The Experts below are selected from a list of 3165 Experts worldwide ranked by ideXlab platform
Jeremy Shiffman - One of the best experts on this subject based on the ideXlab platform.
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the state of political priority for Safe Motherhood in india
2007Co-Authors: Jeremy Shiffman, Rajani VedAbstract:Approximately one-quarter of all maternal deaths occur in India, far more than in any other nation on earth. Until 2005, maternal mortality reduction was not a priority in the country. In that year, the cause emerged on the national political agenda in a meaningful way for the first time. An unpredictable confluence of events concerning problem definition, policy alternative generation and politics led to this outcome. By 2005, evidence had accumulated that maternal mortality in India was stagnating and that existing initiatives were not addressing the problem effectively. Also in that year, national government officials and donors came to a consensus on a strategy to address the problem. In addition, a new government with social equity aims came to power in 2004, and in 2005, it began a national initiative to expand healthcare access to the poor in rural areas. The convergence of these developments pushed the issue on to the national agenda. This paper draws on public policy theory to analyse the Indian experience and to develop guidance for Safe Motherhood policy communities in other high maternal mortality countries seeking to make this cause a political priority.
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the state of political priority for Safe Motherhood in nigeria commentary
2007Co-Authors: Jeremy Shiffman, F E OkonofuaAbstract:Achieving the ambitious maternal mortality reduction aims of the Millennium Development Goals will require more than generating sufficient donor support and carrying out appropriate medical interventions. It also will necessitate convincing governments in developing countries to give the cause political priority. The generation of political priority, however, is a subject that has received minimal research attention. In this article, we assess the state of political priority for maternal mortality reduction in Nigeria, which has more maternal deaths in childbirth than any country except India. We also identify challenges that advocates face in promoting priority. We find that after decades of neglect, a policy window has opened for Safe Motherhood in Nigeria, giving hope for future maternal mortality reduction. However, priority is as yet in its infancy, as advocates have yet to coalesce into a potent political force pushing the government to action. The case of Nigeria suggests that there is an urgent need for Safe Motherhood policy communities in countries with high maternal mortality to transform their moral and technical authority into political power, pushing policy-makers to action. We offer a number of suggestions on how they may do so.
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political history and disparities in Safe Motherhood between guatemala and honduras
2006Co-Authors: Jeremy Shiffman, Ana Lucia Garces Del ValleAbstract:Each year, worldwide, more than 500,000 women die of complications from childbirth, making this a leading cause of death globally for adult women of reproductive age. Nearly all studies that have sought to explain the persistence of high maternal mortality levels have focused on the supply of and demand for particular health services. We argue that inquiry on health services is useful but insufficient. Robust explanations for Safe Motherhood outcomes require examination of factors lying deeper in the causal chain. We compare the cases of Guatemala and Honduras to examine historical and structural influences on maternal mortality. Despite being a poorer country than Guatemala, Honduras has a superior Safe Motherhood record. We argue that four historical and structural factors stand behind this difference: Honduras's relatively stable and Guatemala's turbulent modern political history; the presence of a marginalized indigenous population in Guatemala, but not in Honduras, that the state has had difficulty reaching; a conservative Catholic Church that has played a larger role in Guatemala than Honduras in blocking priority for reproductive health; and more effective advocacy for maternal mortality reduction in Honduras than Guatemala in the face of this opposition.
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generating political priority for Safe Motherhood
2004Co-Authors: Jeremy ShiffmanAbstract:This paper was presented by Jeremy Shiffman on November 18, 2004 at the 38 Annual General Meeting and Scientific Conference of the Society of Gynaecology and Obstetrics of Nigeria (SOGON) in Makurdi, Benue State, Nigeria. Jeremy Shiffman, Ph.D., is Associate Professor of Public Administration at the Maxwell School of Syracuse University in the United States. African Journal of Reproductive Health Vol. 8 (3) 2004: 6-10
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the emergence of political priority for Safe Motherhood in honduras
2004Co-Authors: Jeremy Shiffman, Cynthia Stanton, Ana Patricia SalazarAbstract:Each year an estimated 500 000 to 600 000 women die due to complications from childbirth making this one of the leading causes of death globally for women in their reproductive years. In 1987 a global initiative was launched to address the problem but few developing countries since then have experienced a documented significant decline in maternal mortality levels. Honduras represents an exception. Between 1990 and 1997 the country’s maternal mortality ratio – the number of deaths due to complications during pregnancy childbirth and the postpartum period per 100 000 live births – declined 40% from 182 to 108 one of the largest reductions ever documented in such a short time span in the developing world. This paper draws on three political science literatures – constructivist international relations theory policy transfer and agenda-setting – to explain how political priority for Safe Motherhood emerged in Honduras a factor that underpinned the decline. Central to the explanation is the unusually cooperative relationship that developed between international donors and national health officials resulting in effective transfer of policy and institutionalization of the cause within the domestic political system. The paper draws out implications of the case for understanding the political dynamics of health priority generation in developing countries. (authors)
Cynthia Chazotte - One of the best experts on this subject based on the ideXlab platform.
