Essential interventions for maternal, newborn health

CEBU, Philippines - Poor maternal, newborn and child health remains a significant problem in developing countries, this according to an executive summary released by the Department of Communications of the World Health Organization.

 “Worldwide, close to 400,000 women die during pregnancy and childbirth every year and an estimated 7.6 million children die under the age of five,” the document entitled “Essential interventions, commodities and guidelines for reproductive, maternal, newborn and child health” reported.

Majority of maternal deaths occur during or immediately after childbirth, it said. “The common medical causes for maternal death include bleeding, high blood pressure, prolonged and obstructed labor, infections and unsafe abortions.”

It also mentioned that “a child’s risk of dying is highest during the first 28 days of life when about 40 percent of under-five deaths take place, translating into three million deaths” and that “up to one half of all newborn deaths occur within the first 24 hours of life, 75 percent occur in the first week.”

Globally, it added, the main causes of neonatal death are preterm birth, severe infections and asphyxia (deficiency of oxygen and excess of carbon dioxide in the blood and body tissues). Children in low-income countries are found to be nearly 18 times more likely to die before the age of five than children in high-income countries.

The said global review on key interventions pointed to good maternal health and nutrition as very important contributors to child survival. “The lack of essential interventions to address these and other health conditions often contribute to indices of neonatal morbidity and mortality (including stillbirths, neonatal deaths and other adverse clinical outcomes),” it said.

The following are three different levels of delivery of interventions and these were defined in the publication by the World Bank “Priorities in Health”:

* Community level/home. Health care providers at this level include community health workers (CHW)and outreach workers. It utilizes resources such as volunteers’ time, local knowledge, and community confidence and trust as channels for delivery of interventions generally related to motherhood, nutrition, and simple prevention and treatments. Many countries have attempted to construct links between community-based health care resources and households for a range of health programs. These programs do not substitute for a health system, but provide a channel for reaching families with information and resources. CHWs not only promote healthy behaviors and preventive action but can mobilize demand for appropriate services at other levels. The success of community health efforts depends critically on the context, including level of development of infrastructure, services, and socioeconomic resources.

* First level/outreach. Health care providers at this level of care includes professionals, outreach workers as well as the CHWs. More recently, the WHO Commission on Macroeconomics and Health described the need for developing services that are close to the client. The basic notion is a common one: recognition that a certain range of health care services must act as an interface between families and community programs, on the one hand, and hospitals and national health policies, on the other. There has been substantial convergence in the content of general first level primary care over time: maternity related care (for instance, prenatal care, skilled birth attendance, and family planning), interventions to address childhood diseases (such as vaccine preventable diseases, acute respiratory infections, diarrhea) and prevention and treatment of major infectious diseases.

* Referral level. This level of delivery of interventions refers to hospitals in general. These can be either district hospitals or referral hospitals. The health care providers at this level are professionals.

District hospitals - Generally designed to serve people with services that are more sophisticated, technically demanding, and specialized than those available at a primary care facility/first level care, but not as specialized as those provided by referral hospitals. Their range of services includes diagnostics, treatment, care, counselling, and rehabilitation. District hospitals may also provide health information, training, and administrative and logistical support to primary and community health care programs. It concentrates skills and rsources in one place for the delivery of interventions for conditions that are either uncommon or difficult to treat. It is also a repository of knowledge and diagnostic tools for assessing whether referral to an even more specialized facility is indicated.

Referral hospitals – These provide complex clinical care interventions to patients referred from the community, primary/first, or district hospital levels. Referral hospitals need to provide many forms of support, including advice on which patients to refer, proper post discharge care, and long-term management of chronic conditions. These can also provide important managerial and administrative support to other facilities, serving as gateways for drugs and medical supplies, laboratory testing services, general procurement, data collection from health information systems, and epidemiological surveillance. They are also the vehicle for disseminating technologies by training new staff and providing continuing professional education for existing staff at different facilities.