International journal of health geographics, Jan 27, 2015
As the deadline for the millennium development goals approaches, it has become clear that the goa... more As the deadline for the millennium development goals approaches, it has become clear that the goals linked to maternal and newborn health are the least likely to be achieved by 2015. It is therefore critical to ensure that all possible data, tools and methods are fully exploited to help address this gap. Among the methods that are under-used, mapping has always represented a powerful way to 'tell the…
This paper complements the other papers in the Lancet Series on midwifery by documenting the expe... more This paper complements the other papers in the Lancet Series on midwifery by documenting the experience of low-income and middle-income countries that deployed midwives as one of the core constituents of their strategy to improve maternal and newborn health. It examines the constellation of various diverse health-system strengthening interventions deployed by Burkina Faso, Cambodia, Indonesia, and Morocco, among which the scaling up of the pre-service education of midwives was only one element. Efforts in health system strengthening in these countries have been characterised by: expansion of the network of health facilities with increased uptake of facility birthing, scaling up of the production of midwives, reduction of financial barriers, and late attention for improving the quality of care. Overmedicalisation and respectful woman-centred care have received little or no attention.
The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 2015
The International Conference on Population and Development in Cairo in 1994 laid out a bold, clea... more The International Conference on Population and Development in Cairo in 1994 laid out a bold, clear, and comprehensive definition of reproductive health and called for nations to meet the educational and service needs of adolescents to enable them to deal in a positive and responsible way with their sexuality. In the context of the ongoing review of the International Conference on Population and Development Programme of Action and the considerations for a post-2015 development agenda, this article summarizes the findings of the articles presented in this volume and identifies key challenges and critical answers that need to be tackled in addressing adolescent sexual and reproductive health and rights. The key recommendations are to link the provision of sexuality education and sexual and reproductive health (SRH) services; build awareness, acceptance, and support for youth-friendly SRH education and services; address gender inequality in terms of beliefs, attitudes, and norms; and ta...
... The Lancet 7 February 2009; Volume 373, Issue 9662: Page 508. Public Health Sustainability sc... more ... The Lancet 7 February 2009; Volume 373, Issue 9662: Page 508. Public Health Sustainability science: an integrated approach for health-programme planning more information Russell L Gruen,Julian H Elliott,Monica L Nolan,Paul D Lawton,Anne Parkhill,Cameron J McLaren ...
In the context of the Millennium Development Goals, human resources represent the most critical c... more In the context of the Millennium Development Goals, human resources represent the most critical constraint in achieving the targets. Therefore, it is important for health planners and decision-makers to identify what are the human resources required to meet those targets. Planning the human resources for health is a complex process. It needs to consider both the technical aspects related to estimating the number, skills and distribution of health personnel for meeting population health needs, and the political implications, values and choices that health policy-and decision-makers need to make within given resources limitations. After presenting an overview of the various methods for planning human resources for health, with their advantages and limitations, this paper proposes a methodological approach to estimating the requirements of human resources to achieve the goals set forth by the Millennium Declaration. The method builds on the service-target approach and functional job analysis.
Objective To estimate the amount of additional resources needed to scale up maternal and newborn ... more Objective To estimate the amount of additional resources needed to scale up maternal and newborn health services within the context of the Millennium Development Goals, and to inform countries, donors and multilateral agencies about the resources needed to achieve these goals. Methods A costing model based on WHO's clinical guidelines was used to estimate the incremental resource needs for maternal and newborn health care in 75 countries. The model estimated the costs for care during pregnancy, childbirth, the neonatal period and the postpartum period, as well as the costs for postpartum family planning and counselling, abortion and post-abortion care; programme-level costs were also estimated. An ingredients-based approach, with financial costs for the years 2006 to 2015 as the output, allowed estimates to be made of country-specific and year-specific populations, unit costs and scale-up rates. Two scenarios using different scale-up rates were used (moderate and rapid). Findings The results show that a minimum yearly average increase in resources of US$ 3.9 billion is needed, although annual costs increase over the time period of the model. When more rapid rates of scale-up are assumed, this minimum figure may be as high as US$ 5.6 billion per year. The 10-year estimated incremental costs range from US$ 39.3 billion for a moderate scale-up scenario to US$ 55.7 billion for the rapid scale-up scenario. Conclusion These projections of future financial costs may be used as a starting point for mobilizing global resources. Countries will have to further refine these estimates, but these figures may serve as goals towards which donors can direct their plans. Further research is needed to measure the costs of health system reforms, such as recruiting, training and retaining a sufficient number of personnel.
