Showing posts from category global health.
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VIDEO—Pape Gaye: Improving Maternal Health Training and Services
›February 12, 2010 // By Julia Griffin“Training is probably one of the biggest interventions in terms of making human resources available,” says Pape Gaye, President and CEO of IntraHealth International, to ECSP’s Gib Clarke in this interview on improving maternal health services in developing countries. “Unfortunately, there are a lot of problems associated with training.”
Gaye says obstacles to scaling up maternal health services in rural areas include employee gender inequalities, poor coordination of supplemental training, and a tendency to only offer in-service training in urban areas. Properly emphasizing pre-service education, he underscores, could remedy some of the problems associated with service provider training.
Increasing retention of medical practitioners is also critical to improving maternal health services in developing countries, Gaye explains. In his experience, however, attempts to address perceived security and financial compensation inadequacies produced mixed results. Instead, Gaye suggests that positive recognition may be one of the best methods for retaining health care workers. “We’re seeing some very good successes in places where we have just simple ways to recognize the work… because if people feel valued in a community, then they are likely to stick it out.” -
Gates: More Money for Global Health Is Good for the Environment
›January 28, 2010 // By Gib Clarke
Bill Gates gave the PHE community a much-needed upgrade in his foundation’s 2nd Annual Letter, released this week. Unfortunately it still has a few bugs.
“In the long run, not spending on health is a bad deal for the environment because improvements in health, including voluntary family planning, lead people to have smaller families, which in turn reduces the strain on the environment,” concludes Gates.
This statement could dramatically raise awareness of and funding for population-environment programs. Any time Bill Gates talks, the world listens, as evidenced by the barrage of coverage from Reuters, AFP, and top IT newswires. For the public, it offers a rare glimpse into development strategy, so Gates’ thoughts (and financial commitments) could be seen as representative of the foundation community’s approach to global health problems.
Although it may seem obvious that fewer people place less strain on the environment, this connection has been largely absent from the environmental agenda, including the efforts to combat climate change. Some environmental leaders and organizations have dismissed population as an unimportant distraction from the real business at hand. Others have noted that population growth’s impact on climate change is far greater in the rich world than in poor countries, whose per capita emissions are a fraction of developed countries’.
Gates’ comment may cause those in the first camp to re-evaluate the importance of family planning, and it is likely to energize the converted. But it will have less impact on those focused on consumption. But if it encourages the environmental community to put population and family planning issues back on the table, it will have gone a long way.
However, Gates could have gone further, by explaining that family planning is a relatively inexpensive way to mitigate climate change, compared to complex and emerging technological solutions. He also could have pointed out that climate change is expected to increase the prevalence of vector-borne diseases such as malaria, or that sick or malnourished individuals may be forced to mismanage natural resources.
Because Gates didn’t make these explicit connections, many in the media missed his point. The wire headlines pit health against environment, when Gates was in fact pointing out how interdependent they are. This distortion is symptomatic of the media’s tendency to highlight the horserace. But maybe they would pay closer attention if the Gates Foundation put its money where its mouth is—and funded programs that integrate family planning and the environment.
Perhaps several years from now, we will look back and say that this letter marks the start of the Gates Foundation’s integrated approach to development. But we may need to wait for Letter 3.0 for a complete install.
Photo: Courtesy Flickr User World Economic Forum -
Watch: Harriet Birungi: Challenges Facing HIV-Positive Adolescents in Kenya
›“Services are not necessarily very adolescent-friendly, so when you get children who are HIV-positive they are likely to face discrimination,” says Harriet Birungi, an associate in the Reproductive Health Program with the Population Council in Kenya, in this interview with ECSP’s Gib Clarke following the Global Health Initiative’s Integrating HIV/AIDS and Maternal Health Services panel.
According to Birungi, medical service censoring and targeted exclusion from schools are among the top challenges facing Kenyan adolescents living with HIV/AIDS. She hopes better support systems and intervention strategies, especially for pregnant individuals, will help medical personnel more quickly identify HIV-positive young adults needing critical medical services. -
Human Resources for Maternal Health
›“Pregnancy is not a disease, a woman should not die of pregnancy…it doesn’t need a new drug…it doesn’t need research – we just need skilled workforce at different levels,” argued Seble Frehywot, assistant research professor of Health Policy and Global Health at George Washington University, at the Global Health Initiative’s second event of the Advancing Policy Dialogue on Maternal Health Series.
