Comments on: How to Improve Maternal Health Around the Globe Making the Millennium Development Goals Happen Tue, 25 Jan 2011 13:09:41 +0000 hourly 1 By: Zaharat Ara Tahmina Sarker Zaharat Ara Tahmina Sarker Tue, 07 Dec 2010 20:58:23 +0000 BCC, BCC and BCC. I have diversified experience in the field of reproductive health. My deep concern related to maternal health improvement is communication of necessary focussed information on maternal health issues among the community people. Focus must be given to the religious leaders, community influentials and segmented groups. Messages must be clear and understandable. I found in many places that service are available but demands are not considerable. In 3rd world countries women do not have freedom to move and to seek health care for themselves. Awaring families is of great importance which will cover care of a girl to care of women and motherhood. Our family health workers are the person who make awareness and few radio and TV messeges are there but all families do not have access to those media. Street dramas and folklore songs are limited activities. We need to explore more alternatives of behavior change communication activities keeping in mind that many people are not literate.

We found one of the three delays are delay in transportation. We can involve local tranport union as partner to organise immediate transport of an emergency maternal case to secondary/tertiary healthcare facilities. It is possible in many situations.

I was involved in developing advocacy folder of on maternal health of Afghanistan for Advocacy folder of UNICEF (ROSA), I saw many efforts were going on but the security situation and geography made adverse situation of maternal health situation in Afhghanistan. Those needs intensive political advocacy, developing appropriate realistic policy and strategy and appropriate implementation plan along with workable monitoring and supervision plan.

I have seen partnership activities in the PHC-FP project of CLP (The Chars Livelihoods Programme) in Bangladesh. A good effort in demand side financing throughestablishing health voucher system. Making community members as partner of the project. Private hospitals are partner and providing good services. All is needed a better monitoring by the community themselves.

By: Gary Forster Gary Forster Mon, 01 Nov 2010 15:03:13 +0000 In order to accelerate progress towards MDG 5, Transaid has been undertaking a number of projects focussing on reducing the 2nd delay – primarily seeking solutions for minimizing the delay associated with reaching health facilities and also reducing the associated transport costs.

In Nigeria we have been working on projects to establish emergency referral systems in partnership with the National Union of Road Transport Workers (NURTW). Union members are trained how to recognise signs of a maternal emergency, how to lift a pregnant woman, the importance of minimizing delay, and basic vehicle maintenance. In 4 states where the system has been established we have seen more than 1,000 women transferred in the past 12 months.

In Nigeria we have also been working to strengthen the management of government ambulance services; training transport officers how to manage their vehicles, how and when to maintain them, and how to ensure appropriate budgets are available for offering referral services.

In Zambia we have been undertaking 2 projects associated with improving referral systems. Firstly we have been helping to review the transport arrangements for the most rural communities as part of the Mobilizing Access to Maternal Health Services in Zambia (MAMaZ) project. MAMaZ is a UK Department for International Development (DFID)-supported programme that promises to be a catalyst to addressing the underlying reasons why people do not get the maternal and newborn health services they need. The programme is being managed by Health Partners International.

Also in Zambia we have just completed the final monitoring visit for the Eastern Province Bicycle Ambulance Project. The latest data shows that 30 bicycle ambulances were involved in approximately 270 patient transfers of which approximately 70 were associated with deliveries.

In Afghanistan we have been working to support NGOs develop designs for stretchers to move women from very hard to reach mountainous communities and advising on the establishment of community “stretcher teams” – groups of men who will take responsibility for ensuring pregnant women will reach the facility promptly when emergencies arise.

Transaid is an international development charity that seeks to reduce poverty and improve quality of life through providing better access to basic services such as health, education and economic opportunities in Africa and the developing world. Transaid does this by building local skills and knowledge to make transport safer, cheaper and more effective.

