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?

An example of a simple, low-cost, life-saving tool is a calibrated bag that is used to measure postpartum hemorrhaging, which is the leading cause of maternal death in low-resource settings. In these settings, there is often no way to measure how much blood a woman is losing during delivery — often midwives will simply look at how many cloths are soaked through with blood. A group in India developed a calibrated drape — a bag that simply collects the blood and measures volume of blood lost. This simple plastic bag can (with proper training of the birth attendant) help signal when a woman needs to be urgently referred to a higher level of care.

Mahmoud Fatallah eloquently stated a connection between maternal survival and human rights, saying “When women are risking death to give life, they are entitled to have their own right to life and health protected.” The rights to skilled care at birth, to measurement of what is going wrong in labor and delivery, to other life saving tools are all extremely concrete dimensions of the human right to health.

Our approach is extremely practical, and we rely upon reports from the field about new, simple technologies and about which techniques that are working. For example, through the Maternova site, we learned that a group in California has imported the drape concept from India and is now using it throughout the state.

We believe that by connecting the various groups already linking nurses, midwives, and physicians (including GHDonline’s Global Health Nursing and Midwifery Group) and exchanging concrete solutions, we can accelerate and amplify the kinds of exchanges described in the calibrated postpartum hemorrhage bag example. And looking forward, we would like to assist these groups in bringing their own priorities for innovation to the forefront of global health policy dialogue.

For more information, please visit http://maternova.net. To go directly to the tools for maternal health, please see http://maternova.net/tools/to-save-mothers, and for the tools for newborn health, please see http://maternova.net/tools/to-save-infants. For Structures and Systems, please see http://maternova.net/tools/structures-and-systems. And if you have a specific idea for an innovation to be featured in the Index, please send word through the comment section on the Maternova site.

Meg Wirth is the founder of Maternova and a S.E.VEN fellow. She has worked on women’s health and inequalities in health throughout her career in Appalachia, for John Snow International’s Mothercare project in Jakarta and South Kalimantan, Indonesia, and for the Rockefeller Foundation. She is also a co-author of the UN Millennium Project’s final report on child and maternal health titled Who’s Got the Power? She has a BA from Harvard University and an MPA in international development from Princeton University’s Woodrow Wilson School.

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.

The Center for Reproductive Rights, Action Canada for Population and Development, and the Sexual Rights Initiative suggest that organizations interested in submitting should focus on hard-to-find resources at the intersection of MMM. Here are some examples:

1. Identify how to incorporate a human rights-based approach in addressing this issue. Respondents may provide comments and guidance as to how governments, in both donor and developing countries, can incorporate a human rights-centered approach into their programs and policies to combat maternal injuries and deaths. Input could also include some examples of best practices in incorporating a human rights-based approach to this issue. The Center notes, “We would suggest that, whether the input explores this issue generally or through a best practice case study, the input draw reference to at least some of the basic principles of a human rights-based approach, including: non-discrimination and equality, transparency and participation, monitoring and accountability, and international cooperation and assistance.”

 

2. Identify and describe one or more international initiatives related to MMM or “maternal health.” These might include those that are inter-governmental, based in international organizations, non-governmental, funder-initiated, or mixed. Descriptions should identify whether the initiatives use a human rights framework as a main component to their work, and if so what this framework consists of.

 

3. Identify what gaps exist in the international response to MMM. What is missing in the approach to MMM eradication internationally that the situation has not changed much in the last many years? Such an identification of the gaps is very important in order to determine the role that the Human Rights Council can play in combating maternal mortality and morbidity, to complement and not duplicate existing efforts. Of note, “Inputs in this respect could usefully be holistic in scope or, instead, could seek to identify gaps or limitations relating to one or more particular international initiatives on MMM (which could be inter-governmental, based in international organizations, non-governmental, funder-initiated or mixed). In both cases, the most helpful inputs would seek to identify gaps or limitations that are particularly related to the human rights mandate of the Council (i.e., providing a basis for suggestions that the Council play a role to fill these gaps).”

 

4. Identify concrete steps the Council can take to fill in gaps with respect to the international response to MMM. These need not include only usual recommendations for intergovernmental bodies to address an issue; creative thinking on this point is important and most welcome.