Research shows that increased access to skilled health workers during pregnancy and delivery, including midwives and other practitioners, can significantly reduce maternal mortality in developing countries. One solution to the current human resource crisis is to expand, and in many cases, acknowledge, the skills and responsibilities of non-physician health workers.
Task-Sharing: Who, What, and How
“There are too many preventable deaths…if we look at the data, quality maternal health services are not available,” argued Frehywot, as she presented the following evidence:
There are four common types, or levels, of task-shifting:- Countries that have the highest maternal mortality rates are those that also have the greatest worker shortage
- In Africa, for every 10,000 births, only 2 physicians and 11 nurses or midwives are present at delivery.
- According to the World Health Organization, there needs to be at least 53 skilled health care workers (nurses, doctors, midwives) per 10,000 births to meet Millennium Goal 5 which seeks to reduce maternal deaths by 75 percent by 2015.
1. Doctors to non-physician health clinicians
“All [task-shifting] needs to be done through a sound regulatory framework…it is very important to match tasks that are needed at the ground level with the competency needed to back it up,” maintained Frehywot. Regulatory issues such as the scope of practice, standard of care, training, licensure, and supervision must be addressed to ensure safe and high-quality treatment. Additionally, political buy-in and commitment from the Ministry of Health, medical universities, and professional councils and associations are necessary for long-term development, argued Frehywot.
2. Health clinicians to registered nurses and midwives
3. Nurses/midwives to community health care workers
4. Community health care workers to expert patients
Policies for scaling-up human resources should start at the district level, as these localized hospitals are geographically closest to the need, argued Frehywot. “If one really wants to decrease the maternal mortality ratios, especially by 2015, this is where most of the people live.”
Applying Task-Shifting in Afghanistan“Maternal mortality ratios in Afghanistan are the second highest in the world,” declared Jeffrey Smith, regional technical director for Asia at Jhpiego. In 2002, when Smith arrived in Afghanistan, there were limited health workers, most with out-of-date skills, and no functional schools for training. “The most important decision made early in the reconstruction [of] Afghanistan was that midwives would be the backbone of the reproductive health workforce and they would be empowered with the skills to perform the tasks necessary for provision of basic emergency obstetric care,” shared Smith.
Making the case for task-shifting, Smith discussed the importance of empowering health workers on the front line so that they may provide services in the most peripheral areas. “Task shifting should not be a temporary fix until we have more doctors,” argued Smith, as this framework disenfranchises a cadre of health workers and fails to build long-term solutions for human resources. Instead, Smith advocated for the “Health Center Intrapartum Care Strategy” that makes midwives the foundation of care and includes strategies for training, staffing, and linkages to the overall health system.
In this post-conflict setting, task-shifting began as an emergency approach. However, it rapidly became a development strategy for professionalizing the workforce and rebuilding the health system. Afghanistan’s Ministry of Public Health was imperative to the success of scaling up midwives as they clearly defined from the beginning what was needed and who would provide care, taking steps to ensure that the midwifery schools maintained legitimacy and received formal accreditation.
“Keep it clinical and keep it local,” shared Smith. The midwifery schools made efforts to recruit individuals from the provincial level, teaching specific life-saving skills applicable in the field. This framework has successfully retained 86% of its graduates, and many of the women report that the program has provided them with a sense of community and ownership.
Building a Sustainable Health Workforce“We invite the maternal health community to take advantage of the incredible momentum that human resources for health is having right now,” shared Pape Gaye, president and CEO of IntraHealth. While there are many issues within the health system that need to be strengthened, Gaye maintained that “we must pick our battles” and advocated for an emphasis on scaling-up the training and availability of midwives.
In order to scale-up midwives for maternal health we must avoid the same old traps, particularly the lack of donor coordination shared Gaye. “If we do a better job of improving coordination we will start solving the problem.” Additionally, Gaye discussed the implications for training generation “Y,” emphasizing the importance of including new technologies available for training, including PDA’s and e-learning courses.
