Thursday, November 11, 2010

Global Forum, Day 4

For the online discussion, click here. The forum community is continuing to grow with 624 members from 86 countries!
Optimizing the roles of health workers to improve MDGs 4 and 5 discussion forum.

Today's question:
Today we will continue to discuss the role of the lay health workers. However, we would like you to elaborate more on the specific issues below:
- What wider social roles, such as promoting female empowerment, should lay health workers take on in communities?
- What approaches that have been used in different settings to motivate and retain lay health workers, to improve the quality of the services they deliver and to promote the delivery of high priority services for maternal and newborn health?

- Contributors have highlighted the need for guidelines or manuals that outline the tasks and roles of lay health workers. It would be useful to hear more about existing guidelines of this sort, including how they are used and the extent to which they are evidence-based. Given the wide variation across settings in the tasks that lay providers take on, what functions might guidelines at the international level on optimizing tasks and roles have?
- What strategies have been used to improve collaboration between lay providers and professionals, particularly nurses working in primary care? How has the allocation of roles and tasks between different cadres been negotiated or established in different settings?

My comment:
There is a great deal of interesting discussion available at the forum site. The Contribution 24 in Day 3's discussion focuses on the value of the Partogram in reducing maternal and perinatal morbidity and mortality. It's a lengthy post, by Dr Munoh Kenne Foma from Cameroon, and indicates the lack of acceptability of the tool in his country where there seems to be a heavy reliance on lay birth attendants. In my opinion, this is a clear example of the importance of skilled professional care - the care of a midwife - for women in established labour and birthing. This work cannot be delegated to the lay health worker of any category.


Many surveys have reported the utilization rate of the partogram to be very low in Cameroon, even in Big Towns. Reasons sited for this low use include;
1 Inability to correctly use the partogram
2 Few personnel
3 Partographs not available
4 Ignorance about the partogram
5 Not seen to be important
6 Late arrivals of parturients

A recent survey in the Santa Health District, in the North West Region of Cameroon by the authors Dr MUNOH KENNE FOMA in February 2010 showed that none of the Health institutions were using the Partogram.

Munoh Kenne Foma

ps - I do not use a partogram for spontaneous, uncomplicated births at home. I make recordings of my observations, but in many instances I do not perform a vaginal assessment of dilation or the station of the head, and I am confident with other markers of progress. However, if a woman needs to transfer to hospital for any reason, I would want to make a full assessment of the status of both the labour and the woman's vital signs, and commence the partogram.

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