 

5. Identify the actual causes of maternal mortality in countries, whether these are underlying socio-economic or structural causes, barriers in accessing maternal health services, or lack of access to certain types of reproductive health services. It is unlikely that the study will go into particular country situations (except in potential best practice examples), but “such submissions might provide useful support particularly for the identification in the study of root or immediate causes that might have a politically-sensitive nature, such as gender inequality, unsafe abortion, contraception or EC access, and so on.”

If organizations or advocates would like to submit information, please contact the following representatives with information about your organization’s activities in reducing maternal mortality and morbidity: Neha Sood – Youth Coalition (neha at youthcoalition dot org), Ximena Andion – Center for Reproductive Rights (XAndion at reprorights dot org), or Action Canada for Population and Development (sandeep at acpd dot ca).

Resolution 11/8 states that “increased political will and commitment, cooperation and technical assistance at the international and national levels are urgently required to reduce the unacceptably high global rate of preventable maternal mortality and morbidity.” By aligning women’s health and human rights, mobilizing a global network of maternal health advocates and experts, and requesting the implementation of new strategies, the Human Rights Council is on the right track to helping reduce the rate of maternal mortality globally.

If you have relevant and helpful information regarding MMM, you can help, too.

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.

In a similar low-tech program, USAID’s maternal health group ACCESS (Access to Clinical and Community Maternal, Neonatal, and Women’s Health Services) focuses on developing and extending home and community based interventions. A new report from ACCESS is a guide for carrying out “community mobilizations” to improve maternal and newborn health. The program focuses on identifying the specific obstacles of the community, and working with the population to implement realistic changes. For example, essential interventions like the use of misoprostol (which induces labor) can generally be provided safely by trained health care workers at the household and community level, and prevent almost 70% of infant deaths. Additionally, simple preparations, such as providing folic acid to the mother during pregnancy and preparing a clean space for the birth, can be done by community health workers trained in pregnancy and childbirth.

More information:

Video: Birth of a Surgeon (documentary of Mozambique’s midwife training program)

In War and Isolation, a Fighter for Afghan Women

Bold Solutions to Africa’s Health Worker Shortage

Malawi: Role of traditional birth attendants to change

Global Low-cost Health Initiatives

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).

Taking lessons from the work done by the associations of persons living with HIV/AIDS at the community level, Rwanda dedicated two other village-elected CHWs, one woman and one man, to dealing solely with end-of-life issues. These CHWs are responsible for caring for people in the late stages of any disease, which helps ease the burden on family members. Their care also decreases the number of dying patients brought to the hospital.

CHW explaining how to feed children and the meaning of the growth chart outside a house. Photo by Cathy Mugeni.

As there continues to be a high maternal morality rate in Rwanda, the Government is also training traditional birth attendants as CHWs to promote birth delivery at health facilities. CHWs are paid for every delivery they transfer to the local health center.

All activities are included in the health reporting system through reports that CHWs give to the Executives Secretary of each Sector, who in turn report activities to the Director of Health at the District level. At present, CHWs are all volunteers, but the Government of Rwanda is working on compensating these workers with performance-based financing and helping them to create cooperatives.

In conclusion, the five CHWs per village create community ownership, since it is the community who elected them. They also improve access to care and decrease hospitalization through what they manage at the community level. The harmonized training of all CHWs throughout the country is key. Community health workers are a smart and unavoidable solution that enables effective health care to bypass a lack of infrastructure in a resource-constrained country.

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.

WHO: Pakistan

USAID: Pakistan

IRIN Asia reports on Imams involved in the Pakistan health initiative

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.

While this analysis alone is striking, in the report, PHR gives voice to seven individual victims of pregnancy-related complications, thereby providing a face for the severity of maternal mortality in Peru. PHR researchers write of the stark case of Pabla, who desperately tried to deliver at hospital but still died in the room where her own mother had also died giving birth. Along with the stories of five other women, the researchers also revealed the terrible outcome when Melania’s midwife never arrived at her home. Maternal mortality in Peru, the report illustrates, represents the ways in which the health system exacerbates the health concerns among the already marginalized indigenous and poor women, drawing clear parallels to the endemic gender discrimination and poverty throughout the nation. By leaving the reader and the international community with crucial recommendations for change, we are given hope that with timely, conscientious action, change can occur in Peru.

To read the full report and list of recommendations go to:

Physicians for Human Rights Report

Child Rights Information Network

WHO Profile on Peru