An article in the New York times reported on an interesting community approach to infant mortality.
A recent study published in the Lancet http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2962274-X/abstract investigated the efficacy of a program to train and sponsor lady health workers to enact community interventions in Pakistan. The lady health workers program was developed in Pakistan to reduce perinatal and neonatal morbidity in rural areas of Pakistan where 57% of deaths before the age of five are attributed to newborn morbidity (Bhutta et al, 2011).
The results of this study are promising. Since the lady health workers program started, the communities where these women worked have experienced a 15% decrease in newborn deaths and 21% decrease in stillbirths. The program attained these successful results despite the fact that the lady health workers were not able to perform all of their assigned duties and failed to follow through on several post-birth baby visits.
More impressive than the results, is the fact that this program required minimal expertise and training from the women health workers. The lady health workers had on average only a tenth-grade education and only participated in one week of training before the program started. Their duties included distributing soap and clean razors for sterile cutting of the umbilical cord, and instructing midwives on the importance of keeping newborns warm and how to give them mouth-to-mouth resuscitation.
Two organizations partnered to fund this study: The World Health Organization and the Saving Newborn Lives Program of Save the Children which is funded by the Bill and Melinda Gates Foundation.
I believe much of the success of this program could be attributed to the fact that lady health workers easily earn trust from females in the community. Any scientific discovery, whether epidemiological, biomedical, or environmental, is nothing if the people its results affect will not buy it. This program's efficacy is evidence that social connections between women in communities are perhaps the most valuable circuits through which public health endeavors can communicate. I am excited to see how the results of this study shape community interventions for reproductive and maternal health across the globe!
Article Link: http://www.nytimes.com/2011/01/25/health/25global.html?ref=health
This article shows how undervalued basic public health improvements are, mainly focusing on sanitation and education. It's funny because so much of what we chalk up to medicine is high-minded, complicated, or technology-dependent when really at the very root of health basic issues, like these, serve as the foundation.
ReplyDeleteI wonder how exactly the health infrastructure is, or isn't, functioning in the Middle East. Do they have a government infrastructure in place at all, or is it mainly left up to non-profit and other outside agencies? While the US is fighting for health care for all, countries like Pakistan seem to be fighting for very basic rights for the few. The article doesn't describe anything in relation to the women who participated, but I wonder what their socioeconomic status was and if they were in a more urban or rural environment.
All in all though, it was promising to see that such little, easy changes can have such a huge impact.
You make a good point! Improving public health does not have to be complicated.
ReplyDeleteIn response to your question about the government infrastructure in Pakistan, the Pakistani government appears to place a strong emphasis on Primary and Preventative Care. It was the Pakistani government, not non-governmental or other non-profit organizations, that introduced the National Program for Family Planning and Primary Health Care and resulting training of lady health workers. While this government program has been in state since 1994, the study I outlined was funded by NGOs and was the first study assessing its effectiveness in reducing infant mortality.
Regarding socioeconomic status, the study said that the lady health workers targeted the rural communities in Pakistan as they have higher infant mortality rates than urban regions within the country. 83% of the mothers the lady health workers served were illiterate, 8% had primary middle school, and 1% had post-secondary education.
There is something else you might find interesting. The majority of women in rural Pakistan give birth at home, assisted by Dias (midwives). Instead of trying to convince the women to abandon their custom and go to hospitals, the program invited Dias to participate in lady health worker education and encouraged lady health workers to educate and collaborate with the Dias to improve their methods.
If you follow this link and sign in through your SLU account, you can read the full text of the study. It might answer more of your questions. http://www.ncbi.nlm.nih.gov.ezp.slu.edu/pubmed?term=Improvement%20of%20perinatal%20and%20newborn%20care%20in%20rural%20Pakistan%20through%20community-based%20strategies%3A%20a%20cluster-randomised%20effectiveness%20trial
One thing that caught my attention from this article was the fact that the success was based largely on the fact the women bought into the new program. At the end of the day, if the patients don't buy into the changes then most likely any program will have a limiting impact. The women believed in the new procedures because they were told about them by the people in the community they respect and trust
ReplyDeleteI believe this is an important lesson in the field of public health. Instead of making wholesale changes to a structure, start by working through people and organizations that the patients are both familiar with and trust. Like said before, not everything has to be so complicated. Oftentimes, simple resources and medications made available to the population can go a long way in fixing the root of the problem.
Thing thing I love about this article is that it gives concrete evidence as to how easy it can be to make positive change in a community without large spending, ect. A simple concept, such as education, or hygiene, can spread through a community faster than kind of "trickle-down economic aid" ever can.
ReplyDeleteThere is a great book by Greg Mortenson, called "The Cups of Tea", in which he talks about how important it is to focus on the education and empowerment of women. A favorite quote of mine is, "if you educate a man you simply educate an individual, but if you educate a woman you educate a family". I think this is so true. If healthcare were approached this same way, not only could millions of dollars be saved, but so could millions of lives.
I agree with the ideas posted that working through the established system can sometimes allow change to take place more effectively than through other methods. Often, it seems as though higher income countries approach issues in other countries as something "bad" that they are doing which can be fixed by applying something "good" that we are doing. This story shows that breaking down that notion into a more flexible sharing of systems and ideas can lead to a surprisingly simple, elegant and efficient health care solution such as the one shown here. It goes to show that understanding an existing structure and system can go a long way.
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