While you’re here, we’d like you to consider subscribing to Pistols Firing and becoming a PFB+ member. It’s a big ask from us to you, but it also comes with a load of benefits like ad-free browsing (ads stink!), access to our premium room in The Chamber and monthly giveaways.The other thing it does is help stabilize our business into the future. As it turns out, sending folks on the road to cover games and provide 24/7 Pokes coverage like the excellent article you just read costs money. Because of our subscribers, we’ve been able to improve our work and provide the best OSU news and community anywhere online. Help us keep that up. Gundy on Jeff Carr: “I would love for him to develop in that (RB) role. But you’ve got a couple guys that will be right there on this tail.”— Kyle Fredrickson (@kylefredrickson) March 6, 201710. Zach Sinor is literally the centerpiece on the spring media guide. This is the best. Let’s send him to New York for the Heisman presentation. I want Tom Rinaldi to play the piano and make me cry Knoshown Moreno-sized tears as he narrates an existential piece on the history of the punter featuring Sinor.Front and center: @ZachSinor29. #Sinor4Heisman #okstate pic.twitter.com/eF2DGmlqBH— Hayden Kyle Barber (@HK_Barber) March 6, 2017 Mike Gundy spoke to the media for the first time in an official capacity this spring on Monday at Boone Pickens Stadium. He rocked the mullet, wore dad jeans and said a lot of interesting stuff. Let’s jump into 10 takeaways from the hour-long presser.1. Our team will dive into this more in the coming days, but apparently Ramon Richards is moving to safety, at least part-time. That’s a bit of a shocker to me given the lack of depth at cornerback and Richards’ relatively diminutive stature (can he roll with guys like Tre Flowers and Jordan Sterns?) although, as some people pointed out, Richards played a little there last year.It’s worrisome that OSU is now going into the season with little to no experience at one of the most vulnerable slots when it comes to Big 12 play, but I suppose the optimist looks at this and says, “Gundy must love OSU’s young corners.”LOOK: 2016 starting cornerback Ramon Richards (@chief_vii) is listed in the #OKState spring media guide as a SAFETY. pic.twitter.com/TzxzH5XVPo— Hayden Kyle Barber (@HK_Barber) March 6, 20172. Gundy is insistent on potentially having a J.W. Walsh-like package for one of his backup quarterbacks. Should they? Last year the Pokes were 25th in red zone scoring but just 58th in red zone TDs. I can be talked into having a J.W. package, although I didn’t hate No. 2 running it a little at the end of last season. It’s true that they need to be better when it comes to scoring TDs in the red zone, but I get antsy any time the ball is taken out of No. 2’s hands.3. Is Oklahoma State going to play a freshman at left tackle? Mike Gundy said it could as UAB transfer left tackle Victor Salako will be replaced by redshirt freshman Dylan Galloway. But as Kyle Boone wrote about last week, Cal transfer Aaron Cochran seems like the more likely player to fill this role should he go ahead with the transfer to Stillwater.Gundy: Redshirt freshman Dylan Galloway will replace Victor Salako as #OKState’s starting left tackle. Stay tuned for a grad transfer.— Hayden Kyle Barber (@HK_Barber) March 6, 2017Maybe OSU should just change the position to be a “graduate transfer left tackle.” Here’s our offensive line: We have a left guard, a right guard, a right tackle, a center and a graduate transfer left tackle.4. One of the other big moves on defense is Kenneth Edison-McGruder going from safety to linebacker. This isn’t nearly as stunning as Richards moving to safety given Edison-McGruder’s size (6-0, 220 lbs.) and the fact that he played there in the Alamo Bowl, but it’s worth noting.Kenneth Edison-McGruder getting his Jordan Sterns on early. pic.twitter.com/7sLrUGsAS9— Pistols Firing (@pistolsguys) December 30, 20165. Be still. Mike Gundy starts comparing 2011 to 2017. I’m weak. Interestingly, though, he says the defense on this 2017 team might be better than a really solid 2011 defense which led to a 12-1 season.He notes that they are deeper in 2017 but have to “hit a couple of corners.” That’s true, and hopefully they will be able to add Clemson transfer Adrian Baker to the mix.Gundy on comparisons between the 2011 team and 2017. #okstate pic.twitter.com/f5qI91y4XH— Hayden Kyle Barber (@HK_Barber) March 6, 20176. Given the pieces returning, Gundy noted that OSU would probably use more four-wide sets than it has in the recent past. I want to praise Gundy here, but let’s be honest, only a fool would not use as much of James Washington, Chris Lacy, Marcell Ateman, Jalen McCleskey and Tyron Johnson as possible. Gundy is no fool.7. On the backup QB race, Gundy thinks Jelani Woods could weigh 270 lbs. Two-hundred and seventy pounds! A quarterback! Carson about lost it on our podcast on Monday over this news, and it is significant. The race for