New estimates of nurse/midwife shortages in Africa

The availability of skilled professionals is key to maternal and neonatal health.  At Maternova, we are interested in mapping the current locations of skilled birth attendants–but just as interested in highlighting the precise areas where access is most inadequate.  A new study documents health workers shortages country by country in Africa and I briefly cover it here.

The World Health Organization has previously estimated that Africa needed 818,000 additional health care professionals.  A more recent analysis by Scheffler, Mahoney, Fulton Dal Poz and Preker forecasts the shortage of midwives, nurses and doctors in 39 African countries.  The article is available free in a web exclusive for about 8 more days on the Health Affairs website.

The authors forecast that the shortage in Africa is 240,000 doctors and 551,000 nurses and midwives.  Shortage estimates per country are estimated using a metric of professionals per 1,000 population.  For nurses and midwives, the top ten countries with the most severe nurse/midwife shortages are as follows:

Mozambique

Gambia

Madagascar

Central African Republic

Burundi

Rwanda

Cameroon

Equatorial Guinea

Lesotho

Niger

Simple calibrated bag to measure blood loss

Part of our goal as a hub is to collect, categorize and highlight innovation for maternal and neonatal health.  We will feature high-tech for a low price or low-tech for a very lower price.  We will cover extremely creative or just highly practical ideas.  And we categorize innovations in the pipeline or still in research and development versus those that are on the market.  Soon http://maternova.net will be interactive, allowing comments from the field on priority needs and reviews on particular products.

This simple plastic bag for collection of blood in an obstetric hemorrhage is an example of an innovation that is incredibly simple and yet of tremendous significance for maternal health.  In areas with little health care infrastructure, measurement of blood loss is difficult.  And yet determining the amount of blood lost is critical to the decision of whether to refer a mother to a higher level health facility.   Tied around the mother’s waist right after delivery, the calibrated bags capture blood and at the 500 mL identify when the dangerous point has been reached. The device was designed by Dr. Aloke from FOGSI in India. The innovation and photo are courtesy of Solution Exchange India.

We are interested in highlighting, tracking and soliciting input on as many critical innovations as we can.  Please submit comments on this blood collection device, others like it, its use in the field and best practices.

Breath of Life: breath of fresh air for newborns

Breath of Life is a program that directly addresses infant mortality in Southeast Asia through low-cost innovative clinical solutions.    The East Meets West Foundation is a nonprofit which began the Breath of Life program in response to high infant mortality rates in Vietnam and elsewhere.   Breath of Life saw the lack of attention and resources for neonatal mortality as a problem they could address.  Concentrating resources on solutions for the first four weeks of life, the group focused on design and distribution solely for neonates.  Tackling head-on the global problem of expensive donated equipment, Breath of Life designed durable, inexpensive machines and translated directions into local languages.  Local manufacturing means the controls are in the local language and that each hospital has easy access to replacement parts and continuous technical support.  The Breath of Life machines have no consumables cutting down on ongoing costs.  The  program aims to equip and empower medical institutions at all levels to provide appropriate, responsive newborn care from national hospitals to rural clinics. **  A five-year R&D process resulted in a suite of three life-saving machines designed and produced in Vietnam. The equipment is designed and manufactured by KSE Medical.

Their package of neonatal technologies include the following:

• Continuous Poisitive Air Pressure (CPAP)
• LED phototherapy
• LED bilibed
• Infant resuscitation station and infant warmer
• Pulse oximeter
• Light meter
• Baby bonnet

The Maternova site–under Tools– covers three of these devices.

“Breath of Life” CPAP (Continuous Positive Airway Pressure) machine

This is a device to treat newborn respiratory distress syndrome, asphyxia, apnea and pathologic conditions.  According to the non-profit, East Meets West, this model of CPAP is particularly suitable for developing countries because:

• it has been developed and produced in Vietnam following 5 years of research in local hospitals, with local material and resources
• all parts are 100% reusable – the machine design allows to avoid the use of any disposable item, and all components can be reused after disinfection for several years
• the cost of the machine is a fraction of equipment produced in western countries
• the model is very robust, reliable and simple to use, with a very user-friendly interface
• it has its own low-noise air pump – can be used in hospital without availability of medical air
• manuals and instruction are provided in the local language where the machine is used

Currently, more than 400 “Breath of Life” CPAP machines are in use in 130 hospitals in Vietnam, Laos, Cambodia and East Timor, in every level of care from national hospitals to district level facilities, treating more than 15,000 newborn every year. This machine has been officially approved (after complete medical trails) as the national standard of care by the Ministry of Health of Vietnam.  It costs $2,300 to provide one CPAP machine to a neonatal unit along with appropriate training and maintenance for three years.

The “Breath of Life” LED Phototherapy machine: a device to treat pathological Jaundice in newborns

This model of phototherapy is particularly suitable for developing countries because:

• it has been developed and produced in Vietnam following 5 years of research in local hospitals
• the light intensity is very high, allowing high standard to treatment for the patients
• there are no disposable or consumables parts, such as light bulbs to be changed on a regular base. LED lights last for more than 5 years at very high intensity
• the cost of the machine is a fraction of equipment produced in western countries
• the model is very robust, reliable and simple to use
• manuals and instruction are provided in the local language where the machine is used

Currently, more than 200 “Breath of Life” LED phototherapy are in use in 80 hospitals in Vietnam, Laos, Cambodia and East Timor, in every level of care from national hospitals to district level facilities, treating more than 5,000 newborn every year.

