Innovative Approaches to Maternal and Newborn Health

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PVO contribution to MNH Example of Georgia
The Child Survival Mini University III Johns
Hopkins Bloomberg School of Public HealthJune
6-10, 2005 USAID Child Survival and Health Grants
Program

• Innovative Approaches to Maternal and Newborn
  Health
• (Panel Discussion), June 8, 2005

Panel Presentation by Dr. Revaz Tataradze A Call
to Serve (ACTS) Georgia
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Why is it so important to get MoLHSA (Ministry of
Labor, Health and Social Affairs) Involved?
Mutual Benefits

• For MoLHSA
• Support of state MNC policy
• Organizational capacity building through training
  of the ministry staff
• Collaboration with NGO network
• Development of knowledge base and communication
  channels
• Access to technical materials developed by
  International CS network (US AID CSTS, CORE)

• For ACTS CS Project
• Participation in health policy development and
  coordination at the national level
• Support of the project activities by the project
  site health providers
• Support in conduction of educational activities
  on community and medical professionals level
• Support in establishing maternal and newborn
  health partnership network
• Support in generation of a local information base
  for action

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Some Results of Cooperation with MoLHSA

• ACTS together with American Academy of Family
  Physicians (AAFP) organized and facilitated
  conduction of ALSO (Advanced Life Support in
  Obstetrics) course in Georgia in the fall of
  2004. MoLHSA was involved into the process from
  the very beginning. As a result the Ministry
  Council for issuing licenses and certificates
  recognized introduction of the course into the
  obstetricians training curriculum
• Cooperative efforts and involvement of MoLHSA
  into all steps of CS project implementation
  resulted in amendments in the National Health
  Promotion Strategic Plan through assigning the
  highest priority to the problems of maternal and
  newborn care.

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AAFP ALSO Course
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Georgia
Georgia (Sakartvelo) is a country to the east of
the Black Sea in the southern Caucasus. It shares
borders with Russia in the north and Turkey,
Armenia, Azerbaijan in the south. Georgia is at
crossroads between Asia, Europe, and Middle east.
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(No Transcript)
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Infant Mortality in Georgia

• Infant mortality rate has more than doubled since
  1993 rising from 20 to 51.2 deaths per 1,000 live
  births in 2003 (World Fact Book, 2003)
• Approximately 67 of child mortality belongs to
  children under one year of age
• 80-85 of infant mortality occurs in the early
  neonatal period (0-7 days)
• The leading causes of mortality are
  undifferentiated neonatal, infectious and
  respiratory pathologies
• Source Health Policy Department of MoLHSA of
  Georgia, 2005

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ACTS Experience in working with MoLHSA

• Implementation of the Child and Maternal Healthy
  Food Project (1993)
• Urgently Needed Medications for Immediate
  Distribution (1994-up to present) ACTS provided
  50 of all international humanitarian medicines.
• Training of Local Medical Staff in the high
  mountains regions on Disease prevention and
  management issues and provision with
  pharmaceutical update on medications (1997- up to
  present)
• World Learning funded Program Screening and
  Vaccinations project (1994)
• Development of Policy Framework on CVD Prevention
  Strategies (1998-1999)
• Involvement of Mass Media in the field of Health
  Education (1998, 1999)
• Implementing Partner for CVD Prevention National
  Program (1999)
• Outreach Diabetic Children treatment and
  Education (2001)
• Contribution to the Institutional Capacity
  Building (Georgian-American Eye Bank program,
  Family Medicine Association of Georgia, Georgian
  Association of Transplantologists etc)

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A Call to Serve InternationalPeople helping
People build a free and peaceful world

• A Call to Serve (ACTS) International is the first
  American NGO in Georgia, founded initially by Dr.
  Patricia Blair and headquartered in Columbia,
  Missouri.
• ACTS-Georgia was established in 1992 in direct
  response to requests for help from colleagues
  from the Georgian Medical Association.

