The World Health Organization (WHO) defines maternal health as the health of women during pregnancy, childbirth and the postpartum period. Worldwide, roughly 800 women die from preventable conditions associated with pregnancy and childbirth every day¹. A significant amount of these deaths occur in low-resource settings as a result of complications that include high blood pressure, infection, severe bleeding, and issues during birth.
The risk of a woman in a low and middle-income country dying from a maternal-related cause is about 33 times higher in comparison to a woman in a developed nation. Maternal mortality is a health indicator that exposes vast disparities between high and low-income populations.
Today a range of proven and cost-effective solutions are available to prevent the majority of conditions causing maternal and neonatal deaths. These vary from antibiotics for infections, and sterile blades to cut umbilical cords; as well as point of care diagnostics like test blood glucose, syphilis, and HIV testing for early diagnosis and management of risk factors² ³.
With an array of cost-effective measures, it's visible that the barrier to expanding the access and quality of maternal health in the developing world lies in the availability of frontline health workers that identify risk cases and deliver treatment.
In Ghana, there are 350 deaths per 100,000 deliveries (WHO, 2010), this ranks Ghana 31st in the World Maternal Mortality Index. The chance of a mother losing her life due to pregnancy is 58 times higher in Ghana than in the Netherlands.
The scarcity of skilled gynecologists and midwives in Ghana is a limitation to antenatal care coverage and quality. Not identifying risk factors among patients is a possibility since there is no nation-wide operational model in place. Without a functional system, the gynecologists are reluctant to shift tasks to nurses and even midwives thus limiting their capacity to perform specialist tasks.
What is task shifting?
The shortage of well-trained health workers is a global issue, but developing countries feel this crisis most acutely. The lack of health workers is the primary limitation in scaling access to healthcare in the low and middle-income countries.
Task shifting is the process of moving or delegating specific tasks to less specialized health workers. By restructuring the workflow in this form, task shifting makes better use of the available human resources. For instance, when physicians are in low numbers, a trained nurse can often prescribe and dispense antiretroviral therapy or medication to treat pain and fever or a community health worker can provide basic life support.
Further, community health workers can potentially deliver a wide range of services, such as evaluating risk factors and referral for treatment; therefore relieving the requirement for qualified nurses. Preparing a new community health worker requires between one week and 12 months depending on the skills needed. This is considerably less than the three years, on average, that is demanded to train a fully qualified nurse.
This process increases the pool of human resource rapidly. Also, it has the benefit of strengthening the link between the health facility and the population and produces new jobs and commercial opportunities⁴.
The launch of Woman360
Most pregnancies are uncomplicated and do not need gynecologist attention. Only a small amount of pregnancies develop complications and risks. Not identifying and treating these issues lead to high morbidity and maternal mortality rates.
Shifting maternal healthcare from gynecologists to midwives and nurses results as a direct way of reducing pressure on the scarce specialist resources. This enables the specialist to apply his expertise and skills to patients that need it most.
PharmAccess Foundation, with the support of the Dutch Ministry of Foreign Affairs, has launched Woman360: a franchise network of private clinics and hospitals which seek to scale the access and quality of antenatal care in Ghana⁵.
Well-trained midwives working from spoke clinics are providing quality and affordable maternal healthcare to pregnant women in coordination with hub hospitals. The midwives work in coordination with the hub hospital and can refer risk cases for a gynecologist's evaluation and treatment⁶.
For task shifting to work, two things must occur. First, lesser skilled health workers have to identify risk cases adequately. Second, there has to be a higher level available for referral.
In the Woman360 clinics, the midwives maintain the medical history of the patients on paper records for local regulatory needs. Without a shared electronic health record between the clinics and the hospitals, coordination and monitoring would be a manual and slow task. Also, there is the chance that risk cases are not correctly identified and therefore not referred to a specialist.
Here is where Teamscope has entered to fill in this gap and allow the hub and clinics to work in collaboration. The midwives use an electronic case report form (eCRF) on the Teamscope mobile app to capture critical clinical parameters of each patient. The app supports the midwives work by displaying visual alerts when a patient has any of the risk factors.
When a patient requires a referral, the gynecologist and his assistant receive a notification. This allows them to be coordinated with the clinics and review the patient’s medical data before she arrives.
Teamscope's web application provides the managing team with real-time reporting on the number of pregnant women seen treated per clinic, as well as statistical analysis on any of the clinical parameters collected at the clinics.
In the last 20 years, the world's maternal death ratio has seen a 44 percent drop – a tremendous achievement. But despite these advances, every day roughly 800 women still lose their lives from complications linked to pregnancy or childbirth. This is approximately one woman every two minutes.
Also, for every woman who dies, 20 or 30 encounter infections, disabilities, and injuries. The majority of these fatalities and conditions are entirely preventable.
Task shifting result to be a well-fit way to expand the reach of antenatal health care, especially in African countries where there is a scarcity of gynecologists.
The widespread consensus is that task shifting is an effectual way to scale risk prevention and the provision of essential treatments. However, proper management, support, supervision distinguish the initiatives that are successful.
Electronic Data Capture (EDC) platforms such as Teamscope serve as an aid for health workers when providing care to patients, a monitoring tool for specialists to review risk cases and a reporting platform for stakeholders to track the reach and effectiveness of these interventions.
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Diego is the founder and CEO of Teamscope. Follow his journey: @dmenchaca15.