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.
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