QB2 should be one of the best storylines this spring, although I guess if I’m betting I have to bet on the guy who could weight 270 pounds and throws lasers all over the field.Mike Yurcich getting his first chance to work with freshman QB Jelani Woods. He’s every bit of 6-7. pic.twitter.com/jRYOSsWvqb— Kyle Fredrickson (@kylefredrickson) March 6, 20178. Gundy mullet update: Pristine.Mike Gundy mullet update: pic.twitter.com/fxe4H5YePt— Jake Trotter (@Jake_Trotter) March 6, 20179. Remember this guy? The pre-fall running back competition will be interesting, and whoever comes away with a spring win will be the favorite to join the mix starting in September with Justice Hill and freshmen J.D. King and Chuba Hubbard. Gundy said on Monday that speedster Jeff Carr could be the best of the RB bunch this spring with Hill out.
Cards on the table, I want the College Football Playoff to move to eight teams. I think that’s the number that allows for maximum drama but minimum (legitimate) complaining. It would allow for a bit of wriggle room for the Oklahoma States and TCUs of the world while giving some much-needed latitude to the CFB Playoff Committee in its choices.It would expand the preposterous revenue that is already being generated.However, I do understand why people are hesitant to go to eight. The CFB Playoff has been a rip-roaring success to this point. Why gamble with what you know works, the thinking goes. And there is some truth to that sentiment. The Playoff has been awesome. It has (mostly) made the regular season more intense and fun, and it has delivered some absolute classics for the true national championship.AdChoices广告But what is best for college football as a whole isn’t always great for the much-maligned Big 12 Conference. I want the Big 12 to rock. Heck, if the conference was given the option to add Texas A&M, Colorado, Missouri and Nebraska back in, I’d do it in a heartbeat. I don’t want OSU to move on to the Pac-22 or SEC or whatever.But I also want college football to keep growing and to become more popular than the NFL. As a fan and as someone with a financial interest.And so I’m torn.“It’s a high-stakes game of musical chairs,” Big 12 commissioner Bob Bowlsby said recently. “There are at least five suitors and only four seats. We’re three years into this, and we’ve only been in this once and we know we need to be in more.”The reality here is that the Big 12 is going to be at a disadvantage for the short-term future as long as there are other humans picking the teams for the playoff. It just is. It doesn’t have enough big names or great teams for me to think otherwise.Jake Trotter wrote a terrific piece last week about the future of the conference — for once not in peril during the summer! — and in it he talked about the Big 12 Championship game that will debut this year (and 100 percent without a doubt feature a 12-0 Oklahoma State team getting trounced by OU).The league added a championship game that will make its debut this December, and provide each member with an additional $2 million-$3 million in annual revenue. The title game will also give the Big 12 a bigger presence on championship weekend, as well as a 13th game, which the league believes will finally put it on equal footing with the other conferences in the eyes of College Football Playoff selection committee. [ESPN]Maybe, but it seems like the Big 12’s issues run deeper than just play another game.I know we talk a lot about the Big 12 Championship game and the CFB Playoff here at PFB, but the reality here is that the future of the Big 12 (and thus where Oklahoma State plays sports) is at least partially tied to those things. In other words, this stuff is a big deal financially and politically.So I guess in the end I land on accepting and enjoying the CFB Playoff because I think generally what is best for the industry is best for the Big 12. And what is the alternative? The Big 12 wasn’t exactly lighting up the national landscape with title winners in the olden days of the BCS, either. The four-team playoff is here to stay which might be bad for the Big 12 in the short term and could even contribute to it splitting up eventually. It’s been awesome for the sport, though, and with less than 60 days to go until the regular season, I’m more excited about it than ever.… but I still want it to be eight teams. While you’re here, we’d like you to consider subscribing to Pistols Firing and becoming a PFB+ member. It’s a big ask from us to you, but it also comes with a load of benefits like ad-free browsing (ads stink!), access to our premium room in The Chamber and monthly giveaways.The other thing it does is help stabilize our business into the future. As it turns out, sending folks on the road to cover games and provide 24/7 Pokes coverage like the excellent article you just read costs money. Because of our subscribers, we’ve been able to improve our work and provide the best OSU news and community anywhere online. Help us keep that up.
