This Week's News 7-11 June 2010

7

How Mobile Phone Technology Can Fight Maternal Mortality
UN Dispatch

08/06/2010

By Fabiano Teixeira da Cruz, Inter-American Development Bank
Ed note: Tomorrow, the author will participate in the Women Deliver conference panel ‘Mobilizing Reproductive Health: How Cell Phones Are Revolutionizing Women’s Health’, organized by the mHealth Alliance, which the Rockefeller, UN and Vodafone Foundations launched in 2009 to facilitate cross-sector collaboration to bring mHealth to sustainable scale. These are a preview of her remarks.
Maternal mortality remains a major challenge to health systems worldwide.
According to the World Health Organization (WHO), every minute, at least one woman died from complications related to pregnancy and childbirth, about 585,000 women each year. To make matters worse, for every woman who dies in childbirth, 20 more suffer injuries, infection or disease (about 10 million women each year). And 4 million babies die before they are 30 days old. Millions more die from diseases such as malaria that has largely been eradicated in the developed world.
This map shows the huge number of maternal deaths in Latin American and the Caribbean (LAC) countries. Although Chile is better placed than the other countries in the region, appearing as 46th in the global league table, 21.1 women die for every 100,000 live births. In the case of Haiti, the worst performer in the region and 155th (out 181) in the MMR global rank (numbers before the earthquake), the report shows 582.5 deaths for every 100,000 live births.
Maternal mortality ratio (MMR) - the number of maternal deaths per 100,000 live births - in the LAC countries.
Why is there so high maternal mortality?

Poor access to the health care system

Access to family planning - counseling, services, supplies

Low coverage of antenatal care (e.g. missing appointments)

Inability or difficulties to communicate with providers and health-care team in case of emergencies and when needed

No access to lab results

No health care-related information easily available

The promise of information and communications technologies (ICT) for health: a paradigm shift towards digital health care.

Modern information and communication technology (ICT) has a pivotal role to play in tackling health-related problems, by empowering individuals and equipping decision makers with timely information about critical health issues. It can, among other things, enable healthcare workers to conduct remote consultation and diagnosis, store and disseminate healthcare information, improve access to and use of information by patient, strengthen epidemiological surveillance and management, establish databases to track vaccination, raise awareness through knowledge sharing, improve quality of health services provision, improve patient compliance with treatment regimen, improve access to health services, expand access to ongoing medical education and training for health workers.
In the fight against maternal mortality, ICT can critically reduce the incidence of maternal death numbers by: facilitating access to information and healthcare services, and reaching women with information to prevent unnecessary deaths and complications.
Also, with the expansion of wireless networks, mobile technology is an important ally. It’s the most rapidly adopted technology in history and represents an exciting opportunity to “reach the unreached”.
According to International Telecommunications Union (ITU), mobile subscriptions globally will surpass the 5 billion mark by the end of 2010, two-thirds of which are in low- and middle-income countries (LMICs) – the total number of PCs in use worldwide including laptops is 1 billion.
Almost 90% of the LAC population has a cell phone. Some forecasts indicate that it could grow by 8.2% annually in the region in 2010. Cell phones have become firmly ensconced as essential goods rather than luxury items.
There is a growing body of evidence that demonstrates the potential of mobile communications to radically improve healthcare services — even in some of the most remote and resource-poor environments. The key applications for mHealth (defined as the use of mobile communications for health services and information) in developing countries are:
Education and awareness

Remote data collection

Remote monitoring

Communication and training for healthcare workers

Disease and epidemic outbreak tracking

Diagnostic and treatment support

Appointment reminders (to patients and workers)

To sum up, ICT by itself certainly play a key role in helping saving lives but it isn't a silver bullet. Health system strengthening as a whole is the key to the success of any kind of mHealth intervention.

