Archive for the ‘Meetings’ Category

Day 2 at NTEN 2011: People are at the center of technology

Saturday, March 19th, 2011 by Raji Mohanam

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.  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!

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Day 1 at NTEN 2011: So many sessions, so little time!

Thursday, March 17th, 2011 by Raji Mohanam

Written by: Raji Mohanam, MHTF Knowledge Management Specialist

 

Almost 2,000 people converged in Washington D.C. today to attend the 2011 Nonprofit Technology Conference. The conference, which runs today through Saturday, brings together professionals in the nonprofit sector who are interested in how technology, especially the internet-based kind, can help them achieve their organizations’ missions.

 

It’s my second time at an NTEN conference, so I already know I am going to learn a lot. For days, I’ve been following #11NTC* on my TweetDeck and reading conference tips and announcements from speakers and attendees alike. I have a pretty good idea of what the “hot” sessions will be, like the plenary tomorrow featuring Dan Heath, co-author of Switch.

 

Still, as I page through the conference program book and see the vast number of sessions available to me over the next few days, I can’t help but feel slightly overwhelmed. There are literally hundreds of interesting topics being covered (definitely more than last year), and a number of ‘tracks’ like Social Media, Communications, Advocacy, and Fundraising. To me this signifies the growing demand in the nonprofit sector for timely and good information on how new technologies and online tools can help accelerate and improve the important mission-driven work that we do.

 

So, I need to identify the sessions that will most benefit the Maternal Health Task Force. During the past few months, we have been taking a closer look at our site’s Google Analytics and discovered a steady increase of visitors coming from Facebook (it has become the second or third highest source of traffic to our site next to direct visits or Google searches!). We have a community on our FB page of about 620 people. In our universe, that’s a pretty big group! It’s a group that is vocal, interested, and partly comprised of those who work in resource-poor settings trying to save women’s lives every day! We obviously want to continue growing and engaging this audience. So, it makes sense for me to attend the session on the new Facebook features. However, there’s a simultaneous session on community mapping. With the MHTF interactive maternal health maps growing in popularity among our new and returning members, this is also on my ‘do not miss’ list. What’s a Knowledge Management Specialist to do?

 

Luckily, I’m here with my colleague Chris Lindahl. We will divide and conquer!

 

More updates tomorrow….stay tuned.

 

*You can follow NTC Tweets on Twitter using #11NTC

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A Doctor in Your Pocket: mobile phone-based innovations revealed at the mHealth Summit

Monday, November 15th, 2010 by Raji Mohanam

Written 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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October 27th: New Applications for Existing Technologies to Improve Maternal Health

Saturday, October 9th, 2010 by Raji Mohanam

*Updated with new speaker information*

Please join the Woodrow Wilson Center’s Global Health Initiative, the Maternal Health Task Force, and the United Nations Population Fund (UNFPA) for the eighth event of the series on Advancing Policy Dialogue on Maternal Health: New Applications for Existing Technologies to Improve Maternal Health.

This program features David Aylward, Executive Director, mHealth Alliance at the UN Foundation; Alain Labrique, Assistant Professor, John Hopkins University Bloomberg School of Public Health; and Josh Nesbit, Executive Director, FrontlineSMS: Medic.

Program Date: October 27, 2010

Time: 3:00 p.m. – 5:00 p.m.

Location: 5th Floor Conference Room, Woodrow Wilson International Center for Scholars 1300 Pennsylvania Avenue, NW, Washington D.C. (Note: Photo identification is required to enter the building. Please allow additional time to pass through security.)

Live Stream: If you are interested, but unable to attend the event, please tune into the live or archived webcast at: www.wilsoncenter.org. The webcast will begin approximately 10 minutes after the posted meeting time. You will need Windows Media Player to watch the webcast. To download the free player, visit: http://www.microsoft.com/windows/windowsmedia/download.www.wilsoncenter.org/directions.

Please RSVP to globalhealth@wilsoncenter.org with your name and affiliation.

Program Summary:  In developing countries, the women most in need are often the most isolated, but mobile and web technologies are emerging as a way to bridge this gap and improve maternal health. Technologies such as SMS text messaging provide mothers, health care workers, and institutions with up-to-the-minute information critical to saving lives and building local capacity.

