Translating Coverage Gains into Health Gains for All Women and Children: The Quality Care Opportunityby Jai K Das
The health outcomes of women and children have not matched expectations from the gains in the coverage of care. Robust evidence exists for one explanatory factor: the poor–rich gaps in coverage found along the continuum of care for women and children, and particularly for the crucial period around childbirth. The more-neglected explanation for the mismatch between coverage and health outcomes is the quality of the care provided to women and children. The following paper is structured around a key cause and a consequence of the neglect of quality—weak measurement and poor evidence for action—and concludes with priorities for seizing the quality care opportunity.
Maternal, newborn, and child health indices in Nigeria vary widely across geopolitical zones and between urban and rural areas, mostly due to variations in the availability of skilled attendance at birth. To improve these indices, the Midwives Service Scheme (MSS) in Nigeria engaged newly graduated, unemployed, and retired midwives to work temporarily in rural areas. This paper describes the structure, processes, challanges and the outcomes acheived through MSS.
Comprehensive Approach to Improving Maternal Health and Achieving MDG 5: Report from the Mountains of Lesothoby Jai K Das
The emerging consensus is that improvement in women's health cannot be made through simple, vertical strategies; rather, it requires broad-based health system strengthening at every level of care, from the community to the clinic to the hospital. This paper reports experience in rural Lesotho, where a pilot program was implemented that provided comprehensive care of pregnant women from the community to the health center level, linking key primary care services (include HIV testing and treatment) to antenatal care (ANC) and facility-based delivery.
Antenatal care (ANC) provides a crucial opportunity to reach high risk women and prevent pregnancy related complications and the consequent mortalities. We share a study conducted in Zambia that evaluates the role health service factors. The study objective was to assess how distance to facilities and level of service provision at ANC facilities in Zambia influenced the number and timing of ANC visits and the quality of care received.
Among the hypertensive disorders that complicate pregnancy, pre-eclampsia and eclampsia stand out as major causes of maternal and perinatal mortality and morbidity. The majority of deaths due to pre-eclampsia and eclampsia are avoidable through the provision of timely and effective care to the women presenting with these complications.We share the recent WHO guidelines for the prevention and management of Pre-Eclampsia/Eclampsia
Post Partum Haemorrhage (PPH) is generally defined as blood loss greater than or equal to 500 ml within 24 hours after birth, while severe PPH is blood loss greater than or equal to 1000 ml within 24 hours. PPH is the most common cause of maternal death worldwide. We share the WHO guidelines for the mangement of PPH. It recommends that active management at the third stage of labour should include: (i) administration of a uterotonic soon after the birth of the baby; (ii) clamping of the cord following the observation of uterine contraction (at around 3 minutes); and (iii) delivery of the placenta by controlled cord traction, followed by uterine massage.