Maternal and newborn health: some experiences and roles of the WCH Knowledge Hub in Asia and the Pacific Chris Morgan Principal Fellow, Centre for International Health Burnet Institute

1. Maternal and newborn health: some experiences and
roles of the WCH Knowledge Hub in Asia and the Pacific
Chris Morgan
Principal Fellow, Centre for International Health
Burnet Institute

2. Knowledge Hub work on maternal and
newborn health care, in high mortality settings
• Adopted a systems perspective
 Matching the health systems framework of
the other AusAID knowledge hubs
• Firmly focused on service delivery options
 Collating implementation research on
o Interventions,
o Packages of care and
o The delivery of those packages
• Sought approaches for high mortality settings
 Also those with high proportions of births outside
health facilities
 Examining what could be done at community level at
the time of childbirth
 Complementing work by other Compass WCH Hub
partners on quality of care and the evidence base for
interventions in first- and second-level health facilities

3. Community-based care at childbirth – can it safely
extend coverage in high mortality settings?
• Literature review in 2009
 Update in 2013
• Site analyses of policy and
practice in
 Papua New Guinea
 Solomon Islands
 Lao PDR
 Indonesia’s NTT province
 Policy brief in 2011
• Packages of care with potential
for significant newborn and
maternal survival impact
 But need caution and measured
introduction
 Must be synchronised with health
facility strengthening
Established packages for newborn
care (warmth, hygiene, EBF), clean
delivery kits, chlorhexidine;
Community mobilisation, facilitated
referral;
Oxytocics from trained workers or
self-administered;
Antibiotics from trained workers
(lay or paid); and
? pre-filled injection devices for
vaccination or oxytocics.

4. Policy and practice analysis demonstrates
differences by setting – the need for tailored
approaches

5. Community-based MNH service delivery
options unique to the Western Pacific Region
• Integrating postnatal care with birth-
dose vaccination for hepatitis B
• A strong WPRO-led program
• Opportunities to spread since new global
Viral Hepatitis Strategy - WHA 2010
(and a link to “post-survival” newborn care)
• Drawing on past research by PATH, Burnet
and others (including national governments)
• Out-of-cold-chain usage, Uniject injection
• Scaled up in Indonesia, tested in
China/Vietnam
• In PNG we had demonstrated feasibility in
reaching 75% home births with integrated
postnatal care and birth-dose vaccination

6. Hub-funded contributions to the service
delivery evidence base, with WHO and others
• Hub-funded work with WHO on effective
practices for birth-dose vaccination
• Contribution to WHO’s standard publications
• Stronger integration of postnatal care for
mothers and newborns with vaccination
• Review of provision of injections by lay
health workers
• With Norwegian Knowledge Centre and
WHO RHR, contribution to WHO evidence
base on task-shifting
• Community actions for MNCH
• With WPRO Health Systems team
• Review of studies on maternal sepsis
• Examining both maternal sepsis (including
puerperal sepsis) and early newborn sepsis
• Potential of pre-referral treatment of the
mother during PNC home visits

7. Policy- and advocacy-oriented evidence
reviews of community-based care for
mothers, tailored to Papua New Guinea
• Collaboration with World Vision Australia
• Reviewed MNCH community-care evidence
 By intervention, package and delivery option
 Documenting global practice and PNG’s own
highly varied spectrum of experiences
 Adding a value-for-money judgement
• Dissemination of a 30page policy report
and targeted 2 page policy briefs
 Tailored separately to Australian and PNG
policy-makers
 Clear action requests
 Definitive response from the PNG government
 First national conference on health volunteers
 Newly filled national position to review and
develop policy, standards and procedures

8. Service delivery
questions remain
WCH Hub work so far has set up
some clear directions for future
implementation research
- PNG and Myanmar promising sites
Issues for newborns and home visits:
- timing of home visit
- preventive care only, or treatment
- integration with maternal and
immunisation programs
Issues for mothers:
- can ‘stop-gap programs risk
encouraging home births
or distracting from facility care
- misoprostol - treatment or
prevention; vs oxytocin, timing
- unknowns around puerperal
sepsis in the community
- role of psychological support
Issues for both:
- how to introduce in concert with
health system strengthening
- links family planning
- comprehensive PHC still offers
best health system environment

9. A regional knowledge platform, supported
by a development partner, enabled
• Policy-oriented evidence
collation, analysis and knowledge generation
• Forcing researchers to address policy needs
• And development staff to consider
implementation evidence
• Tailored work to address
 Sites in our region
 Specific settings, such as those with high
rates of home birth
• Regional and global engagement
 Beyond that often available to Australian
agencies and partners
 Such as sustained work with WHO
 Networks like AHPSR (Health Systems
Global), PMNCH, Women Deliver

10. Knowledge Hubs for Health are a strategic partnership initiative funded by the
Australian Agency for International Development
Acknowledgements:
Fellow researchers on site analyses:
• Jenny Kerrison, Indonesia
• Pilly Mapira, Papua New Guinea
• Louise Sampson, Lao PDR
• Chris Hagarty, Solomon Islands
Fellow researchers in synthesis papers:
• Abbey Byrne, Nossal Institute for
Global Health
• Jess Davis, Burnet Institute
• Kelly Durrant, Burmet Institute
• Liz Comrie-Thomson, Burnet Institute
Partner Institutions:
• Papua New Guinea, National
Department of Health
• Norwegian Knowledge Centre for the
Health Sciences
• World Vision Australia
• Save the Children international
• World Health Organization, Vaccines
and Biologicals
• World Health Organization,
Reproductive Health Research