David Aylward, executive director of mHealth Alliance at the UN Foundation will explain how mobile and other emerging technologies such as digital games can facilitate the continuum of care for maternal health. Alain Labrique, assistant professor at John Hopkins University Bloomberg School of Public Health, will present data on mobile use in obstretric crises in rural Bangladesh and discuss opportunities, challenges and priorities for maternal and neonatal mHealth interventions in resource-limited settings. Josh Nesbit, executive director of FrontlineSMS: Medic, will discuss the role of collaborative partnerships and share challenges and lessons learned for scaling up existing technologies.

About the Maternal Health Policy Series: The reproductive and maternal health community finds itself at a critical point, drawing increased attention and funding, but still confronting more than a half million deaths each year and a high unmet need for family planning. The Policy Dialogue series seeks to galvanize the community by focusing on important issues within the maternal health community.

The Wilson Center’s Global Health Initiative is pleased to present this series with its co-conveners, the Maternal Health Task Force and the United Nations Population Fund (UNFPA), and is grateful to USAID’s Bureau for Global Health for further technical assistance.

For more information on the Advancing Policy Dialogue Series on Maternal Health, click here.

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Proud to be Indian and Making a Difference in Women’s Lives

Friday, September 10th, 2010 by KateMitch

Written by K G Venkateswaran, IntraHealth International

A longer version of this blog was originally posted on the IntraHealth International Global Health blog.

Sitting here in Delhi at the Global Maternal Health Conference in the India Habitat Center, I feel proud to be Indian. Yes, in part it is that the conference is well-run, and the speakers are thoughtful and thought-provoking, but also it is the fact that India is among the countries showing steady decline in the numbers of deaths related to pregnancy. In fact, the latest The Lancet numbers suggest we may be achieving as many as 4% fewer deaths every year in India.

These numbers reflect years of work and commitment on the part of many groups, including the Indian government. At the conference’s opening session, a number of government representatives spoke, including Dr. Montek Singh Ahulwalia, the deputy chairman of the planning commission. He pointed out that in 2004, India spent less than 1% of its GDP on public health; today that number is 1.2%. In the next five years, the government plans to increase spending on health to 3% of the GDP. In terms of the government’s focus on saving women’s lives, Minister of Health and Family Welfare Ghulam Nabi Azad said, “Finding the solution is not the challenge; the challenge is in implementing the solution.” Azad shared the government’s strategy of prioritizing districts that are in particular need of intervention and funneling additional human resources into the health system to strengthen the country’s ability to deliver health services. Even as we scale-up our funding and focus on public health and maternal health, Dr. Gita Sen, professor at the Indian Institute of Management in Bangalore, urged the global community to look beyond its focus on lowering maternal mortality rates to actually measuring women’s health outcomes in a variety of ways that account for the social, economic, and human development context.

This week, I have also had the pleasure to present several IntraHealth-led experiences, along with my colleagues Madhuri Narayanan, Fatou Ndiaye, and Sara Stratton:

· In Uganda, expansion of human resources for health, especially in the nursing field

· In India and Uganda, alternative supervision approaches to compensate for a shortage of people in supervisory positions

· In Rwanda and Mali, strengthened pre-service education

· In Senegal, integration of indicators on use of active management of third stage labor in the national level tracking of health performance.

I have been thrilled to hear about work similar to IntraHealth’s in Nepal, India, and Tajikistan on creating call centers and working with communities to provide emergency transport to women with childbirth complications and providing women with cash incentives to make maternal health services more accessible and encourage their use.

It has been a motivating week, and I look forward to sharing more of the development from Delhi soon.

K G Venkateswaran is the deputy director of the Planning for Improving Maternal and Neonatal Health in Northern India Project at IntraHealth International, Inc.

For more posts about the Global Maternal Health Conference, click here.

Visit the conference site here.

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Post-partum Haemorrhage: Low-tech Interventions, High Potential to Save Lives

Tuesday, September 7th, 2010 by KateMitch

Written by Maria M. Pawlowska, Cambridge University Gates Scholar

According to the latest WHO Countdown report, post-partum haemorrhage (PPH) is responsible for over a third of maternal deaths worldwide. During a session at the Global Maternal Health Conference last week, I learned about a number of prevention and treatment methods for PPH.