By: Regina Gyampoh-Vidogah Regina Gyampoh-Vidogah Tue, 26 Oct 2010 19:11:43 +0000 Improving maternal health in developing countries using digital information systems

Maximizing mortality impact for mothers, newborns and children in developing countries depends on using local data to priorities the most effective mix of interventions, while building a stronger health system. The challenge remains in the following areas:
• Gap between essential information systems and technology skills and workforce capacity at state and local level.
• Lack of trained health workers to serve remote communities.
• Lack of medical assistance and other resources to cater for mothers (such as, transport, health centers especially in rural areas).
• Lack of affordable and timely access to reliable and comprehensive information that can track diseases and cases so that appropriate and equitable health care can be provided in rural areas.

Promoting the use of information systems and communication technology
• A system should be in place to improve access to new technologies.
• Reported maternal cases should be in place and an independent body to check data from admission, discharge and delivery. Thus, the use of local data to priorities mortality support, improved population and facility-based information systems so that they can generate, analyze and use reliable information from multiple data sources in collaboration with partners.
• Community nurses or outreach services should be based/available within communities to monitor the women.
• An information system that can track and monitor maternal cases.

Enhancing contents and skills of health professionals
The need for digital information system that will provide information and training including:
• Information relating to children, mothers and families on aspects of child and maternal health.
• Information should be designed to help staff/nurses become effective.
• Develop skills in areas such as management, consultation processes and high level clinical competence and other applied research.
• Field placements that will allow health professionals test their newly acquired knowledge and skills, using data and research to identify the best ways to accomplish this.

By: Ali Muhammad Ali Muhammad Tue, 19 Oct 2010 10:55:17 +0000 We can improve the reproductive health status through Participative integrated and meaningful Public Private Partnership at grass root level.

Community Support Concern has implemented a project “Improving the Reproductive health & rights of marginalized and underserved communities: Dera Ghazi Khan, Pakistan” from Apr 2006 to Sep, 2010 with financial and technical assistance of European Commission and Interact world wide respectively. During which quality health services including Ultra Sound through CSC’s & Collaborative community clinics, mobile service units with Govt Health department under Public Private Partnership (at Basic Health Unit and District Head Quarter Hospital DG Khan) and capacity building of all stakeholders e.g Community elites/CBOs, local elected representatives, religious leader, Traditional Birth Attendants. Community Based Distributors. Private Practitioners, adolescents and women groups have been made in integrated way and through BCC techniques so that sustainability aspect remained alive after the project completion.
The above endeavor contributed in the light that mean age marriages has been increased from 15- to 18%, knowledge regarding danger signs (at least 3) during pregnancy, delivery and post natal period increased by 85.4%, 87.9% and 95.9% respectively. Moreover 90 % CBOs members and youth adolescents have advanced knowledge on RH&R, women mobility by 42%, and their control over resource increased by 98%, 50% Religious Leaders actively taking part in promotion RH&R, CPR increased by 23.1%, Pregnant women check-up by trained Birth attendant increased by 71.9%, 2 or more Ante-natal check increased by 60%, immunization against tetanus increased by 42.4%, 57.7% deliveries conducted by trained birth attendants at home level during which 100% TBAs washed their hand before delivery process, 60% used new tread for code tying where as use of new blade for cord cutting remained 92% during deliveries. Quality of care protocols were available and adopted in service outlets therefore more than maximum clients were seems satisfied during exit interview. Public private partnership with Health department demonstrated at good working relationship for provision of services at Basic Health Unit / District Head Quarter Hospital and at grass root level. Project management remained very satisfactory and all record of operational interventions including statistical data of health service outlets made in professional way.

Ali Muhammad
Project Manager
Reproductive health Programs
Community Support Concern

By: Jackie Lane, Head of Programmes Jackie Lane, Head of Programmes Mon, 18 Oct 2010 21:03:59 +0000 Mobilizing Access to Maternal Health Services in Zambia (MAMaZ) Programme

Health Partners International (HPI) has doubled its effort to supporting the realisation of Millennium Development Goals 4, 5 and 6 through a strategy of health systems strengthening, using evidence and demonstrating impact to inform national and regional policy.

Mobilizing Access to Maternal Health Services in Zambia (MAMaZ) is a UK Department for International Development (DFID)-supported programme that promises to be a catalyst to addressing the underlying reasons why people do not get the maternal and newborn health services they need. The programme is being managed by Health Partners International, working with Oxford Policy Management, the Mailman School of Public Health at Columbia University, and various regional and national partner organizations.