While you’re here, we’d like you to consider subscribing to Pistols Firing and becoming a PFB+ member. It’s a big ask from us to you, but it also comes with a load of benefits like ad-free browsing (ads stink!), access to our premium room in The Chamber and monthly giveaways.The other thing it does is help stabilize our business into the future. As it turns out, sending folks on the road to cover games and provide 24/7 Pokes coverage like the excellent article you just read costs money. Because of our subscribers, we’ve been able to improve our work and provide the best OSU news and community anywhere online. Help us keep that up. OSU’s opening drive of the season was everything you could’ve expected.The Cowboys strung together an 8-play, 74-yard drive that spanned only 2 minutes and resulted in a deep ball to none other than Tyron Johnson — the LSU transfer receiver — who bagged it for six points from 44 yards out. Take a look.WATCH: Welcome to the SEAson of Orange! Rudolph to Tyron Johnson to start the night for #OKState! #MA2ON pic.twitter.com/lAutT6MuwB— Cowboy Football (@CowboyFB) August 31, 2017AdChoices广告Johnson sat out the 2016 season due to NCAA transfer rules after logging just 150 yards through the air as a freshman with the Tigers, but despite the down time, he doesn’t look like he’s dealing with any rust in his new threads in orange and black.
ShareEmailPrint To learn more, read: Posted on January 13, 2014August 10, 2016Click to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Reddit (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window)The MHTF and our partners at UNFPA and the Wilson Center are convening Maternal Health and HIV: Global Priorities for Research and Action, the latest in the ongoing MH Dialogues series today at the Wilson Center in Washington, DC. The dialogue will include be webcast live, beginning at noon (EST), with two panel discussions:12:00 pm – 2:00 pm: Creating a Comprehensive Research and Evaluation Agenda for Maternal Health and HIV in Sub-Saharan Africa2:00 pm – 4:00 pm: Addressing HIV Stigma and Preventing Disrespect and Abuse: Global Insights to Improve Maternal Health and Promote Reproductive RightsIn addition to exploring critical challenges for developing and implementing high quality maternal health, HIV and AIDS services, the first panel will also serve as a launch for the Research and Evaluation Agenda for Maternal Health and HIV in sub-Saharan Africa, developed by the Maternal Health Task Force and the CDC based on last June’s technical meeting, Maternal Health, HIV and AIDS: Examining research through a programmatic lens – the full agenda and a technical summary will be published on the MHTF website following the dialogue.To take part, tune in to the Wilson Center’s webcast or join our discussion on Twitter under the hashtag #MHDialogue or follow the MHTF: @MHTFShare this:
Posted on March 21, 2014November 7, 2016By: Ciro Franco, Senior Principal Technical Advisor for MNCHClick to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Reddit (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window)In celebration of the one-year anniversary of the Manifesto for Maternal Health, Management Sciences for Health (MSH) congratulates our global community, including ministries of health, their partners, and the women we serve and work with, on the progress made toward creating a healthier world for mothers and their babies. The manifesto communicates both passion and rationale, the two main drivers needed for profound change around the approach to maternal health and to women’s health more generally. It forces us to attend not just to the maternal aspect of women’s health, but to think of women’s needs more broadly.For over 40 years, MSH has worked to improve health in countries throughout the developing world. Our maternal health projects strengthen all levels of the health system, including the community, providing care from pregnancy through the postpartum period. MSH supports the manifesto in its entirety, particularly its emphasis on integration and quality of care. However, we have found that aspects two and six of the manifesto—improving access to care for all women, especially those who are underserved due to political, geographic, or cultural barriers, and strengthening every level of the health system to support universal access to health care—are especially important when working in fragile states, where much of MSH’s work is focused.For instance, in Afghanistan recent USAID projects implemented by MSH have reached every level of the health system and have contributed to the country’s astounding improvements in maternal and child survival over the past decade.The USAID-funded Strengthening Pharmaceutical Systems (SPS) project works with the Afghan Ministry of Health to improve the rational use of medicine and better manage pharmaceutical services and products, including those necessary for healthy pregnancy, birth, and child health care. In collaboration with the ministry, SPS has helped establish a coordinated