Task-Shifting--Or Why Doctors Might Not Always Be Necessary to Save Mothers' Lives
The Global Maternal Health Conference 2010 is underway! Unfortunately, I’m not there in New Delhi to witness it all first-hand but the organisers are kindly live streaming some of the sessions so I can still feel like I’m participating in this extraordinary event, while sitting in my office in Cambridge, UK.
The theme of the live streamed afternoon session (which took place in the early morning UK time yesterday) was “Strengthening access to maternal health” and I tuned in to listen about the importance of human resources.
The White Ribbon Alliance has been doing an amazing job the past months and spreading the word about the importance of skilled birth attendants and campaigning for funds to train health workers. The presentations in this session further stressed the importance of training staff who are not necessarily obstetricians and gynaecologists, available to help and treat birthing women.
Helen de Pinho from AMDD talked about the changing situation in Africa, where increasing numbers of non-physician clinicians (NPC) are broadening the scope of health services they provide. NPCs already provide emergency obstetric care in 6 countries and this number is bound to increase in the near future. De Pinho stressed task-shifting as the key – it’s been proven that NPCs can provide, regular and emergency obstetric care with equal success to doctors. Importantly, their training is shorter, quicker and cheaper with no loss in the quality of services they provide to their patients.
In keeping with the theme, Jeffrey Smith, Jhpiego regional director in Asia spoke about the advantages of midwifery services and what it takes to educate a midwife in the developing world. He argued that the aim of a midwife’s education should be to produce a “health worker [who] is competent, employed and able to work effectively”. Thus, it’s important to focus midwives’ education on clinical practice and continually assess the learning process. Students must be given the permission to provide care, obviously under supervision at least at first, and not just watch others providing it. In order to really gain the skills they require to effectively treat their patients they must have the hands-on clinical experience. Once their education is done, the key is to make sure the midwife is employed and her skills are properly taken advantage of – therefore she must have access to at least basic drugs and a space where she can safely see her patients. A “clinic” without a roof and no medical supplies just won’t do it! It’s also important to remember that both the midwives themselves, and communities tend to benefit most from medical training if the midwife is allowed to return to practice in her home village/town after graduation.
The role of training health workers is hard to overestimate and it will take time to train the health professionals we are currently lacking. In the mean time it should be remembered that there are other very cheap and highly effective methods of combating maternal mortality in the short run. Ndola Prata, and colleagues, from the University of California, Berkeley, School of Public Health have very recently published an analysis showing that the cheapest and most effective way of preventing maternal deaths is investing in family planning and misoprostol (a drug for stomach ulcers turned haemorrhage prevention and treatment “miracle” pill). Misoprostol has recently been gaining mainstream media attention for how incredibly cheap, safe and effective it is at saving lives.
Stay up to date with the conference happenings! Follow the Maternal Health Task Force and EngenderHealth on Twitter: @MHTF and @EngenderHealth. The conference hashtag is #GMHC2010.
For more posts about the Global Maternal Health Conference, click here.
For the live stream schedule, click here.
Check back soon for the archived videos of today’s presentations.