Performance outcomes and training are the two key pillars of effective scale-up, shared Gaye. Task-shifting also requires legal support and the endorsement from medical associations to help legitimize this new health system framework. “This is not simple work; you really need to have a systems approach. What we seek in the end is good integration. Integration across systems, integration across roles, courses, learning processes, and training for maximum adaptability,” shared Gaye. -
‘DotPop: ’ New Toolkit for Population, Health, and Environment
›December 29, 2009 // By Wilson Center StaffThe PHE Toolkit, launched by Building Actors and Leaders for Advancing Community Excellence in Development (BALANCED), is a new source of information and resources on Population, Health, and Environment (PHE).
The interactive online library of documents, videos, and other resources will provide “one-stop shopping” for the target audience of program managers working on health, family planning, development, and conservation programs—as well as policymakers, researchers, academics, and educators. All users can contribute resources and participate in discussions through the toolkit.
The Environmental Change and Security Program, along with several PHE partner organizations, helped build the framework and will contribute its PHE resources to the toolkit. ECSP is also a member of the PHE Gateway, which can be accessed through the toolkit.
The PHE toolkit is one of five public toolkits housed on the Knowledge for Health (K4Health) website, which is supported by USAID’s Bureau of Global Health. Together, the current and forthcoming toolkits will form an updated and vibrant community for information on health, including family planning, HIV/AIDS, and reproductive health.
The PHE toolkit is made possible through the collaboration of Johns Hopkins University Center for Communication Programs (JHU/CCP) and the BALANCED Project. BALANCED is spearheaded by the Coastal Resources Center (CRC) at the University of Rhode Island and its partners, PATH Foundation Philippines Inc. and Conservation International. -
Integrating HIV/AIDS and Maternal Health Services
›Integrating maternal health and HIV/AIDS services “includes organizing and providing services that meet several needs simultaneously…focusing not only on the condition, but also the individual,” argued Dr. Claudes Kamenga, Senior Director of Technical Support and Research Utilization at Family Health International, during the first event of the Advancing Policy Dialogue on Maternal Health series co-convened by the Wilson Center’s Global Health Initiative, Maternal Health Task Force (MHTF), United Nations Population Fund (UNFPA), and technical support from U.S. Agency for International Development (USAID). Joined by Michele Moloney-Kitts, assistant coordinator at the Office of the U.S. Global AIDS Coordinator, and Harriet Birungi, a program associate with the Population Council in Kenya, the panelists discussed how integration of HIV/AIDS and maternal health services not only improves health outcomes, but also increases program efficiencies, strengthens health systems, and saves money.
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Tackling the Biggest Maternal Killer: How the Prevention of Postpartum Hemorrhage Initiative Strengthened Efforts Around the World
›On Friday, November 20th, 120 representatives from the maternal health community, the U.S. and around the world, gathered for an all day meeting at the Woodrow Wilson International Center for Scholars to discuss the report, Tackling the Biggest Maternal Killer: How the Prevention of Postpartum Hemorrhage Initiative Strengthened Efforts Around the World. This report describes the challenges and successes of the U.S. Agency for International Development (USAID) funded Prevention of Postpartum Hemorrhage Initiative (POPPHI).
The five-year POPPHI project was executed through the support of many partners whose main goal was to catalyze the expansion of active management of the third stage of labor (AMTSL) worldwide. The conference convened experts and advocates in the field of maternal health, to share best practices, new innovations, and future challenges for tackling maternal health’s leading killer: postpartum hemorrhage (PPH). Panelists included POPPHI field partners such as International Federation of Gynecology and Obstetrics, The International Confederation of Midwives, the World Health Organization, and international researchers.
Preventing Postpartum Hemorrhage: AMTSL
“We need to work on women postpartum–after birth we leave them,” argued Deborah Armbruster, POPPHI Project Director. Due to the fact that many women in the developing world give birth at home or in local clinics that lack the sufficient resources to prevent postpartum hemorrhaging, approximately 132,000 women die annually. Fortunately, effective and feasible interventions such as those established by POPPHI have been proven to save lives.
Active management of the third stage of labor (AMTSL) includes three factors that, when used together, can avert postpartum hemorrhage, including:1. Administration of uterotonic drugs (including oxytocin – the most preferred drug)
POPPHI’s “BOLD” Approach
2. Controlled cord contraction
3. Uterine massage after the delivery of the placenta
In collaboration with its partners, POPPHI implemented country-level and global programs to scale up AMTSL. Driven by the “BOLD” approach, Armbruster described how the initiative provided overall frameworks and approaches for strengthening PPH interventions by Building on evidence, Obtaining consensus, Linking partners, and Demonstrating to policymakers AMTSL’s feasibility.
