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On May 27th, Sarah Boseley reported on her Global Health Blog that the families of two women who died in childbirth have taken legal action against the Ugandan government, asserting that the women’s rights to life and health were violated.

Sarah Boseley’s Global Health Blog, The Guardian

“…The case is unprecedented in Uganda. Aid agencies and medical charities and donor governments can condemn the death toll in pregnancy and childbirth, but the most powerful argument is the devastating testimony of those who suffer.

Sylvia Nalubowa died in Mityana hospital on 10 August 2009 from the complications of obstructed labour. She was carrying twins, one of whom was delivered. The second died with her. Jennifer Anguko died in Arua regional referral hospital on 10 December 2010 when her uterus finally ruptured after 15 hours of obstructed labour. Her status as a district councillor brought her no favours – she was said to be the fourth woman to die in that hospital that day…”

Read the full story here.

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The Safe Motherhood Program at UCSF is accepting applications for an upcoming internship opportunity in the Copper-belt of Zambia. The intern will spend the majority of their time in the labor and gynecology wards at a district hospital and several peri-urban clinics, gaining an understanding of front-line maternal health service delivery and research.

Position Description:

This internship is based in the Copperbelt Region of Zambia.  The intern will work on a study that aims to reduce maternal mortality and morbidities in Zambia and Zimbabwe caused by obstetric hemorrhage.  This is a cluster randomized control study that compares outcomes based on evidence from intervention and control clinics.  The intervention clinics in this study are the clinics that are using the NASG (Non-pneumatic Anti-Shock Garment) as a first aid device for patients suffering from hypovolemic shock caused by bleeding during pregnancy.

Some of the duties of the intern include:

-Providing logistic support for the local Zambian team – distributing supplies, copies, etc.
-Reviewing data collection forms
-Encouraging protocol adherence
-Conducting trainings with local hospital and clinic staff
-Visiting the study clinics
-Following up on cases
-Liaising with the San Francisco office and the in-country staff

Desired qualifications: Experience in international settings, interest in maternal health, research experience, familiarity with clinical environments.  Must be highly detail-oriented, be well organized and have excellent follow-through skills.

Time requirements: Must be able to commit a minimum of 2 months in the Copperbelt, although 3 months is preferred.

Compensation/Funding:
Interns must secure their own funding for travel and lodging. There is no funding for these positions but it is valuable experience for someone who wants to make a huge difference in women’s lives.

To learn more about the NASG (Life Wrap), visit: www.lifewrap.org.

If interested, please send your CV and cover letter to Elizabeth Butrick at ebutrick@globalhealth.ucsf.edu, with a copy to Kathleen McDonald at kathleen.p.mcdonald@gmail.com

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The Global Health Corps is now accepting applications for their fellowship placements in Burundi, Rwanda, Uganda, and the USA.

I learned about this opportunity from Emily Bearse, a GHC fellowship alum, current GHC staff member, and grad school buddy of mine!  Here is what Emily had to say about it:

“Being a GHC alum from their inaugural class as well as working on their staff team now, I truly believe GHC has a great model and the power to build the movement for global health equity. We are built on a unique partnership model where we work with existing organizations addressing pressing issues in under-served communities. We partner one national with one international fellow at each site to promote knowledge sharing and synergies in order to create deeper impacts in the communities where fellows serve. We engage people from outside the traditional health space in order to bring valuable expertise to strengthen health systems.”

Emily also mentioned that GHC is offering several placements with Elizabeth Glaser Pediatric AIDS Foundation, Millennium Villages Project, and mothers2mothers–organizations with a strong focus on maternal and child health.

Excerpt from the press release:

“Global Health Corps is expanding this year to support 70 emerging leaders in their 2011-2012 fellowship class. Applications for placements in Burundi, Malawi, Rwanda, Uganda and the USA are now open at www.apply.ghcorps.org.  GHC is seeking applicants with diverse skill-sets from areas that are often viewed as outside of the traditional health workforce—managers, communicators, architects, computer scientists, supply chain analysts and other exceptional young people from disciplines important to building strong health systems.

‘The complexity and scope of today’s challenges requires people with diverse skills from a wide range of fields beyond medicine. To truly shift the tide of global health challenges, we need to engage young leaders from all backgrounds.’ Barbara Bush, cofounder and CEO said.

Global Health Corps aims to mobilize a global community of emerging leaders to build the movement for global health equity. GHC does this by providing young leaders year long paid fellowships with outstanding organizations working on the frontlines of the fight for global health equity…”

Read the full press release here.

For more info about the Global Health Corps, click here.

