Thank you for supportering Partners In Health's Maternal Mortality Reduction Project in Lesotho. With help from supporters like yourself, Partners In Health Lesotho (PIHL) has succeeded in achieving the following program objectives in its catchment area:
Through this work, PIHL has successfully scaled up the Maternal Mortality Reduction Project across the entire PIHL network and extended access to health care to many of the most vulnerable women and children in rural Lesotho.
Maternal Health Workers are key to the program’s success – they accompany women throughout their pregnancies, promote testing and treatment for infectious diseases, and ensure attendance at prenatal appointments. Importantly, MHWs also support women and families to make the choice to deliver at a health facility with skilled health professionals, which reduces the risk of maternal and neonatal deaths due to emergency obstetric complications. MHWs continue to receive monthly, performance-based compensation for their work and monthly trainings by PIHL staff.
Mary (pictured above) is a 37 year old nurse-midwife that has been working with PIHL for ten years. She’s the lead on-site clinician at Tlhanyaku Health Center; she juggles a multitude of medical tasks while simultaneously providing administrative and logistical support to PIHL. The clinic she works at is located in one of the most remote regions – it is three hours from the nearest referral hospital. As Mary explains, “Our country is so mountainous. Doing outreach and home visits to some areas is difficult as the cars cannot reach those areas, hence we travel by horses or on foot.” She and her colleagues are improving health outcomes for women and newborns and catalyzing national system change. The MMRP is delivering real results. As she proudly reports, “Our efforts to stop HIV transmission are well coordinated. From a mother’s first antenatal care visit at which she’s tested for HIV, we accompany families. We provide education and support, and we continue to follow up with them.”
Thank you for your generous support of Partners In Health! We're thrilled to share the following excerpt, recently published on our website, announcing the Ministry of Health's transformative national initiative to ensure access to high-quality care for women and children in Lesotho, in which Partners In Health/Lesotho will play a major role.
Improving outcomes by working in the community
Lesotho is struggling to address some of the most pressing health challenges in the world. In recent years, the country has lost ground on important measures of health. Between 2000 and 2010, maternal mortality nearly tripled, from 419 to 1,155 per 100,000 live births. In the same period, the child mortality rate climbed from 110 to 119 per 100,000 live births. Meanwhile, nearly one in four people in the country has HIV—the prevalence of the virus has held steady at 23.6 percent since 2004. This HIV crisis has helped fuel a nationwide tuberculosis epidemic—Lesotho is one of few sub-Saharan countries where TB incidence has climbed by more than 10 percent over the past two decades.
In 2006, the government of Lesotho invited PIH to help tackle some of these challenges, beginning by supporting the Ministry of Health in a handful of rural health centers. Following the PIH approach, the goal was to design and implement a comprehensive program that addressed the social determinants of illness, such as poverty, hunger, and poor work conditions, that prioritized equity, and expanded access to care for vulnerable patients in a small number of districts. PIH/L’s initial strategy focused on bringing the health system to the people who needed it by improving services at hard-to-reach mountain clinics. Village health workers (VHWs) were vital in this strategy, forging trusting relationships between patients and clinicians and overcoming cultural and economic barriers that impeded access to care.
As the years went on, PIH/L’s ambitions expanded. In 2009, in the village of Bobete, the organization piloted its Maternal Mortality Reduction Program (MMRP)—a truly integrated approach to maternal care that weaves comprehensive accompaniment and active case finding with antenatal care, HIV testing and counseling, family planning, and an array of other clinical services. Identifying patients as early as possible allows PIH/L to help prevent pregnancy-related complications, mother-to-child transmission of HIV, and other problems that claim the lives of mothers every day in Lesotho.
A cornerstone of the program is maternal waiting homes. Many pregnant women walk hours on treacherous mountain paths, sometimes in the snow, to reach clinics. Doing so while in labor could spell disaster—or keep women from trying to reach a facility at all. Maternal waiting homes provide a comfortable space for soon-to-be moms so that when labor begins, they are only a few feet from trained medical staff and a well-stocked health facility.
“We improved infrastructure, we treated patients with dignity, we addressed transportation challenges and we made sure expectant mothers were accompanied to the clinics before their due date,” PIH/L Director Dr. Hind Satti said. “Focusing on these issues and properly training staff made a significant difference. Addressing maternal mortality is a gate for us to address all aspects of women’s health—empowering women, which impacts their children’s and families’ health.”
The program was a major success. The year before the program launched, only 46 women delivered at Bobete Health Center. The year after, more than 215 women delivered at the facility. PIH/L expanded the program to seven different health centers, and each health center saw noticeable jumps in the number of facility-based deliveries. The program also yielded significant improvements in the number of women being tested for HIV, child vaccination rates, TB detection efforts, and family planning.
PIH/L’s approach and successes caught the attention of the country’s leaders.
The question: How did PIH/L achieve substantial, sustainable progress toward key health indicators in some of the most rugged parts of Lesotho, while the rest of the country was losing ground on the same measures? Could Lesotho adopt the PIH/L model at a national level?
A new level of accompaniment
In late 2013, PIH/L and the Ministry of Health began collaborating on a plan to scale up the maternal mortality program so that all health clinics would be able to deliver a comparable level of care to what PIH/L had been delivering for years. While PIH/L will be intimately involved in training staff and providing technical assistance, the health centers will remain under the purview of the Ministry of Health. The national reform will occur in three phases over five years.
The first phase, happening now, focuses on bolstering infrastructure, improving the supply chain, designing monitoring and evaluation systems, training staff, and building a system to support a cadre of VHWs who will be vital to earning the trust of communities. The first phase focuses on four districts.
