Strengthening health systems by focusing on community midwifery

Dans cet article, Della R. Sherratt explique en quoi le développement de sages-femmes professionnelles intégrées dans les communautés fait sens, notamment dans les pays aux ressources financières et humaines limitées. Selon cette consultante spécialiste de la question, la formation des sages-femmes au niveau communautaire est l’une des voies pour construire un système de santé durable

Experiences of a new cadre of midwives in Bangladesh: Findings from a mixed method study

Sophie Witter - ORCID: 0000-0002-7656-6188 https://orcid.org/0000-0002-7656-6188Background Bangladesh did not have dedicated professional midwives in public sector health facilities until recently, when the country started a nation-wide programme to educate and deploy diploma midwives. The objective of the findings presented in this paper, which is part of a larger study, was to better understand the experience of the midwives of their education programme and first posting as a qualified midwife and to assess their midwifery knowledge and skills.Methods We applied a mixed method approach, which included interviewing 329 midwives and conducting 6 focus group discussions with 43 midwives and midwifery students. Sampling weights were used to generate representative statistics for the entire cohort of the midwives deployed in the public sector health facilities.Results Most of the midwives were satisfied with different dimensions of their education programme, with the exception of the level of exposure they had to the rural communities during their programme. Out of 329 midwives, 50% received tuition fee waivers, while 46% received funding for educational materials and 40% received free accommodation. The satisfaction with the various aspects of the current posting was high and nearly all midwives reported that a desire to work in the public sector in the long run. However, a significant proportion of the midwives expressed concerns with equipment, accommodation, transport and prospect of transfers. The scores on the knowledge test and self-reported skill levels were varied but reasonably high.Conclusion While the midwives are highly motivated, satisfied with many aspects of their current jobs and have adequate knowledge and skills, there are some bottlenecks and concerns that, if unaddressed, may derail the success of this programme. To capture the career progress of these midwives, additional research, including a follow-up study with the same cohort of midwives, would be beneficial to this programme.This research has been funded by South Asia Research Hub, Research and Evidence Division, Department for International Development (DFID), Government of United Kingdom (UK). The authors from DFID were actively engaged in the design and writing the manuscript.https://doi.org/10.1186/s12960-020-00505-818pubpu

Chemical analysis of pottery demonstrates prehistoric origin for high-altitude alpine dairying

The European high Alps are internationally renowned for their dairy produce, which are of huge cultural and economic significance to the region. Although the recent history of alpine dairying has been well studied, virtually nothing is known regarding the origins of this practice. This is due to poor preservation of high altitude archaeological sites and the ephemeral nature of transhumance economic practices. Archaeologists have suggested that stone structures that appear around 3,000 years ago are associated with more intense seasonal occupation of the high Alps and perhaps the establishment of new economic strategies. Here, we report on organic residue analysis of small fragments of pottery sherds that are occasionally preserved both at these sites and earlier prehistoric rock-shelters. Based mainly on isotopic criteria, dairy lipids could only be identified on ceramics from the stone structures, which date to the Iron Age (ca. 3,000 - 2,500 BP), providing the earliest evidence of this practice in the high Alps. Dairy production in such a marginal environment implies a high degree of risk even by today’s standards. We postulate that this practice was driven by population increase and climate deterioration that put pressure on lowland agropastoral systems and the establishment of more extensive trade networks, leading to greater demand for highly nutritious and transportable dairy products

Human resources for maternal health: multi-purpose or specialists?

A crucial question in the aim to attain MDG5 is whether it can be achieved faster with the scaling up of multi-purpose health workers operating in the community or with the scaling up of professional skilled birth attendants working in health facilities. Most advisers concerned with maternal mortality reduction concur to promote births in facilities with professional attendants as the ultimate strategy. The evidence, however, is scarce on what it takes to progress in this path, and on the 'interim solutions' for situations where the majority of women still deliver at home. These questions are particularly relevant as we have reached the twentieth anniversary of the safe motherhood initiative without much progress made

Evaluation of individual and ensemble probabilistic forecasts of COVID-19 mortality in the United States

Short-term probabilistic forecasts of the trajectory of the COVID-19 pandemic in the United States have served as a visible and important communication channel between the scientific modeling community and both the general public and decision-makers. Forecasting models provide specific, quantitative, and evaluable predictions that inform short-term decisions such as healthcare staffing needs, school closures, and allocation of medical supplies. Starting in April 2020, the US COVID-19 Forecast Hub (https://covid19forecasthub.org/) collected, disseminated, and synthesized tens of millions of specific predictions from more than 90 different academic, industry, and independent research groups. A multimodel ensemble forecast that combined predictions from dozens of groups every week provided the most consistently accurate probabilistic forecasts of incident deaths due to COVID-19 at the state and national level from April 2020 through October 2021. The performance of 27 individual models that submitted complete forecasts of COVID-19 deaths consistently throughout this year showed high variability in forecast skill across time, geospatial units, and forecast horizons. Two-thirds of the models evaluated showed better accuracy than a naïve baseline model. Forecast accuracy degraded as models made predictions further into the future, with probabilistic error at a 20-wk horizon three to five times larger than when predicting at a 1-wk horizon. This project underscores the role that collaboration and active coordination between governmental public-health agencies, academic modeling teams, and industry partners can play in developing modern modeling capabilities to support local, state, and federal response to outbreaks

OF COMPREHENSIVE MIDWIFERY REVIEW

This report contains the results and recommendations from a comprehensive review of midwifery in Cambodia undertaken as an important component of the Mid-Term Review (MTR) of the Health Sector Strategic Plan, 2003-07 (HSP), and the Health Sector Support Project, 2003-07 (HSSP). The death of a mother is not just a matter of personal family tragedy, but also constitutes a huge human and socio-economic loss to the nation. As such a high maternal mortality ratio is one of Cambodia’s most pressing health concerns to which the Ministry of Health and its development partners are committed to addressing as a priority. As made clear in the First National Midwifery Forum held in 2005, the evidence is clear that increasing access to skilled and well-trained midwives is crucial to achieving the Cambodia Millennium Development Goal 5 (CMDG5) of reducing maternal mortality. It will also contribute to reducing the numbers of neonatal deaths required to achieve the CMDG4 for child health. For the MoH, midwives are one of the critical cadres for achieving the overall improvements in health, especially in rural and hard to reach communities. Also, a

Quand la santé des femmes rejoint la lutte pour l’égalité des droits

La question des femmes a pris une place incontournable dans le discours des institutions internationales et des États. Mais les ONG n’ont-elles pas une responsabilité particulière pour accompagner un changement social, notamment à partir de l’approche médicale ? La santé sexuelle et reproductive (SSR), qui concerne différents aspects de la santé des femmes (prévention et prise en charge des grossesses non désirées, lutte contre les infections sexuellement transmissibles, prévention de la transmission mère-enfant du VIH...), leur fournit à cet égard un levier important. Les ONG l’utilisent-elles à bon escient ou ne devraient-elles pas investir plus radicalement ce champ en revendiquant un droit à la santé en général ? La SSR va en effet au-delà de la seule mortalité maternelle, portant en elle une charge politique dans le sens d’une autonomie véritable des femmes. C’est peut-être pour cela qu’elle peut servir le combat sur le genre et pour l’égalité hommes-femmes