OpenForum – a blog by the Health and Human Rights community

The information needs of frontline health care professionals are vast, ranging from the latest WHO protocols and country-level policies to knowledge of the newest life-saving technologies. Promising new technologies — including mobile health facilities; lightweight, portable diagnostic tools; solar-powered devices; and simple ways to save neonates — are emerging at a more rapid pace, but these developments are not centrally tracked. Such innovations are often reported in medical journals, but subscription requirements mean that this information is out of reach for many. In addition, most innovations are only written up once they are through testing and/or trials and not at the very early stages of their development. Thus, even after life-saving technologies are developed, a major barrier to use of these technologies still exists — knowledge of their existence. One solution: websites like Maternova.

Maternova is a new online knowledge-sharing platform (or “innovation portal”) that brings together social entrepreneurs who are developing or have developed life-saving technologies. The website allows all of their ideas and innovations to be documented in a single place. A number of these innovators are well known globally, but many of the innovations have only been uncovered after months of research. Now, innovators are starting to come to us through word of mouth.

As our name suggests, Maternova purposefully focuses on much-needed global access to information on maternal and newborn technologies. We also provide information on a variety of more general innovations — to us, anything that augments or expedites safe childbirth (for mother and infant) in the field is an innovation, including improvements in lighting, power, infrastructure, communication technologies, and, of course, health technologies. These are all part of a health system that can save mothers’ lives.

Three very basic questions guide our work. First, what are the effective, low-cost tools (both those in development and those on the market) that can save lives? Second, given the tools that exist, what are the priorities for new ideas? And third, where are the facilities located that can provide skilled care to women? Read more

More than 500,000 women die each year from preventable complications related to pregnancy and childbirth. The World Health Organization describes the main causes of maternal mortality and morbidity as “unavailable, inaccessible, unaffordable, or poor quality” medical treatment and care. More than 70% of maternal deaths are caused by five complications: hemorrhage (25%), infection (15%), unsafe abortion (13%), eclampsia (seizures caused by high blood pressure – 12%), and obstructed labor (8%). Life-saving surgical services, such as caesarean section, are often not an option for many women in resource-poor settings. Additionally, maternal death devastates the entire family; motherless children are ten times more likely to die within two years of their mother’s death. As a global health and human rights crisis, maternal morbidity and mortality (MMM) has received increased international attention and advocacy since being identified as a target for one of the Millennium Development Goals.

A recent resolution by the United Nations Human Rights Council, adopted in June 2009, “Preventable mortality and morbidity and human rights,” reaffirms and requests new efforts to curb maternal deaths and to promote gender quality and universal access to reproductive health services. Resolution 11/8 tasks the Office of the United Nations High Commissioner for Human Rights (OHCHR) with preparing a “thematic study on preventable maternal mortality and morbidity and human rights, in consultation with States, the World Health Organization, the United Nations Population Fund, the United Nations Children’s Fund and the World Bank, and all other relevant stakeholders.” The study signifies a tangible and actionable way forward for the maternal health agenda.

In order to develop the strongest possible study, the OHCHR has called for input from interested organizations and advocates, due by December 1, 2009. Information is welcome on the following:

(a)    Identification of the human rights dimensions of preventable maternal mortality and morbidity in the existing international legal framework;

 

(b)   An overview of the initiatives and activities within the United Nations system to address all causes of preventable maternal mortality and morbidity;

 

(c)    Identification of how the Council can add value to existing initiatives through a human rights analysis, including efforts to achieve the Millennium Development Goals on improving maternal health; and

 

(d)   Recommended options for better addressing the human rights dimension of preventable maternal mortality and morbidity throughout the United Nations system.

Read more

A number of non-traditional practices are arising in poor and developing communities to fight high maternal mortality rates. One example that has taken hold in many African countries is the use of non-physician clinicians (NPCs) – health care providers who are not licensed physicians but who still provide substantial medical care. The retention rate of these types of practitioners tends to be higher, and the cost of training and deployment much lower, than those of doctors.

At a recent conference, health delegates from 42 countries agreed to implement a new strategy that trains NPCs in emergency obstetric surgery to address the lack of health care workers. Along with other developing areas, most African countries are suffering from a significant lack of medical professionals. This shortage is particularly implicated in the high rates of maternal and infant deaths during childbirth. The WHO has estimated that in sub-Saharan Africa alone, there is a shortage of nearly 1.5 million health care workers; women there face a 1-in-13 risk of dying in childbirth. Most women are unable or unwilling to access medical facilities or workers, even during emergencies; for example, in Ethiopia, only 6% of all births occurred in a health facility.