ICT are only as useful as the substantive requirements and expertise on which they are based. We need clinical and public health experts to explain the needs and challenges they face; then gather the ICT experts to find the points of intersection -- where ICT can help along the continuum of care for pregnant mothers and newborn children, and for those with serious diseases.
References:

[1] "mHealth for Development: The Opportunity of Mobile Technology for Healthcare in the Developing World". United Nations Foundation/Vodafone Foundation Technology Partnership (2009); www.unfoundation.org/technology

[2] "Innovation: Applying Knowledge in Development". Authors: Lee Yee-Cheong, Calestous Juma, Jeffrey D. Sachs; UN Millennium Project 2005, Task Force on Science, Technology, and Innovation.
[3] "Focus on Five: Improving Women's Health to Achieve the MDGs". Author: Women Deliver No. of pages: 22. Publication date: 2009.
[4] "Barriers and Gaps affecting mHealth in Low and Middle Income Countries: Policy White Paper". Authors: Mechael, Patricia N., Batavina H., Kaonga N., Searle S., Kwan A., Goldberger A., Fu L., Ossman J. May 2010. The Center for Global Health and Economic Development (CGHED), Earth Institute at Columbia University and mHealth Alliance.
[5] "Mobile Technology for Community Health (MoTeCH): mHealth Ethnography Report". Author: Mechael, Patricia N.; Dodowa Health Research Center. The Grameen Foundation.
Fabiano Teixeira da Cruz is Program Manager at the Science and Technology Division of the Inter-American Development Bank (IDB), where he heads the Mobile Citizen Program, an initiative that aims to speed-up the implementation of mobile phone-based services to tackle acute social and economic problems in the Latin American and the Caribbean region.

8

How to save lives in Africa
Montreal Gazette

09/06/2010

By KEVIN MCCORT, ROSEMARY MCCARNEY, CHRISTINA DENDYS, DAVID MORLEY, KIMBERLY MORAN, and DAVE TOYCEN, Freelance
When your child is sick, where do you go? In Canada, your choices can include a walk-in clinic, a doctor's office, or an emergency room. If you're pregnant, you can turn to a midwife, a family doctor, or an obstetrician.
Sadly, too many of the world's poorest children and their families have no access to such services. It might take hours or even days to walk to the nearest clinic or hospital; their country might have only a handful of obstetricians or pediatricians; or they might just be too poor to afford what limited care does exist.
Because of this inequity, at least 8 million children die each year from mostly preventable causes before their fifth birthdays and more than 350,000 women die of complications from pregnancy, labour and delivery. It's time to bridge the gap that divides the world's poorest from the dependable and accessible health services that we take for granted.
This health gap really is even more intolerable given that many of the life-saving solutions that remain out of reach for millions - immunizations, oral rehydration salts, and nutritional supplements - often cost dimes, not dollars per treatment.
It does not have to be this way. Canada could launch a revolution in maternal, newborn, and child health by leading the G8 to invest in a massive increase in the number of frontline community health workers trained to provide the very poor with dependable care close to home. While not the whole solution, scaling up frontline health workers is a critical part of it and an area where Canada can add real value.
The answer is to provide families with the healthcare they need in the communities where they live. And this depends on a legion of frontline workers prepared to tackle the leading causes of illness and disease in the developing world. Frontline health workers include doctors, nurses, and midwives, but can also include community health workers - promising young women who are supported and trained to provide life-saving medical interventions in their own communities, whether rural villages or urban slums.
The answer lies with people like Fikre Berhanu, a community health worker in rural southern Ethiopia. She is one of 30,000 women trained to treat the main causes of illness and death in the poorest pockets of this sub-Saharan country. Berhanu has only the equivalent of a Grade 10 education, but she has received a year's training as a "health extension worker" and is now back in her community preventing and treating illness and saving lives.
She and her partner Meseret are frontline warriors in the battle to curb the most common and preventable killers of children and their parents. Working in one of 15,000 health posts spanning the rural country-side, they are trained to diagnose and treat ailments like malaria, diarrhea, pneumonia, and malnutrition; to vaccinate kids against killers like measles, polio, and diphtheria; to treat HIV and TB; and also to counsel women on birth spacing and contraception. Although not physicians or midwives, they are also trained in safe birthing techniques and are equipped to monitor the progress and contribute to the health of pregnant women.
As frontline community health workers, Berhanu and Meseret are central to the "continuum of care," the broad range of health-care services that connects homes and communities to clinics and hospitals. They, and many others like them around the world, are key to improving maternal, newborn, and child health.
Canada's investment must be new funding - not reassigned, not repackaged, and not reallocated - to insure a tremendous and measurable impact in lives saved. It is important that this investment not come at the expense of other priorities, such as the commitment to tackling HIV and AIDS.
Canada's share of the estimated $30-billion global financing-gap to save 10 million women and children's lives by 2015 is $1.4 billion over five years - an amount only slightly higher than the security tab for the G8 and G20 summits. Canada should commit to this as part of a larger, long-term effort to scale up our investment in health aid. We can only imagine what a million workers like Berhanuand Meseret could do for the lives of these 10 million women and children.
This month, Prime Minister Stephen Harper can show leadership by making a commitment to training and equipping hundreds of thousands more young women who will bridge the health divide, save lives, and ensure a stronger future for their communities. Let this be Canada's G8 legacy.
Kevin McCort is president of Care Canada; Rosemary McCarney is president of Plan Canada; Christina Dendys is executive director of RESULTS Canada;
David Morley is president of Save the Children Canada; Kimberly Moran is president of UNICEF Canada; and Dave Toycen is president of World Vision Canada.

