From the Clinic to Policy and Advocacy: Koki Agarwal

In a highly anticipated follow-up to her video interview with GKII Program Manager Beth Romanski, Dr. Koki Agarwal also answered our more technical questions about her approach to her work, and the reasons why it’s so personal to her.

In case you missed her interview, Dr. Koki Agarwal is a physician and an internationally recognized expert in safe motherhood, reproductive health, and family planning policies and programs, as well as promoting policy dialogue and advocacy for policy reform. She has more than 25 years of service delivery experience in reproductive health, family planning, and maternal health, and for over two decades has led, managed, and implemented large-scale USAID-funded global health projects. Dr. Agarwal is currently the Vice President of DC Operations for Jhpiego and directs MOMENTUM Country and Global Leadership— a project within the USAID MOMENTUM suite of awards funded by USAID to holistically improve voluntary family planning and maternal, newborn, and child health services in partner countries around the world.

You’ve had extensive experience leading large-scale global health projects. What are some key lessons you’ve learned about effective project management and leadership in such complex initiatives?

A large-scale global health project is built on solid partnerships. USAID’s MOMENTUM Country and Global Leadership Program comprises 12 consortium partners supporting critical reproductive, maternal, newborn, child health, nutrition, and other activities across over 28 countries. These partners come together to bring their own specific sets of skills, expertise, and strengths to the task of accelerating progress to end preventable maternal and child deaths. I’ve learned it’s important to honor that partnership by 1) working to bring forth the best from each organization; 2) creating an environment of trust and mutual respect; 3) giving credit to individuals and partners; 4) commitment and building a team with creative and dedicated individuals; and 5) delegating responsibilities so everyone is truly making an important contribution that they can be proud of. I authored an article on partnerships on a previous USAID flagship Maternal and Child Health Integrated Program (MCHIP) that I led that explains more about the critical approach of developing strong partnerships in leading large global health projects.

In your current role as the director of MOMENTUM Country and Global Leadership award, what are the most pressing challenges you’re currently addressing, and how do you envision overcoming them?

We are upholding USAID’s commitment to locally led development by intentionally shifting power to local actors; in fact, since the project started in 2019, we have collaborated with more than 134 local partners. But demonstrating the results of locally led development takes time, and often short time frames of funding and projects do not enable meaningful capacity strengthening for partners and organizations. We should ensure local partners have the meaningful and long-term support they need to deliver impressive results for their communities now and in the future.

Another factor has also been continually pivoting when unforeseen challenges inevitably arise. COVID-19 hit just three months after MOMENTUM Country and Global Leadership started—requiring our entire team around the globe to pivot and be flexible with activities and goals. We also often face conflict, natural disasters, or other disruptions in many of the countries we work in. Building teams and programs that are resilient and adaptable, while also being united in common spirit and purpose, has helped our project collectively and creatively navigate rapidly changing situations.

With your background in both medicine and public health, how do you balance the clinical aspects of maternal and newborn health with the broader policy and advocacy work required to drive systemic change?

I have always found it advantageous to have both a clinical and public health background. For instance, clinicians may want the best or the latest equipment in their hospitals, but from a public health perspective we need to examine the disease burden, the demand for different services, and where the public health impact would be the greatest. Having this dual background can facilitate bringing people together to develop and own a sustainable resolution to any health challenge. Public health experts certainly need to engage clinicians in prioritizing their input and support to develop and implement evidence-based interventions. Recognizing this, we have worked with OB/GYN, pediatric, nursing, and midwifery associations at global and country levels to move the needle on important points of the maternal, newborn, and child health agenda, and bring about improvements in respectful maternal and newborn care, perinatal mental health, small and sick newborn care.

As the Vice President of DC Operations for Jhpiego, what are your priorities in fostering collaboration and innovation within the organization to address evolving global health challenges?

I’ve made it a point to ensure that knowledge management is prioritized within our project and within Jhpiego as a whole. Good knowledge management means systematically and intentionally collecting and curating information and connecting it to the right people at the right time—this ultimately helps us to increase our effectiveness, our ability to influence health decision makers, and our ability to learn from each other. We explore all opportunities for sharing across countries and purposefully create platforms for countries to share their learning and advances with other countries and global and regional entities.

Given the diverse cultural contexts you’ve worked in, how do you ensure that maternal and newborn and reproductive health interventions are culturally sensitive and contextually appropriate?

The concept of respectful maternal and newborn care, or RMNC, is central to our country work and in how we approach our work within those countries. A key tenet of RMNC is that women and newborns receive care that is specific to their needs, culture, and context. Since Jhpiego’s inception, our work to save lives and improve health has reached people in more than 150 countries worldwide. Currently, we have active programs in more than 35 countries across the globe. In these countries our work is always led by a team that is from the country and therefore most familiar with the cultural norms and practices. They often partner with ministry counterparts, local organizations, private sector, and faith-based groups within countries. In many countries, we have also supported an open policy dialogue process that enables everyone to have a voice at the table when it comes to developing strategies and policies to improve maternal, newborn, and child health.

In Ghana, for example, our team conducted a study to better understand women and newborns’ experience of care, with a particular focus on the mothers of small and sick newborns. Findings from extensive interviews and focus groups then informed a co-design process during which a diverse set of stakeholders— from health officials to community leaders, midwives, doctors, facility managers, representatives from professional associations, and beyond—drafted an action plan to improve experience of care for women and newborns. They drafted recommendations targeted at each level of the health system that are rooted in a shared understanding of the current reality that women and providers are facing.

Given that access to comprehensive sexual and reproductive health services has been identified as a critical component of achievement of UHC, what are some of your recommendations for ensuring access to high quality services for women within this broader UHC framing?

Ensuring access to quality maternal and child health services are prioritized within UHC is critical and we work at national, district and local levels to ensure that happens. One of the major ways we do this is to ensure that outcomes for maternal, newborn, and child health services are included as measure of success for health programs generally—because what gets measured gets done.