Objective To determine the cost effectiveness of selected malaria control interventions in the co... more Objective To determine the cost effectiveness of selected malaria control interventions in the context of reaching the millennium development goals for malaria. Design Generalised cost effectiveness analysis. Data sources Efficacy data came from the literature and authors' calculations supported by expert opinion. Quantities for resource inputs came from the literature and from expert opinion; prices came from the WHO-CHOICE database. Methods Costs were assessed in year 2000 international dollars, and effects were assessed as disability adjusted life years averted by a 10 year implementation programme. Analysis was restricted to sub-Saharan regions where the most deadly form of malaria, Plasmodium falciparum, is most prevalent. The impact on population health for various interventions, and their combinations, was evaluated at selected coverage levels by using a state-transition model. Sensitivity analysis was done for age weights and discounting. Results High coverage with artemisinin based combination treatments was found to be the most cost effective strategy for control of malaria in most countries in sub-Saharan Africa. Conclusions A much larger infusion of resources than those currently available is needed to make headway in the fight to roll back malaria. On cost effectiveness grounds, in most areas in sub-Saharan Africa greater coverage with highly effective combination treatments should be the cornerstone of malaria control. However, treatment alone can achieve less than half the total benefit obtainable through a combination of interventions-scaling up the use of impregnated mosquito nets or indoor spraying with insecticides is also critical. Intermittent presumptive treatment of pregnant women can bring a small but important additional health gain at relatively low cost.
In the concluding paper of this Series about midwifery, we look at the policy implications from t... more In the concluding paper of this Series about midwifery, we look at the policy implications from the framework for quality maternal and newborn care, the potential effect of life-saving interventions that fall within the scope of practice of midwives, and the historic sequence of health system changes that made a reduction in maternal mortality possible in countries that have expanded their midwifery workforce. Achievement of better health outcomes for women and newborn infants is possible, but needs improvements in the quality of reproductive, maternal, and newborn care, alongside necessary increases in universal coverage. In this report, we propose three priority research areas and outline how national investment in midwives and in their work environment, education, regulation, and management can improve quality of care. Midwifery and midwives are crucial to the achievement of national and international goals and targets in reproductive, maternal, newborn, and child health; now and...
The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 2015
The International Conference on Population and Development in Cairo in 1994 laid out a bold, clea... more The International Conference on Population and Development in Cairo in 1994 laid out a bold, clear, and comprehensive definition of reproductive health and called for nations to meet the educational and service needs of adolescents to enable them to deal in a positive and responsible way with their sexuality. In the context of the ongoing review of the International Conference on Population and Development Programme of Action and the considerations for a post-2015 development agenda, this article summarizes the findings of the articles presented in this volume and identifies key challenges and critical answers that need to be tackled in addressing adolescent sexual and reproductive health and rights. The key recommendations are to link the provision of sexuality education and sexual and reproductive health (SRH) services; build awareness, acceptance, and support for youth-friendly SRH education and services; address gender inequality in terms of beliefs, attitudes, and norms; and ta...
