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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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The Woodrow Wilson Center’s Global Health Initiative, the Maternal Health Task Force, and the United Nations Population Fund (UNFPA) invite you to attend (or watch online) the sixth event of the series, Advancing Policy Dialogue on Maternal Health: The Impact of Maternal Mortality and Morbidity on Economic Development. The event will take place on July 29th from 3-5pm in Washington, D.C.

Woodrow Wilson International Center for Scholars

Event Details:

Investing in women and girls health is smart economics. According to the United Nations Population Fund (UNFPA) women contribute to a majority of small businesses in the developing world and their unpaid work on the farm and at home account for one-third of the world’s GDP. The U.S. Agency for International Development (USAID) estimates that maternal and newborn deaths cost the world $15 billion in lost productivity.

Mayra Buvinic, sector director of the gender and development group of the World Bank, will address the economic impact of maternal deaths and the role of education and gender equality on economic development. Dr. Nomonde Xundu, health attaché at the Embassy of South Africa in Washington DC will discuss the policy implications of maternal health and share lessons learned in empowering women and girl’s economic status in South Africa. Mary Ellen Stanton, senior maternal health advisor of USAID, will present the foreign policy and economic case for increased donor investment in maternal health.”

For more info and to RSVP, click here.

For info on future events and links to videos of previous events in the maternal health policy dialogue series, click here.

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On July 1st, the Women Deliver team announced the top five highlights from the 2010 conference (June 7-9). See below for a summary of the conference highlights–with links to publications, videos, photos, and additional information that came out of the conference.

This post was originally posted on the Women Deliver website and is reposted on MMD with permission from Women Deliver.
conference-participants.jpg

Women Deliver 2010 Conference participants

Thank you to everyone who contributed to the success of the second Women Deliver global conference. To put world leaders on notice that the time for action on maternal health is now, 3,400 advocates, policymakers, development leaders, health care professionals, youth, and media from 146 countries converged on Washington, DC on June 7-9 at Women Deliver 2010. More than 800 speeches and presentations were given at the six plenaries and 120 breakout sessions.  The heads of five UN agencies, plus the Secretary-General of the United Nations, attended. Thirty countries, UN agencies, the World Bank, corporations, and foundations helped support Women Deliver. Please see below for highlights and recaps of the conference.

1. Key Statements. Read the outcome statements from the:

2. Webcasts. Watch the videos from our plenary sessions and our press conferences, and watch Hillary Clinton’s address to the Women Deliver 2010 attendees.

3. Photos. Take a look at photos from the plenary sessions, breakout sessions and other conference events, and download them at no cost.

4. Programme. Review the plenary and breakout sessions that were held at Women Deliver 2010.

5. Publications and Advocacy Tools. Visit our Knowledge Center to download publications and advocacy tools, including:

Stay tuned for our summary report on breakout sessions by theme.

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The Kaiser Family Foundation is holding a policy forum (open to the public) where experts will comment on progress toward achieving Millennium Development Goals 4 and 5–and explore the role of the U.S. in improving global maternal and child health. The event will take place on May 24th, from 9:30am to 11:00am ET at the Foundation’s Washington D.C. office.

The Kaiser Family Foundation

“…Recently published data from the University of Washington’s Institute for Health Metrics and Evaluation (IHME) show some progress in improving maternal health globally in recent years, though substantially more progress will be needed to achieve the United Nations’ Millennium Development Goals for reducing child mortality and improving maternal health by 2015...

…The expert panel discussion will include Jennifer Klein, senior advisor on global women’s issues at the U.S. Department of State; Flavia Bustreo, director, Partnership for Maternal, Newborn and Child Health, World Health Organization; Ana Langer, president, EngenderHealth; Christopher J.L. Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington; and Jen Kates, vice president and director of Global Health Policy and HIV, Kaiser Family Foundation.  Foundation Executive Vice President Diane Rowland will moderate…”

For event details and information on how to RSVP, click here. You will also find information on how to view the archived webcast of the event.

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The Maternal Health Task Force, UNFPA and the Woodrow Wilson Center’s Global Health Initiative bring you a discussion on Human Resources for Maternal Health: Midwives, TBAs, and Task-Shifting

This event is the second in the series. It will be held tomorrow, Wednesday, January 06 2010, 3:00 p.m. – 5:00 p.m. at the Woodrow Wilson International Center for Scholars in Washington D.C.

Click here to RSVP this event.

If you are interested, but unable to attend the event, check out the live or archived webcast here.

Event Details

Extending the scope of responsibilities to non-physician health workers is potentially an important means to reducing maternal deaths in the developing world. While this strategy has proven to be an effective method for addressing human resource gaps in maternal health, pitfalls such as inadequate training and lack of coordination among key actors must be addressed.

Dr. Seble Frehywot, assistant research professor of health policy and global health at George Washington University, will address the motivation and methods for task sharing. Dr. Jeffrey Smith, regional technical director for Asia at Jhpiego, will discuss his field work experience developing workforce plans for midwives and traditional birth attendants, including in Afghanistan. Finally, Pape Gaye, president & CEO of IntraHealth, will discuss the importance of retention and other long-term strategies in human resources for maternal health.

About the Series

The reproductive and maternal health community finds itself at a critical point, drawing increased attention and funding, but still confronting more than a half million deaths each year and a high unmet need for family planning. The Policy Dialogue series seeks to galvanize the community by focusing on important–and in some cases controversial–issues within the maternal health community.

Did you miss the first event in this series?

Don’t worry! You can watch the webcast or read a report on the event! The first event in this series was held in December. The topic was Integrating HIV/AIDS and Maternal Health Services.

To view the archived webcast, click here. To read a report about the event, click here.

Click here to view Integration is all the Buzz, a previous post on this blog that highlights current news about integration of maternal health services and discusses Integrating HIV/AIDS and Maternal Health Services.

More info

Visit the Maternal Health Task Force website here.

Visit the UNFPA website here.

Visit the Woodrow Wilson Center’s Global Health Initiative site here.

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