A newborn sleeps under a bed net in rural Jharkhand, India. Photo by Kate Mitchell
“You learn in medical school that people exposed to malaria as children develop immunity and rarely die from malaria as adults. What we have found in hospital records, death records, surveys, and other sources shows that just is not the case,” said Dr. Christopher Murray, Director of the Institute for Health Metrics and Evaluation (IHME) and lead author of a new study on global malaria mortality.
According to the press release about the new study, “IHME researchers say that deaths from malaria have been missed by previous studies because of the assumption that the disease mainly kills children under 5. IHME found that more than 78,000 children aged 5 to 14, and more than 445,000 people ages 15 and older died from malaria in 2010, meaning that 42% of all malaria deaths were in people aged 5 and older.”
The study did not look specifically at the number of pregnant women dying of malaria or the relationship between malaria and maternal morbidity and mortality, but it did show that far more adults are dying from malaria than we previously believed. It is safe to assume that the number of pregnant women dying from malaria is likely also largely underreported.
The good news from the study is that the number of malaria deaths has fallen rapidly in recent years—likely due to the ramping up of efforts to combat the disease. Researchers pointed to the scale-up of insecticide-treated bed nets and artemisinin-combination treatments (ACTs) as major factors in the drop of malaria deaths.
Unfortunately, malaria prevention, screening and treatment among pregnant women remains low, despite clear evidence of effective interventions and significant investment in this area—and it is not clear whether malaria deaths are, in fact, falling for this segment of the population.
The Maternal Health Task Force is exploring opportunities to bring together maternal and newborn health professionals with malaria experts in order to discuss the challenge of low coverage of malaria prevention for pregnant women and how we might work together to ensure that malaria deaths are on the decline for pregnant women as well as the general population.
As our work in this area develops, we will keep you posted here on the MHTF Blog.
Related reading:
Check out the data visualizations that accompany the new study–and explore global trends in malaria mortality between 1980 and 2010.
Read the Washington Post coverage of the new study here.
In an Op-ed in the New York Times on Wednesday, Paul Farmer shares four reasons why it is imperative that the Global Fund to Fight AIDS, Tuberculosis and Malaria continues to get the support it needs.
This study, An Autopsy Study of Maternal Mortality in Mozambique: The Contribution of Infectious Diseases, showed that in a tertiary hospital in Mozambique, at least half of maternal deaths were linked to an infectious disease—and highlighted the importance of implementing malaria prevention strategies such as intermittent preventive treatment and insecticide treated bed nets.
For more information on malaria in pregnancy, visit the Malaria in Pregnancy Consortium website. Be sure to check out their interactive map of research projects relating to malaria in pregnancy, here.
This January, I had the pleasure of interning in Bangladesh at the Population Council Dhaka office. I spent my three weeks there focusing on the improvement and automation of a quality assurance checklist for use in the Population Council’s Pay-for-Performance (P4P) project. The P4P project was designed to improve the quantity and quality of maternal and child health care services delivered in three districts of Bangladesh by offering financial incentives to reward service providers for meeting targeted levels of facility performance.
This project is one of the few being undertaken in Bangladesh that directly aims to improve quality of care. Quality is assessed quarterly by Quality Assurance Groups (QAGs) made up of technical experts from nearby medical colleges, hospitals, and professional bodies. In their quarterly assessments, QAGs use a Qualitative Measurement Tool to document and measure the quality of care being provided at a facility. The content of this tool was developed over the course of five consensus-building workshops organized by the Directorate General of Health Services in 2010 and attended by national and local-level program managers and service providers.
When I arrived in Dhaka, the Qualitative Measurement Tool was in an intermediate stage of development. I worked to edit the 500+ indicators included in the tool to make them clearer and to ensure that the point values corresponding to each indicator were accurate and self-explanatory. Working with the P4P team and a software developer, I also helped to design the layout and functionality of an electronic version of the tool. Our goal was to create an intuitive instrument that is structured to correspond with the progression of a QAG facility assessment and which allows for rapid, onsite calculation of results. The refinement of the Qualitative Measurement Tool is still underway, and I am looking forward to continuing to assist in its development from Boston!
Hannah Ratcliffe with Laila Rahman, Senior Program Officer with the Population Council
To learn more about the Field Experience in Maternal Health winter session course, visit the course page hereor check out a recent blog post about the course here.
It is widely known that the maternal mortality rate in Mali is grossly underestimated. However, current data collection methods fail to capture true mortality rates, especially in rural areas of the country. An mhealth project between the Malian Ministry of Health, UNFPA, L’Agence Nationale de Télésanté et d’Informatique Médicale (ANTIM), and Medic Mobile aims to collect more accurate data to better inform future initiatives targeting maternal deaths.
Thanks to support from ANTIM, I visited a number of pilot sites in Koulikoro and Segou with Ibrahim Kante, an ANTIM technician, and Hammadou Dia, a medical ANTIM intern. Our goal was to hear administrative and community health workers’ (CHW) experiences with the pilot to date so that their input can be incorporated into the project as it is scaled-up nationally.
In a roundtable discussion in the town of Bla, Dia and I posed questions about some of the preliminary advantages and challenges health administrators have encountered in their use of the mobile phones.
Dia and I spoke to representatives from various districts and communities about the former/current demographic collection system, the shortcomings, and general aspirations for the mobile project. We also asked the CHWs involved in the pilot to share their experiences with the phones, including challenges they have had, if any, and their reflections on the training they received.
