.

Dr Djoumé Diakité, Muso Country Director and Co-Founder, added: “The PPE has been of great use to Muso and our partners for several reasons: protecting community health workers from COVID in their routine care delivery at the household level; protecting clinical providers in health facilities against COVID; strengthening the confidence of the population in the use of health services in the facilities; and ensuring continuity of care for the population. With PPE, we have also innovated on our approach to care: we introduced a triage system at the door of Muso’s partner health facilities to distinguish suspected COVID-19 cases from other patients.”

MAMaZ Against Malaria At Scale
Innovator: Development Data
Location: Zambia

Reaching rural and highly mobile populations

Children in rural areas of Zambia presenting with severe malaria may be too sick to ingest oral anti-malarial drugs, and are often living far from facilities with access to intravenous anti-malarial treatments. Their disease can progress rapidly during travel from the community to the first-level health center, making early diagnosis and interim treatment crucial to these patients’ survival.

MAMaZ Against Malaria At Scale is ensuring children with severe malaria have access to rectal artesunate (RAS) — a lifesaving malaria drug administered to prevent progression of severe malaria while a child is transferred to a higher-level health facility Their innovative approach integrates procurement and distribution of RAS via public- and private-sector partnerships, with training for community health volunteers on identification of suspected severe malaria. As well, a system of bicycle ambulances helps transport emergency patients to the local health centre. By the end of 2019, 1,800 children had received RAS as a result of the MAMaZ against Malaria At Scale program.

Auxilia Piringondo, Director of Development Data, added: “Working from home has proved to be a challenge, particularly for female employees. Schools are closed in Zambia, so mothers are shouldered with the bulk of household work and also need to assist their children with school work and online learning. As a result, they often have to work outside the normal working hours. Nonetheless, we are ensuring that community-based child health activities continue safely and without disruption.”

Blue Box Primary Healthcare Clinic Network
Innovator: North Star Alliance East Africa
Location: Sub-Saharan Africa (multiple countries)

Reaching rural and highly mobile populations, real-time monitoring and contact tracing

High-risk mobile populations in sub-Saharan Africa, such as truck drivers and sex workers, are often neglected by public health facilities, which prevents consistent and reliable healthcare access for both themselves and the communities they interact with. North Star Alliance East Africa makes services available for these groups through a network of Roadside Wellness Centres, otherwise known as ‘Blue Boxes’: shipping containers converted to primary care clinics, which are strategically located along the major transport routes of sub-Saharan Africa. To ensure continuity of care, North Star have also developed an innovative cross-border electronic medical records system, which enables client details to be accessed as they move from Blue Box to Blue Box and between countries.

COVID-19 supplemental funding: Supporting the equipping of Blue Box health workers providing wellness services with the capacity and equipment to safely screen and educate high-risk travellers for COVID-19, in order to minimize its transmission.

Eva Mwai, Regional Director of North Star Alliance East Africa, added: “Our staff have so far remained resilient, although the added pressure of working with high-risk populations, even with strict infection prevention and control measures, has contributed to fatigue and anxiety in a number of cases. To mitigate this, our management teams have ensured our clinics have been provided with infection prevention and control materials, supplies and equipment. The support provided by Grand Challenges Canada has, and will continue to contribute towards our staff remaining healthy without becoming infected, which in turn enables our clinics to remain open.”

Ubuntu-Afya Kiosk Network: Community Co-ownership for Quality Care in Rural Kenya
Innovator: Afya Research Africa/Ubuntu Health Ltd
Location: Kenya

Reaching rural and highly mobile populations

Under the innovative Ubuntu-Afya Kiosk network model, community self-help groups co-own their own primary care clinics. Clinic costs are subsidized through supplementary businesses, making services affordable to those in the community. A network of 25 primary care clinics (kiosks) in rural Western Kenya offer services to primarily women and children. GCC support to date has been focused on improving the sustainability of the business model, and ensuring quality access to reproductive, maternal, newborn and child health care and non-communicable disease services. With project funding from Grand Challenges Canada, the kiosk model is projected to improve the lives of more than 175,000 women and children under the age of 5 by 2030.

COVID-19 supplemental funding: In addition to continuing to provide reproductive, maternal, newborn and child health services, the supplement will support the training of kiosk health personnel on COVID-19 prevention and care and the distribution of PPE to health workers. Funding will also support ensuring community health workers can disseminate COVID-19 information to communities.

Samson Gwer, Executive Director, Afya Research Africa, added “We see a need to persist in providing primary care health services in spite of the pandemic. The related morbidity associated with poor maternal and newborn health outcomes, increasing malnutrition, mental health issues and disability related to domestic violence represents the hidden pandemic, which is little documented but also has so many casualties, perhaps more than the pandemic itself.”

Motivational Platform to Improve Sexual, Reproductive and Maternal Health Outcomes
Innovator: Triggerise Stichting
Location: India

Real-time monitoring and contact tracing

Triggerise is a digital platform that facilitates access to sexual, reproductive, and maternal health services by linking adolescent girls and young women with local service providers and health products. The platform connects users of its Tiko Explore membership program to providers, and generates demand for their primary-level care by rewarding members with subsidized services and reward cash points (Tiko Miles) as incentives that can be spent on other non-health sector products and services. This approach is particularly compelling in informal markets where platform users may not have access to cash. Triggerise is also able to generate behavioural insights to track and project areas of need at a community level.

COVID-19 supplemental funding: Supporting the development of a specific COVID-19 module for the mobile app used by trained micro-entrepreneurs/community health workers who deliver the program, Tiko Pros. Leveraging the app’s existing user base and capabilities for delivery of sexual, reproductive, and maternal health content, the COVID-19 module will be designed for community-based surveillance and real-time monitoring in a variety of contexts, ensuring rapid pandemic response. This application module has already generated interest from other markets, including demand from the Ethiopian government to potentially integrate the finished program within its existing community health worker network.

Payal Rajpal, India Country lead for Triggerise, added: “COVID-19 has had several impacts on our communities. India’s three-month lockdown halted access to sexual and reproductive health services for our users, and income opportunities for our micro-entrepreneurs. As the country gradually reopens, Triggerise is using agile principles to pilot virtual models that provide our communities with access to health services in a safe manner. We aim to strengthen the government, NGO and the private sector’s pandemic response capabilities through hyper-local COVID-19 tracking and data.”

Click here for a list of all 14 supported innovations.

  1. UNFPA, Avenir Health, Johns Hopkins University (USA), Victoria University (Australia). (2020). Impact of the COVID-19 pandemic on family planning and ending gender-based violence, female genital mutilation and child marriage.
  2. Roberton, T., Carter, E. D., Chou, V. B., Stegmuller, A. R., Jackson, B. D., Tam, Y., … & Walker, N. (2020). Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study. The Lancet Global Health, 8(7), E901-E908.


About Grand Challenges Canada

Grand Challenges Canada is dedicated to supporting Bold Ideas with Big Impact®. Funded by the Government of Canada and other partners, Grand Challenges Canada funds innovators in low- and middle-income countries and Canada. The bold ideas Grand Challenges Canada supports integrate science and technology, social and business innovation—known as Integrated Innovation®.

One of the largest impact-first investors in Canada, Grand Challenges Canada has supported a pipeline of over 1,300 innovations in 106 countries. Grand Challenges Canada estimates that these innovations have the potential to save up to 1.78 million lives and improve up to 64 million lives by 2030.


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Douglas Chow, Senior Manager, Communications
Grand Challenges Canada