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Date: Wed, 29 May 2002 13:29:53 -0400
From: Sonia Elabd <[log in to unmask]>
Subject: MNH Update, May 2002
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Please click on the website address http://www.mnh.jhpiego.org/updates/ to read the MNH Update. For those who cannot access the version on the website, please scroll down below for a text version.
THE MNH PROGRAM: BUILDING A LEGACY FOR IMPROVED MATERNAL AND NEWBORN CARE
The MNH Program has issued a new report reviewing its first 3 years of programming. Some highlights of The Maternal and Neonatal Health Program: Building a Legacy for Improved Maternal and Newborn Care (A Review to Date) include the following:
In 1998, the MNH Program operated country programs in seven countries in Africa, Asia, and Latin America. By 2001, the Program worked in 11 countries-Bolivia, Burkina Faso, Guatemala, Guinea, Honduras, Indonesia, Nepal, Peru, Tanzania, the Regional Centre for Quality of Health Care (based in Uganda), and Zambia. In these countries, across regions and in its global work, the Program is building a legacy of change in support of the international safe motherhood agenda by working toward lasting results in clinical services, policy, and behavior change:
· The MNH Program has worked through global partnerships to develop and establish international evidence-based standards for maternal and newborn care and to implement them both globally and at the country level. The completion, launch, and dissemination in 2001 of Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors represented the culmination of 3 years of collaboration with the World Health Organization.
· By helping to implement international evidence-based standards and guidelines in national policy, curricula, and competency-based training, the MNH Program works to improve the quality of skilled attendance. In 2001, the Program began adapting and implementing Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors as a standard for essential maternal and newborn care in eight countries-Bolivia, Burkina Faso, Guatemala, Indonesia, Nepal, Peru, Tanzania, and Zambia.
· The MNH Program promotes birth preparedness and complication readiness as a means to reduce the delays-in deciding to seek care, reaching care, and receiving care-that often result in maternal and newborn deaths. A major focus and goal of the Program is to develop awareness of and encourage communication about the factors that cause these delays and to promote shared responsibility for birth preparation and complication readiness among women, families, communities, providers, facilities, and policymakers.
· The MNH Program collaborates with other donors and technical agencies to combine expertise and input, to promote synergies, and to ensure the coordination of available resources to increase the use of evidence-based practices, tools, and approaches. The MNH Program continues to expand its network of global partners and to strengthen and deepen its ongoing relationships. Key partners include the Centers for Disease Control and Prevention, Columbia University's Averting Maternal Death and Disability Program, UNICEF, United Nations Population Fund, World Bank, and World Health Organization.
The Program is also working to establish the evidence base for social and behavior change interventions that generate informed demand and collective action for maternal and newborn health. In the majority of program countries, the MNH Program is supporting innovative strategies and approaches for social and behavior change that include promoting the global White Ribbon Alliance at the country level, community participation in the development of health services, mobilization of religious groups for Safe Motherhood, and innovative media campaigns. Read the full report on the MNH Program website (www.mnh.jhpiego.org).
MANAGING COMPLICATIONS IN PREGNANCY AND CHILDBIRTH MANUAL USED AS GUIDELINES TO UPDATE REGIONAL AND NATIONAL STANDARDS OF CARE
Emergency Obstetric and Newborn Care Curriculum in West Africa Updated to Include Evidence-Based Practices
For more than 1 year, the MNH Program has participated in the development of an emergency obstetric and neonatal care curriculum for preservice education and inservice training in Francophone West Africa. This document is the result of joint efforts of multiple JHPIEGO awards, primarily the Santé Familiale et Prévention du SIDA (Family Health and AIDS Prevention) Project, the MNH Program, and the Training in Reproductive Health Project. The Soins Obstetricaux et Neonataux d'Urgence (SONU) curriculum covers many clinical areas of emergency care and includes an introduction to the management of bleeding during early pregnancy. From 22 to 26 April 2002, the MNH Program participated in a workshop in Abidjan, Côte d'Ivoire, to work with a group of doctors and midwives from medical and midwifery schools in five African countries to ensure that the new curriculum is consistent with the evidence-based practices outlined in the manual Managing Complications in Pregnancy and Childbirth. The curriculum will be disseminated to more than 20 medical and midwifery schools in West Africa where it can be adapted to country needs.