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Map of Georgia and Target Regions
Zestaphoni and Chiatura two mining towns in the
region of Imereti located in Western Georgia
collapse of manganese mining and processing
resulted in a staggering unemployment rate (65).
Kvemo Kartli most ethnically diverse region
bordering both Armenia and Azerbaijan in East
Georgia.
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Project Collaborators

• Ministry of Labor, Health and Social Affairs and
  its departments (Health Policy, Public Health,
  Human Resources) and Division of Maternal and
  Child Health
• Georgian Medical Association (member of the
  European Forum of Medical Associations and WHO)
• Claritas - an IBFAN (International Baby Food
  Action Network) affiliated group in Georgia
• Local NGOs in Kvemo Kartli (Tanadgoma) and
  Imereti (Women Wellness Center)

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Primary Technical Areas for Interventions of the
Project

• Maternal and newborn care
• Breastfeeding promotion
• Nutrition
• Case management of diarrhea
• Case management of ARI/Pneumonia

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Cross Cutting Intervention Areas

• Behavior Changes
• Capacity Building
• Integrated Management of Childhood Illnesses

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Strategies and activities undertaken and planned
to improve maternal and newborn health in Georgia

• Integrated Approach Countrywide MNH policy with
  testing in a demonstration areas
• Balancing population and high-risk strategies
• Assessing and monitoring information base
• Contribute to building capacity at the national
  and community level for MNH programs

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Baseline Assessment Findings

• Knowledge of danger signs of pregnancy
  complications is low
• Percentage of women who indicated as a symptom
  prompting to seek medical care during pregnancy
• High fever 21.8
• Bleeding 22.1
• Shortness of breath 13.2
• Swelling 19.3
• Did not know any symptoms 19.0

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Baseline Assessment Findings

• Knowledge of danger signs of childhood illnesses
  is low
• Percentage of mothers
• Who can cite at least 4 danger signs in children
  14.7
• With ARI who sought medical treatment two or more
  days after the onset of the symptoms 23.6
• Who breastfeed the child when he/she has a
  diarrhea less than usual or did not 38.6

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The reasons for selecting of integrated approach

• Recognition that a number of lifestyle related
  factors are common to MNH
• Promotion of joint actions against unhealthy
  behavior
• Building the full continuum of health promotion,
  disease prevention and health care on existing
  health infrastructures and resources
• Identifying gaps in local and national MNH
  activities and providing a focal point for the
  coordination of these activities

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Steps to implementation

• Situation analysis
• The establishment of project joint management
  together with MoLHSA
• Coalition building among local stakeholders
• Baseline survey
• Updating the protocol and plan of action
• Development of guidelines and methods of
  intervention

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Steps to implementation (Contd)

• Participation of project team in the USAID
  workshops and CSTS meetings
• The start of intervention
• Joint mid-term and final evaluations
• The further development of the national program
  for maternal and newborn health

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Integrated approach assessment
Strengths Increased consistency among health
policies, public health messages (that are
coherent and mutually reinforcing), and the
diffusion of results to other communities
Cahllenges Difficulty of harmonized action of
many people and institutions
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Action Oriented MNH Strategy in Georgia
(Demonstration sites Kvemo Kartli region,
Imereti)

• Action focusing on life style related factors
• Care giving care seeking behavior
• Nutrition including breastfeeding
• Sanitary and hygiene

• Reduction of health burden by targeting major
  problems
• Neonatal diseases
• Diarrhea
• ARI/Pneumonia

• Related reduction of
• Delayed referral to health provider
• Dietary deficiencies caused disorders
• Risk of communicable diseases

• Improving socio-economic environment by
  controlling social determinants of MNH
• Poverty
• Education
• Employment

Empowerment of Health system to respond MNH needs

• Integrated strategic approaches
• Population individual risk reduction
• Empowering PHC
• Referral system support

• Major Strategies for implementation
• Policy capacity building
• Surveillance
• Dissemination