Dr. Sydney A. Spangler, Research Fellow at the Johns Hopkins Bloomberg School of Public Health, stressed that with any intervention, it is very important to consider the context not only on the national level, but also on the community level.

Misoprostol

The session focused to a large extent on misoprostol, a drug that is used for treating and, importantly, preventing post-partum haemorrhage in low-resource settings with minimal financial inputs but remarkably impressive health outputs.

Notable characteristics of misoprostol:

1.)   It is cheap

2.)   It is widely available

3.)   It has mild or no side affects

4.)   It is chemically stable in high temperatures (i.e. no need to have access to refrigeration or reliable electricity supply).


Misoprostol has an interesting background story. It was initially used to treat stomach ulcers. It was then discovered to be a safe method for inducing medical abortion (i.e. with no need for surgical interventions)—and it was soon realized that the same uterine contractions that lead to abortions in the first trimester can also stop or prevent excessive bleeding during labour, making it highly effective against post-partum haemorrhage.

Blood Collection Mat

When exactly is bleeding excessive? There is always some blood loss associated with birth, and as mentioned by Shabram Shanaz from Pathfinder, women in places like Bangladesh give birth in their clothes, so it is often difficult to judge blood loss.  In order to help women and their families decide when there is need to seek referral to a health clinic, an absorbent mat has been developed which indicates when a threshold of 500ml blood loss is reached. The mat is now one of the supplies given out to pregnant women.

Education

Shabram Shanaz went on to describe how the Pathfinder project in Bangladesh taught women and their families life-saving procedures which can be implemented with or without the assistance of a skilled birth attendant. Dr. Shanaz stressed the importance of empowering women and their families. If families are provided with basic information in a clear and culturally appropriate fashion, they can quickly become skilled at labour risk management and empowered to make the right decisions–whether it be taking the appropriate medication at home or seeking hospital referral. Pathfinder not only provides educational workshops but the organization also provides women with a post-partum haemorrhage kit. The kit, packed in a bright red bag, includes everything that a woman might need–including mobile phone numbers for health workers in the area. Supplying the bags costs only US$1 per bag—but have had a huge impact on the lives of women and their families. They are empowered to act. In fact, in the Pathfinder study area, all of the women used the supply kits.

Supplying misoprostol along with other basic equipment such as blood collection mats, in a way that is easily accessible when needed (i.e. in a container which is well-labelled and difficult to lose such as the red bags handed out by Pathfinder) is a low-tech and affordable, but effective way of improving maternal health. Gaps in research and funding are not the major barriers to making preventable maternal mortality a thing of the past––we know what works and many of the effective interventions are quite affordable.  Now, we need to think critically about how to get passed the barriers to implementing these proven interventions at scale.

For more posts about the Global Maternal Health Conference, click here.

Visit the conference site here.

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Maternal Health Accountability: The Crucial Next Step

Thursday, September 2nd, 2010 by KateMitch

Written by Kate Mitchell, Maternal Health Task Force


Ann Blanc, Director of the Maternal Health Task Force, welcomed attendees of the Global Maternal Health Conference to the third and final day of the conference. She recalled the Safe Motherhood Conference held in 1987 in Nairobi–and said, “Experts at the Nairobi meeting did not expect to be here today. They would have thought that by now preventable maternal mortality would be a thing of the past.”

Lynn Freedman, Director of the Averting Maternal Death and Disability program at Columbia University and moderator of the final plenary, opened the session with a statement that she said few could argue with: Many of the pieces are in place to make preventable maternal mortality a thing of the past; technical knowledge, money, political will, and big improvements on the great challenges of implementation. What we need now is accountability. The title of plenary three was Maternal health accountability: successes, failures, and new approaches.

Insights from plenary three panelists:

Sigrun Mogedal, of the Ministry of Foreign Affairs in Norway, discussed bi-lateral and mulit-lateral aid for maternal health. She noted the current momentum around maternal health but reminded conference participants that we have been here before–and asked, “Why should now be different?” She pointed out that consensus in New York is not the same as action on the ground. The missing piece needed for more action on the ground is accountability–and this is a matter of hard domestic policies. She said that bi-lateral and multi-lateral debates “take up too much space.” The global must serve and respond to the local, NOT the other way around.