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On Monday, I traveled with my colleague, Anupam Sarkar, a nutrition and newborn health expert and Project Advisor for the Maternal and Newborn Survival Initiative (MANSI), to Hudu, a small, hard-to-reach village amidst forest, steel plants, and roaming wild elephants. It took us nearly 2 hours from Jamshedpur, weaving around and cutting through steel plants and villages along bumpy and muddy roads–the same roads that pregnant women must travel on if they opt for institutional delivery. We were heading to Hudu to observe a Seraikela Chhau peformance.

Seraikela Chhau is a traditional form of dance that originates in the Seraikela block of Jharkhand, part of the eastern steel belt of India. Over the past six months, I have been working as a Clinton Fellow with the Maternal and Newborn Survival Initiative in the Seraikela block. MANSI is a partnership between the American India Foundation, Tata Steel Rural Development Society, and the local government—with technical support from SEARCH. As part of our project activities, our team has recently coordinated a series of Seraikela Chhau performances that will combine the native dance form with key maternal and newborn health messages throughout the 174 villages of our project area.

When Anupam and I arrived in Hudu, we learned that a pair of twins had recently passed away in the village and we decided to visit the family before the performance began. We are conducting similar home visits for every maternal and newborn death that has been reported in our project area (spanning 174 villages) since the baseline survey was completed in 2009. The goal of the home visits is to gain a better understanding of the ground realities and knowledge gaps so that we can shape and inform the messages of the MANSI health communication campaigns in a way that meets the needs of the communities.

The local health worker guided us to the home where the twins had passed away. The parents were not at home–but we were able to meet with the paternal grandparents, Asha and Ganesh Sardar.

 

They shared their story…

The mother of the twins, Vilasi, is 28 years old. She and her husband, Ragdu, already had four children, all girls, and the family was  eager to have a boy. Soon they became pregnant with twins, one girl and one boy. All four of the previous children were delivered at home without complication–and the family assumed that this delivery would also be free of complications. They explained that they were unaware of the benefits of institutional delivery. When the twins were born, they seemed very small. Immediately following delivery, the mother put the babies to her breasts to feed them. They were weak and unable to suckle. Initially the family thought about giving them goat’s milk–but eventually decided to give sugar water (locally called Misri Pani). When it became clear that the babies were extremely weak and in critical condition, the family wanted to take the infants to the hospital but they had not anticipated the emergency. They were not prepared. They did not have a transportation plan or money set aside. One baby died the very same day–and the other died the following day.

We thanked the grandparents for sharing their story and asked them if it would be OK if we also shared their story with other communities. The grandparents agreed and the grandfather said, “After losing the twins, I have come to know about the importance of institutional delivery. Why not share our story and let others also come to know?”

It is tough to know precisely what led to the death of the twins—and if giving birth in a facility would have made a difference. But it is clear that many factors were stacked against them. The family was faced with poor roads, long distances to health centers, limited resources, combined with a lack of information at the community level about birth spacing and planning, care of low birth weight babies, danger signs, institutional delivery, and information on how to tap into government schemes that offer cash incentives for institutional delivery—all potential topics for future Chhau performances.

With the story of the twins on our minds, we returned to the center of the village to observe the performance.

With no electricity in the village, the performers rigged their loud speaker system to their vehicle battery. They began beating their drums and singing loudly, calling on community members to gather in the village center.

It did not take long for community members to gather, all curious to know what the commotion was about. They formed a crowd of boys and girls, and men and women of all ages. Soon the drumming and singing picked up pace, a performer dressed in a traditional colorful costume with a big mask jumped out from behind the vehicle, and the show began!

The performers acted out various situations, using dance and drama to cover several critical maternal and newborn health topics—with a focus on the importance of institutional delivery, birth planning/preparedness, and the five cleans of safe delivery. The audience watched with great enthusiasm.

As we traveled the bumpy roads away from Hudu, a jagged rock punctured our tire–delaying our return to Jamshedpur and reminding me of the numerous barriers that women face in accessing care. While we waited for the tire to get repaired, I thought of the twins and the grandparents who we interviewed. I also thought of the Chhau dance and all of the community members in attendance. That day, I witnessed the consequences of the various factors that were stacked against the twins. I also witnessed one strategy for building community awareness of critical maternal and newborn health information. I left feeling confident that the Chhau performance that we observed will help to equip the community of Hudu with key information about maternal and newborn health—and will serve as one of many important steps toward the overall goal of protecting the health of women and infants in the Seraikela block.

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On November 15th, Maternova, an organization that conducts continuous research into the latest innovations impacting maternal and newborn health, featured the “paperless partogram” on their blog. The blog post explains that for the past thirty years, the partogram has been the recommended practice for preventing prolonged labor in low-resource settings–but it seems that not all health workers find it to be an appropriate tool for the contexts in which they work.