system to ensure necessary medicines and commodities are available at all points of service.To address the dearth of qualified female health workers, the Leadership, Management, and Governance (LMG) project helped catalyze the development of midwives in Afghanistan, who have played a role in the decrease of maternal mortality from 1,600 per 100,000 live births in 2002 to less than 400 maternal deaths per 100,000 live births in 2010. As women are the best stewards of their own health, LMG focuses on moving more women into leadership and governance roles in the health sector. We believe that women in leadership roles will be more affective and assertive in guiding the “unseen women” of Afghanistan and other fragile states toward life-saving maternal and child health services.The Afghanistan Technical Support to the Central and Provincial Ministry of Public Health project, which was operational from 2006-2012, partnered with the ministry to expand the basic package of health services, improved access to family planning and reproductive health services, and increased the percentage of female community health workers and the number of facilities with at least one female health worker.These and other projects have worked in concert with families, communities, facilities, and the Ministry of Health to improve women’s access to quality health care in Afghanistan, with measurable, powerful results.But in Afghanistan, as in the rest of the world, there is still work to be done to ensure every woman has access to high quality, safe maternal health services. Let us think concretely about how to use this anniversary to push women’s health to the forefront of the global health dialog. At the country level, how can this manifesto become owned by civil society, professional organizations, nongovernmental organizations, and governments? It has the potential to serve as a rallying cry, as a strong advocacy piece at various levels of government, including with ministries of finance or national assemblies, as well as ministries of health.It is vital that this manifesto be transformed into something operational that people can use to mark their progress. It could be translated into a dashboard for each country that would show the gap in maternal health services to ministries and parliamentarians. Taking the manifesto to the next level, making it into something more operational, trackable, and with associated advocacy tools can help us all in our efforts to improve maternal and women’s health.The MHTF is currently celebrating the Manifesto for Maternal Health’s one year anniversary through a blog series. Would you like to contribute? Connect with us on Twitter and Facebook. Or send us an email.Share this: ShareEmailPrint To learn more, read:
ShareEmailPrint To learn more, read: Posted on February 19, 2015October 28, 2016By: Katie Millar, Technical Writer, Women and Health Initiative, Harvard T.H. Chan School of Public HealthClick to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Reddit (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window)Investment in HIV services may improve quality of prenatal and postnatal care. At the facility level, the mere presence of HIV treatment services was associated with higher quality prenatal and postnatal care, shows a new study in the American Journal of Public Health.Researchers from Columbia University, the CDC and Kenyan public health institutions, analyzed data from 560 hospitals and clinics in Kenya, a country with a high maternal mortality ratio, to compare the quality of prenatal, postnatal, and delivery services in facilities that had HIV treatment services and those that did not. The researchers found that the existence of PMTCT and ART treatment programs was associated with significantly increased quality in prenatal and postnatal care, irrespective of HIV status. However, quality of delivery care was similar across the two settings.Driving this association is the fact that “the introduction of PMTCT and ART programs may have brought with it better tools, resources, and infrastructure for outpatient maternal health, services,” shared Dr. Margaret Kruk, lead author on the paper, now at the Harvard T.H. Chan School of Public Health.What does this mean for the Kenyan woman? “HIV monies that have poured into Kenya from the U.S., and from a number of other partners, including the Kenyan government, are making a difference to some aspects of her [health care] experience, even if she’s HIV-negative,” shared Kruk.Limitations to the research include the inability to show a relationship between HIV services and maternal health outcomes and the inability to show causality since the research was cross-sectional and not prospective.Moving forward, this research shows that donors can stretch the effects of their investments. Kruk shares, “I think the big takeaway is, if we had planned for these collateral benefits, we could have done more with the investment to benefit the entire facility, to benefit more services.” As the world gears up for the Sustainable Development Goals and new funding mechanisms such as the Global Financing Facility, these lessons can be leveraged to create synergies between health sectors in order to strengthen the entire system.Share this:
