Optimizing the delivery of key interventions to attain MDGs 4 & 5 through task-shifting(Optimize4MNH)

RECOMMENDATIONS for HEALTH PROFESSIONALS

A. Metin Gülmezoglu

World Health Organization

Health worker categories

Lay health workers Auxiliary

– nurses– nurse-midwives

Nurses Midwives Associate clinicians (Non-physician clinicians)

– Associate clinicians– Advanced level associated clinicians

Non-specialist doctors

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"[The authors] have shown, unequivocally, that appropriately trained midlevel providers are able to do both surgical and medical abortions as competently as are doctors in relatively low-resource settings where the need is greatest."

Yap-Seng Chong and Eng-Kien Tan Comment, Lancet

Special cases: abortion

Abortion provision by mid-level providers is being addressed through a separate guideline developed by RHR department and is not included this process.

Guideline panel was convened in July 2011 and the guideline is currently going through GRC and publication clearance 3

Special cases

HIV-PMTCT questions were addressed– The recommendations made by this panel will feed into a more

comprehensive guideline that is in progress led by the HIV/AIDS department

Regulatory aspects of task-shifting programmes is being considered by HSS/HRH as a separate guideline. In the Opt4MNH guideline, these issues are highlighted in the evidence frameworks

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Special cases: Contraception

Contraception questions will be addressed by this panel.– HRP/RHR and The Reproductive Health Supplies Coalition (RHSC) will

support a follow-up finalization and operationalization meeting dedicated to contraceptive task-shifting/sharing

– This meeting will take place in Geneva on 26 June 2012

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Key interventions

Promotional interventions for maternal and newborn health

Distribution of oral supplements

Initiation and maintenance of antiretroviral treatment or antiretroviral prophylaxis for pregnant women and for prevention of HIV infection in infants Undertaking of external cephalic version (ECV)

Delivery of injectable antibiotics for preterm pre-labour rupture of membranes (pPROM) Continuous support during labour

Delivery of specific childbirth interventions

Postpartum haemorrhage related interventions

Vacuum extractionIntravenous fluid for resuscitation

Bimanual uterine compression

Suturing for genital lacerations

Manual removal of placenta

Prevention and treatment of postpartum haemorrhage

Pre-eclampsia/eclampsia related interventions

Antihypertensive use for high blood pressure

Delivery of loading dose of magnesium sulphate to prevent eclampsia Delivery of maintenance dose of magnesium sulphate to prevent eclampsia Delivery of loading dose of magnesium sulphate to treat eclampsia

Delivery of maintenance dose of magnesium sulphate to treat eclampsia

Management of puerperal sepsis using antibiotics before referral

Delivery of neonatal resuscitation

Initiation and maintenance of kangaroo mother care

Delivery of antibiotics for neonatal sepsis

Recommendation categories

1. Recommend2. Recommend with (targeted) monitoring and evaluation3. Recommend only in the context of rigorous research4. Recommend against

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