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Posts Tagged ‘Gates Foundation’

This post is the first in a series on maternal health in the Seraikela block of Jharkhand, India. 

In 2009, Sarah Blake and I worked together at the Maternal Health Task Force, a Gates Foundation funded maternal health initiative based at EngenderHealth in New York City. Since then, Sarah went on to work as a consultant with several non-profit organizations, including UNFPA and Women Deliver.  I took off for India as a Clinton Fellow with the American India Foundation where I have been working for the past nine months on a maternal and newborn health project in Jharkhand, a state with high levels of maternal and newborn deaths.

A new mom holds her newborn in a small community called Sini, in the Seraikela block, as community members look on.

Sarah and I recently teamed up again (this time, in India) to explore our common interest in maternal health. Over the past two weeks, we have visited hospitals, health centers, government offices, rural villages, and homes in the Seraikela block, a rural area with rugged terrain and limited infrastructure outside the industrial city of Jamshedpur, in the state of Jharkhand.  We conducted a series of interviews with women, families, health workers, and government health officials. We asked questions about pregnancy, childbirth and the postpartum period. We learned about the women’s experiences with home and institutional deliveries–and the factors that influence their decision to deliver at home or in an institution. We explored the implementation of and attitudes toward Janani Suraksha Yojana, a conditional cash transfer program that aims to increase institutional deliveries across India.

A collapsed road on the way from Jamshedpur to the Seraikela Block of Jharkhand.

Conditional cash transfers are trendy. Various governments, non-governmental organizations, and private enterprises across the globe are supporting cash transfer initiatives in efforts to improve school attendance, reduce child under-nutrition, improve maternal and newborn health, and to address other development goals.

What is a conditional cash transfer program? According to the World Bank, “conditional cash transfer programs provide cash payments to poor households that meet certain behavioral requirements, generally related to children’s health care and education”.

Janani Suraksha Yojana (JSY) is a widely discussed (mostly within the global health community but to some extent in mainstream media) and frequently praised cash transfer program. JSY was launched by the Indian government as part of the National Rural Health Mission in 2005, in an effort to reduce maternal and newborn deaths by increasing institutional deliveries.

JSY provides cash incentives to women who deliver in government health institutions as well as accredited private health centers. The program also provides a cash incentive to the health worker who supports the woman throughout her pregnancy and accompanies her to the facility. (For details and FAQs on JSY, click here.)

A community health worker accompanies a pregnant woman to Mahatma Gandhi Memorial Hospital in Jamshedpur, the main referral hospital for the surrounding rural communities.

Maternal and newborn death rates have gradually been declining across India (and the world), but the problem has yet to be resolved. Both maternal and newborn deaths in India continue to make up an extremely large percentage of the overall global burden. According to a study published in the Lancet last year, 20% of global maternal deaths and 31% of global newborn deaths in 2005 occurred in India.

JSY is a big program (the biggest of its kind in the world) that aims to deal with a big problem. The lessons that are drawn from it have the potential to influence global health policy in a big way. The 2010 evaluation of JSY published in the Lancet suggested that the program is having a significant impact on perinatal and neonatal health, but the paper asserted that the verdict was still out in terms of any impact on maternal mortality.

The lesson that has emerged from JSY for newborn health is that giving women money increases institutional deliveries and reduces perinatal and neonatal mortality.  It is likely that the same message will emerge in terms of reducing maternal mortality—and there is a good chance that this approach will be picked up in national health programs in numerous other countries that also have high levels of maternal and newborn mortality.

Our concern is that JSY is far more complex than providing women with money—and reducing maternal mortality is far more complex than increasing institutional delivery.

Given the scope, cost, and potential of JSY; it is incredibly important that we ask questions about the nuances of JSY—the role of money as an incentive for women, families and health workers; the readiness of institutions;  the challenges with transportation; the human rights implications of the program; and a variety of other related factors.

Over the next week (or couple of weeks), Sarah and I will share our experiences and insights from our time with the women, families, health workers, and government health officials of the Seraikela block of Jharkhand, a focus state for JSY. We will highlight stories from the people most impacted by and involved in Janani Suraksha Yojana.