Despite some technical hiccups, unexpected advantages of the project are rapidly becoming apparent. Thanks to unlimited calling, CHWs and medical and administrative staff report that they communicate more frequently about villagers’ medical needs and concerns. A review of the data collected at the end of the month, and again at the end of each month of the three-month pilot phase will provide a clearer picture of the health of the project.
Even though the pilot phase is in its early stages, CHWs and administrators hope that the project will continue and will expand to include a wide range of health data collection.
When I wasn’t in the ANTIM office or visiting the pilot sites, I had the opportunity to enjoy some of the great live music Bamako has to offer. Serendipitously, I bumped into Habib Koité, one of my favorite Malian musicians, at the Centre Culturel francais de Bamako!
To learn more about the Field Experience in Maternal Health winter session course, visit the course page hereor check out a recent blog post about the course here.
Click hereto learn about Medic Mobile’s work, supported by the MHTF, to develop three mobile tools for maternal health.
Written by: Raji Mohanam, Knowledge Management Specialist, MHTF
With 2,000 people trying to access a limited Hilton wi-fi service, it was a struggle to get and then keep a connection on Day 2 at NTEN 2011. It severely undermined our ability to live-tweet during sessions. Apologies! However, this made clear that one thing techie folks understand is the inherent fragility of technology and that for all its amazing potential, it’s still just a tool. Sometimes tools break. In those moments, we are left with the human capacity to adapt. No technology compares to human genious….and we got to see plenty of that today.
I was very impressed with Akhtar Badshah, Senior Director of Global Community Affairs at Microsoft. He moderated a session on innovation and technology where he outlined how our world view is changing because of technology. He said there were three important shifts happening around the world, even at the village-level:
1. Technology is now ubiquitous, affordable, accessible and relevant
2. Economics of technology is changing in that the developed markets no longer drive growth, it’s the developing world that is driving growth
3. People are at the center of technology and knowledge creation; they are no longer on the periphery as passive observers of technology.
I think his third point is especially apparent in the development sector. Innovation happens when people apply and adapt technologies to address individual and local problems. Innovation is not a given just because a new technology is introduced. It happens because people take technology into their own hands to change their lives and their destinies. We can see many examples of this ‘customization’ of technology all over the world. ThemPesa program uses mobile phones to address local banking needs in Kenya. Local telemedicine strategies are revolutionizing the way problems are solved in healtchare in India. Egyptians used social media to organize protests that eventually brought down a dictator. And there are many less-known examples.
As a result of this rapidly changing global landscape, NGOs and donors no longer view women, men, and families living in resource-poor countries as ‘victims’ of poverty but as capable agents of change. This global view has occurred to a large extent because of the way human beings are using technology to meet their own needs, and not because of technology itself.
The paradigm is shifting…..and it’s exciting to be part of it!
What I heard was a lot of talk: conversations I have heard before about the need to convince people of “the importance of family planning,” and the desire to focus on family planning only as a means of birth spacing rather than as a critical tool that people need to exercise their rights to make informed choices about pregnancy and childbearing.
When UN Secretary-General Ban Ki-moon formally launched the Global Strategy for Women’s and Children’s Health last September during the 2010 UN General Assembly meeting, a range of stakeholders made commitments totaling $40 billion for improved maternal and child health programs and services. The Global Strategy, a plan to save the lives of 16 million women and children in the world’s poorest countries, cuts across all the Millennium Development Goals, especially those related to health (MDGs 4, 5 and 6). It is designed to serve as a global roadmap to identify and mobilize resources, policies, and critical interventions, with engagement by governments, donors, academic institutions, health professional associations, NGOs, corporations, and many others.
These ambitious goals and generous pledges, promising though they may be, are not enough to bring real change. That will come only when commitments are translated into real money and concrete action. As my organization, Family Care International, wrote in our own commitment to the Global Strategy, “commitments don’t save lives until they are actually delivered.”
During a strategy meeting in Washington, DC last Friday, I shared an overview (here) on the Global Strategy, noting that accountability will be the key to ensuring that the Global Strategy drives clear, quantifiable progress toward achievement of MDG targets by 2015. The Global Strategy document stated this clearly:
Accountability is essential. It ensures that all partners deliver on their commitments, demonstrates how actions and investment translate into tangible results and better long-term outcomes, and tells us what works, what needs to be improved and what requires more attention.
Last month, the UN announced the establishment of a high-level Commission on Information and Accountability for Women’s and Children’s Health, co-chaired by the President of Tanzania and the Prime Minister of Canada. This Commission, with members from developed and developing countries, academia, civil society and the private sector, is charged with developing a framework for tracking resources and results at the global and country levels. Its two working groups — on ‘accountability for resources’ and ‘accountability for results’ – are already hard at work; the Commission’s draft report is due to the UN this May.
As a member of the results working group, I will return to the MHTF blog soon to solicit your input on appropriate indicators, measurement needs, and accountability mechanisms (each working group has posted a “discussion forum” page here) , and to report back on our progress.
Written by: Anrudh K. Jain, Ph.D., Distinguished Scholar, Population Council, New York
Vapari Bai’s death (Human Rights Watch, January 10, 2011) due to eclampsia in Barwani district hospital in Madhya Pradesh, India highlights the need of reducing unnecessary delays in reaching the appropriate health facility equipped to offer comprehensive emergency obstetric care (EmOC) services through an effective referral system, between communities and facilities without these services with those facilities equipped to offer these services. Investigation of maternal deaths, while important, may have an unwarranted side effect of providers refusing care to those who really need it.