Helena Hofbauer, Manager of Partnership Development at the International Budget Project, raised questions about aid effectiveness–and discussed national governments’ commitments to spending on maternal health. She described the work of the International Budget Project to use budget analysis to address persistent inequalities in maternal mortality. She said that the budget is a nation’s single most important overarching policy document. Helena asked, “What would happen if people actually asked the government how much and specifically on what they are spending to improve maternal health?” The International Budget Project did ask these questions on behalf of citizens, and the response was “deplorable”. In fact, the reply from Nigeria was that this sort of information is “sensitive and controversial” and from Tajikistan, “Please don’t bother the minister with these sorts of requests.” Helena declared, “This is, in practice, an accountability free zone.”

Nancy Northup, President of the Center for Reproductive Rights, talked about accountability within the context of a human rights and legal framework for improving maternal health. She described a paradigm shift from considering maternal health solely as a public health issue to now understanding it as a human rights issue. Nancy described the legal framework for how and why governments should be held accountable for maternal deaths–citing the right to life, health, equality and non-discrimination, privacy, spacing of children, to be free from cruel, inhumane or degrading treatment, and to education, information and the benefits of scientific progress. She described the process of litigation at the national and international level to demand individual compensation and systemic change–noting that demanding this sort of accountability is the next critical step in improving global maternal health.

Aparajita Gogoi, Executive Director of CEDPA India and the India National Coordinator for the White Ribbon Alliance, commented on accountability through grassroots advocacy. She said that working on the issue of accountability at the grassroots level occurs in three phases: gathering information, spreading awareness, and speaking out. She described a number of tools that can be employed to give local communities a voice including public hearings, check lists, verbal autopsies, and more. Aparajita talked about the importance of providing a safe setting for dialogue—a place where communities can voice concerns and demand action. She pointed out that crucial here, is that people with power are also present, take the concerns seriously, and are held accountable for taking action.

Follow the Maternal Health Task Force and EngenderHealth on Twitter: @MHTF and @EngenderHealth. The conference hashtag is #GMHC2010.

For more posts about the Global Maternal Health Conference, click here.

For the live stream schedule, click here.

Check back soon for the archived videos of the conference presentations.

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Making Outpatient Abortion Services a Reality

Thursday, September 2nd, 2010 by KateMitch

Written by Janna Oberdorf, Women Deliver

Every year, an estimated 20 million unsafe abortions take place. And of all maternal deaths, unsafe abortion accounts for 13%. Imagine if we could change that. Imagine if we could make a serious dent in the deaths and morbidities that are caused from botched abortions, from unhygienic surgeries, and from unskilled providers.

Now, imagine if we could change that with a few simple, low-cost pills. That’s what the drugs mifepristone and misoprostol are doing for women around the world.

At today’s panel session on “Reducing the toll of unsafe abortion using simple medical technology” at the Global Maternal Health Conference in Delhi, panelists laid out the landscape of how introducing and expanding access to medical abortions could save lives and prevent injury:

•    Beverly Winikoff, of Gynuity Health Projects, talked about misoprostol as first-line treatment of incomplete abortion, and about introducing and expanding existing services and implications for training. As she said, misoprostol is low cost, and it can increase women’s choice and reduce the burden on doctors and health facilities.

•    Patricio Sanhueza Smith, from the Secretariat of Health in Mexico City, talked about lessons learned from Mexico City on the potential of misoprostol alone for transitioning services. He said, “Medical abortion with misoprostol alone is not the Gold Standard, but it is a duty to widely disseminate its use, while mifepristone becomes available.”

•    Selma Hajiri, of the Center for Research and Consultancy in Reproductive Health, talked about a randomized controlled trial of medical abortion with misoprostol only versus mifepristone plus misoprostol. She said that although the combination is the gold standard, misoprostol alone should be promoted where mifepristone is not accessible.

•    Kelsey Lynd, of Stanford University, spoke about making outpatient services a reality. She discussed research on administering mifepristone and misoprostol at home, and a pregnancy test that could simplify medical abortion provision.

•    Hillary Bracken, of Gynuity Health Projects, spoke about expanding access late in the first trimester, and the promise of outpatient mifepristone and misoprostol after 63 days.

Though I’m constantly amazed by the possibility and potential of mifepristone and misoprostol for safe abortion, I was even more amazed to hear about Kelsey Lynd’s work on making outpatient services a reality.