Maternova

“…The partograph is a low-cost tool for saving the lives of mothers and babies. But does that mean it is an appropriate tool? Dr. A. K. Debdas of India would say no. Even after the WHO simplified the partograph model to make it more user-friendly in 2000, the partograph is still rarely used in low-resource areas, and, when actually used, it is rarely interpreted correctly (2). Debdas argues that the WHO’s partograph fails to meet the organization’s own requirements for appropriate technology: the partograph has not been adapted to local needs, is not acceptable to those who use it, and cannot be used given the available resources. Debdas believes the partograph is simply too time-consuming for overburdened clinicians and too complicated for many skilled birth attendants—many of whom have not received higher education.

Dr. Debdas proposes a new, low-skill method for preventing prolonged labor—the paperless partogram. It takes 20 seconds, requires only basic addition and the reading of a clock or watch, and holds potential for more effectively mobilizing clinicians to prevent prolonged labor. Appropriate on all counts…”

Click here to read the full post on the Maternova blog and learn how the “paperless partogram” works!

And while you are on the Maternova site, be sure to check out the Health Innovations page. I found the “Baby Bubbles” and the “Salad Spinner Centrifuge for Anemia” particularly interesting…

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The International Reporting Project at Johns Hopkins University is offering two groups of fellowships this spring: International Journalism and Global Health Reporting.

Up to five fellows will be selected for the Global Health Reporting Fellowship with the International Reporting Project. They will be given five weeks to report on a specific topic in global health such as malaria, HIV/AIDS, tuberculosis, or maternal and child health.

“Fellows will spend two weeks in Washington at the IRP offices preparing for their overseas trips and then five weeks reporting on their chosen health topics in the country of their choice. Fellows will return to Washington for a final two weeks of reporting and presentations of their findings.”

Eligible candidates are journalists based in the United States with five years of professional experience in journalism.

The dates of the fellowship are March 3, 2011 to May 7, 2011.

Deadline to apply is December 20, 2010.

For more info, click here.

Click  here to apply!

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The Center for Reproductive Rights has released, Dignity Denied: Violations of the Rights of HIV-positive Women in Chilean Health Facilities, an in-depth investigation into the issue of discrimination against HIV positive women in Chile—specifically when seeking reproductive health services. 

In an email I received from colleagues at the Center for Reproductive Rights, they wrote:

“Over a period of six months, we spoke with 27 women in five different regions of Chile, gathering their stories. The research confirmed what we already knew from a previous study carried out by VIVO POSITIVO—women living with HIV/AIDS were frequently pressured not to become pregnant, were often scolded by healthcare workers for wanting to do so, and were sometimes pressured, coerced or forced to undergo surgical sterilization. The Center wanted to make clear that the abuse and mistreatment suffered by HIV-positive women are violations of their human rights…”

Excerpt from the report:

“In 2004, Julia received the good news that her viral load was undetectable. With this improvement in her health and after witnessing other HIV-positive women give birth to healthy, HIV-negative children, Julia and her partner decided to try for a child in consultation with a private physician. however, despite the low risk of mother-to-child transmission (mTCT), healthcare professionals repeatedly chided Julia after she became pregnant, telling her, ‘What were you thinking? Don’t you see that you are going to have a sick child?’

During the first trimester of her pregnancy, Julia began experiencing an orange-colored vaginal discharge. Concerned, she went to the hospital to have it checked out. Instead of treating her, however, hospital workers turned her away and told her to return for her regularly scheduled check-up. She was admitted to the hospital three days later, hemorrhaging and with severe abdominal pain, but she still sat untreated…”

Download the full report here

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On Tuesday, September 14th, the Guardian launched a new website in collaboration with the Gates Foundation. The site is dedicated entirely to global development, was built with the Millennium Development Goals as a framework, and launched just one week before the UN Summit.

Be sure to check out the following components of the new site:

See below for the press release about the new site:

The Guardian today has launched a new website in partnership with the Bill & Melinda Gates Foundation to help focus the world’s attention on global development. The site will provide a new space for discussion and interaction on the biggest challenges affecting the lives of billions of people across the developing world, including poverty, hunger, infant mortality, adaptation to climate change and economic development.

One aim of the website, which launches just a week before a major UN summit, is to hold governments, institutions and NGOs accountable for the implementation of the United Nations millennium development goals (MDGs), which 192 countries signed up to in 2000. Huge advances have been made with many of the MDGs, and the new site will enable people around the world to better monitor how each country is performing.

For the first time, individuals will be able to access a central data store using the world’s top sources for development and aid data, through which they can access development statistics, and information. For example, users will be able to find out who has given the most aid to Pakistan, or which countries have the highest Aids rates.