© Copyright (c) The Montreal Gazette

9

Public Sector contract talks
Montreal Gazette

04/06/2010

By KEVIN DOUGHERTY, The Gazette
Union leaders in Quebec's public sector pledged yesterday they would not sign a final agreement that doesn't include nurses and other health workers.
Premier Jean Charest agrees.
"I want an agreement with the health care sector," Charest said, commenting on contract talks with Quebec's common front of 475,000 public sector workers, from civil servants to education and health care workers.
"We can't understand why there is no progress at the negotiating tables in health and social services," said Gilles Dussault, spokesperson for the Secrétariat intersyndical des services publics, adding that non-monetary agreements have been signed with civil servants and education workers, but not with Quebec's 245,500 health workers.
Treasury Board president Monique Gagnon-Tremblay said she is pleased with the progress of contract talks, noting that she hopes a negotiated settlement can be reached by the end of June.
"You have to understand that in health, there are major changes expected on both sides," said Health Minister Yves Bolduc, explaining the government wants more flexibility, to reorganize work, with the goal of retaining personnel.
Gagnon-Tremblay, who is overseeing the negotiation progress, said the demands from health workers are about $1.7 billion more than the government is willing to pay.

© Copyright (c) The Montreal Gazette

10

A model for maternal health
Toronto Sun

03/06/2010

By LAURA PAYTON, Parliamentary Bureau
OTTAWA – A woman best known for her work in the fashion world is turning her attention to Canada's G8 maternal health initiative and so far she likes what she sees.
Christy Turlington Burns, best known as the supermodel who formed part of the so-called Trinity with Linda Evangelista and Naomi Campbell, is praising Canada for its rumoured $1 billion pledge to the G8 maternal and child health initiative.
Turlington Burns has been advocating different causes since the early 1990s and working with the international development group CARE since 2005. She's just completed a documentary, No Woman, No Cry, about maternal health issues in four different countries.
“What's most exciting about what's happening here ... is that Canada's made this commitment (to a maternal and child health initiative),” Turlington Burns said in an exclusive interview with QMI Agency.
“What's important is that the rest of the leaders of the G8 come up to the table too and have something to contribute.”
Turlington Burns, who is in her second year of a Masters in public health at Columbia University, says the G8 countries must contribute new money to the initiative, not money already allocated to other programs or pledged in previous announcements.
Experts estimate millions of trained health-care workers are necessary to make it safe for women in developing countries to give birth. Right now one woman dies every minute of pregnancy or childbirth complications and 90% of those deaths are preventable.

She's also looking forward to hearing the details of Canada's plan.

“There's room for the various countries to contribute where they're able,” she said, adding “it's unfortunate” the abortion debate has derailed the maternal health discussion.
“However, it's also important to acknowledge that 13% of all maternal deaths come from unsafe abortion. Being a public health student, I can't look away from that,” Turlington Burns said.