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implementing obstetric venous thromboembolism protocols on a statewide basis results from new york state s Safe Motherhood initiative
2019Co-Authors: Alexander M Friedman, Cande V Ananth, Cynthia Chazotte, Jessica A Lavery, Adiel Fleischer, Mary E DaltonAbstract:Objective To determine whether a state-level initiative to reduce obstetric venous thromboembolism (VTE) risk affected outcomes and process measures. Methods In 2013, the Safe Motherhood Initiative (SMI) developed a VTE Safety bundle to reduce obstetric VTE risk. A total of 117 of 124 hospitals providing obstetrical services in New York participated in SMI. Data evaluating thromboembolism events (deep vein thrombosis and pulmonary embolism) and thromboprophylaxis process measures were collected from March through November 2015. Results A total of 107 hospitals, in any individual quarter, reported data on each of the VTE bundle outcomes and measures. Centers that provided low-risk care (Level 1 centers) reported the lowest rate of bundle implementation at the end of the study period (55.6%). Mechanical prophylaxis for a cesarean was common at all centers. Hospitals that adopted the bundle were more likely to provide routine pharmacologic prophylaxis for women undergoing cesarean. The risk of VTE did not differ by bundle implementation. Conclusion While adoption of the SMI VTE bundle occurred at a majority of centers across New York, uptake was less likely at low-acuity centers. Bundle adoption was associated with implementation of recommended practices. The rare nature of VTE events underscores the need for large data samples to determine the best prophylaxis strategies.
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the new york state Safe Motherhood initiative early impact of obstetric hemorrhage bundle implementation
2019Co-Authors: Dena Goffman, Cande V Ananth, Mary E Dalton, Jessica A Lavery, Kristin Zielinski, Adiel Fleischer, Richard M Smiley, Cynthia ChazotteAbstract:Objective To determine the effects of the Safe Motherhood Initiative's (SMI) obstetric hemorrhage bundle in New York State (NYS). Study Design In 2013, the SMI convened interprofessional workgroups on hemorrhage, venous thromboembolism, and hypertension tasked with developing evidence-based care bundles. Participating hospitals submitted data measured before, during, and after implementation of the hemorrhage bundle: maternal mortality, intensive care unit (ICU) admission, cardiovascular collapse, hysterectomy, and transfusion of ≥4 units of red blood cells (RBCs). Data were analyzed for trends stratified by implementation status. Results Of the 123 maternity hospitals in NYS, 117 participated, of which 113 submitted data. Of 250,719 births, transfusion of ≥4 units RBCs (1.8 per 1,000) and ICU admissions (1.1 per 1,000) were the most common morbidities. Four hemorrhage-related maternal deaths (1.6 per 100,000) and 10 cases of cardiovascular collapse requiring cardiopulmonary resuscitation (4.0 per 100,000) occurred. Hemorrhage morbidity did not change over the five quarters studied. Risks were similar across hospital level of care and implementation status. Conclusion Statewide implementation of bundles is feasible with resources critical to success. The low hemorrhage-related maternal death rate makes changes in mortality risk difficult to detect over short time intervals. Long-term and timely data collection with individual expert case review will be required.
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Safe Motherhood initiative early impact of severe hypertension in pregnancy bundle implementation
2018Co-Authors: Lynn L Simpson, Burton Rochelson, Cande V Ananth, Peter S Bernstein, Mary E Dalton, Cynthia Chazotte, Jessica A Lavery, Kristin ZielinskiAbstract:Objective To describe the implementation and early results of the American College of Obstetricians and Gynecologists District II Safe Motherhood Initiative's Severe Hypertension in Pregnancy bundle on the timely treatment of severe hypertension in New York State obstetric hospitals. Methods This is a retrospective comparative study of two time periods during voluntary implementation of the Severe Hypertension in Pregnancy bundle in New York State's obstetric hospitals. The main outcome measure was the administration of an appropriate antihypertensive agent within 1 hour of the second elevated value for all pregnant or postpartum patients with severe hypertension. Results Of the 117 obstetric hospitals participating in the Safe Motherhood Initiative, 111 (94.9%) submitted data included in this analysis. During the study period, 80 of the 111 (72.0%) hospitals reported implementing the hypertension bundle. Overall, 2.4% of pregnant women were diagnosed with severe hypertension, and 60 to 65% of patients were treated within an hour of the second elevated value. Although not statistically significant, a greater numbers of patients were treated within an hour of the second elevated value in the second time period compared with the first in most obstetric hospitals (overall 64.8 vs. 60.8%; p = 0.33). Conclusion There were increasing numbers of patients receiving timely treatment of severe hypertension during early implementation of a Severe Hypertension in Pregnancy bundle in New York State obstetric hospitals. However, bundle implementation requires significant financial and human resources and the long-term impact on maternal morbidity and mortality in our state remains uncertain. Precis There was a tendency toward more timely treatment of severe hypertension following implementation of a Severe Hypertension in Pregnancy bundle in New York obstetric hospitals.
