Of Ideas, National Programs, and Innovations in Service Delivery
Written by Saumya RamaRao, Population Council
It is Day 2 at the Global Maternal Health Conference and the energy level has revved up as all participants roll up their sleeves to get down to detailed discussions. Today I learnt of ongoing innovations in maternal and newborn health from different parts of the world. As I listened to the presentations, it was indeed learning about “context” and identifying general lessons for application elsewhere.
Here are my picks for the day gleaned from different sessions and conversations over tea with colleagues during breaks.
National programs: India’s National Rural Health Mission (NRHM) is an ambitious government initiative aiming to improve the health and wellbeing of its citizens with an emphasis on reaching the underserved with accessible and good quality services. The NRHM provides a framework for individual states to experiment with ways to “accelerate the pace of decline in maternal mortality.” A flagship project of the NRHM is the Janani Suraksha Yojana that provides poor, indigent women with cash incentives to deliver in health facilities. It will be exciting to see whether the multi-pronged investments in health infrastructure, quality accreditation mechanisms, workforce retention strategies and others will indeed result in demonstrable gains in maternal and newborn health.
Ideas: An idea that was repeated in different ways at different sessions was that it is not always necessary to follow an “either or” approach whether it is a choice between community based initiatives versus facility based initiatives, oxytocin versus misoprostol for post-partum hemorrhage, or any other such choice. These tensions can be resolved by “context” specific rationale and solutions too may change and evolve over time with changing circumstances.
Another idea discussed in several sessions was the active role that communities play in the organization of their health care—whether taking on activities such as health promotion and education that are “task-shifted” to them or resource generation to fund volunteers and or services. In a world of health sector reform, as Zulfiqar Bhutta noted devolution can “create demanding communities” leading to a “democratization of public health”.
Innovations in service delivery: Today there were many opportunities to learn about programming strategies currently being tested in many countries. I was able to attend a couple of sessions on community-based initiatives for post-partum hemorrhage prevention and control.
Here are my sound-bytes from these sessions:
• Community-based distribution of misoprostol for PPH is feasible in resource poor settings
• There is a high degree of correct use by women delivering at home
• Common side-effects include shivering, nausea, dizziness, and fever which seem to occur at the same rate in both misoprostol and non-misoprostol treated women
• Misoprosotol is acceptable to women, families, and their communities
• There has been little misuse noted of the drug whether for labor induction, augmentation or for terminating a pregnancy
• Women can be trusted to be educated consumers when they are treated as active rather than passive participants of programs
• As misoprostol for PPH prevention goes to scale, it will be important to think about ensuring adequate supplies and logistics.
Saumya RamaRao is an economic demographer with research interests in safe motherhood, abortion and postabortion care, and family planning. She has experience in monitoring and evaluation of reproductive health programs, cost analysis, and the use of data for program design and improvement.
For more posts about the Global Maternal Health Conference, click here.
For the live stream schedule, click here.
Check back soon for the archived videos of today’s presentations.
Categories: Contributor Posts