Optimizing the delivery of key interventions to
attain MDGs 4 & 5 through task-shifting
(Optimize4MNH)
A. Metin Gülmezoglu
World Health Organization
Outline
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Background to the guideline
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WHO Guideline development standards
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Process to date
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Optimizing the delivery of key interventions for MNH
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Current controversies in the field of maternal and newborn health
where WHO guidance may be helpful
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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 meetings
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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_we
b.pdf
The WHO Guideline Development Standards
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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 development
technical unit  GRC  technical unit GRC  final approval
The Guideline Development Process
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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 objective
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To identify and make recommendations on cadre(s) of workers who
can increase access to effective practices in a safe way
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In other words, we are interested in both task-shifting and expanding the
roles of cadres to optimize access
Chronology
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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 horizontal?
Maternal
•When
•Who
•What
•Where
Newborn
Immunization
HIV
NCD
Tb
Others?
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Guideline questions
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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 Group
WHO internal working group
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Health Systems / Human Resources for Health
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Carmen Dolea
Annette Mwansa Nkowane
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HIV/AIDS
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Maternal Newborn, Child and Adolescent Health
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Eyerusalem Kebede Negussie
Rajiv Bahl
Blerta Maliqi
Matthews Mathai
Annie Portela
Qualitative reviews group
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Luz Maria De-Regil
Juan Pablo Pena-Rosas
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
Claire Glenton
Simon Lewin
Sarah Rosenbaum
Jenny Moberg
Unni Gopinathan
Elin S Nilsen
Jane Noyes
Chris Colvin and the SA team
Arash Rashidian and the Iran team
Chris Morgan
Neil Pakenham-Walsh
Onikepe Owolabi
Effect reviews
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Rajesh Khanna
Zohra Lassi
Olufemi Oladapo
Stephanie Polus
Watananirun Kanokwaroon
Priya Miriyam Lerberg
Alliance for Health Systems and Policy Research
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Reproductive Health and Research
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Norwegian Knowledge Centre
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Nutrition
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Technical working group
Taghreed Adam
Nhan Tran
Global Health Workforce Alliance
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George Pariyo
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Thanks
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