In March, 2005, The Lancet published a series of four articles 1-4 and two Comments, 5,6 highligh... more In March, 2005, The Lancet published a series of four articles 1-4 and two Comments, 5,6 highlighting a huge number of largely neglected deaths-the 4 million newborn babies who die every year, of whom 99% are born in developing countries. 1 4 million is roughly the number of babies born every year in the USA or in the 23 largest countries of western Europe. It is also roughly the number of AIDS and malaria deaths combined in 1 year. Yet deaths in newborn babies are rarely mentioned in global-health priorities. A misconception has been that highly technical care is needed. On the contrary, our estimates suggest that up to three-quarters of these deaths could be prevented with low-technology interventions at an additional cost of less than US$1 per head for the 75 countries with the highest mortality. 2,4 What is needed is the political will to ensure that these interventions reach the women and babies who need them. 3,4 1 year on, we ask: what progress has been made over the past year in policy, in funding, and most importantly, in programmes in high-mortality countries?
Every year, 4 million newborn babies die in the first month of life, 99% in low-income and middle... more Every year, 4 million newborn babies die in the first month of life, 99% in low-income and middle-income countries. 1 Babies born in the poorest countries have the highest risk of death, and within these countries the neonatal mortality rate (NMR) among the poorest families is 19-44% higher than among the richest (regional averages based on 48 demographic and health surveys [DHS], 1995[DHS], -2002. Up to 70% of deaths could be prevented if proven interventions were implemented effectively with high coverage where they are needed most 2 -a modern-day example of the inverse care law (figure 1). 3 Although universal recommendations can be given for evidence-based interventions, the delivery strategy for a particular intervention varies across settings 4 and should be adapted to local reality. 5 Health care can be delivered through population-oriented outreach services, family-oriented and community-oriented services, and individual-oriented clinical services. Interventions that have the greatest effect on neonatal deaths are less dependent on technology and commodities than on people with skills. Ideally, every woman should be able to choose to deliver with a skilled attendant present, and if either the mother or her newborn baby have complications, both have the right to access safe professional care. In high-income countries, this ideal exists. In south Asia and sub-Saharan Africa, however, where two-thirds of neonatal (and maternal) deaths happen, only about a third of women deliver in the presence of a skilled attendant. Coverage of postnatal care is lower still, although comparable DHS data are available for only a handful of countries. The average number of mothers giving birth with a skilled attendant in Africa has risen by 0·2% per year for the past decade (http://www.childinfo.org). At this rate, by the year 2015 the average skilled attendant coverage in Africa will still be less than 50%. Rates of caesarean sections are low in the highest mortality countries in Africa. 7 Clinical care is even less equitable than antenatal care: within poor countries the richest women have two-times to three-times higher antenatal care coverage than the poorest, but about sixtimes higher skilled attendance (figure 1). Thus, coverage is low, progress is slow, and inequity is high.
... The UN Millennium Project (MP) is an independent advisory board commissioned by the Secretary... more ... The UN Millennium Project (MP) is an independent advisory board commissioned by the Secretary General to advise on strategies to achieve the MDGs [3]. The MP views country ... While people's participation in policy and development decisions that impact them is a ...
Acta Obstetricia et Gynecologica Scandinavica, 2012
There is strong evidence that the health risks associated with adolescent pregnancy are concentra... more There is strong evidence that the health risks associated with adolescent pregnancy are concentrated among the youngest girls (e.g. those under 16 years). Fertility rates in this age group have not previously been comprehensively estimated and published. By drawing data from 42 large, nationally representative household surveys in low resource countries carried out since 2003 this article presents estimates of age-specific birth rates for girls aged 12-15, and the percentage of girls who give birth at age 15 or younger. From these we estimate that approximately 2.5 million births occur to girls aged under 16 in low resource countries each year. The highest rates are found in Sub-Saharan Africa, where in Chad, Guinea, Mali, Mozambique, Niger and Sierra Leone more than 10% of girls become mothers before they are 16. Strategies to reduce these high levels are vital if we are to alleviate poor reproductive health.