Alan Rusbridger, Editor-in-Chief, Guardian News & Media, said: “All too often the mainstream press ignores long-term development stories. However, it is essential to have a place where some of the biggest questions facing humanity are analysed and debated, and through which we can monitor the effectiveness of the billions of pounds of aid that flows annually into the developing world. The creation of this website is a natural step for the Guardian, which has always been internationalist in its outlook and passionate about social justice.”

Kate James, Chief Communications Officer for the Bill & Melinda Gates Foundation, which is part-funding the site along with Guardian News & Media, said: ” We are excited to be working with the Guardian on this unique project – creating a global hub for information, debate and action around global development. We welcome the Guardian’s commitment to bringing together and galvanizing the community engaged on these issues and believe that, in doing so, this hub can play an important role in putting a spotlight on global health and development.”

The website features the best of the Guardian’s writers on development, including Madeleine Bunting, Sarah Boseley, Larry Elliott and John Vidal, as well as bringing together a selection of the most distinctive development blogs from around the world and a monthly ‘Poverty Matters’ podcast. In keeping with guardian.co.uk’s mutualisation strategy, the website will focus on linked reporting and response, giving readers the ability to follow conversations and debates, compare sources and links, and get involved.

It is also being supported by more than 20 of the world’s leading development experts, including Nobel prize winner Amartya Sen and American economist and Director of the Earth Institute at Columbia University, Jeff Sachs.

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In April, the Lancet published new maternal mortality estimates (out of the Institute for Health Metrics and Evaluation) that showed a significant reduction in global maternal deaths, shaking up the global health community’s understanding of the global burden of the issue–and providing new hope. The report also illustrated the important links between HIV/AIDS and maternal mortality.

In the wake of the Lancet report, maternal health professionals from various organizations engaged in robust dialogue (like this one) about measurement methodologies–and raised questions about when the World Health Organization would release their estimates and how they might differ from the IHME estimates.

On September 15th, WHO, UNICEF, UNFPA, and the World Bank released their new maternal mortality estimates in a report, Trends in maternal mortality. Their report also showed a significant drop in maternal deaths—a 34% decrease between 1990 and 2008.

Excerpt from the WHO press release:

“The new estimates show that it is possible to prevent many more women from dying. Countries need to invest in their health systems and in the quality of care.

‘Every birth should be safe and every pregnancy wanted,’ says Thoraya Ahmed Obaid, the Executive Director of UNFPA. ‘The lack of maternal health care violates women’s rights to life, health, equality, and non-discrimination. MDG5 can be achieved,’ she adds, ‘but we urgently need to address the shortage of health workers and step up funding for reproductive health services’…”

More highlights from the report:

  • Ten out of 87 countries with maternal mortality ratios equal to or over 100 in 1990, are on track with an annual decline of 5.5% between 1990 and 2008. At the other extreme, 30 made insufficient or no progress since 1990.
  • The study shows progress in sub-Saharan Africa where maternal mortality decreased by 26%.
  • In Asia, the number of maternal deaths is estimated to have dropped from 315 000 to 139 000 between 1990 and 2008, a 52% decrease.
  • 99% of all maternal deaths in 2008 occurred in developing regions, with sub-Saharan Africa and South Asia accounting for 57% and 30% of all deaths respectively.

Click here to read the press release and here to read the full report.

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Colleagues at the Women’s Health and Empowerment Center of Expertise at the University of California Global Health Institute are working to develop a multidisciplinary book on women’s health and empowerment.  The book will feature a set of case studies that examine the application of a specific disciplinary (or multi-discplinary) approach to addressing issues of women’s health and empowerment.  The book is being designed as a textbook to be used in undergraduate and graduate programs focused on global health, women’s studies, development studies, medical anthropology, sociology and other related disciplines. See below for the call for abstracts and case study nomination form.

Call for Abstracts

Women’s Health &Empowerment (WH&E) COE

Purpose:

The WH&E COE believes that advances in women’s health globally are impeded by poverty, limited access to educational and economic opportunities, gender bias and discrimination, unjust laws, and insufficient state accountability. These forces intersect to restrict access to vital women’s health services and the information that women need to improve their lives. By prioritizing women’s health concerns, rights, and empowerment, this COE is uniquely poised to catalyze societal-level changes that will yield sustainable improvements in health and well-being for women on a global scale.

