Prioritizing RH Technologies for Introduction in Crises Settings

Harshad SanghviVice President & Medical Director

Seattle, May 2008

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Harmful or Ineffective technologies that have taken off

Ineffective: Various hormonal and non hormonal

treatment of threatened abortionHarmful: Routine EpisiotomyWasteful: Therapeutic course of antibiotics for

prophylaxis after CSLess effective, harmful and more

costly Routine EFM Routine GA for CSections Diazepam, lytic cocktail, for eclampsia

Source: Wright 2003

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Normal

Fast

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Some effective technologies that are languishing

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Normalslow

FP/RHEmergency contraception Post exposure prophylaxisImplants, DMPA, IUDsMaternal and newborn HealthMagnesium suphate to prevent EclampsiaPartogramVacuum extractorLaryngeal mask for safer GA

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Defining the need for technologies for RH in crisis settings

Is the problem a major public health concern? Is there a high demand for a technology

solution? Is there a readily available (or can be

developed) solution? Will the solution have a significant impact on

correcting the problemIs the solution feasible to implement Are the limitations of the solution acceptable?

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Is there an already existing technology?

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PPH related Technologies

Need Potential Technology Crisis Settings

PPH detection Brass V drape, Pad

Prevention Misoprostol, Oxytocin in Uniject

Treatment Misoprostol

Hydrostatic (condom)

Tamponade

Safe Transfer Antishock Garment

Retained Placenta Intra umbilical Oxytocin

“Cool” storage for Oxytocin

?,

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Other Technologies that have Great Potential

Need Potential Technology

Abortion Misoprostol

Treatment of Incomplete abortion

Misoprostol

Mixed level of skills of Providers

Job aids.

Talking “books” or practice guides

Training and standardization

Distance and E learning Technologies

Diagnostic tests that yield immediate results

?

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A systematic approach to taking Innovations to Scale

Disseminating audience specific information Developing champions Addressing resistance

Encourage ownership by allowing for reinvention, modification

Allaying anxiety: Demonstrating through Videos, simulations, drills and on patients

Visits to high performing sites

Training ( inservice, preservice)

Developing and implementing standards of care Monitoring progress, rewarding success

In healthcare, invention and research is hard,

but changing practices is even harder.

Berwick 2003

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Developing Champions

Characteristics of early adopters:Opinion Leaders - trusted by colleagues

Locally well-connected

Often “first on the block” to try new things: willing to risk criticism

Often chosen as leaders or representatives

Source: Ryan and Gross 1943; Rogers 1995

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Creating Champions

Mid career Professionals who Understand the evidence basis for key innovations have become proficient and capable users Have introduced and practice the Innovation in their setting Can demonstrate it and teach the skill Have advocacy and leadership skills

At each stage of this process: candidates develop and implement an action plan that is monitored by peers and mentors

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We must first make the Investment case.

Too many technologies to choose from?

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