To achieve the Millennium Development Goal for child survival (MDG-4), neonatal deaths need to be... more To achieve the Millennium Development Goal for child survival (MDG-4), neonatal deaths need to be prevented. Previous papers in this series have presented the size of the problem, discussed cost-effective interventions, and outlined a systematic approach to overcoming health-system constraints to scaling up. We address issues related to improving neonatal survival. Countries should not wait to initiate action. Success is possible in low-income countries and without highly developed technology. Effective, low-cost interventions exist, but are not present in programmes. Specific efforts are needed by safe motherhood and child survival programmes. Improved availability of skilled care during childbirth and family/community-based care through postnatal home visits will benefit mothers and their newborn babies. Incorporation of management of neonatal illness into the integrated management of childhood illness initiative (IMCI) will improve child survival. Engagement of the community and ...
In the concluding paper of this Series about midwifery, we look at the policy implications from t... more In the concluding paper of this Series about midwifery, we look at the policy implications from the framework for quality maternal and newborn care, the potential effect of life-saving interventions that fall within the scope of practice of midwives, and the historic sequence of health system changes that made a reduction in maternal mortality possible in countries that have expanded their midwifery workforce. Achievement of better health outcomes for women and newborn infants is possible, but needs improvements in the quality of reproductive, maternal, and newborn care, alongside necessary increases in universal coverage. In this report, we propose three priority research areas and outline how national investment in midwives and in their work environment, education, regulation, and management can improve quality of care. Midwifery and midwives are crucial to the achievement of national and international goals and targets in reproductive, maternal, newborn, and child health; now and...
This paper complements the other papers in the Lancet Series on midwifery by documenting the expe... more This paper complements the other papers in the Lancet Series on midwifery by documenting the experience of low-income and middle-income countries that deployed midwives as one of the core constituents of their strategy to improve maternal and newborn health. It examines the constellation of various diverse health-system strengthening interventions deployed by Burkina Faso, Cambodia, Indonesia, and Morocco, among which the scaling up of the pre-service education of midwives was only one element. Efforts in health system strengthening in these countries have been characterised by: expansion of the network of health facilities with increased uptake of facility birthing, scaling up of the production of midwives, reduction of financial barriers, and late attention for improving the quality of care. Overmedicalisation and respectful woman-centred care have received little or no attention.
International journal of health geographics, Jan 27, 2015
As the deadline for the millennium development goals approaches, it has become clear that the goa... more As the deadline for the millennium development goals approaches, it has become clear that the goals linked to maternal and newborn health are the least likely to be achieved by 2015. It is therefore critical to ensure that all possible data, tools and methods are fully exploited to help address this gap. Among the methods that are under-used, mapping has always represented a powerful way to 'tell the…
This paper complements the other papers in the Lancet Series on midwifery by documenting the expe... more This paper complements the other papers in the Lancet Series on midwifery by documenting the experience of low-income and middle-income countries that deployed midwives as one of the core constituents of their strategy to improve maternal and newborn health. It examines the constellation of various diverse health-system strengthening interventions deployed by Burkina Faso, Cambodia, Indonesia, and Morocco, among which the scaling up of the pre-service education of midwives was only one element. Efforts in health system strengthening in these countries have been characterised by: expansion of the network of health facilities with increased uptake of facility birthing, scaling up of the production of midwives, reduction of financial barriers, and late attention for improving the quality of care. Overmedicalisation and respectful woman-centred care have received little or no attention.
The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 2015
The International Conference on Population and Development in Cairo in 1994 laid out a bold, clea... more The International Conference on Population and Development in Cairo in 1994 laid out a bold, clear, and comprehensive definition of reproductive health and called for nations to meet the educational and service needs of adolescents to enable them to deal in a positive and responsible way with their sexuality. In the context of the ongoing review of the International Conference on Population and Development Programme of Action and the considerations for a post-2015 development agenda, this article summarizes the findings of the articles presented in this volume and identifies key challenges and critical answers that need to be tackled in addressing adolescent sexual and reproductive health and rights. The key recommendations are to link the provision of sexuality education and sexual and reproductive health (SRH) services; build awareness, acceptance, and support for youth-friendly SRH education and services; address gender inequality in terms of beliefs, attitudes, and norms; and ta...
