Maternal & Child Health

Guidance for integrated postpartum care at the community/household level that reduces maternal and newborn mortality and encourages health in the immediate postpartum period is lacking. This report identifies and summarizes descriptive and research studies of existing community-based postpartum programs which provide counseling and services along with education on self-care. The literature review identified three models of community-base postpartum care: home visits by professional health care providers, home visits by community workers and home visits by community workers with referral or health facility support.

This report presents the child mortality impact of a trial of primary healthcare service delivery strategies in rural Ghana. After adjustment for sociodemographic factors, underfive mortality in areas with village-based community-nurse services fell by 16 percent during the five years of program implementation compared with mortality before the intervention. [from abstract]

This assessment evalutes the RACHA program in Cambodia which was intended to strengthen the capacity and sustainability of the public and private sectors to deliver quality reproductive health and child survival services. The five technical intervention areas were birth spacing, STD/HIV prevention, safe motherhood, childhood diarrhoeal diseases and micronutrient deficiences. One of the key intermediate results identified within these areas was inproved human resource capacity to address these issues. [adapted from author]

This review and discussion paper highlights the important role that private practitioners are already playing in providing health services to children in many countries, and the far greater contribution that they could be called upon to make.

Recent efforts to improve maternal health have focused on skilled attendants and emergency care at health facilities. Skilled birth attendants and access to emergency obstetric care are essential to saving mothers lives. In developing countries, 60 million women give birth at home without skilled care and with high maternal and neonatal mortality. Nearly all essential newborn care can be provided safely, effectively, and at a low cost at the household level. The same is true for care of the mother, and many effective interventions can be implemented at the household and community level that will save mothers’ lives.

This paper explores the potential for private-sector midwives to provide services beyond their traditional scope of care during pregnancies and births to address shortcomings in less developed countries’ ability to reach MDGs. This paper examines factors that support or constrain private practice midwives’ ability to offer expanded services in order to inform the policy and donor communities about PPMWs’ potential. [from executive summary]

Many women choose to use traditional birth attendants in Guatemala to deliver their babies - a fact that can’t be ignored, according to local public-health officials. They hope a new culturally sensitive approach to training traditional birth attendants will help improve their quality of care and save lives. [adapted from author]

This Royal College of Nursing (RCN) publication is designed to assist you in your role as a mentor to pre-registration nursing and midwifery students. It outlines your responsibilities alongside those of the student, higher education institutions (HEIs) and placement providers. [introduction]

The 2006 Review seeks to provide a South African perspective on prevailing international public health issues, and in particular provides an opportunity to reflect on progress to achieving the Millennium Development Goals many of which are linked to maternal and child health. It also seeks to stimulate debate and critical discourse, to provide a platform for assessing progress and to identify key gaps and opportunities for future action that is realistic and sustainable. [from foreword]

These revised and expanded guidelines aim to help [national nursing associations], nursing and midwifery personnel, nurse managers, employers and others to address the educational needs and ethical responsibilities of nursing and midwifery personnel in reducing transmission of HIV/AIDS, HBV, HCV and tuberculosis; develop strategies for a safer work environment and increased protection for nursing and midwifery personnel; and address the socioeconomic welfare issues related to the health care needs, compensation and financial security of HIV-positive nursing and midwifery personnel.

Increasing evidence supporting the value of screening women for cervical cancer once in their lifetime, coupled with mounting interest in scaling up successful screening demonstration projects, present challenges to public health decision makers seeking to take full advantage of the single-visit opportunity to provide additional services.

This presentation was part of the 2006 Global Health Mini-University. This session will provide an overview of factors that support or constrain the delivery of expanded services by midwives. It will discuss successful case studies to build sustainable practices. This includes a program to promote business training and access to financing to grow and improve private midwife practices in the Philippines. Presenters will also discuss the use of networks for private midwives for service expansion, quality improvement, and sustainability in Kenya. [adapted from publisher’s description]

This presentation was part of the ECSACON Conference. It discusses the advantages and disadvantages of traditional teaching versus distance education for nurses and midwives.

This case study describes how healthcare providers in Nicaragua worked together to improve the quality of obstetric care at their health centers and posts. They began by measuring the extent to which staff performed according to standards. Once aware of the quality gaps, they formed QI teams and used rapid team problem solving to implement quality improvements so that healthcare providers could perform according to obstetric standards. Continuous monitoring shows their success in meeting the standards and improving health outcomes. [author’s description]

This cost analysis is based on QAP research on the effectiveness of two interventions (self-assessment and peer review) in sustaining or increasing the effectiveness of interpersonal communications training that midwives had taken. The research had measured the effectiveness of the interventions in terms of the number of utterances midwives made during family planning consultations, and this case study followed on, measuring the cost of each intervention in terms of the number of utterances generated.

