MOMI - Missed Opportunities in Maternal and Infant Health, june '13 newsletter

MOMI Newsletter V O L U M E

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I S S U E

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J U N E

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MOMI Project Management Team meets again MDG 4 GOAL

From March 12th to 14th, the third MOMI Project Management Team meeting was organized by ICRH

Reduce by two thirds, between 1990

Mozambique and the Eduardo Mondlane University in Maputo, Mozambique. Participants included staff

and 2015, the mortality rate of children under five

of all eight consortium partners. The opening session was attended by representatives of the Mozambican Ministry of Health, the EC MDG 5 GOAL:

delegation,

To reduce by three quarters, between

Universidade Eduardo Mondlane. During

1990 and 2015, the maternal mortality ratio and achieve by 2015, Universal access to reproductive health

and

the

Rector

of

the

this session an introduction was given of the MOMI project and the consortium, a brief presentation was made of the maternal and infant health situation in the

INSIDE THIS ISSUE: MOMI project outputs

four 2

African

project

countries,

the

objectives of the meeting were outlined, and an overview was given of the causes of maternal and infant health in Mozambique and the Ministry of Health goals to reverse maternal and child

MOMI in the spotlights

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Introducing MOMI partners—continued

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PACHI team in Malawi

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mortality and improve service coverage rates by 2015. The relevance of MOMI research for enhancing postpartum policies and procedures was highlighted. During the technical meetings on the first and second day, an overview was given of progress made on the different work packages during the project’s second year of implementation, including the challenges met and lessons learned. A more detailed discussion followed on the selected interventions that will be implemented in the four countries during

New MOMI consortium project adminis-

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reached on the activity plan to be followed for the

trator MOMI clinical review of MNCH policies

the coming two years and an agreement was

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next year. On the third day, the MOMI team visited a primary health care facility, located in Maputo, and discussed maternal and infant services with the director, the chief nurse and the nurse responsible for maternal and infant health services.

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MOMI project outputs Work Package 2: Critical review

Work Package 3: Detailed situation

of maternal, newborn and child

analysis of maternal, newborn and

health policies

child health

The WP2 cross-country report uses the four

The WP3 cross-country report compares the

country policy reports of Burkina Faso,

situation analysis of maternal and newborn

Kenya, Malawi and Mozambique and docu-

health care services, with emphasis on post-

mentary analysis to facilitate cross-country

partum care in the selected districts (Kaya

learning as well as informing the next stages of the MOMI project more widely. This

MOMI report

district in Burkina Faso, Kwale district in Kenya, Ntchisi district in Malawi and Chiúta district in

comparative report focuses most exclusively on national poli-

Mozambique). The analysis was based on care service character-

cy content for postpartum care. It examines the policy con-

istics (description of postpartum care services available), the

tent in more detail and how this deviates from internationally

involved resources and the timing of provision of care; on the

defined best practices. It presents a critical review of the im-

coverage of health services; and, on the health outcomes, invol-

pact of the wider policy environment on implementation of

ving mortality rates, burden of disease and nutritional status of

interventions and considers implications of these findings for

infants. The report serves as a baseline guidance to design inter-

the MOMI project (see more on page 4 of this issue).

ventions and to frame the evaluation of their impact.

Mann S. 2013. Cross-Country Analysis of Maternal, Newborn and

Barros H., Lopes S.C. 2013. Cross-Country Situation Analysis of Maternal

Child Health Policies in Burkina Faso, Kenya, Malawi and Mozambi-

and Newborn Care in Burkina Faso, Kenya, Malawi and Mozambique.

que. European Commission FP7 MOMI project.

European Commission FP7 MOMI project.

These reports can be downloaded from www.momiproject.eu/links.aspx A large WHO multicountry survey examined data from more than 300 000 women attending 357 health care facilities in 29 countries. This study found a poor correlation between coverage of ‘essential interventions’ (e.g. uterotonics for preventing postpartum haemorrhage; magnesium sulfate for eclampsia) and maternal mortality in health facilities. This study suggests that to achieve a substantial reduction in maternal mortality, a comprehensive approach

to

emergency

care,

and

overall

improvements

in

the

quality

of

maternal

health

care

will

be

needed.

(more to be found on http://www.who.int/reproductivehealth/en/index.html)

MOMI in the spotlights 

In January Christine Katingima (ICRHK) gave a presentation at the STD/AIDS Collaborative Research Group meeting in Nairobi, Kenya.



Early February Sue Mann and Tim Colbourn (UCL) presented at a global health "mapping day" at the Institute for Women's Health of UCL, which was conceived in order to map all the different global health activities that are currently going on with a view to developing the Institute Women's Health Global Strategy.



Out of MOMI’s spotlights: Irene Jao (ICRHK), Christine Katingima (ICRHK) & Birgit Kerstens (UG-ICRH) will stop working for MOMI. We wish them all the best in their future activities and hope to keep them updated through this newsletter.

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Introducing MOMI Partners continued……..

PACHI team in Malawi Last but not least we want to introduce the team of the Parent and Child Health’s Initiative (PACHI) from Malawi. PACHI is headed by Dr Charles Mwansambo-MBChB, BSc, DCH, FRCPCH (UK). Gibson Masache (MPA, BSoc Sc) provides technical support and facilitation of the MOMI project, as well as manages the finances for the project.