Mission:

We envision a world in which all women and girls are empowered and healthy. Our mission is to promote justice, equity and scientific advances to reduce gender and health disparities globally. Grounded in human rights principles, our approach is interdisciplinary and transformative.  Through innovative research, education and international collaboration, we build and strengthen the capacity of the next generation of leaders in women’s health and empowerment. Our core activities focus on assuring safe motherhood, reducing violence against women, improving access to family planning and reproductive technologies, advancing sexual and reproductive health and rights, preventing HIV/AIDS, and reducing environmental threats to women’s health.

Book Project

The WH&E COE is developing a multi-disciplinary book of case studies that address the intersection of scholarship and practice in two areas: women’s health and women’s empowerment.  The book will document innovative research and programmatic efforts in the field and will strive to capture and define the latest thinking within the interlinked areas of women’s health and empowerment.  Each chapter will include a “lead-in” section written by an expert in the specific chapter discipline and incorporate one or more cases to effectively document the “real world” experience of the intervention or study.

Each abstract must consider both women’s health and empowerment. The book will be designed as a textbook in undergraduate and graduate programs focused on global health, women’s studies, development studies, medical anthropology, sociology and other related disciplines. Questions at the end of each chapter will aid in learner assessment and enhance the utility of the text in the classroom.

We are eliciting abstracts from authors interested in contributing to this multi-disciplinary textbook.  Abstracts will be screened as below and the selected authors will be asked to contribute to a chapter for this book project in consultation with its editors over the 2011-2012 calendar year.  Travel stipends for case study completion may be available.

Abstract Objectives

1.     Features innovative field research and/or programs that address the intersection of women’s health and empowerment,

2.     Facilitates students’ learning about the interrelated nature of women’s health and empowerment,

3.     Documents major lessons learned from these projects, including challenges and failures, and

4.     Includes an assessment of how the specific effort has been effective or ineffective and clearly analyzes the reasons for its success or lack thereof.

Abstract Guidelines

  • An abstract of no more than 500 words should state the premise of the case study (principal research question/hypothesis or programmatic intervention), discuss its significance, and describe the methods and data sources.
  • If the case is based on a partnership, state the manner in which partners will be included in the development of the case study.  Considering the audience for the book will be from multiple disciplines, both academics and practitioners, abstracts should avoid disciplinary jargon to promote inclusivity.
  • Your curriculum vitae (4 pages maximum)

Review Process & Criteria

All submitted abstracts will go through an initial screening review. Based upon the initial review, the author will be contacted with questions of clarification and initial feedback.  For abstracts that successfully pass the initial screening, authors may submit a “revised” abstract that incorporates requested revisions.  Each first-round selected abstract will be presented to the COE members during a mid-November 2010 meeting.  The presentations will be done either in person or electronically.  The final abstract selections will contribute significantly to the formulation of the individual book chapters.

The abstracts will be rated upon the:

1.     Innovative contribution to women’s health and empowerment,

2.     Comprehensiveness of argument and analysis,

3.     Capacity to communicate cutting edge research and/or programmatic intervention,

4.     Strength of evaluation of the documented success or failure,

5.     Inclusion of the perspectives and engagement of the population that stands to benefit from research or program, and

6.     Proposed recommendations.

Deadlines

All abstracts must be submitted by 5:00 PM (Pacific Time) on October 15, 2010.  Abstracts should be sent to Katie Gifford (giffordk@obgyn.ucsf.edu) and be in a Word document format.  If you would like to discuss a concept prior to submission, please contact Katie Gifford at the above email address.

Nomination of Case Concept

Click here for the nomination form.  Please use the form to nominate case concepts of particular interest.  The COE will follow up directly with the nominee contact to facilitate full abstract development.

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More from the Global Maternal Health Conference in Delhi.

See below for my recap of the third and final plenary of the conference.

Ann Blanc, Director of the Maternal Health Task Force, welcomed attendees of the Global Maternal Health Conference to the third and final day of the conference. She recalled the Safe Motherhood Conference held in 1987 in Nairobi–and said, “Experts at the Nairobi meeting did not expect to be here today. They would have thought that by now preventable maternal mortality would be a thing of the past.”

Lynn Freedman, Director of the Averting Maternal Death and Disability program at Columbia University and moderator of the final plenary, opened the session with a statement that she said few could argue with: Many of the pieces are in place to make preventable maternal mortality a thing of the past; technical knowledge, money, political will, and big improvements on the great challenges of implementation. What we need now is accountability. The title of plenary three was Maternal health accountability: successes, failures, and new approaches.

Insights from plenary three panelists:

Sigrun Mogedal, of the Ministry of Foreign Affairs in Norway, discussed bi-lateral and mulit-lateral aid for maternal health. She noted the current momentum around maternal health but reminded conference participants that we have been here before–and asked, “Why should now be different?” She pointed out that consensus in New York is not the same as action on the ground. The missing piece needed for more action on the ground is accountability–and this is a matter of hard domestic policies. She said that bi-lateral and multi-lateral debates “take up too much space.” The global must serve and respond to the local, NOT the other way around.