Building followers and converting them into donors doesn’t have to be a daunting task if you have a good social media strategy in place. How you interact with your followers and what you post—and when—can be the difference between receiving a donation or just a post like. Coordinating across your chosen social media channels allows you to bring a unified message to the public and build your brand’s awareness in the process.Beginning in 2017, Facebook has allowed users to create birthday fundraisers to encourage their friends to donate to their favorite charity or cause. In 2018, Facebook users donated over $300 million on birthday donations. That’s one of the many reasons your nonprofit should have a presence on this site. Your Facebook profile is typically the first thing people see when they search for you on social media. One of the ways to make it easy for people to find you on Facebook, Twitter, and Instagram is to use the same name and profile picture for each site.For Facebook and Twitter, you’re allowed a profile picture and cover photo. The profile picture should be your nonprofit’s logo. With the cover photo you can get more creative and change it often to promote upcoming events, news about your organization, or to show pictures of recent success stories.As you create your Facebook page, it’s imperative that your ‘About’ section is up-to-date with the following information:• Your location and contact information• Your website address• Your company info and a brief bioBe sure to list any upcoming events for your organization on the ‘Events’ section.Now that you’ve created your Facebook page, it’s time to think about content. Focus on posts that will drive engagement and build awareness for your organization. Be personable, approachable, and fun. Posts with images, either video or photos, typically result in a stronger engagement level than text-only posts.Share the content below to turn your likes on Facebook into donations for your organizationFundraising CampaignsWhile your content shouldn’t focus solely on obtaining gifts from donors, it can be a driving force for your fundraising. When you add content for fundraising purposes, be sure to include links to your donation page, the event page, or wherever you’re trying to drive traffic and increase awareness.Press and AnnouncementsKeep your followers up-to-date on everything from grants and awards to press mentions and job postings.EventsLet your followers know about upcoming fundraising galas, community events, performances, panel discussions, town halls, etc. Take plenty of pictures at these events and post them afterward. Let your followers see what they’re missing!Thank YousTake the time to acknowledge major donors or fundraisers for your organization. Publicly acknowledging them with a photo and explanation of their gifts on your social media pages is a great way to take show your appreciation.Read more on The Nonprofit Blog
ShareEmailPrint To learn more, read: Posted on May 13, 2015October 26, 2016By: Professor Kumar Devadutta, School of Computer Engineering, KIIT UniversityClick to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Reddit (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window)This post describes the process of implementing RHCLMIS, a web and mobile application for automating RH supplies for the Health Department in Odisha in India. Innovadors Lab, a tech start up based in Bhubaneswar in India designed and implemented the Reproductive Health Commodities Logistics MIS (RHCLMIS) for the Department of Health & Family Welfare, Government of Odisha to modernize the supply chain management for RH commodities across the state. UNFPA Odisha provided technical and financial support in this process.The National Health Mission, India’s public health program, delivers a range of family planning services through a Health Sub Centre at the village level (covering population size of 5000), Primary Health Centre at block level (covering 30,000 people) and Community Health Centre for cluster of 2-3 blocks (covering population size of 120,000). In the rural health program, community health workers and providers counsel for and provide a number of oral contraceptives and condoms. In addition, the National Health Mission performs IUCD implantation, sterilization, and other operations primarily in Primary Health Centres and higher-level facilities through trained providers.Most state health departments are managing the supply chain management for family planning services manually. This practice provides little information to the suppliers and providers to manage their RH procurement, stocking, indenting, transporting, and monitoring for supplies.RHCLMIS functionsWe used ASP as the front end and MS SQL as the back end for development. For mobile data collection, all the CHWs were given access through