Peter Byass - One of the best experts on this subject based on the ideXlab platform.
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undertaking a complex evaluation of Safe Motherhood in rural burkina faso
2008Co-Authors: Wendy J Graham, Nicolas Meda, G Conombo, Sosthene D Zombre, Peter Byass, Vincent De BrouwereAbstract:Evaluations of composite health interventions, such as those attempting to make Motherhood Safer, are by definition complex, but nevertheless regarded as essential to informing progress in global health. This paper introduces a series of reports which set out the basis of Family Care International's Skilled Care Initiative in rural Burkina Faso, go on to describe strategies and methods for evaluating it, and present evaluation findings in terms of pregnancy outcomes, utilisation and effects of the intervention and economics. Although there were encouraging findings, no 'magic bullets' emerged from these studies, illustrating the reality that sustained and increasing resources are needed to achieve Safe Motherhood for all. There is no cheap or short-cut solution.
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from evaluating a skilled care initiative in rural burkina faso to policy implications for Safe Motherhood in africa
2008Co-Authors: Nicolas Meda, Sennen Hounton, Issiaka Sombie, Vincent De Brouwere, Peter ByassAbstract:Evaluation findings from a particular setting need to be generalized into policy implications if they are to find widespread use. Skilled attendance at delivery is widely regarded as one of the most important intervention strategies for Safe Motherhood in low-resource settings, particularly in Africa, but implementations of such strategies are often not rigorously evaluated or interpreted into future policy. Initiative for Maternal Mortality Programme Assessment (Immpact) has applied a package of research-based monitoring and evaluation tools to assess the Family Care International Skilled Care Initiative in Ouargaye District, Burkina Faso. This evaluation research aimed to generate reliable, evidence-based policies for accelerating Safe Motherhood programmes in Burkina Faso and elsewhere in Africa. Five policy priorities were identified as representing real chances of improving the Safety of Motherhood: (1) enhancing national coverage of delivery by professionally skilled attendants; (2) to provide a network of 24-h basic emergency obstetric care within 5 km; (3) to have an effective referral system, equipped and resourced to undertake a reasonable number of Caesarean sections; (4) to promote community mobilization activities as a lever to increasing delivery care utilization; and (5) to implement strategies to remove financial barriers to delivery care. To meet Millennium Development Goal five by 2015, both supply and demand side constraints on the provision of quality maternity care have to be addressed, which in turn need greater political commitment and funding.
Vincent De Brouwere - One of the best experts on this subject based on the ideXlab platform.
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undertaking a complex evaluation of Safe Motherhood in rural burkina faso
2008Co-Authors: Wendy J Graham, Nicolas Meda, G Conombo, Sosthene D Zombre, Peter Byass, Vincent De BrouwereAbstract:Evaluations of composite health interventions, such as those attempting to make Motherhood Safer, are by definition complex, but nevertheless regarded as essential to informing progress in global health. This paper introduces a series of reports which set out the basis of Family Care International's Skilled Care Initiative in rural Burkina Faso, go on to describe strategies and methods for evaluating it, and present evaluation findings in terms of pregnancy outcomes, utilisation and effects of the intervention and economics. Although there were encouraging findings, no 'magic bullets' emerged from these studies, illustrating the reality that sustained and increasing resources are needed to achieve Safe Motherhood for all. There is no cheap or short-cut solution.
