Universidad Peruana Cayetano Heredia
BRIGHTER FUTURESImproving maternal and child health
through innovative models for the uptake of POCTs
Why focus on mothers and children?
• Every year more than half a million women die from complications related to pregnancy and childbirth
• This means that one woman dies every minute
• Women are the foundation of their families, the educators and often, the only economic support
• Good antenatal care (ANC) is key• ANC requires a basic diagnostics package: HIV,
syphilis, anemia, glucose, malaria, protein and leukocytes
• In developing countries, there is poor ANC coverage and poor quality ANC
• Accompanying tests are often not available and results are not given in an opportune manner
Simple actions can improve MCH
• They are not available for the conditions needed or they are too complex
• We still don’t understand: – People’s needs, communities’ needs– Interface with IT (e.g. cell phones) – How to involve communities in implementation– How to implement in different environments – How to broaden their use (expansion)– Sustainability and costs
POCTs could help, but…
• To identify needs, costs, barriers and opportunities for the introduction of POCTs in ANC and child health care.
• To develop and evaluate a social business model for the introduction of POCTs, which could work in different environments, is designed for sustainability and has a positive impact on communities
Brighter Futures: Project goals
Community
Policy, laws, regulatory,
surveillance, logistics
Health guidelines
Health providers
Policy Makers
Market opportunities
(Private sector)
Technologies
New POCTsIT (cell
phones)
Model
Validation
Innovative model
“Brighter Futures”
Improvement of MDG 4, 5
and 6
Environment and structural
support for introduction of
POCTs in maternal & child
health Understand:
•Demand
•Supply
•Facilitators and challenges
Framework
• 3 sites– Ventanilla (Coast)
• Alt: 55m/a.s.l• Mat mortality: 55.3• Population 75,000
– Quispicanchis (Andes)• Alt: 3158 m/a.s.l• Mat mortality: 271.2• Population 30,000
– Yurimaguas (Jungle)• Alt: 148 m/a.s.l• Mat mortality: 180.1• Population 63,000
Total Population
28 807 034
76% urban
Sites
•Census of health establishments: services, tests and flows
•23 focus groups (10 MH, 13 CH) with 153 community members
•32 in-depth interviews with local health providers
•6 workshops with experts in maternal and child health
•15 interviews with local entrepreneurs
•2 workshops with entrepreneurs at national level
•Household survey with 1,200 community members
•Critical review of international and national MH/CH guidelines
Methodology
• Health providers believe in technologies• Communities believe in diagnostics (hx. and payment)• Access through health centers and local posts• Local champions• High penetration of cell phones• Success with POC syphilis• Private sector & Public sector• Some POCs in development
Opportunities
• Regulatory Issues• Requirement of local “distributors” : increase prices!
• Logistic issues • purchase system• Distribution• Waste management
• Health workers´ “fears” • Roles, power, costs
• Limited knowledge about diagnostics and attributes• Guidelines do not include POC/dx• Lack of POC now for the Maternal package!!!
Barriers
The most important diagnostic testsneeded for maternal health
Community members
• Anemia• Urinary infection• Hepatitis
Local health providers
• Anemia• Urinary infx
(E.coli)• Preeclampsia• Syphilis&HIV
National experts
• Preeclampsia • Urinary infx
(E.coli)• Asymptomatic
bacteriuria
•A package with all ANC tests as POCT:HIV, Syphilis, Hto, Glu, Urine & preeclampsia
Beauty consultants
Medical support
Referral
Explore needs of their clientsOffer orientation and counselingPOCs: Sample, testing and resultsRefer for management
POCs & Electronic support
cel phones/tabs
Transmission of results in real time
Result interpretation, support for health consultants, recommendations
Pregnant women: beauty and healthy!
Allow Beauty consultants to improve their income and status
Beauty consultant business model in process
Muchas Gracias!!