Having an abortion is a difficult and traumatic decision, with serious health repercussions. But that decision becomes so much harder when you have to pay for a sonogram to determine gestation period; to attend a clinic to take the mifepristone; to return to the clinic two week later for a follow-up visit and second dose; and to have a second sonogram to ensure the pregnancy was terminated. It’s a time-consuming and costly decision… but every one of those steps also takes an emotional toll.

Lynd presented research that showed that it is safe for women to self-administer mifepristone and misoprostol at home. Though this is great news for time and money saving reasons, it also gives women some control and choice over when to start their abortion.

Lynd also presented findings on a home pregnancy test that determine their pregnancy status after abortion. This semi-quantitative pregnancy test is administered at the health facility while the woman is pregnant to achieve a baseline of her hCG blood level. Then, 1 to 2 weeks after the woman has been administered mifepristone and misoprostol, she can use the test to check if her hCG blood level has decreased, thus confirming termination of pregnancy. In her findings, 98% of women felt they could use the test on their own in the future, and the tests identified ALL ongoing pregnancies.

The implications for this research are mind-boggling. I think it is obvious that cutting down clinic visits and sonograms would save time (for the woman and the provider) and save money. But it is the emotional implications that jump out at me. The ability for women to feel they have some control over their bodies and their abortions is something that is severely needed.

One last note is that although these findings are encouraging in making outpatient services a reality, they must be partnered with education, information, and counseling. Home abortions are a scary thing. Bleeding for days on end is a scary thing. And women need to understand complications that need treatment, and have some emotional support. We need to guide these women with the proper education, counseling, call centers, job-aids, and more, if and when we finally make outpatient services a reality.

Janna Oberdorf is the Communications Manager at Women Deliver.

Follow the Maternal Health Task Force and EngenderHealth on Twitter: @MHTF and @EngenderHealth. The conference hashtag is #GMHC2010.

For more posts about the Global Maternal Health Conference, click here.

For the live stream schedule, click here.

Check back soon for the archived videos of today’s presentations.

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Of Ideas, National Programs, and Innovations in Service Delivery

Thursday, September 2nd, 2010 by KateMitch

Written by Saumya RamaRao, Population Council

It is Day 2 at the Global Maternal Health Conference and the energy level has revved up as all participants roll up their sleeves to get down to detailed discussions.  Today I learnt of ongoing innovations in maternal and newborn health from different parts of the world.  As I listened to the presentations, it was indeed learning about “context” and identifying general lessons for application elsewhere.

Here are my picks for the day gleaned from different sessions and conversations over tea with colleagues during breaks.

National programs: India’s National Rural Health Mission (NRHM) is an ambitious government initiative aiming to improve the health and wellbeing of its citizens with an emphasis on reaching the underserved with accessible and good quality services.  The NRHM provides a framework for individual states to experiment with ways to “accelerate the pace of decline in maternal mortality.”  A flagship project of the NRHM is the Janani Suraksha Yojana that provides poor, indigent women with cash incentives to deliver in health facilities.  It will be exciting to see whether the multi-pronged investments in health infrastructure, quality accreditation mechanisms, workforce retention strategies and others will indeed result in demonstrable gains in maternal and newborn health.

Ideas: An idea that was repeated in different ways at different sessions was that it is not always necessary to follow an “either or” approach whether it is a choice between community based initiatives versus facility based initiatives, oxytocin versus misoprostol for post-partum hemorrhage, or any other such choice.  These tensions can be resolved by “context” specific rationale and solutions too may change and evolve over time with changing circumstances.

Another idea discussed in several sessions was the active role that communities play in the organization of their health care—whether taking on activities such as health promotion and education that are “task-shifted” to them or resource generation to fund volunteers and or services.  In a world of health sector reform, as Zulfiqar Bhutta noted devolution can “create demanding communities” leading to a “democratization of public health”.

Innovations in service delivery: Today there were many opportunities to learn about programming strategies currently being tested in many countries.  I was able to attend a couple of sessions on community-based initiatives for post-partum hemorrhage prevention and control.

