Description of subprojects and results, including major changes from the original proposal

We completed the three major aims of this project as described in the original proposal:

1. Gather real-world data on the impact of our training on clinical practice and the number of beneficiaries reached by our training,

2. Feed those data into an improved cost-effectiveness model that links our program outputs (number of health workers trained) to outcomes (effect on clinical practice and number of beneficiaries reached) and impacts (number of deaths averted by the training).

3. Hire a stakeholder engagement lead in Nigeria who will help us to navigate the bureaucratic approvals and barriers that we need to clear in order to effectively scale up our work.

A more detailed update on this evaluation work can be found here.

There were no major changes from the proposed plan.

We completed an recent evaluation of the HealthLearn Newborn Care Foundations course, which showed significant improvements in birth attendants’ clinical practices and key birth outcomes. Early initiation of breastfeeding, strongly linked to reduced newborn mortality, improved significantly in the evaluation.

After applying large (>10X) discounts, we estimate the course is ~24 times more cost-effective than GiveWell’s cash transfer benchmark. We are uncertain about the precise magnitude of impact, but a sensitivity analysis suggests that the program is cost-effective under a wide range of plausible scenarios.

Our already-low unit costs should decline as we scale up. This is likely to increase or at least maintain the program’s cost-effectiveness, even if the impact per trainee is lower than our current point estimate. We also earn revenue by hosting courses for another NGO, which covers a portion of our core team costs and increases cost-effectiveness per philanthropic dollar spent.

We have identified key uncertainties in evidence strength, sustainability of clinical practice change, and intervention reach. We plan to improve our monitoring and evaluation to assess these uncertainties and develop more precise estimates of impact per trainee. We will continue our work to improve and scale up the Newborn Care Foundations course, while also developing new courses addressing other gaps in clinical practices where impactful interventions are needed.

What progress have you made since your last update?

We are making steady progress towards the objectives outlined in the grant proposal. Our objectives for this grant, awarded in early 2024, were to:

• gather better data to assess our program’s cost-effectiveness, and

• successfully navigate government approvals in Nigeria in order to scale up to train thousands of health workers.
  

We have largely achieved the second objective. The grant enabled us to hire a Nigerian medical doctor and public health professional who has shepherded HealthLearn’s Newborn Care Foundations course through required approvals by the Federal Ministry of Health, Nursing and Midwifery Council of Nigeria, and Community Health Practitioners Registration Board of Nigeria. At the time of writing this update, over 4,000 health workers in Nigeria have completed the Newborn Care Foundations course this year. This provides proof-of-concept that our program can scale to reach many thousands of birth attendants in Nigeria.

We are also making progress on the first objective. We are working closely with a local organization that is leading an evaluation of the impact of the Newborn Care Foundations course on birth attendants’ clinical practices. We have nearly completed pre-training data collection and we are on track to finish the evaluation by the end of 2024. We look forward to reporting the results and using that information to update our estimates of the program’s effectiveness and cost-effectiveness.