This case study describes how five Integrated Management of Childhood Illness (IMCI) trainers and supervisors conducted an assessment of provider knowledge and skill to carry out IMCI at 38 facilities in two districts in Kenya. [author’s description]

The purpose of this study is to estimate the cost implications of implementing the newly proposed Integrated Management of Childhood Illnesses algorithm in first-level health care facilities in rural areas of Bangladesh. Bangladesh policymakers need to know the cost of IMCI prior to its implementation so that they allocate adequate resources, particularly personnel and drugs, and the associated financial resources to health facilities. [from author]

In 1993, Uganda began decentralization of its health care sector to the district and subdistrict levels. Its objectives were to increase local revenue for health service provision, in part through user fees; involve the consumers in the management of their health care services; and integrate all providers, including non-governmental organizations, missions, and non-traditional providers, into the care delivery system. The increased revenues and consumer participation was expected to improve quality and increase utilization of services. With a focus on maternal and child health (MCH) services, this study used statistical data and interviews with local health administrators and physicians to assess how the reform policies have been implemented and how they have impacted MCH service provision and utilization.

Networks of private providers can be highly effective in reaching women with Family Planning/Reproductive Health (FP/RH) services Advantages: service delivery points are already in place, often financially sustainable, and have excess capacity. Private midwives provide 46% of all contraceptive use in Indonesia. A “linking organization” is key to link providers, identify incentives, develop a plan to meet service objectives and broker training, supplies, quality, and outreach to customers. [author’s description]

This study examines the relationship between IMCI compliance and three cost issues: the length of client-provider consultations, treatment drugs, and workload. The setting was 26 health clinics in Niger, the only developing country setting where QA was implemented before IMCI. [publisher’s description]

This report presents data on in-hospital care for childbirth and obstetrical emergencies in 14 hospitals. This report examines intervals between critical events

This report presents the results from Rwanda for the of the Quality Assurance Project’s three Safe Motherhood Studies: competence of skilled birth attendants, the enabling environment for skilled attendance at birth, and the causes of the delay in receiving medical attention after a woman arrives at a healthcare facility. The Rwanda study focused on an urban referral (tertiary care) hospital with an active maternity department, two mid-sized referral (secondary care) hospitals, and four health centers. [publisher’s description]

Through its Safe Motherhood Research Program, the Quality Assurance Project carried out three studies to explore issues regarding competence of skilled birth attendants, the elements that contribute to an enabling environment and the causes of the delay in receiving medical attention after a woman arrives at a healthcare facility in countries with high maternal mortality ratios.

This report discusses care provided to 245 women during labor, delivery, and immediate postpartum and their newborns during immediate postpartum. The quality of care for different tasks (e.g., monitoring fetal heart rate) is presented by country, by hospital type, and overall. The report details performance on recommended tasks and should inform program managers and providers in finding similar weaknesses in their own care delivery systems. Report includes 21 data tables and the data collection instrument for observations. [publisher’s description]

Case management maps (CMMs) are a type of job aid: a sheet of paper with information that guides healthcare providers in treating patients. Each patient has his or her own condition-related CMM, which is maintained in the patient’s chart or on the wall near the patient’s hospital bed to inform providers of the treatment protocol, what treatment was provided when and by whom, what to do should a critical event occur, etc. This report describes a study that implemented two CMMs that were introduced about a year apart in a 500-bed hospital where such job aids had not previously been used.

This report documents the efforts of the Institute for Reproductive Health (IRH) to integrate natural family planning methods into the health delivery system in the Phillipines. It discusses the venues used for implementation such as government and NGO partnerships as well as IRH’s training resources and activities for nurses and midwives on family planning. Finally, the report details best practices and lessons learned from the multi-year project.

The Integrated Management of Childhood Illness (IMCI) strategy seeks to reduce [childhood] deaths through three main components: improving the skills of health workers, improving health systems an improving family and community practices. IMCI has been shown to be associated with improved quality of care, which should result in improved health outcomes. However, concern about the costs of implementing IMCI had been given as a reason why some countries have not adopted it on a large scale. It is important, therefore, to assess whether IMCI does, in practice, cost more than routine care for children who are less than 5 years old, and if so, by how much…Here we present results from the cost components of the MCE study in the United Republic of Tanzania.

This presentation discusses the AMRN role of strengthening nurses and midwives in their responses to HIV/AIDS by improving their knowledge and skills in evidence based practice, research, counseling, advocacy and education. Included is information about the magnitude of the HIV/AIDS problem and some strategies that AMRN has used to address the problem through nurses and midwives.

In order to identify potentially effective models of home-based care (HBC) within which paediatric palliative care could be integrated, and to identify critical aspects requiring strengthening, the NMCF commissioned an in-depth evaluation of three NGOs that have been supported through the Goelama Program. The objectives of the evaluation were: to evaluate the current capacity of the three HBC projects to provide paediatric palliative care as a component of overall HBC - this focused on the overall management of the projects, as well as the competencies of carers to provide both general HBC and palliative care to children; To explore the possibilities for strengthening the provision of paediatric palliative care as an integrated component of HBC; and to explore the role of home-based carers and HBC projects in the provision of ART to children. [author’s description]

The Government of Ghana has adopted the WHO focused antenatal care (ANC) package in a move to improve access, quality and continuity of ANC services to pregnant women. As part of these efforts, the Government has exempted fees for ANC clients. The main objective of this study, undertaken by Noguchi Memorial Institute for Medical Research in collaboration with the Ghana Health Service (GHS), FRONTIERS, and with USAID funding, was to examine the extent to which adaptation of the package influenced quality of care received by pregnant women and its acceptability to both providers and clients. The study used a policy analysis and a situation analysis in ten intervention clinics in which the package had been introduced and four comparison clinics.