We believe that we have scratched the surface of some interesting issues related to JSY, but our time in Seraikela certainly left us with more questions than answers, and we will be sharing those questions in upcoming posts.

We will also be asking our colleagues working in maternal and newborn health to share their thoughts through guest blog posts. If you are interested in submitting a guest post, contact us at katemitch@gmail.com and sarahcblake@gmail.com.

Tata Steel Rural Development Society, my host organization for my fellowship, provided us with transportation and interpreter services. Many thanks to Shabnam Khaled for her help with translation. 

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In an effort to improve the reproductive health, maternal and neonatal health, maternal and child nutrition and access/use of vaccines of the poorest 20% of Mesoamerica (which translates to 8 million people in Panama, Costa Rica, Nicaragua, Honduras, El Salvador, Guatemala, Belize and the southern states of Mexico), the Gates Foundation, the Carlos Slim Health Institute, the Spanish government and the Inter-American Development Bank have formed an innovative public-private partnership–called Salud Mesoamerica 2015.

IDB (Inter-American Development Bank)

“…Salud Mesoamérica 2015 will work in partnership with the health ministries of Mesoamerican countries and in close coordination with the Mesoamerican Public Health System. This system is part of the regional integration platform known as Proyecto Mesoamérica.

In contrast to many other international programs, countries will not compete for resources under SM2015, because amounts will be allocated per country over a five-year period based on their poverty and health inequality status. Moreover, governments themselves will determine the projects that will be financed by the Initiative within the identified areas…”

Read the full story.

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Over 3,500 maternal health providers, researchers, policymakers, and advocates from all over the world have gathered in Washington D.C. for Women Deliver 2010, a global conference focused on maternal and newborn health. Earlier today, I posted a short blog post on the MHTF Blog with highlights from day one of the conference.

The MHTF Blog

The post includes links to the announcement of the  Gates Foundation commitment to $1.5 billion in additional funding for maternal and child health (announced yesterday by Melinda Gates), a special themed issue of the Lancet dedicated to Women Deliver, the launch of the University of Oxford’s maternal health crowd-sourcing initiative, and several other announcements of major developments in the field of maternal and child health. The blog post includes several useful links for more information on each of the highlights.

Click here to read the post  on the MHTF Blog.

If you are not attending the conference but would like to participate remotely, view the live webcast here.

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The Seattle Times reports on a rise in Gates Foundation funding for programs that aim to improve maternal and newborn health–and according to Melinda Gates, investing in the health of moms and babies saves lives at a far lower cost than treating diseases later on.

The Seattle Times

“…Gates talked about teaching a method known as “Kangaroo Mother Care,” which encourages mothers to wrap and hold their babies until they can maintain their own body temperature. (In fact a study published this week found that “kangaroo mother care” cut newborn deaths by more than 50 percent and was more effective than incubators). Inexpensive drugs can also prevent mothers from hemorrhaging in childbirth.

Such a comprehensive program, together with contraception, could cut maternal deaths by 75 percent and reduce newborn deaths by 44 percent, she said…”

Read the full article, Melinda Gates: Foundation Investing More in Mothers and Newborns.

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Round 5 of the Grand Challenges Explorations Initiative is focused on New Technologies to Improve the Health of Mothers and Newborns.

MHTF Blog

“…The goal of the initiative is to foster innovation in global health research. The Bill and Melinda Gates Foundation supports this initiative and will make initial grants of $100,000–and successful projects will have the opportunity to receive a follow-on grant of up to $1 million…

…This is the first GCE topic focused entirely on maternal and neonatal health. The goal is to solicit novel and innovative technologies to reduce maternal, fetal or neonatal mortality and morbidity…”

For more information on the Grand Challenges Explorations Initiative–including information on how to apply–read the full post on the MHTF Blog here.

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Maternal Health Task Force

The Maternal Health Task Force (MHTF) and the Public Health Foundation of India (PHFI) have announced their 2010 conference on maternal health.

