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Monday, May 27, 2024

MSD for Mothers, Jhpiego collaborate to champion high-quality maternal health care in Sorsogon

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Filipino mothers are often referred to as “ilaw ng tahanan” (light of the home). Many are celebrated for the sacrifices they make: from the moment they learn they are “expecting”, and even when their children already have children of their own. Maternal mortality, sadly, remains a major health issue globally, with almost 95% of all maternal deaths occurring in low and lower middle-income countries in 2020, and most could have been prevented.

Nanay Nancy Gardon from Barangay Tabunan, Matnog in Sorsogon had pre-existing hypertension. In May 2023, she developed a rare emergency complication during labor and delivery but was provided life-saving treatment through prompt medical coordination by Sorsogon health units. She is one of the women who benefited from the program of Jhpiego —  a nonprofit organization for international health affiliated with Johns Hopkins University — supported by a grant from MSD for Mothers. Prior to the implementation of the program, the Provincial Health Office (PHO) of Sorsogon recorded an upsurge in maternal mortality just over a decade ago. Mothers in the province were succumbing to death from preventable pregnancy-related issues that included hemorrhage, hypertension, eclampsia, and pre-eclampsia.

Photo Courtesy of Geri Matthew Carretero from JHPIEGO. Stakeholders watch the video of Nanay Nancy during the dissemination forum.

According to the World Health Organization, both of the following are true: 1) maternal mortality happened almost every two minutes in 2020, with almost 95% of all maternal deaths occurring in low and lower middle-income countries, and 2) care by skilled health professionals throughout pregnancy and after childbirth can save the lives of women and newborns.

Aligned with WHO’s call, global biopharmaceutical company MSD launched a $650-million initiative for the wellbeing of mothers, spanning more than 13 years and across 68 global sites. MSD for Mothers is focused on enabling non-government organizations around the world in improving maternal healthcare and ensuring that “no woman has to die of giving birth”.

Through the 3-year MSD for Mothers global grant awarded in 2021, Jhpiego developed an action plan for providing technical assistance in maternity care in 18 public and private health facilities in one rural district in Sorsogon. It was selected as a project site for being a geographically isolated area where families have become vulnerable because of barriers to accessing healthcare and other social services. The project involved strengthening data-recording and emergency responses at each health facility and reinforcing local government capacity within an organized referral system. During the culminating Dissemination Forum held in February, compelling positive outcomes were reported in terms of decreasing preventable morbidity and mortality among Sorsogon mothers, as well as their newborns.

Photo by Geri Matthew Carretero. Launching of the local-based reference manual for the management of high-risk pregnancy (August 30, 2023)

Mobilizing for Mothers

How are these reforms significant on the actual individual level? Let’s go back to the high-risk case of Nanay Nancy. During delivery, her uterus was turned inside out which is a rare but quite serious complication of childbirth that causessevere postpartum bleeding. As soon as the problem was identified, the rural health unit providers sent an electronic referral to the district hospital to alert the doctors that a critical case of uterine inversion would be immediately transferred to them. The district hospital physician promptly attended to the emergency as soon as the patient arrived, and maintained constant communication with his counterpart at the provincial hospital via video communication to ensure that proper procedure was followed and correct medications were given to the patient. After a successful manual management of the uterine inversion, the patient was then sent over to Sorsogon Provincial Hospital to further ensure that the problem had been resolved.

As a result of Jhpiego’s collaboration with the Department of Health, the Provincial Health Office of Sorsogon, and cooperation among health facilities, there had marked improvement in the delivery of emergency care for mothers in the province. “The project enables timely communication,identification, early management, and safe transfer of patients, which are among the key factors that help lead to a significant decrease of maternal and neonatal deaths,” says Dr. Ingrid Magnata, Country Program Manager of Jhpiego. The non-profit affiliated with Johns Hopkins University states that 73% of maternal mortality could be prevented if all women received appropriate emergency obstetric care. She continues, “When the project kicked off in Sorsogon in 2021,through the MSD for Mothers grant, Jhpiego assisted the PHO in structuring and establishing the referral system withinthe Provincial Health Care Providers Network (HCPN). Additionally, together with the local health managers, the MSD for Mothers project formalized the Service Partners Agreement (SPA) within the HCPN which ensures the continuity of health care services in the province in the context of the Universal Health Care Act (UHCA). Cultivating a robust referral network under the UHCA is vital for ensuring that birthing mothers from remote areas in Sorsogon Province receive timely and quality care. By facilitating immediate access to maternal and neonatal care, we strive to reduce maternal mortality and empower local healthcare providers.

Photo by Geri Matthew Carretero. Midwives and nurses together with Nanay Nancy at the Matnog RHU.

Supporting the Carers

Under the MSD for Mothers grant, Jhpiego was able to train a total of 322 frontline service providers composed of doctors, nurses, and midwives. Seventy-six percent of them came from the 18 project sites while the rest were from non-project sites sponsored in part by their respective government units.The trainings were conducted in partnership with the Department of Health-Center for Health Development (DOH-CHD) Bicol University for Basic Emergency Obstetric and Neonatal Care, and covered essential skills like basic newborn resuscitation, and protocols surrounding perinatal care such as determining early abnormalities in fetal findings. By institutionalizing continued capacity building in level 1 facilities like rural health units and barangay health stations, health service providers develop increased confidence during primary care and referral management for emergency maternal cases such as preeclampsia, eclampsia, postpartum hemorrhage, and preterm labor.

Transforming health service delivery necessitates an increased coverage of evidence-based documentation. Toward this end, the first local-based reference manual for the management of high-risk pregnancy was published, guided by two obstetrician-gynecologist consultants from the University of the Philippines-Philippine General Hospital and from the province of Sorsogon. The key resource book contains clinical practice guidelines on proper and effective care and interventions, along with best practices in responding to maternal health emergencies.

Dr. Maita Urbis-Bobis of DOH Bicol explains how the health department’s 8-Point Action Agenda aligns with the goals of MSD for Mothers: “Bicol region—especially the far-flung areas—are critical for healthcare reform, and this is why we actively support advocacies that help strengthen medical services and facilities here. When we channel resources and perspectives into evidence-based and patient-centered healthcare, medical providers and communities experience improved morale and renewed hope for the future of Sorsogon women and families.”

Andreas Riedel, President and Managing Director of MSD in the Philippines, says, “We at MSD are committed to do our part in saving and improving the lives of mothers here and around the world. By enabling development partners via the MSD for Mothers grant, we are better able to generate scalable strategies and best practices that communities and institutions can learn from and sustain in the long term.”

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