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Optimizing the delivery of key interventions to attain MDGs 4 & 5 through task-shifting(Optimize4MNH)
RECOMMENDATIONS for HEALTH PROFESSIONALS
A. Metin Gülmezoglu
World Health Organization
Health worker categories
Lay health workers Auxiliary
– nurses– nurse-midwives
Nurses Midwives Associate clinicians (Non-physician clinicians)
– Associate clinicians– Advanced level associated clinicians
Non-specialist doctors
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"[The authors] have shown, unequivocally, that appropriately trained midlevel providers are able to do both surgical and medical abortions as competently as are doctors in relatively low-resource settings where the need is greatest."
Yap-Seng Chong and Eng-Kien Tan Comment, Lancet
Special cases: abortion
Abortion provision by mid-level providers is being addressed through a separate guideline developed by RHR department and is not included this process.
Guideline panel was convened in July 2011 and the guideline is currently going through GRC and publication clearance 3
Special cases
HIV-PMTCT questions were addressed– The recommendations made by this panel will feed into a more
comprehensive guideline that is in progress led by the HIV/AIDS department
Regulatory aspects of task-shifting programmes is being considered by HSS/HRH as a separate guideline. In the Opt4MNH guideline, these issues are highlighted in the evidence frameworks
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Special cases: Contraception
Contraception questions will be addressed by this panel.– HRP/RHR and The Reproductive Health Supplies Coalition (RHSC) will
support a follow-up finalization and operationalization meeting dedicated to contraceptive task-shifting/sharing
– This meeting will take place in Geneva on 26 June 2012
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Key interventions
Promotional interventions for maternal and newborn health
Distribution of oral supplements
Initiation and maintenance of antiretroviral treatment or antiretroviral prophylaxis for pregnant women and for prevention of HIV infection in infants Undertaking of external cephalic version (ECV)
Delivery of injectable antibiotics for preterm pre-labour rupture of membranes (pPROM) Continuous support during labour
Delivery of specific childbirth interventions
Postpartum haemorrhage related interventions
Vacuum extractionIntravenous fluid for resuscitation
Bimanual uterine compression
Suturing for genital lacerations
Manual removal of placenta
Prevention and treatment of postpartum haemorrhage
Pre-eclampsia/eclampsia related interventions
Antihypertensive use for high blood pressure
Delivery of loading dose of magnesium sulphate to prevent eclampsia Delivery of maintenance dose of magnesium sulphate to prevent eclampsia Delivery of loading dose of magnesium sulphate to treat eclampsia
Delivery of maintenance dose of magnesium sulphate to treat eclampsia
Management of puerperal sepsis using antibiotics before referral
Delivery of neonatal resuscitation
Initiation and maintenance of kangaroo mother care
Delivery of antibiotics for neonatal sepsis
Recommendation categories
1. Recommend2. Recommend with (targeted) monitoring and evaluation3. Recommend only in the context of rigorous research4. Recommend against
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