Dr Jane Sandall
Professor of Midwifery and Women's Health
Florence Nightingale School of Nursing & Midwifery
King's College, London
57 Waterloo Road, London
SE1 8WA
Tel: 020 7848 3605
Fax: 020 7848 3506
e-mail:[log in to unmask]
http://www.kcl.ac.uk
Moderator Midwifery Research Discussion List
for ICM Research Standing Committee
http://www.jiscmail.ac.uk/lists/midwifery-research.html
----- Original Message -----
From: "Jane Sandall" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, August 31, 2001 7:10 PM
Subject: FORWARD: MNH Update, August 2001
--- Begin Forwarded Message ---
Date: Tue, 28 Aug 2001 14:50:18 -0400
From: Sonia Elabd <[log in to unmask]>
Subject: MNH Update, August 2001
Sender: Sonia Elabd <[log in to unmask]>
To: [log in to unmask]
Reply-To: Sonia Elabd <[log in to unmask]>
Message-ID: <[log in to unmask]>
Please click on the website address http://www.mnh.jhpiego.org/Updates/ to
read the August MNH Update. For those that can't access the version on the
website, please scroll down below for a text version.
LATIN AMERICA
Guatemala: Improved Clinical Care Reduces Costs at Amatitlán Hospital
With support from the MNH Program, Amatitlán Hospital has incorporated two
labor and childbirth interventions into its healthcare services: active
management of the third stage of labor and restricted use of episiotomy.
Active management of the third stage of labor involves giving oxytocin to
encourage uterine contractions, using controlled cord traction to deliver
the placenta and massaging the uterus after delivery of the placenta.
Initially, the hospital director was concerned that giving oxytocin to every
woman during childbirth would significantly increase the hospital's costs.
But, because active management reduces the risk of postpartum bleeding in
women, the opposite occurred. Since implementing this practice in February,
the hospital has not had to provide any blood transfusions, whereas four
transfusions were done during the same period last year (February to June).
Also, implementing this intervention has greatly reduced the number of
linens that need to be laundered, which has decreased the use of scarce
resources such as detergent and water.
In addition, the number of episiotomies performed on women who were having
their first childbirth decreased from nearly 100% to 10%. For every
episiotomy that was not performed, the hospital saved about US $25 in
supplies, including sutures and local anesthetic, and the cost of
sterilizing equipment. Contact: Kelly Curran, [log in to unmask]
Sololá Hospital in Guatemala Welcomes Comadronas
In the western highlands of Guatemala, more than 90% of all births occur at
home and are attended by a comadrona, a Mayan traditional birth attendant.
Many women prefer comadronas to healthcare providers at hospitals because
comadronas speak regional languages and provide emotional support to women
during labor and childbirth. In the past, women who gave birth in Ministry
of Health (MOH) hospitals were not allowed to have a support person present
during labor. In addition, healthcare providers at hospitals have not
welcomed comadronas because of a perception that their cultural practices
are not compatible with facility-based care.
Over the past 4 months, the MNH Program has conducted a number of activities
as part of its culturally-adapted hospitals initiative. This project aims to
make MOH healthcare services more culturally accessible and increase the
number of women whose births are attended by skilled providers. To
strengthen the links between comadronas and providers at hospitals, Sololá
Hospital, in the western highlands, has worked with the local comadrona
organization to establish an on-call system for comadronas at the hospital.
The comadronas now have a room in the hospital, just as physicians have,
where they can rest between patients and be available 24 hours a day to
provide emotional and social support during labor and childbirth. The
results of exit interviews have shown that women are now more satisfied with
the quality of care at the hospital. The MOH is monitoring the service
statistics to determine if the new system increases the use of services at
the hospital. Contact: Kelly Curran, [log in to unmask]
Bolivian Community Leaders Participate in Quality Improvement Process
As a part of the decentralization of the health sector in Bolivia, the
government is supporting activities to delegate responsibility for the
management of public sector health services to the municipal level. To
support these efforts, the MNH Program has been working with the MOH,
municipal authorities and community leaders to develop and implement
strategies to improve the quality of health services. One of the main
strategies for sustainable quality improvement is the Defensores de la Salud
(Health Guardians) initiative.
