Wendy J Graham: New Approaches to Maternal Mortality In Africa
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Wendy J Graham (Professor of Obstetric Epidemiology at the School of Medicine and Dentistry, University of Aberdeen; Senior Research Advisor, Department for International Development): Maternal mortality: evidence gaps and measurement traps
Wendy J Graham: New Approaches to Maternal Mortality In Africa
- 1. 珂温岳艶姻稼温鉛油 M t l mortality: evidencegaps& measurement traps ProfessorWendyJGraham NewapproachestomaternalmortalityinAfrica N h l li i Af i UniversityofCambridge:July23rd 2012
- 2. 珂庄鉛鉛艶稼稼庄顎馨油禽艶厩艶鉛看沿馨艶稼岳油赫看温鉛油5温油庄壊油看韓韓t温姻乙艶岳*油油乙鉛看恢温鉛鉛霞 450 400 X deathsper100000livebirths 350 300 250 200 150 珂温岳艶姻稼温鉛油d 100 MMTarget X 50 0 1990 1995 2000 2005 2010 2015 *75%reductioninthematernalmortalityratiobetween1990and2015. Source:UN,May2012
- 3. Canthematernalhealthknowledge community dobetterinwhatwedo andthewaywedoit? and the way we do it?
- 4. 悪稼看敬鉛艶糸乙艶油 悪稼看敬鉛艶糸乙艶油actors Knowledge actors Community Identifyknowledgegaps Measurement traps*: concepts, concepts Gather& Gather & Translate& definitions, synthesizenew communicate indicators, knowledge knowledge sources,tools 悪稼看敬鉛艶糸乙艶油actors 悪稼看敬鉛艶糸乙艶油actors *Graham&Campbell,1992
- 5. 永姻看厩看界温岳庄看稼油1: Provocation 1: Howshouldwedefine&measure success?
- 6. 鰻庄乙艶姻庄温:油馨温岳艶姻稼温鉛油馨看姻岳温鉛庄岳霞油岳姻艶稼糸壊油19852011油 usingUN&IHME*estimates 1400 1200 2015target:MMR275 1000 M 800 M 600 R 400 2015target:MMR100 200 0 1985 1990 1995 2000 2005 2008 2010 2011 Year UN2010 IHME2010 IHME2011 UN2012 Notes:UN2012meansestimatesforyear2010published2012 IHME2008meansestimatesforyear2008publishedbyHoganetal(2010) *InstituteofHealthMetrics& IHME2011meansestimatesforyear2011publishedbyLozanoetal(2011) Evaluation,UniversityofWashington
- 7. HindustanTimes,August20th 20 0 i d i 20 2010
- 8. 禽庄沿沿庄稼乙i稼油&温馨沿;o顎岳油看韓油岳鞄艶油鞄艶温鉛岳鞄油壊霞壊岳艶馨:油鰻庄乙艶姻庄温油(2008) 100 % 90 80 70 60 50 40 30 20 10 0 DPT1dose Metneed C4/4+visits SAD Postnatalvisit Contraceptiveuse feeding FullVaccine ANC1visit natalTetnus aldeliveries 2+TetanusInjections Breast F Institutiona ANC Neon Poorest 2 3 4 Richest Source:ImmpactanalysisofDHSdata;Graham&Fitzmaurice,2011 mostrecentbirthonly
- 9. 意鞄艶油温乙艶油看韓油温界界看顎稼岳温恢庄鉛庄岳霞 The age of accountability Inconsideringsocietysexpectations&ourown d & goals{askknowledgeactors},webelievethatthere isamoralimperativetoreconsiderhowscientific l d h f dataarejudged&used. Youngetal.PLoSMed2008;e201 Y t l PL S M d 2008 201
- 10. 節韓油看顎姻油看恢逮艶界岳庄厩艶油庄壊油岳看油鉛艶温姻稼,油岳鞄艶稼油韓温庄鉛顎姻艶油 If bj i i l h f il representsanimmenseopportunity,andifour aimistoseizethegreatestopportunities availabletous,thenweneedtobecome available to us, then we need to become connoisseursoffailure... Whatisagreatfailureisaprojectinpursuitofa noblegoal...Itisonewelearnfrom. bl l I i l f Gunderman,RD.(2010)
- 12. CopyrightNorthofScotlandHealthServiceArchive Copyright North of Scotland Health Service Archive