... The Lancet 7 February 2009; Volume 373, Issue 9662: Page 508. Public Health Sustainability sc... more ... The Lancet 7 February 2009; Volume 373, Issue 9662: Page 508. Public Health Sustainability science: an integrated approach for health-programme planning more information Russell L Gruen,Julian H Elliott,Monica L Nolan,Paul D Lawton,Anne Parkhill,Cameron J McLaren ...
In the context of the Millennium Development Goals, human resources represent the most critical c... more In the context of the Millennium Development Goals, human resources represent the most critical constraint in achieving the targets. Therefore, it is important for health planners and decision-makers to identify what are the human resources required to meet those targets. Planning the human resources for health is a complex process. It needs to consider both the technical aspects related to estimating the number, skills and distribution of health personnel for meeting population health needs, and the political implications, values and choices that health policy-and decision-makers need to make within given resources limitations. After presenting an overview of the various methods for planning human resources for health, with their advantages and limitations, this paper proposes a methodological approach to estimating the requirements of human resources to achieve the goals set forth by the Millennium Declaration. The method builds on the service-target approach and functional job analysis.
Objective To estimate the amount of additional resources needed to scale up maternal and newborn ... more Objective To estimate the amount of additional resources needed to scale up maternal and newborn health services within the context of the Millennium Development Goals, and to inform countries, donors and multilateral agencies about the resources needed to achieve these goals. Methods A costing model based on WHO's clinical guidelines was used to estimate the incremental resource needs for maternal and newborn health care in 75 countries. The model estimated the costs for care during pregnancy, childbirth, the neonatal period and the postpartum period, as well as the costs for postpartum family planning and counselling, abortion and post-abortion care; programme-level costs were also estimated. An ingredients-based approach, with financial costs for the years 2006 to 2015 as the output, allowed estimates to be made of country-specific and year-specific populations, unit costs and scale-up rates. Two scenarios using different scale-up rates were used (moderate and rapid). Findings The results show that a minimum yearly average increase in resources of US$ 3.9 billion is needed, although annual costs increase over the time period of the model. When more rapid rates of scale-up are assumed, this minimum figure may be as high as US$ 5.6 billion per year. The 10-year estimated incremental costs range from US$ 39.3 billion for a moderate scale-up scenario to US$ 55.7 billion for the rapid scale-up scenario. Conclusion These projections of future financial costs may be used as a starting point for mobilizing global resources. Countries will have to further refine these estimates, but these figures may serve as goals towards which donors can direct their plans. Further research is needed to measure the costs of health system reforms, such as recruiting, training and retaining a sufficient number of personnel.
Objective To determine the cost effectiveness of selected malaria control interventions in the co... more Objective To determine the cost effectiveness of selected malaria control interventions in the context of reaching the millennium development goals for malaria. Design Generalised cost effectiveness analysis. Data sources Efficacy data came from the literature and authors' calculations supported by expert opinion. Quantities for resource inputs came from the literature and from expert opinion; prices came from the WHO-CHOICE database. Methods Costs were assessed in year 2000 international dollars, and effects were assessed as disability adjusted life years averted by a 10 year implementation programme. Analysis was restricted to sub-Saharan regions where the most deadly form of malaria, Plasmodium falciparum, is most prevalent. The impact on population health for various interventions, and their combinations, was evaluated at selected coverage levels by using a state-transition model. Sensitivity analysis was done for age weights and discounting. Results High coverage with artemisinin based combination treatments was found to be the most cost effective strategy for control of malaria in most countries in sub-Saharan Africa. Conclusions A much larger infusion of resources than those currently available is needed to make headway in the fight to roll back malaria. On cost effectiveness grounds, in most areas in sub-Saharan Africa greater coverage with highly effective combination treatments should be the cornerstone of malaria control. However, treatment alone can achieve less than half the total benefit obtainable through a combination of interventions-scaling up the use of impregnated mosquito nets or indoor spraying with insecticides is also critical. Intermittent presumptive treatment of pregnant women can bring a small but important additional health gain at relatively low cost.