The conference will be held in New Delhi, India from August 30th to September 1st.   The two organizations will bring together approximately 500 maternal health experts and members of allied fields to discuss lessons learned, neglected issues, and innovative thinking to improve global challenges in maternal health.

For details, click here.

About the MHTF
“The Maternal Health Task Force at EngenderHealth contributes to shaping collective efforts to improve maternal health worldwide. Supported by the Bill & Melinda Gates Foundation, the MHTF serves as a catalyst to address one of the most neglected areas in global health. “

About PHFI
“The Public Health Foundation of India uses a broad, integrative approach to public health. It works to build institutional capacity in India for strengthening training, research and policy development in the area of public health.”

For information on additional conferences in 2010 that will focus on maternal health, click here.

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Five recent stories published on the site have raised various issues impacting maternal health—including leadership and innovation, maternal death audits, access to primary health care and safe delivery, human rights, and even a proposal for a separate maternal health ministry.

allAfrica.com

Namibia: Leadership Development, Social Innovation and Improved System Performance

The Maternal Health Initiative Team,  an offshoot of the African Public Health Leadership and Systems Innovation Initiative, funded by the Bill and Melinda Gates Foundation, is “developing a model for improving public health leadership and system performance.”

“…The project is underpinned by three principles: local leadership development, social innovation and improved system performance.

The initiative applies a business-consulting approach called the Innovation Lab. Through the Innovation Lab, multi-stakeholder teams are guided through an intensive leadership development and problem-based learning experience. The aim is to tackle a complex social and system problem through a multi-stakeholder and innovation response.

When deciding on a priority health problem to tackle as a pilot, it wasn’t hard for Namibian health leaders to choose maternal health. Between 2000 and 2006, maternal mortality jumped to 449 deaths per 100 000 births, an increase of 178 deaths…”

Read the full article,  Namibia:Health Authorities Tackle Maternal Mortality.

Rwanda: A Call for Maternal Death Audits

“…As a strategic move to curb the maternal death rate further and achieve millennium development goal 5, the government recently extended the fight to the village level.

This was announced recently by the Minister of Health, Dr. Richard Sezibera, during a meeting that was held with a visiting US medical team to discuss Rwanda’s health progress.

During the discussions, Sezibera noted that it was imperative to engage the community in fighting maternal death rates so that leaders at the village level can identify the causes of these deaths in bid to find a lasting solution.

‘This year we started maternal death audits in villages because we believe that social audits on death causes will enable authorities identify answers to this problem,’ the minister said…”

Read the full article, Rwanda: Maternal Mortality Control Extends to Village Level.

Nigeria: Improving Access to Primary Health Care and Safe Delivery

“Health System Development Project II, a World Bank assisted project has commissioned two Comprehensive Primary Health Centres at Dagiri community in Gwagwalada and Dabi village at Kwali.

The Health Centres are to address the high rate of maternal and child mortality cases in the country, said Mrs Anne Okigbo-fisher, World Bank task team leader during the hand over ceremony of the centres. She said Nigeria records 10 percent of the world’s maternal mortality rates out of the 524,000 women that die yearly during child birth, adding that approximately 99 percent of the mortality rate is due to child birth complications in developing countries.

According to her the objective of HSDP II is to reduce such complications and improve safe delivery in the country…”

Read the full article, Nigeria: World Bank Commissions N104 Million Hospitals in Abuja.

Kenya: Human Rights Impacting Maternal Health

Amnesty International calls on Kenya’s Parliament to ensure that the draft Constitution of Kenya upholds respect for, the protection and fulfilment of all human rights. The draft Constitution should retain social and economic rights as enforceable rights. In addition, the organization also calls on Parliament to remove the provision stipulating that the right to life begins at conception and if the article on abortion access is retained, provide for abortion for rape victims…

…If the Constitution explicitly limits women’s access to abortion services, it must, at least ensure women’s access to safe and timely abortion services in cases of risk to the life or health of the woman or pregnancy resulting from rape or incest. Such an exemption is required by international law and is required by the Protocol to the African Charter on Human and People’s Rights on the Rights of Women in Africa, which Kenya signed in 2003. In view of the high number of maternal deaths resulting from abortion complications, the State should protect women’s right to life by ensuring meaningful access to sexual and reproductive health services including information and contraception and commit to address sexual violence and coercion…”

Read the full article, Kenya: New Constitution Must Ensure Rights for All.

