African Field Epidemiology Network (AFENET)

Providing timely, safe C-sections within 30-minutes, 24/7 to save lives

Maternal and perinatal health

We combine AFENET’s epidemiological and public health expertise with proven Midwifery Frameworks to provide universal health coverage to pregnant/birthing women during their most vulnerable time.

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Lead Organization

African Field Epidemiology Network (AFENET)

Kampala, Central Region, Uganda

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To learn more about – or provide significant funding to – this project, please contact Lever for Change.

Project Summary

Societal well-being is threatened by excessive rates of maternal, fetal, and newborn (MFN) mortality. Women in poorer rural/urban communities are worst hit by this silent epidemic. Disadvantaged adolescent girls face a higher risk of mortality, feticide, infanticide, violence, and abuse. Early pregnancies predispose adolescents to reproductive perils which negatively impact their future mental and physical health, culminating in maternal deaths, premature births, and diminished babies’ survival. Girls living in poverty lack educational opportunities and economic stability and will not reach their individual potential for growth and contribution to societal well-being. Midwifery Led Community Care Centers (MWLCCC) provide culturally appropriate evidenced-based healthcare to achieve universal health coverage, especially during their most vulnerable time, birth. MWLCCCs can implement with AFENET and FETPs unified, integrated, and locally managed Maternal_Fetal_Newborn(MFN) interventions known to reduce disparities in coverage, equity, and quality of comprehensive_emergency_obstetrical_newborn_care(CEmONC) services and prevent excessive MFN mortality and morbidity.

Problem Statement

The most significant challenge to address associated with excessive African MFN mortality is how to scale up the UNs’ high-risk CEmONC intervention package in a manner that prevents this “life-saving” package from becoming a “life-threatening” due to iatrogenic or local system related defects.Worldwide, all pregnant/birthing women are impacted, but women in poorer rural/urban communities are worst hit by this silent epidemic. The problem exists partially because there is no “magic bullet”, only a “systems” solution. This neglected tragedy requires us to build system capacity to provide high quality maternity/newborn care provided "to the right person, in the right place, at the right time, doing the right thing, in the right way"(5rights). This system should be flexible, adaptable and use evidence-based intervention to provide locally appropriate solutions. The most influential way to effect the necessary changes is facility by facility, formulating a “Quality culture” in which everyone participates, data drives action to achieve quality of care, and where peoples’ talents and actions are the leverage points where the smallest change can have the biggest impact.We are setting the stage for success by forging a partnership between AFENET and its epidemiological and public health capacities and the internationally acclaimed Midwifery_Framework where midwives are the systems’ “backbone”, taking its pulse, appropriately responding to MFN problems, and providing coverage_equity_quality care along the reproductive continuum, especially at birth. We will adopt and adapt this service/delivery platform centric to the MFN needs to implement major cutting-edge local solutions by following principles of the Maternal_Infant_Storyboard_Methodology.

Solution Overview

Our 21st century’s solution is the Midwifery-Led-Community-Care-Centers(MLCCCs) supported by AFENET’s epidemiological and public health management expertise. There is no “magic bullet” to solve this problem. A well-functioning evidenced-based system at the village, primary care center, and referral hospital levels that are linked through AFENET supported surveillance and public health program management are the solution. MLCCCs are independent, stand-alone sites linked to a cluster of smaller midwifery-maternity-care centers, and a referral hospital. It is critical in the reproductive continuum chain, an integral part of Universal Health Coverage(UHC).MLCCCs represent on-going midwifery 100-year evolution. Concepts derived from around the world are woven together:•UK’s post WW2 decision to invest in community-based midwives;•China’s “barefoot” doctor accounting for every pregnancy, child, woman, and man; •UNRWA’s “pregnancy scouts” monitoring the community’s reproductive health pulse; •U.S. midwives implementing “centering pregnancy” on Native American reservations;•CARE’s Opportunities for Mother/Infant Development (O.M.I.D., “hope” in Dari) in Afghanistan hiring widows to track/account for reproductive-age women in collaboration with community-based midwives.MLCCCs have four integrated functions:•Longitudinal surveillance monitoring and evaluation;•Reproductive health care for the woman/children dyads, •Early childhood development parental instruction adapted from a previous MAF100+ award;•Enhanced local micro-financing to foster MLCCC self-sustainment;•Internet communication portals for connectivity.MLCCCs , the “one-stop-shop”, provide unique models and provide affordable, sustainable infrastructure. They directly impact 8 of 17 SDGs, 4 indirectly, empowering local communities to plan, organize, implement and locally evaluate UHC. MLCCCs foster coherent, collaborative, and coordinated action .

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