Here are my sound-bytes from these sessions:

•    Community-based distribution of misoprostol for PPH is feasible in resource poor settings
•    There is a high degree of correct use by women delivering at home
•    Common side-effects include shivering, nausea, dizziness, and fever which seem to occur at the same rate in both misoprostol and non-misoprostol treated women
•    Misoprosotol is acceptable to women, families, and their communities
•    There has been little misuse noted of the drug whether for labor induction, augmentation or for terminating a pregnancy
•    Women can be trusted to be educated consumers when they are treated as active rather than passive participants of  programs
•    As misoprostol for PPH prevention goes to scale, it will be important to think about ensuring adequate supplies and logistics.

Saumya RamaRao is an economic demographer with research interests in safe motherhood, abortion and postabortion care, and family planning.  She has experience in monitoring and evaluation of reproductive health programs, cost analysis, and the use of data for program design and improvement.

Follow the Maternal Health Task Force and EngenderHealth on Twitter: @MHTF and @EngenderHealth. The conference hashtag is #GMHC2010.

For more posts about the Global Maternal Health Conference, click here.

For the live stream schedule, click here.

Check back soon for the archived videos of today’s presentations.

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Community and Facility Interventions: Striking the Right Balance

Wednesday, September 1st, 2010 by Raji Mohanam

Written by Kate Mitchell, Maternal Health Task Force

Plenary one at the Global Maternal Health Conference in Delhi was about finding common ground amidst two sets of maternal mortality estimates. Much like plenary one, plenary two, Community and facility interventions: reframing the discussion, was also about finding a common ground. It was about closing the divide between those who advocate for community-based care and those who advocate for facility based care–an issue that has caused major debates in the maternal health community for decades. This session was about reframing the discussion from “one or the other” to “both”. Plenary speakers called for an understanding that improving global maternal health must be about striking the right balance–and scaling up evidence-based interventions both at the community level and within facilities.

Brief insights from the second plenary:

Syeda Hameed, Member of the Planning Committee of the Indian government, challenged the nearly 700 conference attendees to think critically about one question: “How do we reach the unreached woman who is grappling with issues of maternal health?” Syeda then asked attendees to consider the woman who died last week on a busy Delhi street after delivering her baby. She asserted that training local women is KEY–and said that illiterate or semi-literate women can be trained and can save lives. She cited projects in Gadchiroli as evidence that this is achievable. Syeda also said that India must spend more not only on health, but also on the social determinants of health.

Zulfiqar A. Bhutta, Head of the Division of Maternal and Child Health at Aga Khan University, asked conference attendees to consider community-based and facility-based interventions as complementary and interconnected. He cited studies that have shown the impact of community-based interventions in improving maternal morbidity as well as increasing institutional deliveries. He characterized the debate around community vs. facility interventions as a confrontation that has unnecessarily split the field of maternal, newborn, and child health. He proposed an approach that focuses on the continuum of care: Where we have no facilities, we must adopt community based interventions. Where we have some access to skilled attendants, we should use incentive systems, like JSY, to encourage facility-based deliveries. And where there are facilities, we should supplement them with community-based services to support antenatal and postnatal care.

Harshad Sanghvi, Vice President and Medical Director of Jhpiego, said that striking the right balance between community-based and facility-based interventions is going to involve task-sharing. He said that one problem with solely advocating for facility-based care is that what often happens is that we go from poor access to low quality services to improved access to crowded and lower quality services. “We need to figure out logistical support to improve quality within facilities and use task-sharing to improve access to quality care at the community level.” Harshad discussed his experience with community-based distribution of misoprostol in Indonesia, Nepal, and Afghanistan which was safe, feasible, and programatically effective. He also raised transport and referral issues, stating that improving the capacity of communities to administer life-saving drugs will help to reduce the need for emergency transport. He also noted maternity waiting homes as a good option to consider.

P. Padmanabhan, Director of Public Health in Tamil Nadu, Ministry of Health and Family Welfare, India, expressed the importance of considering context when implementing maternal health interventions in India. He described numerous context driven maternal health intervention strategies throughout many regions of India–illustrating why some projects work better in certain regions that others. He concluded by saying that we must improve service delivery at both the community and facility level, always taking local context into account.

For more brief insights from our conference presenters, follow the Maternal Health Task Force and EngenderHealth on Twitter: @MHTF and @EngenderHealth. The conference hashtag is #GMHC2010.

For more posts about the Global Maternal Health Conference, click here.

For the live stream schedule, click here.

Check back soon for the archived videos of the conference presentations.

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