Clinical Skills Course in Bolivia Marks Beginning of Implementation of Ministerial Resolution To Include Evidence-Based Practices
The Bolivia Ministry of Health issued a Ministerial Resolution in October 2001 officially incorporating evidence-based practices from Managing Complications in Pregnancy and Childbirth manual as the standard in health facilities throughout the country. Working toward applying those practices in the clinical setting, the MNH Program supported two trainers in conducting a clinical skills course. These trainers had previously been updated in the knowledge and skills that are essential for managing obstetrical complications. They also participated in a clinical training skills course to improve their training skills.
The clinical skills course, called Current Knowledge and Skills for Managing Maternal and Neonatal Complications, was held in El Alto, Bolivia, from 8 to 19 April 2002 and focused on standardizing the skills of eight doctors at two hospitals in El Alto--Hospital Boliviano-Holandes and Hospital Corea. The MNH Program will follow up the participants and the clinical sites to help the participants transfer the skills they learned to others. In addition, the MNH Program will continue to work to strengthen the trainers' skills and training systems that promote the implementation of the Ministerial Resolution.
MNH PROGRAM APPLIES THE PERFORMANCE AND QUALITY IMPROVEMENT PROCESS IN LATIN AMERICA TO IMPROVE MATERNAL AND NEWBORN CARE
Guatemala Institutionalizes the CaliRed Performance and Quality Improvement Process in the Ministry of Health System
As a result of a Ministerial Agreement in November 2001, the CaliRed Performance and Quality Improvement (PQI) Process was formalized by the Ministry of Health as a national strategy for improving the quality of maternal and newborn healthcare. This process has been the key element of the MNH Program strategy to improve maternal and newborn care in Guatemala. In April 2002, the MNH Program facilitated two training workshops.
During the first workshop, external evaluators were trained in how to check the progress in performance at facilities that have implemented the PQI process. Forty participants attended the workshop including representatives from the Ministry of Health, ob/gyn society, medical and nursing schools, and other health professional associations. An action plan was drafted that includes next steps and a timeline. The external evaluators can now participate in verification assessments and recommend whether facilities that have undergone the verification step should be accredited.
The second workshop, conducted in collaboration with the Johns Hopkins University Center for Communication Programs, was the third training module for the Quality Improvement Support Teams. The workshop trained the teams in strengthening the PQI process and integrating the process into the Ministry of Health's institutional systems. Participants of the workshop included representatives from the Ministry of Health, healthcare providers, and administrative staff from several health facilities. The workshop included information about the PQI process, verification assessments, and accreditation, but also involved linking the community with the health services. The participants also reported significant progress in the PQI process in their facilities and devised an action plan that includes next steps and a timeline.
Training Workshop in Honduras Broadens Implementation of PQI Process from One Hospital to the Regional Level
Building on experiences from Guatemala, the MNH Program began the PQI process last year in Hospital Regional del Occidente in Santa Rosa de Copán, Honduras. In April, the MNH Program facilitated a workshop to train a regional Quality and Improvement Support Team to implement and monitor the PQI process in Health Region 5. Twenty-five participants attended the workshop including healthcare providers, staff, and directors from three hospitals, Health Region 5 Director, Health Region 5 Partners for Health Reform Coordinator, and two representatives from the Ministry of Health.
The objective of the workshop was to update participants about quality and performance concepts and methodology. This information will help the participants to apply the process, conduct a baseline measurement of performance in new facilities, analyze performance gaps, and develop an action plan to implement rapid solutions. Providers from the Hospital Regional del Occidente presented their experience and progress to date. The participants are enthusiastic about using the PQI methodology in their facilities, and the key stakeholders that attended showed a high level of interest in and commitment to the process. An action plan and a tentative calendar of activities were outlined to continue the implementation of the process.