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Europe

1

Our aid will hit the spot
The Guardian, UK

03/06/2010

David Cameron
Britain has this week fundamentally changed the way we support the world's poorest. There won't be any less money – in fact, there'll be more. But we are taking a new approach to the way that money is spent, and how spending is monitored. It's time to bring greater transparency and accountability to overseas aid.
To start with, we are going to publish online details of every international development programme, letting people see where aid money should be going. Over time we also want that information to get to the very communities who depend on the funding, so they can blow the whistle if it doesn't get through. Too much aid is too often misplaced, and too much lost to corruption. So we're creating an independent aid watchdog to make sure development projects pass the most crucial test: how many lives were saved or improved?
Making sure that every pound counts means being realistic and practical about what aid can achieve. Without being hard-hearted, we have to be hard-headed. We should ask: "What are the things that aid can best deliver and that make a real long-term difference?" That's why we've focused on things like anti-malaria bednets and vaccinations for children. It's obvious that without a healthy young population a country can never grow prosperous; it's just as obvious that we should look after women, for they hold the key to development.
In many of the poorest countries pregnancy is a life-threatening condition. By the end of today about 1,400 women will have died in pregnancy or childbirth, nearly all of them in the developing world. A decade ago, the world set a target of reducing maternal mortality by 75% by 2015. Yet once again, for all the talk of development goals, little has changed. Levels of maternal mortality in many regions have barely fallen in 20 years.
That is shocking and shameful. But it doesn't have to continue like this. Our own experience can point the way. The last time Conservatives and Liberals were in government together maternal mortality in Britain was called "the great blot on public health". Our predecessors turned this around with new policies and resources, including

the establishment of a national midwifery service. Within 15 years maternal deaths had fallen by 80%. It's now time to take a similarly radical approach abroad.

As a first step, we are establishing a £5m fund to help midwives and health workers share their skills with birth attendants, nurses and doctors in the world's poorest countries. It will also enable us to expand links between the NHS and overseas health systems, and share innovations in health technology.
When I met Stephen Harper, the Canadian prime minister, today we agreed to do all we can to make tackling the scandal of women dying in childbirth a top priority for the G8/G20 meetings in Toronto this month – and at the UN development summit later in the year. The G8 should set an ambitious target of saving three million more lives by 2015. We should be ambitious, as we were in Britain 70 years ago. But we must back our words with real action.
People in developed countries are fed up with hearing grand promises from political leaders which are never fulfilled. They're angry that money they give too often doesn't reach the people they wanted to help. And, despite some amazing success stories, like the eradication of smallpox and the near-eradication of polio, they're frustrated about the lack of progress in the developing world. The answer is not to pull back: even in

these difficult times we will meet our commitment to increase spending on aid to 0.7% of gross national income from 2013. But if we're asking the country to give more, it's our responsibility to make sure we get more for it.

