Chris Morgan, Women Deliver 29 May 2013

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Maternal and newborn health: some experiences and roles of the WCH Knowledge Hub in Asia and the Pacific
Chris Morgan
Principal Fellow, Centre for International Health
Burnet Institute

Published in: Business, Education
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Chris Morgan, Women Deliver 29 May 2013

  1. 1. Maternal and newborn health: some experiences androles of the WCH Knowledge Hub in Asia and the PacificChris MorganPrincipal Fellow, Centre for International HealthBurnet Institute
  2. 2. Knowledge Hub work on maternal andnewborn health care, in high mortality settings• Adopted a systems perspective Matching the health systems framework ofthe other AusAID knowledge hubs• Firmly focused on service delivery options Collating implementation research ono Interventions,o Packages of care ando The delivery of those packages• Sought approaches for high mortality settings Also those with high proportions of births outsidehealth facilities Examining what could be done at community level atthe time of childbirth Complementing work by other Compass WCH Hubpartners on quality of care and the evidence base forinterventions in first- and second-level health facilities
  3. 3. Community-based care at childbirth – can it safelyextend coverage in high mortality settings?• Literature review in 2009 Update in 2013• Site analyses of policy andpractice in Papua New Guinea Solomon Islands Lao PDR Indonesia’s NTT province Policy brief in 2011• Packages of care with potentialfor significant newborn andmaternal survival impact But need caution and measuredintroduction Must be synchronised with healthfacility strengtheningEstablished packages for newborncare (warmth, hygiene, EBF), cleandelivery kits, chlorhexidine;Community mobilisation, facilitatedreferral;Oxytocics from trained workers orself-administered;Antibiotics from trained workers(lay or paid); and? pre-filled injection devices forvaccination or oxytocics.
  4. 4. Policy and practice analysis demonstratesdifferences by setting – the need for tailoredapproaches
  5. 5. Community-based MNH service deliveryoptions unique to the Western Pacific Region• Integrating postnatal care with birth-dose vaccination for hepatitis B• A strong WPRO-led program• Opportunities to spread since new globalViral Hepatitis Strategy - WHA 2010(and a link to “post-survival” newborn care)• Drawing on past research by PATH, Burnetand others (including national governments)• Out-of-cold-chain usage, Uniject injection• Scaled up in Indonesia, tested inChina/Vietnam• In PNG we had demonstrated feasibility inreaching 75% home births with integratedpostnatal care and birth-dose vaccination
  6. 6. Hub-funded contributions to the servicedelivery evidence base, with WHO and others• Hub-funded work with WHO on effectivepractices for birth-dose vaccination• Contribution to WHO’s standard publications• Stronger integration of postnatal care formothers and newborns with vaccination• Review of provision of injections by layhealth workers• With Norwegian Knowledge Centre andWHO RHR, contribution to WHO evidencebase on task-shifting• Community actions for MNCH• With WPRO Health Systems team• Review of studies on maternal sepsis• Examining both maternal sepsis (includingpuerperal sepsis) and early newborn sepsis• Potential of pre-referral treatment of themother during PNC home visits
  7. 7. Policy- and advocacy-oriented evidencereviews of community-based care formothers, tailored to Papua New Guinea• Collaboration with World Vision Australia• Reviewed MNCH community-care evidence By intervention, package and delivery option Documenting global practice and PNG’s ownhighly varied spectrum of experiences Adding a value-for-money judgement• Dissemination of a 30page policy reportand targeted 2 page policy briefs Tailored separately to Australian and PNGpolicy-makers Clear action requests Definitive response from the PNG government First national conference on health volunteers Newly filled national position to review anddevelop policy, standards and procedures
  8. 8. Service deliveryquestions remainWCH Hub work so far has set upsome clear directions for futureimplementation research- PNG and Myanmar promising sitesIssues for newborns and home visits:- timing of home visit- preventive care only, or treatment- integration with maternal andimmunisation programsIssues for mothers:- can ‘stop-gap programs riskencouraging home birthsor distracting from facility care- misoprostol - treatment orprevention; vs oxytocin, timing- unknowns around puerperalsepsis in the community- role of psychological supportIssues for both:- how to introduce in concert withhealth system strengthening- links family planning- comprehensive PHC still offersbest health system environment
  9. 9. A regional knowledge platform, supportedby a development partner, enabled• Policy-oriented evidencecollation, analysis and knowledge generation• Forcing researchers to address policy needs• And development staff to considerimplementation evidence• Tailored work to address Sites in our region Specific settings, such as those with highrates of home birth• Regional and global engagement Beyond that often available to Australianagencies and partners Such as sustained work with WHO Networks like AHPSR (Health SystemsGlobal), PMNCH, Women Deliver
  10. 10. Knowledge Hubs for Health are a strategic partnership initiative funded by theAustralian Agency for International DevelopmentAcknowledgements:Fellow researchers on site analyses:• Jenny Kerrison, Indonesia• Pilly Mapira, Papua New Guinea• Louise Sampson, Lao PDR• Chris Hagarty, Solomon IslandsFellow researchers in synthesis papers:• Abbey Byrne, Nossal Institute forGlobal Health• Jess Davis, Burnet Institute• Kelly Durrant, Burmet Institute• Liz Comrie-Thomson, Burnet InstitutePartner Institutions:• Papua New Guinea, NationalDepartment of Health• Norwegian Knowledge Centre for theHealth Sciences• World Vision Australia• Save the Children international• World Health Organization, Vaccinesand Biologicals• World Health Organization,Reproductive Health Research

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