MNH AFRICA REGIONAL EXPERT PRESENTS LESSONS LEARNED AT INTERNATIONAL CONGRESS
On 15 April 2002, Mary Jonazi, a midwife from Malawi who is a MNH Africa Regional Expert, gave a presentation titled, "Developing Regional Experts in Maternal and Neonatal Health" at the Twenty-Sixth Triennial Congress of the International Confederation of Midwives in Vienna, Austria. Mrs. Jonazi described the MNH Program's process of developing regional experts in Africa and the lessons learned from this process. After the presentation, the audience discussed the changes in healthcare practices in facilities and institutions that have occurred as a result of the activities that other regional experts have conducted.
UNICEF provided the financial support for Mrs. Jonazi to attend the congress, which took place from 14 to 18 April 2002 and is the largest gathering of midwives in the world.
WINNERS OF THE THIRD ANNUAL WHITE RIBBON ALLIANCE CONTEST FOR SAFE MOTHERHOOD
More than 18 entrants from throughout the world designed awareness-raising campaigns at the community, policy, or health service delivery level for the contest. Congratulations to the top three winning entries: 1) Association of Safe Motherhood Promotions, South East, Nigeria, 2) White Ribbon Alliance, Koupéla, Burkina Faso, and 3) Safe Motherhood Network, Nepal. The Global Health Council and the White Ribbon Alliance for Safe Motherhood will highlight the work of the winners at the Global Health Council Annual Conference in Washington, DC, "Global Health In Times of Crisis" from 27 to 31 May 2002.
ZAMBIA WHITE RIBBON ALLIANCE PROMOTES NATIONAL CAMPAIGN ON MOTHER'S DAY
The Zambia White Ribbon Alliance for Safe Motherhood promoted a national campaign on Mother's Day, 12 May 2002, in coordination with the Zambia Nurse's Association's promotion of International Nurse's Day. To encourage people and organizations to carry out social mobilization activities, the White Ribbon Alliance developed a toolkit that contained technical information on birth preparedness and complication readiness-the theme of the campaign-and distributed the toolkit throughout the country. The kit also contained some ideas for conducting low- or no-cost mobilization activities. Some examples of the mobilization activities that were done throughout the country include marches and rallies in Lusaka and other districts, distribution of the white ribbon and information on safe motherhood in Zambia at concerts and other events, a series of activities in a local chief's village in a remote province, and an event for mothers in a rural village with support from the local area member of Parliament and District officials.
HEALTH COMMITTEE IN GUATEMALA MOBILIZES COMMUNITY RESOURCES FOR LIFE-SAVING PLAN
In Guatemala, community-based life-saving plans (planes de apoyo a la vida) reflect a communities' commitment to the survival of women and newborns. Designed with the support of the MNH Program and the Ministry of Health, the life-saving plans designate the responsibilities of key stakeholders-community leaders, local authorities, and available health service personnel, community members, families, and women-in getting a woman or newborn to life-saving care.
In El Porvenir, Malacatan, Guatemala, the health committee invited leaders from the community, businesses, and churches to one of their bimonthly meetings to tell the community about the community-based life-saving plans. The committee was hoping these leaders would join together to donate resources for the plans (e.g., transportation, communication, money, promotional support, etc.). At the meeting, a priest offered the church's ambulance to provide transportation in case of an emergency. Later, the priest told the committee that the vehicle was not working and that the church was waiting for another vehicle. By mobilizing the resources of public and private sectors, the health committee obtained commitments from the National Civil Police of San Pablo and the Health Area to secure transportation while the church waited for its new vehicle. With the help of the Municipality and other institutions, the health committee is establishing a common fund to support their activities and execute the life-saving plans.
NEW INFORMATION SHEETS ON THE MNH PROGRAM WEBSITE
· Postabortion Care: Skills Care and Comprehensive Services (Best Practice)
· French and Spanish translations of Birth Preparedness and Complication Readiness: A Matrix of Shared Responsibility
· Bolivia Country Profile (Spanish)
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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 are welcome. Previous issues can be viewed on our website at www.mnh.jhpiego.org/updates/. For 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.
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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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