Knowledge Generation

In this proposal we focus on the postpartum period, and compare several low-cost and easily scalable approaches to improve the uptake and quality of postnatal care - approaches that take advantage of our strengths in technology, task shifting, clinical checklists, and community sales networks. In Kenya fewer than 20% of women receive postnatal care in the six-week postpartum period. Our objective is to find a cost-effective way to increase coverage of postnatal care and postnatal family planning within our patient population.

We propose a comprehensive integrated program to address the comprehensive interrelated factors leading to poor maternal and child health. We combine service delivery improvements with demand-side innovations and multiple mobile phone applications. These include safe delivery kits, insurance for transport and treatment of obstetric emergencies, safe water and hygiene products, and small incentives for women to start antenatal care (ANC) early.

Jhpiego proposes a capacity building and sustaining "Day of Birth" approach to bring lifesaving services to remote health facilities where complications must be prevented and managed simultaneously and swiftly, often by a single provider. This approach uses evidence-based practices in prevention and treatment of the two biggest killers of women and newborns in the hours after birth -PPH and neonatal asphyxia.

The proposed tool, HemoGlobe, is a small, very low-cost device that transforms rural health workers' cellphones into noninvasive, prick-free hemoglobinometers. Hemoglobin levels are pictorially displayed on the cellphone screen for easy, actionable interpretation. Concurrently, the information is transmitted to a central server via automatic SMS, which contributes data to a real-time geographical map of anemia prevalence and severity that can be used for higher-level public health policy decisions.

HealthPartners community-owned, sustainable health coop model empowers local stakeholders to partner for increased access to care and improved health outcomes. This is critical for reducing barriers for pregnant women to seek antenatal care, delivery with a skilled health professional and to receive critical follow up care immediately after birth. Addressing the problem of demand, HealthPartners Cooperative model reduces out of pocket, health-related expenditures for pregnant women through risk pooling. Healthy individuals offset expenses incurred by those who fall sick.

This project confronts the barriers to maternal and neo-natal health constructed and maintained by some community and religious leaders (CRLs) in six states of Nigeria. CRLs provide the ideology, messages and personal life examples which counter the myriad maternal and neonatal health interventions in this region. Previous interventions avoided resistant CRLs, engaging only liberal scholars in one-off events such as workshops. This has failed to bring down the barriers and the death rates persist.

We seek to address a critical fourth delay that sustains high rates of maternal and neonatal mortality in western Kenya: the delay in a community's accountability to its mothers and infants. We will develop an innovative information technology that fosters rapid communication and feedback between mothers, their communities, and their healthcare providers: The Mother-Baby Health Network.

We propose to develop a novel once-daily microencapsulated micronutrient powder containing iron, folic acid, and calcium (Prenatal Sprinkles) to overcome barriers to the integration of calcium into prenatal care in developing countries. If successful, our innovation - "differential time-release microencapsulation" - will mask the taste of iron and the gritty tongue-feel of calcium, and facilitate differential iron and calcium absorption.

In Nepal, despite recent efforts to increase deliveries attended by a skilled provider, fewer than 20 percent are reached with such care. Much of the population faces significant geographic barriers to care, and a large proportion of newborns are exposed to poor hygiene conditions over their first few days of life. Nearly 70 percent of infant deaths occur within the first month of life, the most common cause being infection. A trial in Nepal has shown that risk of death can be reduced by 24 percent with application of the antiseptic chlorhexidine (CHX) to the umbilical cord stump.

Operative Experience, Inc. has pioneered unique, simulation-based methods to teach major surgical operations and currently trains military physicians and combat medics in critical trauma procedures. We propose to utilize our methods to teach healthcare providers in underserved areas to perform emergency cesarean sections. Our system is based on video demonstration of operative procedures using physical models of unprecedented anatomical and surgical accuracy. The models consist of artificial tissues that can be cut, dissected, retracted and sutured using standard surgical instruments.