The MAMaZ programme supports Zambian stakeholders to design and test effective ways to reduce barriers to accessing maternal health services. National data suggest that the Maternal Mortality Ratio in Zambia has been improving, however the drivers behind the data are not well understood. By improving the evidence base on what does and does not work on the ‘demand-side’ MAMaZ aims to:
• demonstrate impact, using evidence to improve practice and roll-out successful community based innovations across all districts in Zambia
• analyse available data, and use this information to inform national and regional policy.

One such pilot scheme aiming to stimulate demand for maternal health services, currently in the planning stages, is conditional cash transfers. Cash transfers are regular, non-contributory payments of money provided by government and non-government organisations to individuals and households. Many schemes are designed around payments to families, often women, with the objective of decreasing chronic or shock induced poverty, addressing social risks and reducing economic vulnerability. Social cash transfers can also be a way of stimulating demand for health and education services – either through redressing financial barriers to access, including costs related to health seeking behaviour, or more directly if receipt is conditional on use of services.

There is considerable experience with such schemes in Latin America, but recently a growing interest in East and Southern Africa with a number of countries setting up pilot schemes. Evidence suggests that conditional cash transfer programmes are effective in increasing the use of preventive services – although evidence on improving health outcomes is less clear, which points to the importance of a simultaneous supply side response for demand side programmes such as these to have a more reliable effect on health outcomes.

In MAMaZ, initial work in our three project districts has highlighted that the cost of travelling or other costs of seeking care is a significant barrier for the most vulnerable – and particularly for those living in remote areas with few transport options to reach health facilities/Basic Emergency Obstetric Care sites. Testing cash transfers as a means of overcoming these barriers will be particularly timely. There are a number of existing pilot schemes in Zambia and other countries in the region from which to learn lessons. In addition, the World Bank is in the process of setting up a Results Based Financing pilot which focuses on payments for improvements in service provision. A pilot on use of conditional cash transfers on the demand side is a good complement to this experience and will open up future opportunities for scaling up across Zambia.

By: MARGARET COOPER MARGARET COOPER Fri, 08 Oct 2010 15:21:22 +0000 Maternal love should be compulsary, it’s a natural state of being!but it’s really criminal if you know you can’t even afford to feed the baby you have already, to than again get pregnant!so don’t have any more babies until you can afford them, & be independent financially always, you can only do your best, but at least try!
the west is going through hardships of our own, so it’s time to change expectations, and impose demands for reforms from your OWN GOVERNMENTS, & don’t let them get away with corruption!
good luck

By: salmazeb salmazeb Fri, 08 Oct 2010 05:05:34 +0000 The situation of maternal, newborn and child health in Pakistan is one of the poorest in South Asia. Despite some improvements in the 1990s, Pakistan has lagged behind many of it neighbors in terms of health and population outcomes. The infant mortality rate of 78 per 1000 live births and a recently calculated maternal mortality rate of 276 per 100,000 live births are both higher than other neighboring South Asian countries. Very high fertility rates, a high unmet need for family planning and very low rates of skilled birth attendance are some of the fundamental underlying causes for the poor health of women and children in Pakistan. There are numerous additional factors affecting this situation, including political instability, poor governance, rising religious conservatism and militancy, a vastly under-resourced public social sector, and a poorly functioning public sector health service delivery system at all Disstricts.

By: Dr M R Surwade Dr M R Surwade Thu, 07 Oct 2010 06:35:59 +0000 Application of Information and Communication Technology (ICT) has great potential in achieving MDG 5 – improving maternal health. We used the telemedicine network to guide and enable birth attendants take appropriate actions in case of obstetric complications and normal deliveries.
We developoed a training module for telemedicine centre managers to facilitate delivery of healthcare at village level. This not only address the problem of access to healthcare service but also supports skilled birth attendant take timely action. Community action for referral can also be appropriately supported by telemedicine centre network.

