muriithi: task shifting and implications for newborn care

7/28/2019 Muriithi: Task Shifting and Implications for Newborn Care

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Outline

Background Status of newborn health

Mortality levels

Coverage of effectiveinterventions MNCH

Health workforce challenges

WHO recommendations on task

shifting Implications for newborn care


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Status of newborn survival

Neonatal deaths account for 40% (3.1 million) of globalunder-five mortality

38% (1.1 million) of those deaths are from the Sub-Saharan region

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Major causes of death in neonates and children under-five in the African Region, 2010

Source: WHO. Global Health Observatory (http://www.who.int/gho/child_health/en/index.html)
http://www.who.int/gho/child_health/en/index.htmlhttp://www.who.int/gho/child_health/en/index.html


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World Health Report, 2006

Critical shortage of health service providers(doctors, nurses and midwives)


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Way forward from "What" to "HowWhat

The need to improve access and quality health care formothers, newborns and children along the continuum ofcare

Through having people, with the right skills in the rightplace, at the right time

How

Optimizing the role of available health workers or taskshifting is an option

through building competencies for the required skills and having the required supportive environment

Available evidence shows that task shifting has been inexistence since the 1960s but without muchdocumentation and with no guidance.

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WHO Recommendations on task shifting. Outlined in the WHO 2012 publication on Optimizing health workers

role to improve access to key maternal and newborn health

interventions through task shifting, OPTIMIZEMNH

Developed to address the identified need to optimize potential of theexisting health workforce.

Objective: to issue evidence based recommendations to facilitateuniversal access to key MNCH interventions through optimization of

health workers role.

Developed through use of evidence by a multi-stakeholder taskforce

The process included:

(i) identification of priority questions and critical outcomes;(ii) retrieval of the evidence;(iii) assessment and synthesis of the evidenceiv) Presentation of evidence using structured health systems framework.(iv) formulation of recommendations.


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Categories of Recommendations4 categories Recommendation-should be considered for

implementation. Recommendation with targeted monitoring and

evaluation

Recommendation only in the context of rigorousresearch

Recommended against practice should not beconsidered for implementation

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Implication for newborn health

The guideline recommendations: Includes maternal, newborn interventions

together with contraceptives and HIV/PMTCT

Clarifies Lay Health Workers (LHW) roles inhealth promotion and preventive aspects fornewborns

Includes recommendations and skills for care of

the newborn for other cadres of health workers:auxiliary nurses, midwives and associateclinicians (Non-physician clinicians)

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Implications for newborn health

Direct implications include Good care practices for the mother during pregnancy,

delivery and postnatal period:

Promotion of ANC and skilled delivery

Postnatal care including family planning

Care for the newborn

Home based care for newborns including promotion ofbreastfeeding, cord care, recognition of danger signs

Better care seeking practices for the newborns.

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Key messages for Task shifting

In the application of WHO recommendations the following

should be considered: Context

Need an initial situation analysis of numbers and skills ofthe existing health workers (HW).

Empower the HW being assigned the new roles

All stakeholders must be involved

Institutionalization and sustainability

Ensure policies, structures, funds, processes are in place Identify informal task shifting already taking place and

formalize it.

Consider including some of the successful practices into the

pre-service training. 13


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Key messages cont.. Communication and advocacy

Ensure communication on the process of optimizing formaternal and newborn health is to all stakeholders.

Advocate with all stakeholders for support in optimizingfor health service delivery.

Monitoring and evaluationAgree on key measurable indicators for monitoring

progress especially focusing on improved access tohealth interventions.

Monitor and evaluate policy implementation andidentify and address challenges and bottlenecks.

Documentation

Document and share lessons learnt.

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Conclusion

We need to scale up interventions for newbornhealth at all levels but there is inadequatehuman resources in the region.

Evidence exists to support task shifting

recommendations. Task shifting must be context specific with close

monitoring.

A large number of task shifting options stillrequire rigorous research to build up the requiredevidence.

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Thank

you

muriithi: task shifting and implications for newborn care

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