Uganda: A Call for an Independent Maternal Health Ministry

“An independent ministry should be set up to handle maternal health, the deputy Speaker of Parliament, Rebecca Kadaga, has said.

‘Who is planning for women’s health in this country? Basic things like antibiotics, oxytocins (drugs that help manage bleeding) which cost sh300 and manual vacuum aspirators to remove retained products from the womb are not there,’ she told journalists at a briefing on the state of maternal health on Friday…”

Read the full story, Uganda: Kadaga Wants Independent Maternal Health Ministry.

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Can integrating family planning services into HIV/AIDS treatment and care increase contraceptive use and decrease unintended pregnancy among HIV-positive women? UCSF is partnering with the Kenya Medical Research Institute and Ibis Reproductive Health to find out.

University of California, San Francisco

“’Two-thirds of the world’s HIV-infected population lives in sub-Saharan Africa and 60 percent are estimated to be women. Recent evidence suggests high rates of unintended pregnancy among HIV-infected women. Family planning is the cornerstone for preventing mother-to-child transmission of HIV and can also reduce maternal mortality, but family planning services are not always accessible at many of the public health clinics providing HIV care and treatment,’ said the study’s primary investigator, Craig R. Cohen, MD, MPH, professor of obstetrics, gynecology and reproductive sciences at UCSF.

The research will be conducted at 18 HIV care and treatment clinics in Nyanza Province, Kenya. With 15.3 percent of its population HIV-infected, Nyanza Province has the highest seroprevalence rate amongst provinces in Kenya. These clinics are supported by the Family AIDS Care and Education Services (FACES) Program, a collaboration between UCSF and the Kenya Medical Research Institute (KEMRI). At 12 randomly selected clinics, HIV-infected clients will receive the intervention package of integrated family planning and HIV care. At each of the six clinic control sites, HIV-infected clients will receive standard HIV care and a referral to a separate family planning clinic within the same facility for contraceptive services.

The study’s first objective is to improve family planning clinical and counseling skills of clinicians and community health workers at all the FACES-supported HIV care and treatment clinics. A training curriculum on family planning counseling and method provision will be developed and implemented…”

Read the full news release here.

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The Grameen Foundation, Columbia University’s Mailman School of Public Health and the Ghana Health Service are working together on a project called Mobile Technology for Community Health (MoTeCH). This joint initiative, funded by the Gates Foundation,  is exploring how to best use mobile phones to increase quality and quantity of maternal and neonatal health services in Ghana.

MobileActive.org

“…For example, a woman might come in for a health check-up when she’s 12 or 14 weeks pregnant, at which point she would be registered into the MoTeCH system. She would then be on track to receive two kinds of messages: informative texts and action texts. The informative texts simply tell the parents what to expect (i.e., developmental stages) during a pregnancy, while the action texts encourage parents to make clinic visits based on their personal histories (such as needs for shots or follow-up appointments).

The other target audience of MoTeCH is community health workers who provide the vast majority of primary care in much of the developing world. The workers use mobile phones to enter data such as when they have seen a patient and what kind of treatment these patients received. Data is then compiled to more easily track patients.

The idea behind MoTeCH is to link the two systems so that the messages can be more specifically targeted and tailored to the needs of the individual parents; for example, if a pregnant woman misses a tetanus shot, the community health workers’ records will show how many weeks along she is and she can be easily sent a reminder. Similarly, messages can be sent to village community health workers alerting them to patients who are in need of specific services in order to locate the patient and encourage him or her to get treatment. ‘It gets community health care workers out of the clinic and seeking patients who need care a little bit more immediately,’ said Wood…”

Read the full story here.

For more info on the subject, take a look at Dying for Cell Phones (Literally).

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