Helena Hofbauer, Manager of Partnership Development at the International Budget Project, raised questions about aid effectiveness–and discussed national governments’ commitments to spending on maternal health. She described the work of the International Budget Project to use budget analysis to address persistent inequalities in maternal mortality. She said that the budget is a nation’s single most important overarching policy document. Helena asked, “What would happen if people actually asked the government how much and specifically on what they are spending to improve maternal health?” The International Budget Project did ask these questions on behalf of citizens, and the response was “deplorable”. In fact, the reply from Nigeria was that this sort of information is “sensitive and controversial” and from Tajikistan, “Please don’t bother the minister with these sorts of requests.” Helena declared, “This is, in practice, an accountability free zone.”

Nancy Northup, President of the Center for Reproductive Rights, talked about accountability within the context of a human rights and legal framework for improving maternal health. She described a paradigm shift from considering maternal health solely as a public health issue to now understanding it as a human rights issue. Nancy described the legal framework for how and why governments should be held accountable for maternal deaths–citing the right to life, health, equality and non-discrimination, privacy, spacing of children, to be free from cruel, inhumane or degrading treatment, and to education, information and the benefits of scientific progress. She described the process of litigation at the national and international level to demand individual compensation and systemic change–noting that demanding this sort of accountability is the next critical step in improving global maternal health.

Aparajita Gogoi, Executive Director of CEDPA India and the India National Coordinator for the White Ribbon Alliance, commented on accountability through grassroots advocacy. She said that working on the issue of accountability at the grassroots level occurs in three phases: gathering information, spreading awareness, and speaking out. She described a number of tools that can be employed to give local communities a voice including public hearings, check lists, verbal autopsies, and more. Aparajita talked about the importance of providing a safe setting for dialogue—a place where communities can voice concerns and demand action. She pointed out that crucial here, is that people with power are also present, take the concerns seriously, and are held accountable for taking action.

For more posts about the Global Maternal Health Conference, click here.

Visit the conference site for archived videos from the conference.

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More from the Global Maternal Health Conference in Delhi.

See below for my recap of the second plenary.

Plenary one at the Global Maternal Health Conference in Delhi was about finding common ground amidst two sets of maternal mortality estimates. Much like plenary one, plenary two, Community and facility interventions: reframing the discussion, was also about finding a common ground. It was about closing the divide between those who advocate for community-based care and those who advocate for facility based care–an issue that has caused major debates in the maternal health community for decades. This session was about reframing the discussion from “one or the other” to “both”. Plenary speakers called for an understanding that improving global maternal health must be about striking the right balance–and scaling up evidence-based interventions both at the community level and within facilities.

Brief insights from the second plenary:

Syeda Hameed, Member of the Planning Committee of the Indian government, challenged the nearly 700 conference attendees to think critically about one question: “How do we reach the unreached woman who is grappling with issues of maternal health?” Syeda then asked attendees to consider the woman who died last week on a busy Delhi street after delivering her baby. She asserted that training local women is KEY–and said that illiterate or semi-literate women can be trained and can save lives. She cited projects in Gadchiroli as evidence that this is achievable. Syeda also said that India must spend more not only on health, but also on the social determinants of health.

Zulfiqar A. Bhutta, Head of the Division of Maternal and Child Health at Aga Khan University, asked conference attendees to consider community-based and facility-based interventions as complementary and interconnected. He cited studies that have shown the impact of community-based interventions in improving maternal morbidity as well as increasing institutional deliveries. He characterized the debate around community vs. facility interventions as a confrontation that has unnecessarily split the field of maternal, newborn, and child health. He proposed an approach that focuses on the continuum of care: Where we have no facilities, we must adopt community based interventions. Where we have some access to skilled attendants, we should use incentive systems, like JSY, to encourage facility-based deliveries. And where there are facilities, we should supplement them with community-based services to support antenatal and postnatal care.

Harshad Sanghvi, Vice President and Medical Director of Jhpiego, said that striking the right balance between community-based and facility-based interventions is going to involve task-sharing. He said that one problem with solely advocating for facility-based care is that what often happens is that we go from poor access to low quality services to improved access to crowded and lower quality services. “We need to figure out logistical support to improve quality within facilities and use task-sharing to improve access to quality care at the community level.” Harshad discussed his experience with community-based distribution of misoprostol in Indonesia, Nepal, and Afghanistan which was safe, feasible, and programatically effective. He also raised transport and referral issues, stating that improving the capacity of communities to administer life-saving drugs will help to reduce the need for emergency transport. He also noted maternity waiting homes as a good option to consider.