The defensores are chosen by their communities and trained by the MNH
Program using a manual developed by the MOH and MNH Program. The defensores
are responsible for helping their communities monitor the quality of health
services by assessing the waiting times and friendliness of the healthcare
providers, ensuring that feedback regarding the quality of services is given
to municipal authorities and conducting community meetings. The MNH Program
is currently field-testing guidelines and job aids that support these
activities. Following validation of these materials, they will be published
and disseminated throughout the country using funds from other donors. The
MNH Program will support their implementation in the 17 priority districts.
Contact: Kelly Curran, [log in to unmask]
MNH Program Launches New Program in Paraguay
In May, USAID/Paraguay awarded funding to the MNH Program to develop a
program in Caaguazú, Paraguay, one of the poorest regions in the country.
The new program will use a PQI approach to improve the quality of maternal
and newborn healthcare services in Caaguazú. The Paraguay program will use
the approaches and lessons learned from the other MNH Program countries in
the region, particularly those from Guatemala and Bolivia. Contact: Kelly
Curran [log in to unmask]
Uruguay Training Improves Healthcare Services
In June, the MNH Program, in collaboration with the Latin American Center
for Perinatology (CLAP) in Montevideo, conducted a training activity at the
Centro Hospitalario Pereira Rossell (CHPR). Twenty-four ob/gyn doctors were
trained in the application of the WHO/JHPIEGO Managing Complications in
Pregnancy and Childbirth manual and the development of innovative ways to
help healthcare providers learn these principles. The majority of the
training occurred on the labor ward of CHPR, and covered interventions such
as active management of third stage of labor, restricted use of episiotomy,
manual vacuum aspiration for incomplete abortion and use of the partograph
to monitor labor progress.
The training had an immediate impact on services in the hospital. Before the
training, 85% of women who were having their first child had episiotomies.
During the first month after the training, 42% of women having their first
child had episiotomies. In addition, active management of third stage labor
is now being more routinely applied. Representatives from CLAP and CHPR plan
to design a practical course to disseminate these best practices. Contact:
Kelly Curran, [log in to unmask]
AFRICA
Uganda: Workshop Promotes Evidence-Based Practices for Maternal and Newborn
Care
The Regional Centre for Quality of Healthcare, with support from the MNH
Program and Regional Economic Development Services Organization (REDSO),
facilitated a workshop in Uganda titled "Improving Quality of Care: Maternal
and Neonatal Health Update" from 6-10 August. Participants from seven
countries attended the workshop. The main goal of the course was to update
participants' knowledge about evidence-based practices for maternal and
newborn healthcare.
During the workshop, participants identified better practices that they
would like to either improve on or apply in their job situations. At the end
of the workshop, participants developed country action plans for
implementing these practices. For example, the Zambian participants will
help form a core team within the Zambia White Ribbon Alliance for Safe
Motherhood (WRA) to build capacity of member nongovernmental organizations
in technical maternal and newborn health content areas. Contact: Alice
Mutungi, [log in to unmask]
Zambia White Ribbon Alliance for Safe Motherhood Elicits Support from the
Community
The MNH Program, in conjunction with the WRA and the Zambia Integrated
Health Program (ZIHP), conducted a safe motherhood competition for
journalists in June and July that generated 40 entries (25 newspaper
articles, 12 two-part radio broadcasts and three TV special news
broadcasts). The competition began on 22 May with an orientation for 22
journalists on key issues in maternal and newborn healthcare. Many of the
submissions reported on aspects of the maternal health crisis in Zambia.
In July, with support from ZIHP and the MNH Program, the WRA actively
participated in the World Population Day (11 July) activities. The main
theme for Zambia was "Improving the Status of Women," and safe motherhood
was one of four sub-themes. The WRA was able to effectively communicate the
message, "Every pregnancy is a risk...make it safe, plan ahead," the
predominant theme at the main event. The Chair of the Alliance, Dr. Mary
Zulu, was one of the keynote speakers at the culmination of the march.