guardian.co.uk © Guardian News and Media Limited 2010

2

Region set for almost 200 NHS job losses

The Scotland Courier, UK

04/06/2010
By Steve Bargeton, political editor, Charlene Wilson, Stefan Morkis and Geraldine McKelvie
ALMOST 200 nursing and midwifery jobs will be axed in Tayside and Fife as part of massive job losses across the health service in Scotland this year.
And the head of NHS Tayside yesterday warned further cuts may well be necessary.
Health secretary Nicola Sturgeon told MSPs yesterday that 3790 jobs will go—1500 of them nurses and midwives, and 1000 administrators.
Although the Scottish NHS budget has increased in real terms this year, staff costs are up around 3% and the cost of hospital drugs has soared by up to 10%, putting huge pressure on health board budgets.
With staff costs making up 70% of the overall NHS budget, health boards are planning major staff reductions.
As already revealed by The Courier, 495 jobs are to go in Tayside from a staff of 11,648 —including 158 nurses and midwives, 156 administrators, 84 support service staff, 45 allied health professionals, 24 healthcare scientists and eight managers.
In Fife the 7185-strong health workforce is to be reduced by 54, including 29 nurses and midwives, and 11 administrators.
In Glasgow 1252 jobs are going, 734 in Lothian and 577 in Grampian.
NHS Tayside chief executive Professor Tony Wells refused to rule out further cuts if the opportunity to make savings arises.
“The quality of patient care is paramount to NHS Tayside and over the next few years we will be continually looking at how we can cut waste and inefficiencies across the whole organisation, while protecting frontline services.
“This will be very much in close partnership with our staff side and trade union colleagues.
“As we have previously stated, NHS Tayside has a no redundancy policy.
“Consistent with NHS Tayside’s existing policy on recruitment to vacant posts we will in the first instance consider all opportunities for the more effective utilisation of existing staff through internal recruitment/redeployment.
“We also plan to reduce the use of overtime, bank and agency staff.
“Like all other responsible organisations, the approach within NHS Tayside is to ensure robust management systems are in place for the careful scrutiny and approval of staff vacancies as they arise.
“We will also take every opportunity to redesign how services are provided and look at how we can change and improve the way we deliver services across the whole organisation.”
An NHS Fife spokesman said, “The figures provided by NHS Fife are estimates at this time and are therefore subject to change as we continue to develop plans with the service and in partnership with staff representatives.
“Reductions will be achieved through turnover, redeployment and the termination of fixed term contracts.”
Ms Sturgeon said, “I have made it clear to boards that staff efficiencies must not compromise the quality of care.
“They have a responsibility to demonstrate that such efficiencies can be achieved by service redesign, by advances like increasing day care rates and by greater productivity.”
“NHS boards are committed this year to securing more than £100 million in non- workforce related efficiency savings which will all be reinvested in frontline care.
“But the drive to deliver services more efficiently also involves looking at staffing requirements and these projections are part of that process.
“These figures are not set in stone. I expect boards to continue to try to minimise the reductions by working hard to maximise non-workforce related efficiencies.
“I have also guaranteed that there will be no compulsory redundancies and the quality of patient care remains paramount. The national scrutiny group will scrutinise health boards’ plans closely to ensure this remains the case.”
However the unions warned the cuts will hit health services.
Royal College of Nursing Scotland director Theresa Fyffe said, “If health boards across Scotland continue to pursue such cost-cutting measures on the wage bill, without properly carrying out service redesign and looking at other areas of cost pressures, they will be left with a demoralised and overstretched workforce and may risk standards in patient care.
“It would also make it difficult and more costly to redesign services to meet patient needs in the future as appropriately skilled nurses and other healthcare professionals may no longer be in the workforce.”
Chairman of the British Medical Association in Scotland Dr Brian Keighley said, “There is intense pressure to make savings in the health service and as the NHS budget begins to shrink, boards will inevitably have to consider cuts to frontline services.
“However, making indiscriminate cuts is not only short-sighted but could cause irreparable damage to the NHS.”
Scottish Labour yesterday launched a campaign attacking the job losses in the NHS under the banner “More Nats Fewer Nurses”—a twist in the SNP election slogan “More Nats, Less Cuts.”
“It didn’t really work for them then and I have to say it sounds pretty hollow now,” said Labour health spokesman Jackie Bailie.
“The hypocrisy of claiming on the one hand to protect frontline services but on the other hand presiding over the worst cuts since the advent of devolution is quite breathtaking and also hugely disappointing.”
Tory health spokesman Murdo Fraser told MSPs health spending has increased.
He added, There are savings to be made and we reject the nonsense this will automatically have an impact on patient care.”
Scottish Lib Dem health spokesman Ross Finnie said, “We are looking at a serious position where those health boards all have to make savings just to cover where we are, never mind any projected future cuts that may be in the pipeline.”
The news sparked an angry war of words between two Fife MSPs amid accusations of “scaremongering.”
Labour MSP for Mid Scotland and Fife, Claire Baker described the announcement as “very bad news” for the region.
She said, “The SNP have been forced to come clean and admit that they plan to cut 54 NHS jobs in Fife this year, the majority of which are nurses and midwives.
“These are cuts to jobs that are involved in the delivery of frontline care and I’m therefore concerned about the effect this year’s cuts will have on patient care.”
SNP Central Fife MSP Tricia Marwick accused Mrs Baker of “scaremongering.”
“Both NHS Fife and the health secretary Nicola Sturgeon have publicly stated that there will be no compulsory redundancies, and that the quality of patient care remains paramount,” she said.