His name was not mentioned at the Women Deliver Conference, here on-going in Kuala Lumpur, yet, presentation after presentation on Day 1 alluded to ideas of Marcus Vitruvius Pollio (born around 80–70 BC) found in his classic work De Architectura. Dealing with Architecture, his work is a treatise on applied systems thinking and design, for the production of purposeful results.
With the global community now in the final 1000-day stretch to the 2015 MDG targets, the discourse on the attainment of results for better maternal and neonatal health has shifted from pilot pursuits to those that need to occur at scale. Here lies the value of Vitruvius’ ideas, tested and tempered over the last 2000 years.
On going to scale, Vitruvius underscored the principle of consistency, which he characterized as “that work whose whole and detail are suitable to the occasion. It arises from circumstance, custom, and nature.”
As we design to take maternal, neonatal, and child health (MNCH) programs to scale, are we thinking simultaneously about the whole health system as we contemplate the minutiae of programs? Have we given sufficient thought to compatibility between the results we seek at scale and the means of getting them? Have we taken the time to thoroughly understand the context, including the culture, power architecture, networks, customs, and geography of the places where we propose to take MNCH programs to scale?
During the meeting as well as in reports, Alice Fabiano talked about the need to build trust as an ingredient for going to scale. Sarah Brown talked about the need for grassroots mobilization as a prerequisite to saving lives. Jeffrey Smith posited on why programs in their design needed to trust women to take medicines such as Misoprostol to prevent postpartum hemorrhage. Another participant spoke about the need to help countries take the lead in MNCH programs at scale. Another spoke about the role of the private sector must play in expanding and delivering on MNCH at scale.
All these ideas have a place in the march to going to scale.
Vitruvius also spoke about the principle of arrangement, which he described as “the disposition in their just and proper places of all the parts of the building, and the pleasing effect of the same; keeping in view its appropriate character… Invention is the effect of this effort; which throws a new light on things the most recondite, and produces them to answer the intended purpose. These are the ends of arrangement.”
This is the task before us here in Kuala Lumpur and especially what must happen when we return back to our countries or our platforms of influence. Health systems strengthening design and the mindset of an architect are mutually compatible.