By: Ainura Ainura Thu, 07 Oct 2010 04:00:35 +0000 To improve maternal health and decrease MMR, the foolowing should be done:
- to deliver a knowlede on maternal health (many approaches, including interactive ones) to populatin/community;
- to acheive a behavior changing due to the new knowledge;
- provide experience share communications;
- to strengthen capacities of health facilities and health professionals (from the lowest to highest level);
- to punish Governments who neglects the world wide accepted health policies.

By: Bongs Lainjo Bongs Lainjo Wed, 06 Oct 2010 22:14:25 +0000 The Millennium development Goals (MDGs): The missing links.

Two weeks, the UN and its 192 member countries assembled to review and re-evaluate the accomplishments that have made since the introduction of the MDGs in 2000.

As expected, the usual fanfare of impressive speeches and political expedience by many countries continued to highlight the daily activities. This scenario however took a few believers by surprise. There still remains the common mind-set by observers that the UN after all is an organization of all talk and no-action. To some extent, there could be some level of truth in this characterization. Such dismissive comments however can sometimes be misleading.

The good news about the three days dedicated to the MDGs is that there have been few distractions (if any). Most countries (especially the donors) have concentrated on what it takes to improve the quality of life of populations in the developing countries. And that should be reassuring to every concerned citizen.

Those who have been following the dynamics of this development initiative (including of course the different political leaders) continue to wish that these objectives – mitigating diseases, poverty, hunger, infant and maternal morbidity and mortality and increased education enrollment, strengthened partnerships etc – be significantly transformed into meaningful results in the next half decade.

The task and challenges remain daunting. And every participating country is fully aware of these challenges with enormous constraints including financial, political and economic forces.

While the West continues to show some leadership and political will and engagement, the thrust required to increase the momentum remains quite inadequate and mind-boggling. For example, during an earlier forum, there was unanimous agreement among developed countries to pledge and donate an equivalent of 7% of each country’s GDP. Apart from some Scandinavian countries, The Netherlands and Luxembourg which complied, achieving these goals remain academic and elusive. Other countries continue to be evasive and defiant. In other words, some donor countries are making us believe that they are unable to donate 70 cents out of every $100 to needy and desperate countries which are in dire straits of a deserved better quality of life. Some damage control is required and time is not on our side.

From a demand perspective, recipient countries have not lived up to their own promises. It is very appalling (as presented in the latest UN progress report) that only two countries (Ethiopia and Ghana) out of over forty in Africa are likely to achieve some of the planned MDG targets. After a decade of development efforts, the donor countries must clearly see the writing on the wall. And the message in this case is loud and clear: business as usual is no longer a viable alternative. Recipient governments need to put rhetoric on the side and work with every vulnerable group in their respective countries to make this world a better place. Some of the weaknesses in these countries include poor governance, graft, (institutionalised in some cases), accountability, transparency and complacence.

How can this be done differently? Here, the donor community has an important leadership role to play. The UN already highlighted the importance of achieving results. While that’s not really a new demand from donor countries, it never hurts to re-emphasize the importance achieving intended results as a sine qua non of foreign assistance. We expect our donors to do more and increase their general funding threshold (at least during the next five years) to the agreed 7% of our GDP. This will not only show good leadership, goodwill and compassion for the less fortunate communities, it will also send the appropriate message and wake up call to other member countries in the West. And that of course is not asking much even with the current financial crisis.

Secondly, the UN can also help the realization of the MDGs by effective initiating a plan. This is something that many donor countries continue to take for granted. Such a plan will help in mainstreaming and restructuring the current development landscape that remains both amorphous and dicey. Such a constructive plan will establish a common operating base and help other countries – both funding and recipient – in focusing their efforts. Such a plan will minimize duplication, facilitate coordination and strengthen synergies among the different stakeholders.

Finally, the UN through its leadership role can proactively advocate for the development of a viable, compelling and effective strategy. This will help in producing the relevant roadmap that is required in order to achieve these intended results. And hence these accomplishments in the next five years will show case the authenticity of attempts by the donors to alleviate suffering among the vulnerable communities in the world.

Bongs Lainjo