It is well known that 15% to 20% of pregnant women experience life threatening complications (e.g. hemorrhage, sepsis, eclampsia, and obstructed labor) around the process of childbirth (pregnancy, delivery, and post-partum). However, these complications cannot be predicted well in advance, but they are the ones which require timely and appropriate care. What to do when these complications start to appear? Finding an appropriate solution has been a major challenge in efforts to reduce maternal mortality in developing countries.
The Government of India is implementing a very ambitious program of conditional cash transfer—the Janani Suraksha Yojna (JSY)—to reduce maternal mortality ratio (MMR) by promoting institutional deliveries. The district level surveys indicate an increase in institutional deliveries from 41% to 54% between 2002/04 DLHS-2 and 2007/09 DLHS-3. However, the statistical analysis of these data published in The Lancet failed to establish any effect of JSY on MMR.
A rise in institutional deliveries is likely to decrease MMR if women experiencing complications around childbirth are shifted from home to institutions with comprehensive EmOC, and if the case-fatality ratio (CFR) among women with complicated deliveries at these facilities decreases. However, CFR among women with complicated deliveries at health facilities, as highlighted by the death of Vapri Bai, may be increasing for two reasons. First, women experiencing complications during childbirth may also be experiencing additional delays in reaching the appropriate institution because they are first taken to health facilities which do not have comprehensive EmOC. Second, those reaching a facility with comprehensive EmOC services may not be getting appropriate care because of the increased workload due to JSY.
It is essential to increase the number of facilities offering comprehensive EMoC and to improve quality of care by training providers at these facilities to offer timely care to women with complications. In the meantime, it is essential to clearly identify and label facilities in a district/state equipped to offer comprehensive EmOC. In addition, providers at other facilities (CHCs, PHCs and even district hospitals) without comprehensive EmOC and providers in communities (ASHAs, TBAs, and Dais) must be trained to identify women experiencing complications and refer them directly to the facility equipped to provide comprehensive EmOC. Linking facilities without comprehensive EmOC to those with comprehensive EmOC through ambulances and other transport facilities would also help. Vapari Bai would, perhaps, still be alive if the family had the information to take her directly to the medical college hospital in Indore instead of first going to the district hospital and wasting valuable time and resources.
Earlier this month, The Guardianreported that nearly 600 UK women had become pregnant while using Implanon, a contraceptive implant that is inserted beneath the surface of the skin. The January 5 article alarmed many women, who questioned whether their implants—known to be more than 99% effective in preventing pregnancy—are actually working.
The reports of unplanned pregnancies among Implanon users elicited both substantial interest and dismay. Contraceptive failure, particularly with highly effective methods such as implants, intrauterine devices (IUDs), female sterilization, and vasectomy, is rare and unexpected. But no method, even sterilization, is 100% effective. When properly inserted, however, the success rate of Implanon ® and other hormonal implants (Jadelle®) has been proven to be greater than 99%—far exceeding the effectiveness of either oral contraceptive pills or condoms.
While the investigation in the United Kingdom is still ongoing, it appears that the errors likely occurred months or years before—at the clinic where health practitioners may have improperly inserted the device. If it is the case that provider error is responsible (either clients were already pregnant at the time of insertion or the device was improperly inserted), these unfortunate events only reinforce the critical importance of quality training for health professionals tasked with inserting implants or other contraceptive devices. Clinics providing implants must maintain robust training standards and curricula for correctly inserting and removing implants to ensure that clients, whether in London or Lomé, receive the highest quality of care possible.
But regardless of the investigation’s outcome, the fact remains that Implanon is a very safe, effective, and popular method of contraception. Millions of women choose implants because they are highly effective and easy to use. Like other long-acting contraceptive methods (e.g. IUDs), Implanon is quickly reversible with prompt return to fertility and is very convenient in that it doesn’t require women to remember to take daily pills or to convince their partners to use condoms in order to prevent pregnancy. But it does require the skill of a well-trained health professional.
Since the Guardian story was published, several health service providers have issued statements clarifying the sources of the failures and advising women on where to seek help if they are concerned about their implants. It is also very important to keep these reports in context: More than 1.3 million units of Implanon have been prescribed in the United Kingdom since 1999, and the number of failures reported to date, regardless of cause, was less than 600. Globally, Implanon is also an increasingly popular method. For more information on what EngenderHealth is doing to promote long-acting family planning methods in countries like Ethiopia, Tanzania, and Bangladesh, visit our web site.
Wednesday, December 1st, 2010 by Christopher Lindahl
During emergency situations and periods of displacement, reproductive health is sometimes lost in the mix of the problems that arise. However, just because other problems arise doesn’t mean that women don’t need access to health services. A woman doesn’t stop being pregnant if she becomes a refugee. Additionally, the search for durable solutions to displacement often takes years and people shouldn’t be expected to entirely put their lives on hold during a time of displacement.
For example, the Nakivale refugee settlement in Uganda (seen in the video below) is populated largely by Rwandan refugees who fled in the wake of the 1994 genocide, many of whom arrived between 1998-2002 after spending time as refugees in Tanzania. The average time spent in a protracted refugee situation is 17 years. As a result, paying attention to maternal health in emergency and protracted refugee situations is necessary.
One example of integrating maternal health and refugees come from the Women’s Refugee Commission (WRC), which has developed the Minimum Initial Services Package for Reproductive Health. Additionally, with funding from MHTF, WRC is advocating for integration of maternal and reproductive health into disaster risk reduction policies and working with governments to design disaster plans with reproductive health components.