The “Breath of Life” Infant Warmer:  solution for infant resuscitation and the protection from hypothermia

This model of warmer is particularly suitable for developing countries because:

• it has been developed and produced in Vietnam following 5 years of research in local hospitals
• it has been developed to work under very rough condition, such as unstable electric supply and substandard maintenance and technical assistance
• it has been provided with a “safe mode capability”: if warming sensors falls off the infant during treatment, the software automatically switch it power into a “safe mode”, with limited amount of heating available that can never harm the patient, to avoid the problem of overheating
• the cost of the machine is a fraction of equipment produced in western countries
• the model is very robust, reliable and simple to use
• manuals and instruction are provided in the local language where the machine is used

Currently, more than 250 “Breath of Life” Infant Warmers are in use in 100 hospitals in Vietnam, Laos, Cambodia and East Timor, in every level of care from national hospitals to district level facilities, treating more than 20,000 newborn every year.

The “Breath of Life” OPTIMA hand sanitizer a solution for infection control in medical facilities.

This specially formulated, isopropanol based antimicrobial hand sanitizer is particularly suitable for developing countries because:

• designed for rapid germ killing when hand washing is not available
• price is a fraction of western equivalent products
• different containers (pumps, small bottles) and different support options (hangers, central system) available
• all bottles are refillable, and small concentrated essence is available for long term availability

The Optima hand sanitizer is widely used throughout most of the hospitals in Vietnam, Laos, Cambodia and East Timor participating in the Breath of Life program.

UNDER DEVELOPMENT:

The BOL “Bilibed”

The Bilibed is used to treat pathologic Jaundice and protect children from hypothermia in very remote areas.

• Cheap and reliable (cost is just a fraction of western equipment price)
• long life high power LEDs, so the machine do not need any regular disposable or consumable item to run
• light and accessible – allows constant contact of the mother with the baby, encouraging sound psychological development of the infant, promoting breastfeeding and better care
• AC/DC choice
• rechargeable battery set (optional)
• solar power generator (optional) – for areas with no access to electricity
• simple in use – no sophisticated training required
• made in Vietnam with local resources

In addition to the fact that these machines were designed, researched and manufactured in Vietnam, the ability to purchase a set of neonate-specific technologies from a single supplier is appealing.  We look forward to hearing from clinics and hospitals who have used these machines.

Luciano Moccia, International Coordinator can be reached at luciano.moccia@eastmeetswest.org.

Please see our main website for information on other innovative products for mothers and neonates:  http://maternova.net.

**  A quick disclaimer: Maternova is a hub for information exchange on innovation– we do not ‘endorse’ particular brands or products.  Wherever possible we will connect to literature on the products that include clinical trials.  In addition we hope to solicit user input on products and how they perform in the field.

Maternova evolving

Maternova as an entity is evolving and solidifying.  Our objective:  to become a ‘go-to’ platform connecting those who work and innovate for maternal and neonatal health.

We see ourselves as a creative web-based platform focused on efficiency. Maternova is a nimble, innovative entity creating value by connecting clinicians and innovators in real-time. We will take a highly fragmented market of 30mm nurses and midwives and consolidate information flows to improve efficiency and save lives. The three current areas of focus are: 1) mapping 2) social networks 3) technologies and innovation.  This is what we are planning beyond what is currently on the website (http://maternova.net)

1) A pioneer of user-generated maps of health clinics
Using the power of Web 2.0, Maternova will create user-generated maps to pinpoint the location of health facilities providing maternal and neonatal care. Systematic, comprehensive maps of public and private clinics do not exist in most countries. In many settings frontline providers are isolated from networks, information and innovation. They may not even know who is working nearby. Maternova will begin with one small country—Haiti—and build out to 10 countries, then 20 then 30. Maps can be used by planners and donors to target gaps in health care and by providers to link with nearby clinics.

2) A host for dynamic social networks tailored to enhancing clinical practice in the field

A social network underlies the mapping function allowing clinicians to have ongoing discussions with peers. The network will facilitate discussion around key areas of practice relevant to each country—and across countries. Key topics will include clinical issues, cultural and behavioral issues, training, logistics and new technologies. To allow rapid communication between groups, Maternova will work with the emerging sms technologies that allow transfer of essential health information via mobile phone. Midwives’ and nurses’ stories may be adapted into a book championing these engines of economic growth.

3) A unique platform tracking and prioritizing technologies and innovation

We’d like to make dissemination of new ideas and new technologies more efficient.  No one entity seems to have the incentive to feature all the innovations for maternal/neonatal health on the market and in research and development. We fill this important gap in a design-savvy, user-friendly way. Maternova features short descriptions and visual updates on all of the cutting-edge appropriate technologies for ob/gyn and neonatal care in the field. The team will build upon this work to spearhead expert-led discussion of new research and
development priorities.

We seek input from all corners of the field in order to be able to fill niches in maternal/neonatal health that are not covered by all the great organizations out there working on this issue.  Mostly we seek to connect what is already there and to innovate where there are gaps.

Initial post

This is a test of a new site on innovation for maternal and neonatal health in the developing world.  The blog seeks to democratize information on a field that as for too long remained divided and insufficiently effective in reducing maternal deaths.  Fresh thinking, new approaches, innovation and simple technologies hold some of the answers.  We need simple low-tech solutions alongside advanced technologies in simple formats.