Optimizing the delivery of key Optimizing the delivery of key interventions to attain MDGs 4 & 5interventions to attain MDGs 4 & 5 through task-shiftingthrough task-shifting(Optimize4MNH)(Optimize4MNH)
A. Metin GülmezogluA. Metin Gülmezoglu
World Health OrganizationWorld Health Organization
OutlineOutline
Background to the guideline
WHO Guideline development standards
Process to date
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Optimizing the delivery of key interventions Optimizing the delivery of key interventions for MNHfor MNH
Current controversies in the field of maternal and newborn health where WHO guidance may be helpful– Misoprostol use by community health workers– TBA training to improve maternal and newborn outcomes– Nonphysician clinicians performing caesarean sections– MgSO4 use by midwives– Contraceptives by lay health workers
Relevant publications and meetingsRelevant publications and meetings
World Health Organization (2010). Increasing access to health workers in remote and rural areas through improved retention. Global policy recommendations. Geneva, Switzerland: WHO. Available at http://www.who.int/hrh/retention/guidelines/en/index.html.
World Health Organization (2008). Task shifting: rational redistribution of
tasks among health workforce teams : global recommendations and guidelines. Geneva, Switzerland: WHO. Available at: http://www.who.int/hiv/topics/systems/health_workforce/en/
World Health Organization. (2008). International conference on task shifting (Addis Ababa Declaration 2008): Geneva, Switzerland: WHO. Available at http://www.who.int/healthsystems/task_shifting/Addis_Declaration_EN.pdf
Bhutta, Z.A., Lassi, Z.S., Pariyo, G., & Huicho, L. (2010). Global experience of community health workers for delivery of health related millennium development goals: a systematic review, country case studies, and recommendations for integration into national health systems. Geneva, Switzerland: WHO & GHWA. Available at http://www.who.int/workforcealliance/knowledge/publications/alliance/Global_CHW_web.pdf
The WHO Guideline Development The WHO Guideline Development StandardsStandards
WHO has internal regulations and standards for developing guidelines: WHO Handbook for guideline development
WHO guideline review committee (GRC) monitors the guideline development process and ensures that the relevant regulations and standards are applied
proposal content developmenttechnical unit GRC technical unit GRC final
approval
The Guideline Development ProcessThe Guideline Development Process
the process includes:
– (i) identification of priority questions and critical outcomes;
– (ii) retrieval of the evidence;– (iii) assessment and synthesis of the evidence;
• GRADE and DECIDE frameworks
– (iv) formulation of recommendations;– (iv) planning for dissemination, implementation,
impact evaluation and updating.
Primary objectivePrimary objective
To identify and make recommendations on cadre(s) of workers who can increase access to effective practices in a safe way– In other words, we are interested in both task-shifting and expanding
the roles of cadres to optimize access
ChronologyChronology
Mid-2010: Support secured to work on the guideline
Late-2010: The WHO internal working group on the Opt4MNH guideline established
December 2010: Guideline scoping meeting January 2011 to date: Evidence synthesis,
quality assessment Mid 2010 to April 2012: Meeting within WHO
WG every 3-4 months, two technical meetings on qualitative reviews
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Scoping challenge: Going vertical or Scoping challenge: Going vertical or horizontal?horizontal?
Maternal Newborn Immunization HIV NCD Tb Others?
•When
•Who
•What
•Where
•Regulatory frameworks
•(legal issues, training, supervision, career paths, re
tention, …)
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Guideline questionsGuideline questions
The focus of the recommendations is on cadre + intervention
We are NOT addressing the questions at the system level We are NOT recommending the initiation or abolition of any
cadre programme We are NOT comparing task shifting to a particular cadre
with another type of intervention that organizes care in a different way (e.g. maternity waiting home)
We are NOT addressing teams of cadres delivering interventions
We are aware that asking the questions in this way does not address the whole problem particularly for national policy-making but, that was the only practical way we could see and agreed upon at the scoping meeting!
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Guideline Steering GroupGuideline Steering Group
WHO internal working groupHealth Systems / Human Resources for Health
– Carmen Dolea– Annette Mwansa Nkowane
HIV/AIDS– Eyerusalem Kebede Negussie
Maternal Newborn, Child and Adolescent Health– Rajiv Bahl– Blerta Maliqi– Matthews Mathai– Annie Portela
Nutrition– Luz Maria De-Regil– Juan Pablo Pena-Rosas
Reproductive Health and Research– João Paulo Dias De Souza– Mario Festin– A. Metin Gülmezoglu– Mario Merialdi– Lale Say– Interns (Stephanie Polus, Watananirun
Kanokwaroon,– Joshua Vogel, Fabiola Stollar)– Cathy Kiener
Alliance for Health Systems and Policy Research– Taghreed Adam– Nhan Tran
Global Health Workforce Alliance– George Pariyo
Technical working groupNorwegian Knowledge Centre
– Claire Glenton– Simon Lewin– Sarah Rosenbaum– Jenny Moberg– Unni Gopinathan– Elin S Nilsen
Qualitative reviews group– Jane Noyes– Chris Colvin and the SA team– Arash Rashidian and the Iran team– Chris Morgan– Neil Pakenham-Walsh – Onikepe Owolabi
Effect reviews– Rajesh Khanna– Zohra Lassi– Olufemi Oladapo– Stephanie Polus– Watananirun Kanokwaroon– Priya Miriyam Lerberg
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ThanksThanks
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