- 13. 珂粥意掘檎鰻粥晦油珂或檎意粥晦鴛意額:油雨稼庄岳艶糸油悪庄稼乙糸看馨 g 900 ve 0,000 liv 800 珂温岳艶姻稼温鉛油mortalityisagreatblot 700 onpublichealthadministration. M atern al D eath s p er 100 600 MinisterofHealth,1935 b irt s 500 th 400 300 200 100 a 0 1850 1870 1890 1910 1930 1950 1970 1990 2010 Year
- 14. 禽看油敬艶油艶厩艶姻油鉛艶温姻稼? Do we ever learn? Twocurrentblindspots: bli d 1.Skilleda endantatbirthskilledcareatbirth 2.Highcoverageisnecessarybutnotsufficient
- 15. SkilledCareatBirth:thecompletepackage Community Enablingenvironmente.g.supplies, g g pp , infrastructure,transport,etc Skilledattendants Skillstopromote Referral Skillstoprovide p utilisationofdelivery comprehensive careandtoconduct emergency normaldeliveries obstetriccare Skillstoprovidebasic emergencyobstetric emergency obstetric care
- 16. Percentageofdeliverieswithskilled attendants 2008 attendants*2008 <25% 2549% 25 49% 5074% 7594% >95% Nodata *Definedashealthprofessionals(doctors,midwives, nurses).Datasource:WHO(2008),WRABirthAtlas2010
- 17. Higher coverage is critical but Highercoverageiscriticalbut savinglivesalsodependsonthe g p qualityofcare. Takingstockofmaternal,newbornandchildsurvival:20002010 DecadeReport.ExecutiveSummary Decade Report Executive Summary Countdownto2015.June2010
- 21. 永姻看厩看界温岳庄看稼油3: Provocation 3: Areweresponsivetochangingneeds anddemands? dd d?
- 22. 粥油糸霞稼温馨庄界油恢顎姻糸艶稼:油馨艶糸庄界温鉛油界温顎壊艶壊油看韓油 y maternaldeaths,Bangladesh2010 Eclampsia 20% Hemorrhage 31% Obstructed Prolonged Labor 7% Abortion 1% OtherDirect 5% Undetermined 1% Indirect 35% Source:BMMS2010Summaryreport
- 24. GlobalStrategyforWomen s&Children sHealth? Global Strategy for Womens & Childrens Health ? Countryledhealthplans y p Comprehensivepackageofessentialinterventionsand services Integratedcare Healthsystemsstrengthening Healthworkforcecapabilitybuilding Coordinatedresearchandinnovation Accountability at all levels Accountabilityatalllevels http://www.who.int/pmnch/activities/jointactionplan/en/index.html
- 25. Maternal mortality is much more 珂温岳艶姻稼温鉛油mortalityismuchmore thanamedicalissue thanamedicalissue BanKimoon UnitedNationsSecretaryGeneral U it d N ti S t G l 2009
- 26. 悪稼看敬鉛艶糸乙艶油stakeholdersarediverse Privatesector Media Funding Research Think Government bodies institutions tanks bodies Advocates,civil Advocates, civil society,NGOs, parliamentarians Adaptedfrom:AllianceforHealthPolicyandSystemsResearch.2007.
- 27. Thereisnothing{we}likesolittleas tobewellinformed;itmakesdecision t b ll i f d it k d ii makingsocomplexanddifficult. making so complex and difficult. JMKeynes J M Keynes (18831946)
- 28. P看鉛庄界霞m温一艶姻壊油 arefromMars. Researchersare fromVenus.* *AdaptedfromJohnGray,2004
- 29. The role of the scientist is to use research to ascertain Theroleofthescientististouseresearchtoascertain theeffectivenessofinnovativepoliciesandprograms. Thisisincontrastto{their}roleasadvisorinwhichthe scientistcanindulgeinover advocacy... scientist can indulge in overadvocacy . DonaldTCampbell1988Theexperimentingsociety.
- 30. Canthematernalhealthknowledge community dobetterinwhatwedo andthewaywedoit? and the way we do it?