Contact: Rick Hughes, [log in to unmask]
Midwifery Education Strengthened in Zambia
In July, the Curriculum Strengthening Team from the Lusaka School of
Midwifery worked with the General Nursing Council to strengthen midwifery
education by implementing their action plan for adopting the revised
midwifery curriculum. The Team conducted technical updates on maternal and
newborn care for 29 healthcare providers from clinical sites where students
receive clinical training. Contact: Rick Hughes, [log in to unmask]
ASIA
Regional Expert Development Course Conducted in Indonesia
Twenty-one midwives and physicians from Bangladesh, Indonesia and Nepal
attended the MNH Program Regional Expert Development course in Jakarta from
16 July-3 August. The intensive course consisted of a 1-week knowledge
update and 2 weeks of clinical training at the Budi Kemuliaan Maternity
Hospital. The course enabled healthcare providers from different areas to
share their ideas and experiences on improving maternal and newborn care in
low-resource settings. This course is the first in a series of courses
designed to develop a core group of regional leaders who can educate and
advocate for the provision of quality maternal and newborn healthcare in
their own countries. Participants have already made a commitment to
introduce changes at their institutions based on the knowledge they acquired
during this course. Course facilitators will follow up participants in their
clinical setting to support them as change agents. Contact: Harshad Sanghvi,
[log in to unmask]
Message and Materials Developed to Improve Maternal and Newborn Survival in
Nepal
The MNH Program is continuing to provide technical assistance to the
National Health Education, Information and Communication Center (NHEICC) in
Nepal to standardize key safe motherhood messages, and is contributing
significantly to the development of the National Safe Motherhood
Information, Education, and Communication (IEC) Strategy. The four
components of the strategy are:
· increasing access to and utilization of services;
· improving service provision, availability and quality;
· promoting an enabling environment, women's status and recognition of
"laaj" (shyness); and
· enhancing operational objectives for implementation.
The strategy has a dual approach: one that increases awareness and birth
preparedness where essential obstetric care (EOC) services are not available
or are non-functional, and another that focuses on appropriate EOC-related
care-seeking behaviors where EOC facilities are available.
The strategy development process has mobilized interest in safe motherhood
IEC, leveraged resources across safe motherhood projects and unified IEC
activities under the proposed strategy. The MNH Program and the Nepal Safer
Motherhood Project are assisting NHEICC to finalize the strategy. The MNH
Program is also providing technical assistance to NHEICC to produce
prototypic materials including posters, fliers, comic books and radio public
service announcements that address the two-part strategy. Contact: Stephanie
Suhowatsky, [log in to unmask]
The Maternal & Neonatal Health (MNH) Program at the JHPIEGO Corporation
produces MNH Updates for those working to promote maternal and neonatal
health. Activities reported are those of the MNH Program. Please notify us
of other Safe Motherhood activities of interest to our readers. Your
comments and suggestions are welcomed! Previous editions of MNH Updates can
be viewed on our website at www.mnh.jhpiego.org/updates/index.htm. To obtain
more information about MNH Updates, e-mail Sonia Elabd, [log in to unmask],
or visit our website, www.mnh.jhpiego.org
This publication was made possible through support provided by the Office of
Health and Nutrition, Center for Population, Health and Nutrition, Bureau
for Global Programs, Field Support and Research, U.S. Agency for
International Development, under the terms of Award No.
HRN-A-00-98-00043-00. The opinions expressed herein are those of the
author(s) and do not necessarily reflect the views of the U.S. Agency for
International Development.
--- End Forwarded Message ---
----------------------
Dr Jane Sandall
Professor of Midwifery and Women's Health
King's College
57 Waterloo Road
London
SE1 8WA
Tel: 020 7848 3605
Fax: 020 7848 3506
email: [log in to unmask]
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