Over the course of the mHealth Summit in Washington D.C., I saw and heard about some amazing new mobile phone-based tools that have the potential to dramatically improve--even revolutionize-- global health. In fact, many of them were unveiled and launched during the conference. These innovations move us closer to an era when we may all have a “doctor in our pocket”!
Below are some descriptions of these amazing tools and links to more information about them.
NETRA, created by scientists at MIT, is a smart phone-based vision test that you can give yourself whenever and wherever you are! The NETRA itself is a device that attaches to your cell phone so you can assess eyeglass prescription. All you need to do is look into the NETRA lens through the cell phone display and align the displayed pattern on the screen. Since light rays from this pattern pass through different regions of the eye, the alignment task gives a measure of the optical distortions in the various regions of the eye. You repeat this procedure for a few different patterns and presto, the system computes the corresponding refractive error for myopia, hyperopia and astigmatism!
This innovation provides hope to many remote, under-served adults and children in the developing world who currently do not have access to eye exams.
Mobisante, based in Redmond, Washington, has developed a small portable mobile phone-based ultrasound device. The device can be used to view ultrasound images/data on the display screen of the phone. The device can be used by healthcare workers directly where an ultrasound machine is not available. As well, it can also be used by non-experts and, potentially, even by patients themselves to transmit images and data to a clinic or healthcare provider for remote diagnosis and monitoring. At scale, the cost is estimated to be less than one dollar per exam! The obvious implications for maternal health in low-resource settings are tremendous and exciting.
BugLabs, based in New York City, has come up with “Bug”--a modular software system on a mobile phone platform. The system allows you to attach various devices to your cell phone to build a customized tool that meets your specific needs. The system has already been used to create customized tools such as heat detectors for firemen, GPS-based alarm clocks, provider-patient appointment reminders, remote patient biometrics monitors, pacemaker monitors, air pollution detectors, and surveillance motion trackers. The potential applications for global health are immense and are limited almost only by our own creativity.
Cell Scope, at UC Berkeley, has developed a microscope device that you simply attach to a mobile phone to take it ‘on the road’! This microscopy-enabled cell phone can then be used to analyze blood or sputum specimens anywhere in the world. The device relies on your cell phone’s camera to turn it into a microscope with 5x-50x magnification. Your phone is then capable of analyzing smears to detect TB, malaria, and many other diseases. Data captured from these analyses is then read by the healthcare provider who is present or transmitted to a clinic or doctor anywhere in the world for remote diagnosis. Imagine the implications for quick and accurate diagnosing of pregnant women in remote areas of the world who are infected with malaria or other deadly parasites.
All these innovative tools have creatively and successfully leveraged the power of a mobile phone as their platform. It is certainly an exciting time for global health! Stay tuned to the MHTF to keep abreast of these and other emerging mobile phone technologies as they improve maternal health around the world.
Let us know how your organization is using mobile phones to improve maternal health!
The posts on this blog do not necessarily reflect the views of the Maternal Health Task Force. Our objective is to provide a platform for our Editorial Committee and other experts to post a myriad of data and evidence, as well as opinions/views that exist in the field which will contribute to expanding the maternal health dialogue.
Archive For The GMHC 2010
Archive for the ‘Commentary’ Category
IHME Report Says that Malaria Interventions are Working, but the Problem is Bigger than We Thought
Friday, February 3rd, 2012 by KateMitchA newborn sleeps under a bed net in rural Jharkhand, India. Photo by Kate Mitchell
“You learn in medical school that people exposed to malaria as children develop immunity and rarely die from malaria as adults. What we have found in hospital records, death records, surveys, and other sources shows that just is not the case,” said Dr. Christopher Murray, Director of the Institute for Health Metrics and Evaluation (IHME) and lead author of a new study on global malaria mortality.
A new report from IHME published in the Lancet yesterday, Global malaria mortality between 1980 and 2010: a systematic analysis, shows that malaria is responsible for almost twice the number of deaths worldwide than previously believed.
According to the press release about the new study, “IHME researchers say that deaths from malaria have been missed by previous studies because of the assumption that the disease mainly kills children under 5. IHME found that more than 78,000 children aged 5 to 14, and more than 445,000 people ages 15 and older died from malaria in 2010, meaning that 42% of all malaria deaths were in people aged 5 and older.”
The study did not look specifically at the number of pregnant women dying of malaria or the relationship between malaria and maternal morbidity and mortality, but it did show that far more adults are dying from malaria than we previously believed. It is safe to assume that the number of pregnant women dying from malaria is likely also largely underreported.
The good news from the study is that the number of malaria deaths has fallen rapidly in recent years—likely due to the ramping up of efforts to combat the disease. Researchers pointed to the scale-up of insecticide-treated bed nets and artemisinin-combination treatments (ACTs) as major factors in the drop of malaria deaths.
Unfortunately, malaria prevention, screening and treatment among pregnant women remains low, despite clear evidence of effective interventions and significant investment in this area—and it is not clear whether malaria deaths are, in fact, falling for this segment of the population.
The Maternal Health Task Force is exploring opportunities to bring together maternal and newborn health professionals with malaria experts in order to discuss the challenge of low coverage of malaria prevention for pregnant women and how we might work together to ensure that malaria deaths are on the decline for pregnant women as well as the general population.
As our work in this area develops, we will keep you posted here on the MHTF Blog.