SMS with keywords and data for indent and stock status reporting.Users shall first define the master data (e.g. place names, facilities, user details, ware house, items, etc.).For each type of master data, users shall use respective forms. For example, users can enter name of the item, code, unit, required percentage, unit per head for creating list of supply items.It allows user to create track centers at any level (e.g. state, district, block, etc.). Track centers are users who can log in the RHCLMIS application to monitor indent, stock and supply status at the units below its level.Users can use ‘forecast function’, to project annual demand by population size for each type of item. The forecasting is available at CHC, PHC, block, district and state levels for a year by the RH product category.For raising ‘indent’, users shall first select the item and select indent type (stock in hand, annual requirement, receive till date automatic fetch). The user shall enter quantity to send the indent.Units can ‘receive’ the supplies from warehouse or supplier. First, select the warehouse or supplier from the list, then enter invoice number, date. Then, user shall select the item and enter quantity, and details of item (e.g. batch no, manufacturing date, expiry date, total quantity, damaged quantity, short supply). User can upload the image of the supplies as well.User can choose to ‘direct issue’ in cases where it does not receive any indent from the concerned units.It allows the user to transfer commodities from one facility to another, using ‘inter transfer’ method.For ‘quality control’, users can enter the receipt of items meant for QC and QC results.User can update the stock status using ‘current stock’.Where units are raising ‘indent’, stores can issue commodities to them and units can issue receipts.Units can enter the details of damage and shortage of stocks through ‘damage/ shortage’ function.Application provides various reports of stock, indent, and supply over level and time period.Project implementationLab developed the RHCLMIS web application and started its pilot implementation in January 2011, with four districts – Boudh (3 blocks), Ganjam (22 blocks), Keonjhar (13 blocks), and Nayagarh (8 blocks).In these blocks, we organized training for ANMs who are the in-charge of the HSCs.Training included: Functioning & features of RHCLMIS, Indenting through RHCLMIS, Stock issue, Stock Receipt and updations, Short supply or Partial Receipt, Minimum Stock level, Inventory management, among other topics.Training for ANMs were provided in every Block Headquarter for 40-50 number of ANMs in 314 blocks of 30 districts of Odisha. For training these ANMs, we trained a group of 20 master trainers. We use classroom lecture methods with hands on practice for training the ANMs. The complete training required total 3 number of training sessions, conducted over a period of 12 weeks. Through the training, we trained the ANMs in entering the keyword and sending SMS, the detail is provided in SMS user guide.Subsequent to the training, Lab provided handholding support through phone calls and visits to project sites at state and districts. We received approximately 350 phone calls which were attended by our help desk to guide them in operation.In a year’s time, in January 2012, RHCLMIS was implemented in another 14 districts.Key project achievementsProject is implemented in 314 blocks in 30 districts of Odisha. It includes HSC, 314 blocks, 30.DH, 1 state HQ, stores as the Users.During 2013-14, RHCLMIS processed 2329 indents by web and 2329 by SMS, and 3015 supplies. In 2015-15, total of 2564 indents by web and 2564 by SMS, while 2857 transactions for supplies were processed.Further developmentsDuring the implementation, we have observed need for a mobile application for the project managers at the state, district and block level for quickly accessing the data and recording the transactions. Lab is currently developing a mobile application which we expect to pilot in one block.Share this:
ShareEmailPrint To learn more, read: Posted on August 26, 2015October 13, 2016By: Katie Millar, Senior Project Manager, Women and Health Initiative, Harvard T.H. Chan School of Public HealthClick to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Reddit (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window)This post is the first of four, which will discuss three interventions that worked synergistically to strengthen a health system and improve obstetric emergency management in Addis Ababa, Ethiopia.Hospital leaders and the Ethiopian Ministry of Health recognized a complicated problem in obstetric care in Addis Ababa. Primary health centers saw few patients and referred many unnecessarily to overcrowded tertiary hospitals. To help fix the problem, they created a midwife exchange program.The Maternal Health Task Force supported the midwife exchange program, which was piloted in the St. Paul’s referral network, made up of St. Paul’s Hospital, a tertiary hospital, and eight health centers. Experienced midwives