The G.R.E.A.T. project and the maternal and perinatal health context
One of the most challenging problems in sexual and reproductive health is how to lower the stubbornly high rates of maternal and perinatal mortality and morbidity, especially in low-income settings in sub-Saharan Africa and South Asia. A key strategy that is being employed to deal with this and other sexual and reproductive health problems is provision of universal access to sexual and reproductive health health-care services, as reflected in the Millennium Development Goal No. 5. Many countries are adopting policies aimed at encouraging women to deliver at health-care facilities. But, access to effective care - the ultimate goal of skilled birth attendance - goes beyond childbearing in health-care facilities. Access to effective care for all women requires expansion of coverage of health-care facilities and improvement of quality of care provided by the health system, all the way from the community to the highest-level health-care facility. Achieving access to good quality care is key for the attainment of MDG No. 4 that targets improving infant health as well.
Expansion of sexual and reproductive health-care services has its own challenges, not least the issue of quality of care. This issue is firmly linked to the capacity of health systems to adopt evidence-based practices, in both clinical practice and organization and implementation of interventions. A key priority therefore has to be the transfer of evidence-based knowledge (in the form of guidelines) to health systems along with well-researched and synthesized knowledge about ways of implementing interventions.
A new knowledge-synthesis-and-exchange-based approach
The UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development, and Research Training in Human Reproduction within the WHO Department of Reproductive Health and Research and its partner institutions have developed a new approach for research on, and implementation of, interventions to improve global maternal and perinatal health in the context of existing international goals. This new approach is based on the knowledge to action framework and several ongoing initiatives within and outside WHO in the past decade. The framework serves primarily as a marker for both ensuring that, on the one hand, appropriate knowledge is generated, synthesized and implemented in a systematic manner to improve maternal and perinatal health, and opportunities for identifying researchable problems are not missed at each stage, on the other.
UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction Department of Reproductive Health and Research: (last revised: June 2010). World Health Organization.