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Reproductive Health
Goal 5 of the Millennium Development Goals sets out by the year 2015 to reduce by three quarters the maternal mortality ratio. Although progress has been made, we remain a long way from this target. A primary focus of attention has been to encourage women to deliver their children at a health facility under the care of a trained midwife or doctor. However recent attention has focused on the poor quality of care that many women and their newborns receive when they come to a health facility. A recent review of this problem in the Lancet (Shankara, et. al. v.371, Issue 9620, April 2008,) noted, “Perhaps the most challenging step is to ensure use of data to improve the quality of routine maternal and newborn care and emergency obstetric care through the strengthening of health systems”. One of the prime reasons for the poor quality of care that women receive is the general shortage of trained health workers. The WHO 2006 world health report “reveals an estimated shortage of almost 4.3 million doctors, midwives, nurses and support workers worldwide. The shortage is most severe in the poorest countries”.
One of the most basic strategies to improve quality of care is to define standards that guide health workers through the process of diagnosis and treatment for the majority of their patients, and develop manuals and tools so that these standards can easily be followed. In wealthier countries, emergency rooms and intensive care units follow computerized treatment guidelines to ensure that patients get the best care quickly and accurately despite changes in staff.
D-tree International is working to develop algorithms for used by health workers at a health facility accurately assesses patients who are pregnant and come to a health facility in labor. The clinical protocol will assess whether the pregnant patient in labor appeared to be progressing normally and whether any specific interventions, emergency or otherwise, are needed at any given point of time during the labor and delivery process. This work is currently at an initial stage of development.
D-tree International is also working in the area of Family Planning where we are developing a screening protocol for use by community and facility based health workers who counsel and treat clients who wish to use family planning. Based on current practice concerning client desires in terms of future childbearing, client’s preference for method, client history of hypertension or other health problems, and basic examination, the algorithms can be used to suggest methods of contraception as well as to prompt health workers for types of advice to give each client during each visit.
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