from St. Paul’s Hospital worked shifts in health centers in exchange for midwives from health centers working shifts at St. Paul’s Hospital. The program offered health center midwives opportunities to improve their skills, exposure and comfort level with obstetric emergencies and, in turn, better distribute the burden of obstetric cases within the referral network.Michael Alenayehu, Midwife at St. Paul’s Hospital (Photo: Katie Millar, MHTF)“The health center midwives see obstetric emergencies in books, or in videos, but cannot actually recognize and manage them. We complain a lot because they refer many simple cases to our hospital and we can’t manage that. We don’t have all the beds, the economics,” said Michael Alenayehu, a midwife from St. Paul’s hospital.Alenayehu’s perception was reality: midwives in health centers don’t often have the opportunity to manage obstetric emergencies during their schooling and are left unprepared when faced with complications or emergencies in health centers. Without the proper skills, the midwife will refer any patient with a suspected complication on to the hospital. Prior to the exchange, referrals occurred without any coordination with St. Paul’s. Referred women were often turned away from an overburdened St. Paul’s and sent from facility to facility, in search of an available bed and the care they needed, even though the majority of these women should be managed at the health center level.The midwife exchange provided opportunities for building skills and gaining knowledge for the management of obstetric emergencies. Midwives at the health center level are not often exposed to obstetric emergencies, since they are relatively rare. With time at St. Paul’s Hospital, health center midwives were able to attend many high-risk deliveries, increasing their familiarity and comfort with recognizing and managing obstetric emergencies.“It’s very helpful for the midwifes from the health centers—who are delivering probably very few patients and not used to seeing complicated cases—coming to hospital and seeing lots of eclampsia, anemia, postpartum hemorrhage and other cases and see, for instance, how magnesium sulfate is administered. And when our midwives [from St. Paul’s] go to the health centers, they have an opportunity to see how the health centers function. And especially when the experienced midwives are sent to the health centers, they can coach the midwives there. It works only if the most experienced midwives go there,” said Delayehu Bekele, assistant professor of Obstetrics & Gynecology at St. Paul’s Hospital Millennium Medical College.Kedir Adem, a midwife at Selam Health Center. (Photo: Katie Millar, MHTF)Midwives from St. Paul’s have the opportunity to take on more responsibilities when they are at the health center, strengthening their leadership and decision-making skills. “The midwives that regularly work at St. Paul’s were the experts here and could take major responsibility,” said Kedir Adem, a midwife at Selam Health Center.Through the exchange, strong relationships were built between the health centers and St. Paul’s Hospital staff, mutual understanding and communication increased, and skills and knowledge for managing obstetric complications improved. The combination of improved skills and communication strengthened the referral network between health centers and St. Paul’s Hospital, which shortened the third delay: getting a woman the skilled care she needs once she reaches a facility.“What we get from this exchange is mutual understanding between St. Paul’s and the Selam Health Center staff. This is very important, especially because when we referred women from here to St. Paul’s, there were many challenges. Now that staff know each other, the mother will get services more easily,” said Adem.Midwives from St. Paul’s agree. “I feel a strong connection was made, especially in person. They have my number in health centers and they are going to call me and consult me [if there’s a complication] … If they can’t handle it, we are going to tell them that we are OK with the referral,” said Alenayehu.The midwife exchange helped correct referral problems within the network by building skills and communication. “The exchange improved women’s care . Previously it was very, very difficult to refer the mother from health center to hospital, difficult to contact hospital staff.” said Tensae Habtamu, a midwife at Selam Health Center.Not only did improved communication ease the referral process, health center midwives who built skills through the exchange can now manage more complex patients, which means fewer patients are referred from health centers to St. Paul’s Hospital. The exchange also initiated a back referrals program, which allows St. Paul’s Hospital to refer low-risk patients to health centers, decreasing the demand on St. Paul’s Hospital and increasing the number of patients in health centers, which provides health center midwives with much needed patient contact to maintain skills. By the end of the project, St. Paul’s Hospital