By expanding the number of NPCs and training them in surgical childbirth procedures, it is hoped that more births will be attended by trained health care workers who can assist women during emergencies. A program in Mozambique that trains midwives in surgical techniques has already achieved significant results. The country is on the way toward meeting several of the UN’s Millennium Development Goals, particularly those surrounding maternal and newborn health. Read more

Community health worker administering medicine in Rwinkwavu. Photo courtesy of Partners in Health.

[Editor's note: In addition to Dr. Binagwaho, Dr. Fidele Ngabo, Cathy Mugeni, and Niloo Ratnayake also contributed writing to this post.]

Access to care in resource-constrained countries has three major barriers to overcome: finances, infrastructure, and geography. Community health workers (CHWs) are an unavoidable solution for both infrastructure and geography. The Government of Rwanda has recognized that CHWs are necessary in order to improve access to health in rural communities. By using CHWs, with their approach to health at the community level, Rwanda hopes to solve 80% of health problems in the country.

Rwanda has set up a system where each village (100 to 150 households) elects two volunteers to act as CHWs for the general population. Because each community votes on one woman and one man to serve the village in this capacity, becoming a CHW is now a position of respect, raising gender equity throughout Rwanda.

These two CHWs are then trained to monitor growth and development in children, to care for people living with HIV, and to refer sick patients to the nearest health facility. Their training is designed by the Ministry of Health, which enables them to provide services in a harmonized manner throughout the country. By sensitizing the local village and making themselves available, they improve access to care; because of CHWs, a greater number of previously unreachable Rwandan citizens now have access to care. The CHWs trained this year to provide services to their villages are trained to treat certain diseases using amoxicillin and to distribute family planning tools (condoms, contraceptive pills, and injectable contraception). Read more

Health and Human Rights Executive Editor, Alicia Ely Yamin, writes with Mary Robinson in an op-ed in today’s Boston Globe:

More than one woman dies every minute from preventable causes in childbirth, and for every woman who dies as many as 30 others are left with lifelong, debilitating complications. Moreover, when mothers die, children are at greater risk of dropping out of school, becoming malnourished, and simply not surviving. Not only is maternal mortality and morbidity a global health emergency, but it triggers and aggravates cycles of poverty that cause generations of suffering and despair.

Asserting that these preventable deaths are an issue of human rights does not mean that poor governments are going to be blamed for not doing what they cannot do. Rather, understanding the profound injustice of disparities in maternal deaths makes it all the more urgent that donor states honor their funding commitments and that effective monitoring and accountability mechanisms are put in place to ensure that aid is going to the interventions that evidence has shown will save women’s lives. Moreover, maternal mortality is a human rights issue within high-income countries as well, where data show that ethnic and racial minorities suffer disproportionately from pregnancy-related deaths.

Read the entire piece here.

Pakistani mother seeks charity from motorists

Local religious leaders are proving to be a crucial resource in the fight against infant and maternal mortality in Pakistan’s southern Sindh Province, where a new Health Ministry initiative is in progress.

“In the communities here, the word of a cleric carries more power than anyone else. Why not use their influence and clout for a healthy cause,” says Ahsan Akbar Dhani, district coordinator of the National Programme for Family Planning and Primary Health Care in Pakistan. Leaflets, distributed at local madrasahs (Islamic religious schools), urge Imams to incorporate messages stressing the importance of good hygiene, TT (Tetanus Toxoid) inoculations for mothers and immunizations for infants.

According to USAID, one in 23 Pakistani women dies in childbirth, compared to one in 5,000 women in developed countries, while in the Federally Administered Tribal Areas (FATA), 135 out of every 1,000 children under the age of five die from curable illnesses. By involving the religious leaders in the health awareness campaign, the Health Ministry hopes to counter misconceptions about vaccinations and even oral rehydration salts, which some people believe may cause impotence. The leaflets contain the footnote “May Allah always give us the strength to stay clean and protect ourselves and others from diseases as well as disseminate information with regards to health and hygiene, Amen.” By using both religious language and the mosque’s pulpit to spread public health messages, the Health Ministry has initiated an effectual method of creating better health outcomes in local communities.

For more information, see links below the fold. Read more

A recent report by Physicians for Human Rights (PHR), entitled Deadly Delays: Maternal Mortality in Peru, A Rights-Based Approach to Safe Motherhood, addresses the vast health care disparities in Peru.

The fact that Peru has the second highest maternal mortality rate in all of South America reveals not only the failings of the health care system but also “the social exclusion faced by rural, especially indigenous, women.” In Peru, over 1,200 women die in childbirth each year. As a PHR publication notes, the absence of quality emergency obstetric care can lead to three crucial “delays”: delays in seeking care, arriving at care, and finally, delays in reception of proper care once at a facility. Read more