Related reading:
Check out the data visualizations that accompany the new study–and explore global trends in malaria mortality between 1980 and 2010.
Read the Washington Post coverage of the new study here.
In an Op-ed in the New York Times on Wednesday, Paul Farmer shares four reasons why it is imperative that the Global Fund to Fight AIDS, Tuberculosis and Malaria continues to get the support it needs.
This study, An Autopsy Study of Maternal Mortality in Mozambique: The Contribution of Infectious Diseases, showed that in a tertiary hospital in Mozambique, at least half of maternal deaths were linked to an infectious disease—and highlighted the importance of implementing malaria prevention strategies such as intermittent preventive treatment and insecticide treated bed nets.
For more information on malaria in pregnancy, visit the Malaria in Pregnancy Consortium website. Be sure to check out their interactive map of research projects relating to malaria in pregnancy, here.
[Translate]
Tags: artemisinin-combination treatment, Dr. Christopher Murray, global malaria mortality, IHME, insecticide-treated bed nets, Institute for Health Metrics and Evaluation, malaria, malaria in pregnancy
Posted in Announcements, Commentary, Evidence, News | No Comments »
Field Experience in Maternal Health: Hannah Ratcliffe Shares her Experience with the Population Council in Bangladesh
Thursday, February 2nd, 2012 by adminOver the first three weeks of January, several Harvard School of Public Health graduate students took part in the Field Experience in Maternal Health winter session, organized by the Women and Health Initiative and the Maternal Health Task Force. In this blog post, Hannah Ratcliffe writes about her field experience with the Population Council in Bangladesh.
Written by: Hannah Ratcliffe
This January, I had the pleasure of interning in Bangladesh at the Population Council Dhaka office. I spent my three weeks there focusing on the improvement and automation of a quality assurance checklist for use in the Population Council’s Pay-for-Performance (P4P) project. The P4P project was designed to improve the quantity and quality of maternal and child health care services delivered in three districts of Bangladesh by offering financial incentives to reward service providers for meeting targeted levels of facility performance.
This project is one of the few being undertaken in Bangladesh that directly aims to improve quality of care. Quality is assessed quarterly by Quality Assurance Groups (QAGs) made up of technical experts from nearby medical colleges, hospitals, and professional bodies. In their quarterly assessments, QAGs use a Qualitative Measurement Tool to document and measure the quality of care being provided at a facility. The content of this tool was developed over the course of five consensus-building workshops organized by the Directorate General of Health Services in 2010 and attended by national and local-level program managers and service providers.
When I arrived in Dhaka, the Qualitative Measurement Tool was in an intermediate stage of development. I worked to edit the 500+ indicators included in the tool to make them clearer and to ensure that the point values corresponding to each indicator were accurate and self-explanatory. Working with the P4P team and a software developer, I also helped to design the layout and functionality of an electronic version of the tool. Our goal was to create an intuitive instrument that is structured to correspond with the progression of a QAG facility assessment and which allows for rapid, onsite calculation of results. The refinement of the Qualitative Measurement Tool is still underway, and I am looking forward to continuing to assist in its development from Boston!
Hannah Ratcliffe with Laila Rahman, Senior Program Officer with the Population Council
To learn more about the Field Experience in Maternal Health winter session course, visit the course page here or check out a recent blog post about the course here.
[Translate]
Tags: Bangladesh, Dhaka, field work, Hannah Ratcliffe, Harvard School of Public Health, HSPH Winter Session, Laila Rahman, P4P, pay for performance, Population Council, quality of care
Posted in Commentary, Opportunities | No Comments »
Field Experience in Maternal Health: Elena Chopyak Shares her Experience with Medic Mobile in Mali
Tuesday, January 31st, 2012 by ablancOver the first three weeks of January, several Harvard School of Public Health graduate students took part in the Field Experience in Maternal Health winter session, organized by the Women and Health Initiative and the Maternal Health Task Force. In this blog post, Elena Chopyak writes about her field experience with Medic Mobile in Mali.
Written by: Elena Chopyak
It is widely known that the maternal mortality rate in Mali is grossly underestimated. However, current data collection methods fail to capture true mortality rates, especially in rural areas of the country. An mhealth project between the Malian Ministry of Health, UNFPA, L’Agence Nationale de Télésanté et d’Informatique Médicale (ANTIM), and Medic Mobile aims to collect more accurate data to better inform future initiatives targeting maternal deaths.
Thanks to support from ANTIM, I visited a number of pilot sites in Koulikoro and Segou with Ibrahim Kante, an ANTIM technician, and Hammadou Dia, a medical ANTIM intern. Our goal was to hear administrative and community health workers’ (CHW) experiences with the pilot to date so that their input can be incorporated into the project as it is scaled-up nationally.
In a roundtable discussion in the town of Bla, Dia and I posed questions about some of the preliminary advantages and challenges health administrators have encountered in their use of the mobile phones.
Dia and I spoke to representatives from various districts and communities about the former/current demographic collection system, the shortcomings, and general aspirations for the mobile project. We also asked the CHWs involved in the pilot to share their experiences with the phones, including challenges they have had, if any, and their reflections on the training they received.
Despite some technical hiccups, unexpected advantages of the project are rapidly becoming apparent. Thanks to unlimited calling, CHWs and medical and administrative staff report that they communicate more frequently about villagers’ medical needs and concerns. A review of the data collected at the end of the month, and again at the end of each month of the three-month pilot phase will provide a clearer picture of the health of the project.