Running the MOMI project on the ground is a team of 11 people. Chrissy Bwazi is the MOMI Coordinator in Ntchisi district. At the end of the five year project, she hopes for an improvement of maternal, newborn and child health services at district level and in the long run at national level as well.

Other team members include: Dr Webster Chirambo (District Health Officer), Malawi MOMI team

James Mtonga (Assistant Environmental Health Officer & Deputy MOMI Project Coordinator), Holystone Kafanikhale (District Environmental Health

Officer), Mackenzie Gondwe (Assistant Statistician, HMIS Officer), Lawrent Banda (Clinical Officer), Judith Kamtayeni (Nurse Midwife Technician), Loveness Mang’ando (Registered Nurse Midwife), Tereza Kaunda (Registered Nurse Midwife), Annily Chisi (Community Health Nurse) and Bwanalori Mwamulima (Environmental Health Officer).

New MOMI consortium project coordinator As from July 2013 Aurore Guieu will replace Birgit Kerstens as the MOMI consortium project coordinator. In Spring 2012, Aurore started at ICRH as a trainee in the frame of her studies at SciencesPo Paris, France, where she obtained a Master’s degree in European Studies, with a focus on social policy and gender equality. During her traineeship at ICRH, she worked on a literature review on migrants’ sexual and reproductive health in the European Union. From December 2012 to March 2013, during the maternity leave of an ICRH colleague, Aurore continued this study. Right now she is working as a junior researcher on the FP7-funded DIFFER project, which aims at improving sexual and reproductive health services for general populations and female sex workers in India, Kenya, Mozambique, and South Africa, and on the SEHIB study on HPV infections and related diseases in Belgium. Aurore will be working part-time for the MOMI consortium. Outside the workplace, her main area of interest is feminist activism, and she is involved in different national and international networks. Aurore can be reached on: aurore.guieu@ugent.be.

When women survive, families & nations thrive. It’s time. Deliver for girls and women.

(Statement from WOMEN DELIVER, May 2013)

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The world can’t wait.

Now is the time to invest in girls and women.

(Statement from WOMEN DELIVER, May 2013)

MOMI critical review of MNCH policies Key learning points have been drawn from a comparative synthesis of policy issues arising across the separate study settings in Burkina Faso, Kenya, Malawi and Mozambique and are summarised here:  International Evidence: There is good evidence for effectiveness of (low cost) interventions for both mother and child in the postpartum period. A combined package of these interventions adapted to local need is likely to reap greatest benefits in improving maternal and child health outcomes. There is a lack of specific guidance targeted at women who deliver in the community, for the postpartum period.  Policy priority of postpartum care: Postpartum care is not a priority in any of the study countries at either policy or programmatic levels. There is little reference to its importance as part of national MNCH policy and where identified (excepting immediate emergency care), the emphasis of care is centred on the neonate with maternal needs relatively neglected during this period. Even in those countries where detailed policy guidance and clear outcome indicators for postpartum care exists, there was very little evidence of effective implementation in any of the study sites. More detailed knowledge of policy processes, funding flows and decision-making in each site is needed in the context of the varying levels of decentralised decision making to understand where disconnects between policy and implementation are rooted and how best to engage policy makers for MOMI interventions.  Integration Policies: Separation of MNCH policy and child health policies has been counter to developing integrated provision for mother and child in postpartum period. Policies that support integration of services, continuum of care and life-course approaches appear to be most developed in Kenya and Malawi compared with the other two MOMI sites.  Technical Guidance: Kenya and Mozambique both have extremely detailed technical manuals for use in training and service delivery. These have not been adapted for use at the local level and there is little knowledge of what is needed, in particular for the mother in the postpartum period. Adapted and simplified guidance that focuses on high impact interventions and is comprehensively distributed could improve utility.  Postpartum Risk: Recorded activity in the postpartum period is focussed on percentage attendance, failing to take account of timing or content of these visits. International level evidence highlights the clear periods of risk for mother and neonate (first 48 hours and first week) and potential vulnerabilities and risk factors. Tailoring of the timing and content of postpartum interventions to risk could maximise impact.  High risk women: Women and babies with extra risk factors such as anaemia or prematurity are at higher risk of complications in the post natal period. Additional surveillance of these women and children is recommended in international guidance. Management of potential complications are identified in the technical guidance for Mozambique and Kenya but strategies for early identification and intervention for women at risk, and promotion in the clinical setting were not identified in any of the four settings.  Delivery without skilled attendance: High rates of community delivery unattended or with traditional birth attendants in all MOMI countries, in spite of a drive to increase skilled attendance at delivery, mean that women and their babies often not access postpartum care during the periods of highest risk. Community-based delivery of care is relatively more developed in the Kenya and Malawi sites.  Continuum of care: Generally across all sites, there is an apparent disconnect between provision of immediate postpartum care in the health facility level and transfer of on-going responsibility to the community largely for preventive care but also for identification of danger signs should they arise. The continuum of care is a stepwise approach for identifying and treating problems early in the community and referring to the next level of care if the situation deteriorates. Policies supporting this approach are most highly developed in Malawi and could be promoted with benefit across the other sites. (summary from WP2 report, see also page 2 of this issue)

The MOMI project aims to add to global knowledge about how postpartum services could be more effectively organized, both at facility and community level, to improve maternal and newborn health.

Contact information ICRH - Ghent University De Pintelaan 185 P3 9000 Ghent Phone: +32 (0)9 332 35 64 Fax: +32 (0)9 332 38 67 http://www.momiproject.eu/

MOMI

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