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from evaluating a skilled care initiative in rural burkina faso to policy implications for Safe Motherhood in africa
2008Co-Authors: Nicolas Meda, Sennen Hounton, Issiaka Sombie, Vincent De Brouwere, Peter ByassAbstract:Evaluation findings from a particular setting need to be generalized into policy implications if they are to find widespread use. Skilled attendance at delivery is widely regarded as one of the most important intervention strategies for Safe Motherhood in low-resource settings, particularly in Africa, but implementations of such strategies are often not rigorously evaluated or interpreted into future policy. Initiative for Maternal Mortality Programme Assessment (Immpact) has applied a package of research-based monitoring and evaluation tools to assess the Family Care International Skilled Care Initiative in Ouargaye District, Burkina Faso. This evaluation research aimed to generate reliable, evidence-based policies for accelerating Safe Motherhood programmes in Burkina Faso and elsewhere in Africa. Five policy priorities were identified as representing real chances of improving the Safety of Motherhood: (1) enhancing national coverage of delivery by professionally skilled attendants; (2) to provide a network of 24-h basic emergency obstetric care within 5 km; (3) to have an effective referral system, equipped and resourced to undertake a reasonable number of Caesarean sections; (4) to promote community mobilization activities as a lever to increasing delivery care utilization; and (5) to implement strategies to remove financial barriers to delivery care. To meet Millennium Development Goal five by 2015, both supply and demand side constraints on the provision of quality maternity care have to be addressed, which in turn need greater political commitment and funding.
Nicolas Meda - One of the best experts on this subject based on the ideXlab platform.
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from evaluating a skilled care initiative in rural burkina faso to policy implications for Safe Motherhood in africa
2008Co-Authors: Nicolas Meda, Sennen Hounton, Issiaka Sombie, Vincent De Brouwere, Peter ByassAbstract:Evaluation findings from a particular setting need to be generalized into policy implications if they are to find widespread use. Skilled attendance at delivery is widely regarded as one of the most important intervention strategies for Safe Motherhood in low-resource settings, particularly in Africa, but implementations of such strategies are often not rigorously evaluated or interpreted into future policy. Initiative for Maternal Mortality Programme Assessment (Immpact) has applied a package of research-based monitoring and evaluation tools to assess the Family Care International Skilled Care Initiative in Ouargaye District, Burkina Faso. This evaluation research aimed to generate reliable, evidence-based policies for accelerating Safe Motherhood programmes in Burkina Faso and elsewhere in Africa. Five policy priorities were identified as representing real chances of improving the Safety of Motherhood: (1) enhancing national coverage of delivery by professionally skilled attendants; (2) to provide a network of 24-h basic emergency obstetric care within 5 km; (3) to have an effective referral system, equipped and resourced to undertake a reasonable number of Caesarean sections; (4) to promote community mobilization activities as a lever to increasing delivery care utilization; and (5) to implement strategies to remove financial barriers to delivery care. To meet Millennium Development Goal five by 2015, both supply and demand side constraints on the provision of quality maternity care have to be addressed, which in turn need greater political commitment and funding.
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undertaking a complex evaluation of Safe Motherhood in rural burkina faso
2008Co-Authors: Wendy J Graham, Nicolas Meda, G Conombo, Sosthene D Zombre, Peter Byass, Vincent De BrouwereAbstract:Evaluations of composite health interventions, such as those attempting to make Motherhood Safer, are by definition complex, but nevertheless regarded as essential to informing progress in global health. This paper introduces a series of reports which set out the basis of Family Care International's Skilled Care Initiative in rural Burkina Faso, go on to describe strategies and methods for evaluating it, and present evaluation findings in terms of pregnancy outcomes, utilisation and effects of the intervention and economics. Although there were encouraging findings, no 'magic bullets' emerged from these studies, illustrating the reality that sustained and increasing resources are needed to achieve Safe Motherhood for all. There is no cheap or short-cut solution.
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describing Safe Motherhood programs for priority setting the case of burkina faso
2005Co-Authors: Sennen Hounton, Julia Hussein, Nicolas Meda, Issiaka Sombie, G Conombo, Wendy J GrahamAbstract:Objective: This study was implemented to describe Safe Motherhood programs in Burkina Faso for planning and programming purposes. Methods: Twenty Safe Motherhood programs were described from November 2003 through May 2004 using a structured questionnaire, interviews with Safe Motherhood program managers and document reviews. Results: Only 2 of the 20 programs were designed to improve the availability of comprehensive emergency obstetric care, and only 2 comprehensively addressed all components of skilled attendance at delivery. Other gaps identified included poor availability of baseline data, few monitoring measures, and lack of planning for evaluation needs. National geographical coverage was also uneven. Conclusion: A systematic overview of Safe Motherhood programs in a country can help to set priorities and aid in decision making for the allocation of resources towards contextually relevant strategies to curtail maternal mortality and severe morbidity. Planning for program design and evaluation may also be aided by such a process.