Additionally, POPPHI provided learning materials such as toolkits, fact sheets, posters, and guides that were used to train providers and increase their use of AMTSL. A pilot project on Uniject (a single use needle pre-prepared with oxytocin) was also executed in Mali. Uniject was shown to be acceptable and successful with birth attendants there, and the study is now being replicated in Honduras.
Voices from the Field
Representatives from Argentina, Bangladesh, Ghana, Guatemala, Peru, and Mali presented their country results with the POPPHI project–concluding that the initiative served as a catalyst for upscaling AMTSL. Dr. Abu Jamil Faisel, Project Director and Country Representative of EngenderHealth in Bangladesh, discussed how the project helped to break through misperceptions that often prevented women from wanting to use misoprostol. In Ghana, policymakers worked with program managers and drug suppliers to register misoprostol in the country’s essential medicine list and updated guidelines to reflect best practices. While each country’s experiences were unique, the importance of partnerships was common to successfully upscaling AMTSL in all locations.
Partnerships: Critical to Success
Integrating maternal health indicators directly into program design is imperative to upscaling AMTSL, argued Niamh Darcy, Director of POPPHI Monitor and Evaluation. Additionally, Darcy argued that the success of POPPHI is due to the project’s emphasis in working with all levels of partners, particularly facility providers. Working with the supportive supervisors at facilities is necessary according to Darcy because this group is ultimately responsible for executing active management and recording project outcomes.
Identifying African experts who have taken leadership and ownership of the project has been instrumental in POPPHI successfully disseminating results at the regional, national and international levels argued Doyin Oluwole, Director, Africa’s Health in 2010. Partnering with local champions as well as policymakers has enabled many of the country projects to build capacity and upscale AMTSL.
Building on Lessons Learned
“A key lesson we have learned is that, when there is political commitment, AMTSL is rapidly scalable,” stated Lily Kak, Senior Maternal and Newborn Health Advisor, USAID. Changing behaviors and practices takes significant amount of resources and time commitment, however, POPPHI demonstrates that partnerships and research can be used to upscale AMTSL and change policies more efficiently.
Photo: Women wait outside a maternity ward in Chad. Courtesy of Flickr user mknobil. -
Nobel Pursuits: Linking Climate Efforts With Development, Natural Resources, and Stability
›December 11, 2009 // By Geoffrey D. DabelkoThe only mention of climate change in President Obama’s Nobel Peace Prize acceptance speech falls squarely in the climate and security context. He introduces the climate imperative by highlighting natural resources and development connections to stability and human well-being.
In these two paragraphs, the President identifies the key communities that must come together, first in dialogue and then in cooperation, but who so commonly don’t: development, natural resources, health, climate, peacebuilding, and security.It is undoubtedly true that development rarely takes root without security; it is also true that security does not exist where human beings do not have access to enough food, or clean water, or the medicine and shelter they need to survive. It does not exist where children can’t aspire to a decent education or a job that supports a family. The absence of hope can rot a society from within.
Photo: President Barack Obama looks at the Nobel Peace Prize medal at the Norwegian Nobel Institute in Oslo, Norway, Dec. 10, 2009 (Official White House Photo by Pete Souza).
And that’s why helping farmers feed their own people — or nations educate their children and care for the sick — is not mere charity. It’s also why the world must come together to confront climate change. There is little scientific dispute that if we do nothing, we will face more drought, more famine, more mass displacement — all of which will fuel more conflict for decades. For this reason, it is not merely scientists and environmental activists who call for swift and forceful action — it’s military leaders in my own country and others who understand our common security hangs in the balance.
Bill Gates gave the 
“Pregnancy is not a disease, a woman should not die of pregnancy…it doesn’t need a new drug…it doesn’t need research – we just need skilled workforce at different levels,” argued Seble Frehywot, 
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“We invite the maternal health community to take advantage of the incredible momentum that human resources for health is having right now,” shared Pape Gaye, president and CEO of IntraHealth. While there are many issues within the health system that need to be strengthened, Gaye maintained that “we must pick our battles” and advocated for an emphasis on scaling-up the training and availability of midwives.
