Task Shifting: The Key to Increasing Access to Essential Maternal Health Services

Below are extracts from a blog on the Maternal Health Task Force.

‘For decades, the medical and global health communities have viewed magnesium sulphate (MgSO4) as the gold standard for PE/E prevention and treatment [*see note below]. We know it works faster and better than other anticonvulsants like diazepam, but in many settings diazepam is still administered instead of MgSO4. So, why then, are the women who need it unable to get it? The reasons are many, but one is the lack of capacity among the existing health workforce. If more health providers – those based at primary and secondary health facilities – could administer MgSO4, more women and babies would survive PE/E…

‘To minimize this gap and improve maternal and newborn health outcomes, including those related to PE/E, the WHO recommends task shifting…

‘We have seen this be successful in many aspects of sexual and reproductive health. Skilled and traditional birth attendants in Madagascar and Mozambique were able to prevent death from hemorrhage when guidelines were changed to allow them to administer misoprostol. Unintended pregnancies are reduced when midwives can insert contraceptive implants and intrauterine devices (IUD) and when pharmacists can provide contraceptive injections. If frontline health workers such as nurses and midwives can provide these clinical services, then surely they can administer a loading dose of MgSO4 and refer PE/E patients to secondary facilities for further management.’

The full text is here: https://www.mhtf.org/2017/02/27/task-shifting-the-key-to-increasing-access-to-essential-maternal-health-services/?utm_source=MHTF+Subscribers&utm_campaign=2bb39ca9ca-RSS_EMAIL_CAMPAIGN&utm_medium=email&utm_term=0_8ac9c53ad4-2bb39ca9ca-183808905

It’s interesting that traditional birth attendants in Madagascar and Mozambique are trained to use misoprostol for complications of delivery, given that in other countries TBAs are  banned altogether from attending deliveries (although in reality these latter countries may well simply be driving TBAs underground, leading to even worse results for individual TBA-assisted deliveries than countries where TBAs are more accepted and supported.)

*Note: I am not an expert, but I think this sentence needs qualification: my understanding is that MsSO4 is not used for the prevention of pre-eclampsia. Rather, it is used for prevention of eclampsia (in a patient who is already in pre-eclampsia) and treatment of eclampsia. I stand to be corrected…

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa.org  


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