was back referring two to three women a day to health centers.ChallengesThe midwife exchange was not without its challenges, including different pay rates between the hospital and the health centers, different schedules, transportation and staff turnover. “Here, [at St. Paul’s], there is an eight hour shift for the midwives, so they work for eight hours and the following 16 hours they rest. And what they usually do is they work at other private hospitals, additionally,” said Bekele. St. Paul’s eight-hour shifts made it difficult for their midwives to work the health center’s 36-hour shifts, especially since St. Paul’s midwives have other jobs in private hospitals. “So it was a negotiation that whenever [St. Paul’s midwives] have some duties in the private hospitals, the health center staff agreed to cover their duties and to let them go,” said Bekele.St. Paul’s Hospital covers transportation to and from work for its midwives, but the health centers do not. Without transportation, midwives from the hospital had a difficult time participating in the exchange. Midwives and health system leadership were able to mitigate these barriers through negotiations and compromises for pay and schedules. But other challenges are harder to mitigate.Staff turnover weakened the progress made by the program. Many experienced midwives, from both St. Paul’s Hospital and the health centers, who were trained in basic emergency obstetric and neonatal care and who participated in obstetric emergency drills, left the public sector for work in the private sector.Moving ForwardThe midwife exchange strengthened skills, improved the referral network and decreased the burden of cases at St. Paul’s Hospital. “We saw change [in the] number of deliveries and staff motivation. Also, staff from health centers who came to St. Paul now understand the challenge posed by unnecessary referrals. Referrals bring overload to the hospital, as mothers who could get care in centers were coming [to the hospital] and those who needed care at the hospital were not getting it. But when the health center midwives came to St. Paul’s, they could see the challenge. So it helped them think twice before they decide on the referrals so that was one of the important achievements, I believe,” said Lia Tadesse, project director of the Maternal and Child Survival Program in Ethiopia.The midwives who participated in the exchange enjoyed their time and valued the skills and relationships that they built. “Generally, the exchange was very, very nice. But the time is short. One month [for the program] is short…But if you can increase this to two or three months, it [will] Improve mothers’ health,” said Habtamu.Share this:
Posted on May 13, 2016September 26, 2016By: Kayla McGowan, Project Coordinator, Women and Health Initiative, Harvard T.H. Chan School of Public HealthClick to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Reddit (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window)Globally, far too many newborns struggle for survival in the first weeks, days, and hours of their lives. According to the World Health Organization (WHO), about 45% of all under-five deaths take place during the neonatal period, the first 28 days of life. While newborn mortality rates are especially high in developing countries, the overall proportion of child deaths that occur within the neonatal period has increased in the last 25 years. Low-cost, low-technology interventions along with clear, setting-specific instructions can, however, prevent many of these deaths.With the Sustainable Development Goals calling for a global reduction in neonatal mortality to at least as low as 12 per 1,000 live births by 2030, we must make every effort to share lessons, practices, and resources related to newborn health. To this end, Global Health Media recently released a set of seven short videos that teach health workers how to follow new and innovative WHO guidelines for ill newborns. The videos are part of the Newborn Care Series, which includes over 30 videos on newborn skills, newborn problems, and special care. They suggest simplified antibiotic regimens in low-resource settings, where access to a hospital may not be feasible.The films provide live footage of clinical warning signs and step-by-step instructions on appropriate treatment. To watch and download these videos, visit the links below.Recognizing Clinical Warning Signs in NewbornsManaging Severe Infections in NewbornsFast Breathing as Single Sign of IllnessCritical Illnesses in NewbornsTreating Sick NewbornsPreparing and Giving Oral AmoxicillinPreparing Ampicillin and GentamicinGiving an Intramuscular InjectionHome Visit for the NewbornThe videos are available in English and French; Spanish and Swahili versions will be released soon.For more videos on neonatal clinical warning signs and newborn care instructions, browse the entire Newborn Series. The Global Health Media collection also features videos on breastfeeding, childbirth, cholera, and Ebola.Share this: ShareEmailPrint To learn more, read: