I N S I D E T H I S

I S S U E :

MOMI project outputs 2

MOMI in the spot-

lights

2

Introducing MOMI

partners—continued

3

PACHI team in Mala-

wi

3

New MOMI consorti-

um project adminis-

trator

3

MOMI clinical review

of MNCH policies

4

MOMI Newsletter J U N E 2 0 1 3 V O L U M E 3 , I S S U E 1

MDG 4 GOAL

Reduce by two thirds, between 1990

and 2015, the mortality rate of

children under five

MDG 5 GOAL:

To reduce by three quarters, between

1990 and 2015, the maternal mortali-

ty ratio and achieve by 2015, Univer-

sal access to reproductive health

MOMI Project Management Team meets again

From March 12th to 14th, the third MOMI Project Management Team meeting was organized by ICRH

Mozambique and the Eduardo Mondlane University in Maputo, Mozambique. Participants included staff

of all eight consortium partners. The opening session was attended by representatives of the

Mozambican Ministry of Health, the EC

delegation, and the Rector of the

Universidade Eduardo Mondlane. During

this session an introduction was given of

the MOMI project and the consortium, a

brief presentation was made of the

maternal and infant health situation in the

four African project countries, the

objectives of the meeting were outlined,

and an overview was given of the causes of

maternal and infant health in Mozambique and the Ministry of Health goals to reverse maternal and child

mortality and improve service coverage rates by 2015. The relevance of MOMI research for enhancing

postpartum policies and procedures was highlighted. During the technical meetings on the first and se-

cond day, an overview was given of progress made on the different work packages during the project’s

second year of implementation, including the challenges met and lessons learned. A more detailed dis-

cussion followed on the selected interventions that

will be implemented in the four countries during

the coming two years and an agreement was

reached on the activity plan to be followed for the

next year. On the third day, the MOMI team visited

a primary health care facility, located in Maputo,

and discussed maternal and infant services with the

director, the chief nurse and the nurse responsible

for maternal and infant health services.

MOMI in the spotlights

In January Christine Katingima (ICRHK) gave a presentation at the STD/AIDS Collaborative Research Group meeting in Nairo-

bi, Kenya.

Early February Sue Mann and Tim Colbourn (UCL) presented at a global health "mapping day" at the Institute for Women's

Health of UCL, which was conceived in order to map all the different global health activities that are currently going on with

a view to developing the Institute Women's Health Global Strategy.

Out of MOMI’s spotlights: Irene Jao (ICRHK), Christine Katingima (ICRHK) & Birgit Kerstens (UG-ICRH) will stop working for

MOMI. We wish them all the best in their future activities and hope to keep them updated through this newsletter.

MOMI project outputs

P A G E 2 V O L U M E 3 , I S S U E 1

A large WHO multicountry survey examined data from more than 300 000 women attending 357 health care facilities in 29 countries. This study found a

poor correlation between coverage of ‘essential interventions’ (e.g. uterotonics for preventing postpartum haemorrhage; magnesium sulfate for

eclampsia) and maternal mortality in health facilities. This study suggests that to achieve a substantial reduction in maternal mortality, a comprehensive

approach to emergency care, and overall improvements in the quality of maternal health care will be needed.

(more to be found on http://www.who.int/reproductivehealth/en/index.html)

Work Package 3: Detailed situation

analysis of maternal, newborn and

child health

The WP3 cross-country report compares the

situation analysis of maternal and newborn

health care services, with emphasis on post-

partum care in the selected districts (Kaya

district in Burkina Faso, Kwale district in Kenya,

Ntchisi district in Malawi and Chiúta district in

Mozambique). The analysis was based on care service character-

istics (description of postpartum care services available), the

involved resources and the timing of provision of care; on the

coverage of health services; and, on the health outcomes, invol-

ving mortality rates, burden of disease and nutritional status of

infants. The report serves as a baseline guidance to design inter-

ventions and to frame the evaluation of their impact.

Barros H., Lopes S.C. 2013. Cross-Country Situation Analysis of Maternal

and Newborn Care in Burkina Faso, Kenya, Malawi and Mozambique.

European Commission FP7 MOMI project.

Work Package 2: Critical review

of maternal, newborn and child

health policies

The WP2 cross-country report uses the four

country policy reports of Burkina Faso,

Kenya, Malawi and Mozambique and docu-

mentary analysis to facilitate cross-country

learning as well as informing the next stag-

es of the MOMI project more widely. This

comparative report focuses most exclusively on national poli-

cy content for postpartum care. It examines the policy con-

tent in more detail and how this deviates from internationally

defined best practices. It presents a critical review of the im-

pact of the wider policy environment on implementation of

interventions and considers implications of these findings for

the MOMI project (see more on page 4 of this issue).

Mann S. 2013. Cross-Country Analysis of Maternal, Newborn and

Child Health Policies in Burkina Faso, Kenya, Malawi and Mozambi-

que. European Commission FP7 MOMI project.

MOMI report

These reports can be downloaded from www.momiproject.eu/links.aspx

Introducing MOMI Partners continued……..

P A G E 3 V O L U M E 3 , I S S U E 1

When women survive, families & nations thrive. It’s time. Deliver

for girls and women.

(Statement from WOMEN DELIVER, May 2013)

As from July 2013 Aurore Guieu will replace Birgit Kerstens as the MOMI consortium

project coordinator. In Spring 2012, Aurore started at ICRH as a trainee in the frame

of her studies at SciencesPo Paris, France, where she obtained a Master’s degree in

European Studies, with a focus on social policy and gender equality. During her

traineeship at ICRH, she worked on a literature review on migrants’ sexual and re-

productive health in the European Union. From December 2012 to March 2013, dur-

ing the maternity leave of an ICRH colleague, Aurore continued this study. Right now

she is working as a junior researcher on the FP7-funded DIFFER project, which aims

at improving sexual and reproductive health services for general populations and

female sex workers in India, Kenya, Mozambique, and South Africa, and on the SEHIB study on HPV

infections and related diseases in Belgium. Aurore will be working part-time for the MOMI consor-

tium. Outside the workplace, her main area of interest is feminist activism, and she is involved in

different national and international networks. Aurore can be reached on: aurore.guieu@ugent.be.

New MOMI consortium project coordinator

Last but not least we want to introduce the team of the Parent and Child

Health’s Initiative (PACHI) from Malawi. PACHI is headed by Dr Charles

Mwansambo-MBChB, BSc, DCH, FRCPCH (UK). Gibson Masache (MPA, BSoc

Sc) provides technical support and facilitation of the MOMI project, as well

as manages the finances for the project.

Running the MOMI project on the ground is a team of 11 people. Chrissy

Bwazi is the MOMI Coordinator in Ntchisi district. At the end of the five year

project, she hopes for an improvement of maternal, newborn and child

health services at district level and in the long run at national level as well.

Other team members include: Dr Webster Chirambo (District Health Officer),

James Mtonga (Assistant Environmental Health Officer & Deputy MOMI Pro-

ject Coordinator), Holystone Kafanikhale (District Environmental Health

Officer), Mackenzie Gondwe (Assistant Statistician, HMIS Officer), Lawrent Banda (Clinical Officer), Judith Kamtayeni (Nurse Mid-

wife Technician), Loveness Mang’ando (Registered Nurse Midwife), Tereza Kaunda (Registered Nurse Midwife), Annily Chisi

(Community Health Nurse) and Bwanalori Mwamulima (Environmental Health Officer).

PACHI team in Malawi

Malawi MOMI team

P A G E 4

The world can’t

wait.

Now is the time

to invest in girls

and women.

(Statement from

WOMEN

DELIVER,

May 2013)

The MOMI project aims to add to global knowledge about how postpartum services could

be more effectively organized, both at facility and community level, to improve maternal

and newborn health.

MOMI critical review of MNCH policies

Contact information

ICRH - Ghent University

De Pintelaan 185 P3

9000 Ghent

Phone: +32 (0)9 332 35 64

Fax: +32 (0)9 332 38 67

http://www.momiproject.eu/

M O M I N E W S L E T T E R

Key learning points have been drawn from a comparative synthesis of policy issues arising across the separate study settings in Burkina Faso, Kenya, Malawi and Mozambique and are summarised here:

International Evidence: There is good evidence for effectiveness of (low cost) interventions for both mother and child in the postpartum period. A combined package of these interventions adapted to local need is likely to reap greatest benefits in improving maternal and child health outcomes. There is a lack of specific guidance targeted at women who deliver in the community, for the postpartum period.

Policy priority of postpartum care: Postpartum care is not a priority in any of the study countries at either poli-cy or programmatic levels. There is little reference to its importance as part of national MNCH policy and where identified (excepting immediate emergency care), the emphasis of care is centred on the neonate with maternal needs relatively neglected during this period. Even in those countries where detailed policy guidance and clear outcome indicators for postpartum care exists, there was very little evidence of effective implementation in any of the study sites. More detailed knowledge of policy processes, funding flows and decision-making in each site is needed in the context of the varying levels of decentralised decision making to understand where disconnects between policy and implementation are rooted and how best to engage policy makers for MOMI interventions.

Integration Policies: Separation of MNCH policy and child health policies has been counter to developing inte-grated provision for mother and child in postpartum period. Policies that support integration of services, con-tinuum of care and life-course approaches appear to be most developed in Kenya and Malawi compared with the other two MOMI sites.

Technical Guidance: Kenya and Mozambique both have extremely detailed technical manuals for use in train-ing and service delivery. These have not been adapted for use at the local level and there is little knowledge of what is needed, in particular for the mother in the postpartum period. Adapted and simplified guidance that focuses on high impact interventions and is comprehensively distributed could improve utility.

Postpartum Risk: Recorded activity in the postpartum period is focussed on percentage attendance, failing to take account of timing or content of these visits. International level evidence highlights the clear periods of risk for mother and neonate (first 48 hours and first week) and potential vulnerabilities and risk factors. Tailoring of the timing and content of postpartum interventions to risk could maximise impact.

High risk women: Women and babies with extra risk factors such as anaemia or prematurity are at higher risk of complications in the post natal period. Additional surveillance of these women and children is recommended in international guidance. Management of potential complications are identified in the technical guidance for Mozambique and Kenya but strategies for early identification and intervention for women at risk, and promo-tion in the clinical setting were not identified in any of the four settings.

Delivery without skilled attendance: High rates of community delivery unattended or with traditional birth attendants in all MOMI countries, in spite of a drive to increase skilled attendance at delivery, mean that wom-en and their babies often not access postpartum care during the periods of highest risk. Community-based delivery of care is relatively more developed in the Kenya and Malawi sites.

Continuum of care: Generally across all sites, there is an apparent disconnect between provision of immediate postpartum care in the health facility level and transfer of on-going responsibility to the community largely for preventive care but also for identification of danger signs should they arise. The continuum of care is a stepwise approach for identifying and treating problems early in the community and referring to the next level of care if the situation deteriorates. Policies supporting this approach are most highly developed in Malawi and could be promoted with benefit across the other sites. (summary from WP2 report, see also

page 2 of this issue)