P. Padmanabhan, Director of Public Health in Tamil Nadu, Ministry of Health and Family Welfare, India, expressed the importance of considering context when implementing maternal health interventions in India. He described numerous context driven maternal health intervention strategies throughout many regions of India–illustrating why some projects work better in certain regions that others. He concluded by saying that we must improve service delivery at both the community and facility level, always taking local context into account.

For more posts about the Global Maternal Health Conference, click here.

Visit the conference site for archived videos.

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Last week, the Maternal Health Task Force and the Public Health Foundation of India convened a meeting of nearly 700 maternal health experts to discuss lessons learned, neglected issues, and innovative approaches for improving maternal health at the Global Maternal Health Conference in Delhi.

See below for my recap of the first plenary.

The opening plenary, Global progress on maternal health: the numbers and their implications, of the Global Maternal Health Conference 2010 in Delhi focused on global progress on maternal health and explored recent maternal mortality estimates. Speakers discussed the numbers and asked questions not only about what the numbers mean–but also about how the maternal health community can use the numbers.

Over-arching questions from the session were:

Which numbers should we use, those published in the recent Lancet report or those soon to be published by the United Nations (presuming that the numbers will be quite different)?

Will these two sets of numbers prove to be a hurdle in the struggle to bring unity to the global maternal health community? If so, how can we reconcile this and avoid a divide in the community?

Will the two sets of numbers push the maternal health community to establish better and more robust methods of measuring maternal mortality and morbidity?

Has the maternal health community collectively neglected the measurement of maternal morbidity–and how can we begin to focus on measuring not only mortality but morbidity as well?

Brief insights from the opening plenary speeches:

Rafael Lozano, Professor of Global Health at the Institute for Health Metrics and Evaluation, succinctly summarized the  statistical analysis behind the recent Lancet publication in one slide. (Presentations will soon be available online here: www.maternalhealthtaskforce.org/gmhc2010) He also described many of the lessons learned from the research that led to the Lancet piece–the gaining of ground in the reduction of maternal mortality, an improved picture of what the key drivers of progress really are, the correlation between HIV/AIDS and maternal health outcomes, and the importance of communication with countries and local researchers.

Lale Say, Medical Doctor and Epidemiologist at the World Health Organization, discussed the inter-agency approach of monitoring progress on maternal health–stressing the importance of country level consultations and technical collaboration. While she did not present the latest maternal mortality estimates, she talked in depth about the methodology that the World Health Organization, UNICEF, UNFPA, and the World Bank use to estimate global maternal mortality.

Wendy J. Graham, Principal Investigator with Immpact at the University of Aberdeen, urged the maternal health community to understand that failure is not a bad word.  She explained that we often emphasize the successes of our efforts so much so that we neglect to learn from our failures. Wendy also reiterated the importance of context when implementing maternal health programs saying, “context, context, context”–and explaining that because an initiative succeeds in one place, there is no guarantee that it will succeed in the next. We must consider the unique context of each setting where we work.

Saroj Pachauri, Regional Director for South and East Asia at the Population Council, asked a number of thought provoking questions throughout her presentation; We count numbers but do numbers count for policy change? Is there a culture of evidence-based programming? How can we address measurement challenges and improve the use of information? Saroj also noted staggering inequities in maternal deaths between and within countries. She explained that the lifetime risk of maternal death in South Asia is 1 in 43 compared to 1 in 30,000 in Sweden–citing this as an example of a failure to bridge the divide between rich and poor.

For more posts about the Global Maternal Health Conference, click here.

Visit the conference site for archived videos.

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In my last few weeks at the Maternal Health Task Force, I have been working with Raji Mohanam, Knowledge Management Specialist at the MHTF, Matthew Meschery, Director of Digital Initiatives at ITVS, and Lisa Russell, Filmmaker and Co-Founder of MDGFive.com, and an incredible team of presenters, to coordinate a panel presentation on digital tools for maternal health for the Global Maternal Health Conference in Delhi. Take a look below for a post I wrote for the MHTF Blog about the upcoming panel session–with info on how to participate remotely.

I am off to India tomorrow! Check back next week for posts from the conference.

The upcoming Global Maternal Health Conference in Delhi (August 30th-September 1st) will focus on lessons learned, neglected issues, and innovative approaches to reducing maternal mortality and morbidity. The anticipated outcome of the conference is increased consensus around the evidence, programs and advocacy needed to reduce preventable maternal mortality and morbidity.