In the concluding paper of this Series about midwifery, we look at the policy implications from t... more In the concluding paper of this Series about midwifery, we look at the policy implications from the framework for quality maternal and newborn care, the potential effect of life-saving interventions that fall within the scope of practice of midwives, and the historic sequence of health system changes that made a reduction in maternal mortality possible in countries that have expanded their midwifery workforce. Achievement of better health outcomes for women and newborn infants is possible, but needs improvements in the quality of reproductive, maternal, and newborn care, alongside necessary increases in universal coverage. In this report, we propose three priority research areas and outline how national investment in midwives and in their work environment, education, regulation, and management can improve quality of care. Midwifery and midwives are crucial to the achievement of national and international goals and targets in reproductive, maternal, newborn, and child health; now and...
The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 2015
The International Conference on Population and Development in Cairo in 1994 laid out a bold, clea... more The International Conference on Population and Development in Cairo in 1994 laid out a bold, clear, and comprehensive definition of reproductive health and called for nations to meet the educational and service needs of adolescents to enable them to deal in a positive and responsible way with their sexuality. In the context of the ongoing review of the International Conference on Population and Development Programme of Action and the considerations for a post-2015 development agenda, this article summarizes the findings of the articles presented in this volume and identifies key challenges and critical answers that need to be tackled in addressing adolescent sexual and reproductive health and rights. The key recommendations are to link the provision of sexuality education and sexual and reproductive health (SRH) services; build awareness, acceptance, and support for youth-friendly SRH education and services; address gender inequality in terms of beliefs, attitudes, and norms; and ta...
In March, 2005, The Lancet published a series of four articles 1-4 and two Comments, 5,6 highligh... more In March, 2005, The Lancet published a series of four articles 1-4 and two Comments, 5,6 highlighting a huge number of largely neglected deaths-the 4 million newborn babies who die every year, of whom 99% are born in developing countries. 1 4 million is roughly the number of babies born every year in the USA or in the 23 largest countries of western Europe. It is also roughly the number of AIDS and malaria deaths combined in 1 year. Yet deaths in newborn babies are rarely mentioned in global-health priorities. A misconception has been that highly technical care is needed. On the contrary, our estimates suggest that up to three-quarters of these deaths could be prevented with low-technology interventions at an additional cost of less than US$1 per head for the 75 countries with the highest mortality. 2,4 What is needed is the political will to ensure that these interventions reach the women and babies who need them. 3,4 1 year on, we ask: what progress has been made over the past year in policy, in funding, and most importantly, in programmes in high-mortality countries?
Every year, 4 million newborn babies die in the first month of life, 99% in low-income and middle... more Every year, 4 million newborn babies die in the first month of life, 99% in low-income and middle-income countries. 1 Babies born in the poorest countries have the highest risk of death, and within these countries the neonatal mortality rate (NMR) among the poorest families is 19-44% higher than among the richest (regional averages based on 48 demographic and health surveys [DHS], 1995[DHS], -2002. Up to 70% of deaths could be prevented if proven interventions were implemented effectively with high coverage where they are needed most 2 -a modern-day example of the inverse care law (figure 1). 3 Although universal recommendations can be given for evidence-based interventions, the delivery strategy for a particular intervention varies across settings 4 and should be adapted to local reality. 5 Health care can be delivered through population-oriented outreach services, family-oriented and community-oriented services, and individual-oriented clinical services. Interventions that have the greatest effect on neonatal deaths are less dependent on technology and commodities than on people with skills. Ideally, every woman should be able to choose to deliver with a skilled attendant present, and if either the mother or her newborn baby have complications, both have the right to access safe professional care. In high-income countries, this ideal exists. In south Asia and sub-Saharan Africa, however, where two-thirds of neonatal (and maternal) deaths happen, only about a third of women deliver in the presence of a skilled attendant. Coverage of postnatal care is lower still, although comparable DHS data are available for only a handful of countries. The average number of mothers giving birth with a skilled attendant in Africa has risen by 0·2% per year for the past decade (http://www.childinfo.org). At this rate, by the year 2015 the average skilled attendant coverage in Africa will still be less than 50%. Rates of caesarean sections are low in the highest mortality countries in Africa. 7 Clinical care is even less equitable than antenatal care: within poor countries the richest women have two-times to three-times higher antenatal care coverage than the poorest, but about sixtimes higher skilled attendance (figure 1). Thus, coverage is low, progress is slow, and inequity is high.