Even though the pilot phase is in its early stages, CHWs and administrators hope that the project will continue and will expand to include a wide range of health data collection.
When I wasn’t in the ANTIM office or visiting the pilot sites, I had the opportunity to enjoy some of the great live music Bamako has to offer. Serendipitously, I bumped into Habib Koité, one of my favorite Malian musicians, at the Centre Culturel francais de Bamako!
To learn more about the Field Experience in Maternal Health winter session course, visit the course page here or check out a recent blog post about the course here.
Click here to learn about Medic Mobile’s work, supported by the MHTF, to develop three mobile tools for maternal health.
[Translate]
Tags: Elena Chopyak, field experience, Field Experience in Maternal Health, Habib Koité, Hammadou Dia, Harvard School of Public Health, HSPH Winter Session, Ibrahim Kante, Koulikoro, L’Agence Nationale de Télésanté et d’Informatique Médicale, Mali, Malian Ministry of Health, Medic Mobile, Segou, UNFPA, Women and Health Initiative
Posted in Commentary, Opportunities | No Comments »
Day 2 at NTEN 2011: People are at the center of technology
Saturday, March 19th, 2011 by Raji MohanamWritten by: Raji Mohanam, Knowledge Management Specialist, MHTF
With 2,000 people trying to access a limited Hilton wi-fi service, it was a struggle to get and then keep a connection on Day 2 at NTEN 2011. It severely undermined our ability to live-tweet during sessions. Apologies! However, this made clear that one thing techie folks understand is the inherent fragility of technology and that for all its amazing potential, it’s still just a tool. Sometimes tools break. In those moments, we are left with the human capacity to adapt. No technology compares to human genious….and we got to see plenty of that today.
I was very impressed with Akhtar Badshah, Senior Director of Global Community Affairs at Microsoft. He moderated a session on innovation and technology where he outlined how our world view is changing because of technology. He said there were three important shifts happening around the world, even at the village-level:
1. Technology is now ubiquitous, affordable, accessible and relevant
2. Economics of technology is changing in that the developed markets no longer drive growth, it’s the developing world that is driving growth
3. People are at the center of technology and knowledge creation; they are no longer on the periphery as passive observers of technology.
I think his third point is especially apparent in the development sector. Innovation happens when people apply and adapt technologies to address individual and local problems. Innovation is not a given just because a new technology is introduced. It happens because people take technology into their own hands to change their lives and their destinies. We can see many examples of this ‘customization’ of technology all over the world. The mPesa program uses mobile phones to address local banking needs in Kenya. Local telemedicine strategies are revolutionizing the way problems are solved in healtchare in India. Egyptians used social media to organize protests that eventually brought down a dictator. And there are many less-known examples.
As a result of this rapidly changing global landscape, NGOs and donors no longer view women, men, and families living in resource-poor countries as ‘victims’ of poverty but as capable agents of change. This global view has occurred to a large extent because of the way human beings are using technology to meet their own needs, and not because of technology itself.
The paradigm is shifting…..and it’s exciting to be part of it!
[Translate]
Tags: #11NTC, NTEN
Posted in Commentary, Meetings | No Comments »
An Imperative to Act: Family Planning in West Africa
Friday, February 25th, 2011 by Christopher LindahlWritten by: Pape Gaye, President and CEO, IntraHealth International
The following was originally posted on the IntraHealth International blog. Reposted here with permission. Cliquez ici pour lire le blog en français.
Earlier this month, I was in Ouagadougou, Burkina Faso with delegates from eight French-speaking West African countries* for the conference, “Family Planning in the context of Population and Development: the Urgency to Act.”
What I heard was a lot of talk: conversations I have heard before about the need to convince people of “the importance of family planning,” and the desire to focus on family planning only as a means of birth spacing rather than as a critical tool that people need to exercise their rights to make informed choices about pregnancy and childbearing.
Read the rest of this entry »
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Tags: family planning, Intrahealth, IntraHealth International, Papa Gaye, West Africa
Posted in Commentary | No Comments »
Making Acccountability Count
Tuesday, January 25th, 2011 by Christopher LindahlWritten by: Ann Starrs, President, Family Care International
When UN Secretary-General Ban Ki-moon formally launched the Global Strategy for Women’s and Children’s Health last September during the 2010 UN General Assembly meeting, a range of stakeholders made commitments totaling $40 billion for improved maternal and child health programs and services. The Global Strategy, a plan to save the lives of 16 million women and children in the world’s poorest countries, cuts across all the Millennium Development Goals, especially those related to health (MDGs 4, 5 and 6). It is designed to serve as a global roadmap to identify and mobilize resources, policies, and critical interventions, with engagement by governments, donors, academic institutions, health professional associations, NGOs, corporations, and many others.
These ambitious goals and generous pledges, promising though they may be, are not enough to bring real change. That will come only when commitments are translated into real money and concrete action. As my organization, Family Care International, wrote in our own commitment to the Global Strategy, “commitments don’t save lives until they are actually delivered.”
During a strategy meeting in Washington, DC last Friday, I shared an overview (here) on the Global Strategy, noting that accountability will be the key to ensuring that the Global Strategy drives clear, quantifiable progress toward achievement of MDG targets by 2015. The Global Strategy document stated this clearly:
Last month, the UN announced the establishment of a high-level Commission on Information and Accountability for Women’s and Children’s Health, co-chaired by the President of Tanzania and the Prime Minister of Canada. This Commission, with members from developed and developing countries, academia, civil society and the private sector, is charged with developing a framework for tracking resources and results at the global and country levels. Its two working groups — on ‘accountability for resources’ and ‘accountability for results’ – are already hard at work; the Commission’s draft report is due to the UN this May.