One session, Maternal Health Digital, will showcase a number of digital communication tools being applied to maternal health. Matthew Meschery, Director of Digital Initiatives at the Independent Television Service, will moderate the session—and will guide panelists and participants through a lively discussion that will explore the potential of digital tools to improve the health of women around the world. Panelists will also address questions about how to measure the impact of such projects.

Throughout the session, conference participants will learn about an email help desk that is aiming to increase access to misoprostol and mifepristine, a mobile phone and radio initiative that is aiming to improve delivery of maternal and neonatal health services, an online media “mash-up” tool that is enabling users to make their own advocacy videos, a crowd-sourcing project that is tapping into the knowledge of front-line maternal health care providers in 9 languages, and more.

This exciting session will include presentations from Google.orgWomen on WebZMQ Software SystemsHealth ChildMDGFive.com, the Social Media Research Foundation, the Pulitzer Center for Crisis ReportingUniversity of Oxford, the Maternal Health Task Force, and the Independent Television Service.

Take a look at the session summary:

In recent years, the health, technology, and communication sectors have come together to innovate health communications through the use of digital media. Advances in tools for cross-media storytelling, social networking, digital games, real-time messaging, and mobile and location-aware technologies are being adapted to fit the needs of the maternal health community—and are helping to fuel the increased momentum around the issue. In this interactive session, conference participants will learn about a diverse range of innovative projects that are aiming to identify challenges and solutions for providing care to pregnant women, build stronger connections among maternal health organizations, create new ways to collect and use data, foster increased collaboration through engaging communities, and continue to drive attention toward the issue. As well as highlighting the promise of these new tools, we will also look at some specific challenges such as measuring impact, working in areas with limited connectivity, and merging online and offline strategies. There will be a series of mini-presentations on crowd-sourcing, interactive mapping, a media mash-up tool, an online reporting hub, mobile health campaigns, and more. Participants will not only get an over-view of a wide variety of strategies and recent developments in digital health communications—but they will also learn tips for applying many of these new tools to their own work and engage in a dialogue around how to maximize the utility of these technologies in order to significantly improve the health of women around the world.

This session will be live streamed! Click here for the live stream schedule.

Join the discussion via Twitter! Conference hashtag: #GMHC2010, Session hashtag: #GMHC2010Digital


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Final preparations are underway for the Global Maternal Health Conference in Delhi! With only a couple of weeks until the conference, things have been very busy at the Maternal Health Task Force! Take a look below for the recently finalized live stream schedule. We will be streaming (open-access, no registration necessary) all plenary sessions as well as a number of parallel and panel sessions. In addition, ALL sessions will be archived for future viewing.

If you are interested in guest blogging about the conference sessions, click here for more info.

Cross-posted from the MHTF Blog.

In just a couple of weeks, the Maternal Health Task Force (MHTF) and the Public Health Foundation of India (PHFI) will convene an unprecedented gathering of over 600 maternal health experts and their allies in a global technical and programmatic meeting. The Global Maternal Health Conference 2010 aims to build on the existing momentum around MDG5.  The conference will focus on lessons learned, neglected issues, and innovative approaches to reducing maternal mortality and morbidity. The anticipated outcome is increased consensus around the evidence, programs and advocacy needed to reduce preventable maternal mortality and morbidity.

In an effort to engage and inform a broader audience, the plenaries and several sessions will be live streamed.

For information on each of the sessions that will be live streamed–including speakers and abstracts, click on the session title below.

This schedule is in India Standard Time. Click here for a time zone converter!

ACCESS LIVE STREAM FOR ALL SESSIONS HERE.

August 30th, 2010

9:00-10:00 Inaugural

11:00-12:30 Plenary Session:
Global Progress on Maternal Health: The Numbers and Their Implications

13:30- 15:00 Parallel Session:
Human Resources for Maternal and Newborn Health: The Key Element

15:30- 17:00 Parallel Session:
Extremely Affordable Technologies for Maternal and Newborn Survival

August 31st, 2010

9:00-10:30 Plenary:
Community and Facility Interventions: Reframing the Discussion

10:45-12:15 Parallel Session:
Task-Shifting to Expand Access to EmOC: Developing a Deeper Understanding of What it Takes

13:45-15:15 Parallel Session:
Prevention and Treatment of Postpartum Hemorrhage

15:30-17:15 Panel Session:
The Next Generation of Maternal Health Solutions from the Young Champions of Maternal Health

September 1st, 2010

9:00-10:00 Plenary Session:

Maternal Health Accountability: Successes, Failures and New Approaches

10:45-12:15 Parallel Session:
Indian Models of Public-Private Partnerships

13:45-15:15 Parallel Session:
Informatics to Improve Systems

15:30-17:15 Panel Session:
Maternal Health Digital

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