... The UN Millennium Project (MP) is an independent advisory board commissioned by the Secretary... more ... The UN Millennium Project (MP) is an independent advisory board commissioned by the Secretary General to advise on strategies to achieve the MDGs [3]. The MP views country ... While people's participation in policy and development decisions that impact them is a ...
Acta Obstetricia et Gynecologica Scandinavica, 2012
There is strong evidence that the health risks associated with adolescent pregnancy are concentra... more There is strong evidence that the health risks associated with adolescent pregnancy are concentrated among the youngest girls (e.g. those under 16 years). Fertility rates in this age group have not previously been comprehensively estimated and published. By drawing data from 42 large, nationally representative household surveys in low resource countries carried out since 2003 this article presents estimates of age-specific birth rates for girls aged 12-15, and the percentage of girls who give birth at age 15 or younger. From these we estimate that approximately 2.5 million births occur to girls aged under 16 in low resource countries each year. The highest rates are found in Sub-Saharan Africa, where in Chad, Guinea, Mali, Mozambique, Niger and Sierra Leone more than 10% of girls become mothers before they are 16. Strategies to reduce these high levels are vital if we are to alleviate poor reproductive health.
To achieve the Millennium Development Goal for child survival (MDG-4), neonatal deaths need to be... more To achieve the Millennium Development Goal for child survival (MDG-4), neonatal deaths need to be prevented. Previous papers in this series have presented the size of the problem, discussed cost-effective interventions, and outlined a systematic approach to overcoming health-system constraints to scaling up. We address issues related to improving neonatal survival. Countries should not wait to initiate action. Success is possible in low-income countries and without highly developed technology. Effective, low-cost interventions exist, but are not present in programmes. Specific efforts are needed by safe motherhood and child survival programmes. Improved availability of skilled care during childbirth and family/community-based care through postnatal home visits will benefit mothers and their newborn babies. Incorporation of management of neonatal illness into the integrated management of childhood illness initiative (IMCI) will improve child survival. Engagement of the community and ...
In the concluding paper of this Series about midwifery, we look at the policy implications from t... more In the concluding paper of this Series about midwifery, we look at the policy implications from the framework for quality maternal and newborn care, the potential effect of life-saving interventions that fall within the scope of practice of midwives, and the historic sequence of health system changes that made a reduction in maternal mortality possible in countries that have expanded their midwifery workforce. Achievement of better health outcomes for women and newborn infants is possible, but needs improvements in the quality of reproductive, maternal, and newborn care, alongside necessary increases in universal coverage. In this report, we propose three priority research areas and outline how national investment in midwives and in their work environment, education, regulation, and management can improve quality of care. Midwifery and midwives are crucial to the achievement of national and international goals and targets in reproductive, maternal, newborn, and child health; now and...
This paper complements the other papers in the Lancet Series on midwifery by documenting the expe... more This paper complements the other papers in the Lancet Series on midwifery by documenting the experience of low-income and middle-income countries that deployed midwives as one of the core constituents of their strategy to improve maternal and newborn health. It examines the constellation of various diverse health-system strengthening interventions deployed by Burkina Faso, Cambodia, Indonesia, and Morocco, among which the scaling up of the pre-service education of midwives was only one element. Efforts in health system strengthening in these countries have been characterised by: expansion of the network of health facilities with increased uptake of facility birthing, scaling up of the production of midwives, reduction of financial barriers, and late attention for improving the quality of care. Overmedicalisation and respectful woman-centred care have received little or no attention.
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Papers by Helga Fogstad