As a member of the results working group, I will return to the MHTF blog soon to solicit your input on appropriate indicators, measurement needs, and accountability mechanisms (each working group has posted a “discussion forum” page here) , and to report back on our progress.
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Tags: accountability, Ann Starrs, child health, Family Care International, funding, Global Strategy for Women, health policy, women's health
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Saving Women’s Lives: Reducing Unnecessary Delays to Comprehensive EmOC
Thursday, January 20th, 2011 by Raji MohanamWritten by: Anrudh K. Jain, Ph.D., Distinguished Scholar, Population Council, New York
Vapari Bai’s death (Human Rights Watch, January 10, 2011) due to eclampsia in Barwani district hospital in Madhya Pradesh, India highlights the need of reducing unnecessary delays in reaching the appropriate health facility equipped to offer comprehensive emergency obstetric care (EmOC) services through an effective referral system, between communities and facilities without these services with those facilities equipped to offer these services. Investigation of maternal deaths, while important, may have an unwarranted side effect of providers refusing care to those who really need it.
It is well known that 15% to 20% of pregnant women experience life threatening complications (e.g. hemorrhage, sepsis, eclampsia, and obstructed labor) around the process of childbirth (pregnancy, delivery, and post-partum). However, these complications cannot be predicted well in advance, but they are the ones which require timely and appropriate care. What to do when these complications start to appear? Finding an appropriate solution has been a major challenge in efforts to reduce maternal mortality in developing countries.
The Government of India is implementing a very ambitious program of conditional cash transfer—the Janani Suraksha Yojna (JSY)—to reduce maternal mortality ratio (MMR) by promoting institutional deliveries. The district level surveys indicate an increase in institutional deliveries from 41% to 54% between 2002/04 DLHS-2 and 2007/09 DLHS-3. However, the statistical analysis of these data published in The Lancet failed to establish any effect of JSY on MMR.
A rise in institutional deliveries is likely to decrease MMR if women experiencing complications around childbirth are shifted from home to institutions with comprehensive EmOC, and if the case-fatality ratio (CFR) among women with complicated deliveries at these facilities decreases. However, CFR among women with complicated deliveries at health facilities, as highlighted by the death of Vapri Bai, may be increasing for two reasons. First, women experiencing complications during childbirth may also be experiencing additional delays in reaching the appropriate institution because they are first taken to health facilities which do not have comprehensive EmOC. Second, those reaching a facility with comprehensive EmOC services may not be getting appropriate care because of the increased workload due to JSY.
It is essential to increase the number of facilities offering comprehensive EMoC and to improve quality of care by training providers at these facilities to offer timely care to women with complications. In the meantime, it is essential to clearly identify and label facilities in a district/state equipped to offer comprehensive EmOC. In addition, providers at other facilities (CHCs, PHCs and even district hospitals) without comprehensive EmOC and providers in communities (ASHAs, TBAs, and Dais) must be trained to identify women experiencing complications and refer them directly to the facility equipped to provide comprehensive EmOC. Linking facilities without comprehensive EmOC to those with comprehensive EmOC through ambulances and other transport facilities would also help. Vapari Bai would, perhaps, still be alive if the family had the information to take her directly to the medical college hospital in Indore instead of first going to the district hospital and wasting valuable time and resources.
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Tags: Anrudh Jain, Barwani district, cash transfers, Dais, emergency obstetric care (EmOC), EmOC, Government of India, Human Rights Watch, JSY, Madhya Pradesh, maternal death, maternal death audits, maternal health, maternal mortality, MMR, TBAs, transporation and referral, Vapari Bai
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Contraceptive Implants: Safe, Effective, and Popular
Wednesday, January 19th, 2011 by Christopher LindahlWritten by: Roy Jacobstein, Medical Director, EngenderHealth
The following post is also published on the Global Health Council blog
Earlier this month, The Guardian reported that nearly 600 UK women had become pregnant while using Implanon, a contraceptive implant that is inserted beneath the surface of the skin. The January 5 article alarmed many women, who questioned whether their implants—known to be more than 99% effective in preventing pregnancy—are actually working.
The reports of unplanned pregnancies among Implanon users elicited both substantial interest and dismay. Contraceptive failure, particularly with highly effective methods such as implants, intrauterine devices (IUDs), female sterilization, and vasectomy, is rare and unexpected. But no method, even sterilization, is 100% effective. When properly inserted, however, the success rate of Implanon ® and other hormonal implants (Jadelle®) has been proven to be greater than 99%—far exceeding the effectiveness of either oral contraceptive pills or condoms.
While the investigation in the United Kingdom is still ongoing, it appears that the errors likely occurred months or years before—at the clinic where health practitioners may have improperly inserted the device. If it is the case that provider error is responsible (either clients were already pregnant at the time of insertion or the device was improperly inserted), these unfortunate events only reinforce the critical importance of quality training for health professionals tasked with inserting implants or other contraceptive devices. Clinics providing implants must maintain robust training standards and curricula for correctly inserting and removing implants to ensure that clients, whether in London or Lomé, receive the highest quality of care possible.
But regardless of the investigation’s outcome, the fact remains that Implanon is a very safe, effective, and popular method of contraception. Millions of women choose implants because they are highly effective and easy to use. Like other long-acting contraceptive methods (e.g. IUDs), Implanon is quickly reversible with prompt return to fertility and is very convenient in that it doesn’t require women to remember to take daily pills or to convince their partners to use condoms in order to prevent pregnancy. But it does require the skill of a well-trained health professional.
Since the Guardian story was published, several health service providers have issued statements clarifying the sources of the failures and advising women on where to seek help if they are concerned about their implants. It is also very important to keep these reports in context: More than 1.3 million units of Implanon have been prescribed in the United Kingdom since 1999, and the number of failures reported to date, regardless of cause, was less than 600. Globally, Implanon is also an increasingly popular method. For more information on what EngenderHealth is doing to promote long-acting family planning methods in countries like Ethiopia, Tanzania, and Bangladesh, visit our web site.
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Tags: contraceptive failure, EngenderHealth, Global Health Council, Implanon, IUDs, Roy Jacobstein, United Kingdom
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Maternal Health in Refugee Situations
Wednesday, December 1st, 2010 by Christopher LindahlDuring emergency situations and periods of displacement, reproductive health is sometimes lost in the mix of the problems that arise. However, just because other problems arise doesn’t mean that women don’t need access to health services. A woman doesn’t stop being pregnant if she becomes a refugee. Additionally, the search for durable solutions to displacement often takes years and people shouldn’t be expected to entirely put their lives on hold during a time of displacement.
For example, the Nakivale refugee settlement in Uganda (seen in the video below) is populated largely by Rwandan refugees who fled in the wake of the 1994 genocide, many of whom arrived between 1998-2002 after spending time as refugees in Tanzania. The average time spent in a protracted refugee situation is 17 years. As a result, paying attention to maternal health in emergency and protracted refugee situations is necessary.
One example of integrating maternal health and refugees come from the Women’s Refugee Commission (WRC), which has developed the Minimum Initial Services Package for Reproductive Health. Additionally, with funding from MHTF, WRC is advocating for integration of maternal and reproductive health into disaster risk reduction policies and working with governments to design disaster plans with reproductive health components.
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Tags: displacement, emergency situations, maternal health, maternal health policy, refugees, reproductive health in conflict settings, Uganda, Women's Refugee Commission
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A Doctor in Your Pocket: mobile phone-based innovations revealed at the mHealth Summit
Monday, November 15th, 2010 by Raji MohanamWritten by: Raji Mohanam
Over the course of the mHealth Summit in Washington D.C., I saw and heard about some amazing new mobile phone-based tools that have the potential to dramatically improve--even revolutionize-- global health. In fact, many of them were unveiled and launched during the conference. These innovations move us closer to an era when we may all have a “doctor in our pocket”!
Below are some descriptions of these amazing tools and links to more information about them.
NETRA, created by scientists at MIT, is a smart phone-based vision test that you can give yourself whenever and wherever you are! The NETRA itself is a device that attaches to your cell phone so you can assess eyeglass prescription. All you need to do is look into the NETRA lens through the cell phone display and align the displayed pattern on the screen. Since light rays from this pattern pass through different regions of the eye, the alignment task gives a measure of the optical distortions in the various regions of the eye. You repeat this procedure for a few different patterns and presto, the system computes the corresponding refractive error for myopia, hyperopia and astigmatism!
This innovation provides hope to many remote, under-served adults and children in the developing world who currently do not have access to eye exams.
Mobisante, based in Redmond, Washington, has developed a small portable mobile phone-based ultrasound device. The device can be used to view ultrasound images/data on the display screen of the phone. The device can be used by healthcare workers directly where an ultrasound machine is not available. As well, it can also be used by non-experts and, potentially, even by patients themselves to transmit images and data to a clinic or healthcare provider for remote diagnosis and monitoring. At scale, the cost is estimated to be less than one dollar per exam! The obvious implications for maternal health in low-resource settings are tremendous and exciting.
BugLabs, based in New York City, has come up with “Bug”--a modular software system on a mobile phone platform. The system allows you to attach various devices to your cell phone to build a customized tool that meets your specific needs. The system has already been used to create customized tools such as heat detectors for firemen, GPS-based alarm clocks, provider-patient appointment reminders, remote patient biometrics monitors, pacemaker monitors, air pollution detectors, and surveillance motion trackers. The potential applications for global health are immense and are limited almost only by our own creativity.
Cell Scope, at UC Berkeley, has developed a microscope device that you simply attach to a mobile phone to take it ‘on the road’! This microscopy-enabled cell phone can then be used to analyze blood or sputum specimens anywhere in the world. The device relies on your cell phone’s camera to turn it into a microscope with 5x-50x magnification. Your phone is then capable of analyzing smears to detect TB, malaria, and many other diseases. Data captured from these analyses is then read by the healthcare provider who is present or transmitted to a clinic or doctor anywhere in the world for remote diagnosis. Imagine the implications for quick and accurate diagnosing of pregnant women in remote areas of the world who are infected with malaria or other deadly parasites.
All these innovative tools have creatively and successfully leveraged the power of a mobile phone as their platform. It is certainly an exciting time for global health! Stay tuned to the MHTF to keep abreast of these and other emerging mobile phone technologies as they improve maternal health around the world.
Let us know how your organization is using mobile phones to improve maternal health!
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Tags: BugLabs, cell phones, cell scope, global health, innovation, mhealth, mHealth Summit, mhealth tools, MIT, mobile microscopy, mobile phones, mobisante, NETRA, remote diagnostics, telemedicine
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