The second phase will bring the reform to the country’s six remaining districts, rigorously document outcomes from phase one, and disseminate those findings so the program can be modified as needed.
The third phase, expected to occur in 2018, will focus on evaluating and analyzing the impact of the program. Thorough documentation may prove invaluable for other poor countries struggling with maternal and child mortality.
“This program will show that it is possible to deliver better services for patients and better outcomes at a lower cost when you work with, and work in, the communities,” Satti said.
In the first few months of the reform, nearly 2,000 VHWs have been trained, and a new national VHW policy has been approved. The team has conducted more than 50 baseline assessments and trained dozens of nurses.
Among those nurses is Justinah Kuotso at the Mohalinyane Health Center, one of the first health centers to undergo the reform. It was Kuotso who accompanied Masechaba Molefsame when she arrived at the clinic in late April. After a week and a half in the maternal waiting home, Molefsame went into labor. Staff worked together seamlessly to deliver a healthy baby girl—the first child delivered under the national reform.
In Lesotho, it is tradition not to name a baby until after the umbilical cord has fallen off. In the days after the delivery, staff at the health center affectionately dubbed the newborn “Reform Baby.” In the following weeks, several more babies, including a set of twins, were safely delivered at clinics throughout the four districts where the reform began.
In Lesotho, the challenges are still immense, and resources still limited. But with a generation of “Reform Babies” on the way, Lesotho has reason to hope for a bright and healthy future.
I’m writing to give you an update on our work to save mothers’ lives, and to show what you’ve helped accomplish as a Partners In Health supporter. Every day, thanks to your generosity, Partners In Health (PIH) is working to bring care to the people who need it most. And no patient we serve needs access to care more than a woman in labor.
Amazingly, in 2014, women still die in childbirth—nearly 800 every day. Almost all of these women live in poor countries. In the U.S., death during childbirth was all but eradicated at the turn of the 20th century. In fact, the Brigham and Women’s Hospital, where I serve as faculty, was founded in 1832 as the “Boston Lying-in Hospital.” Why? Because 150 years ago in the U.S., we recognized the need for women to be close to care when delivering their babies—close to doctors and nurses and close to facilities if surgical care was needed.
In the countries where we work, from Haiti, to Malawi, to Lesotho, we’re still working to spread this high level of care. And together with partners like you, we’re moving toward a future with zero maternal deaths—providing the first-rate health care every woman deserves, no matter where they live, and no matter where they’re from.
This past fall, my colleagues released the inaugural edition of PIH Reports, a series exploring innovations in global health care. The first report, The Role of Maternity Waiting Homes as Part of a Comprehensive Maternal Mortality Reduction Strategy in Lesotho, provides an in-depth look at how maternity waiting homes at remote clinics in Lesotho are increasing the number of facility-based deliveries, making childbirth safer in a country burdened with significant challenges. Per every 100,000 live births, 620 women will die in this tiny African kingdom, where rugged, mountainous terrain and a high burden of HIV present unique hardships. And to provide maternal health care to mothers across the nation, we’ve joined key partners to develop an all-inclusive strategy to save women’s lives.
In this report, we share the effectiveness of maternity waiting homes as part of this strategy to reduce maternal mortality. These homes allow women in Lesotho to make the rigorous trek a week or two before they anticipate going into labor. Once there, a woman can relax for the remainder of her pregnancy, knowing she’s only a few yards from trained medical professionals, needed equipment, and medicines.
And to ensure a safe pregnancy and delivery for expectant mothers in Lesotho, we’ve developed a comprehensive plan—from the community health workers who accompany them to prenatal appointments, to the waiting houses, to the midwives, nurses, and doctors who provide safe deliveries at the health center. And these clinic-based deliveries, with medical staff at the ready and adequate supplies in tow, can be the difference between life and death. I’m excited to report that at the PIH-supported clinic in the village of Bobete, where this comprehensive approach was launched, the number of facility-based deliveries has increased 370 percent since 2009.
If you are interested in reading the report in full, you can download it on our website at http://www.pih.org/knowledge-center.
At PIH, we won't settle for a world where mothers die for lack of access to health care. Instead, we’ll expand our work to provide prenatal care, safe deliveries, and crucial family planning to women across the countries where we work—bringing the fruits of medical science to some of the world’s poorest, hardest to reach communities.
On behalf of my colleagues and partners, please accept my sincere thanks for your support and for believing in us.
Dr. Joia Mukherjee Chief Medical Officer
Above: Maternal Health Worker Malineo Sethobane works in the village of Lipeneng, Lesotho.
Thank you so much for your support of the Maternal Mortality Reduction Project at Partners In Health/Lesotho. We are excited to share the following story with you, which was published in our recent Partners In Health newsletter. Thanks to your generosity, PIH/Lesotho can make pregnancy safe for more mothers and more babies in Lesotho.
Lesotho is among the most dangerous countries for pregnant women.
From conception to delivery, daunting terrain, sparse medical facilities, and cultural barriers make it difficult to access proper health care.
In this mountainous nation, for every 100,000 live births, more than 1,000 women die from pregnancy-related complications. That gives Lesotho one of the highest maternal mortality ratios in the world. Malineo Sethobane is helping change this.
The 50-year-old mother of five began working for Partners In Health/Lesotho in 2010 as a maternal health worker (MHW) in the village of Lipeneng. In the few years Sethobane has been working as an MHW, she’s accompanied several mothers from the village to the health center and made hundreds of home visits.
She says she’s learned that commitment to the individual patient is vital, and that simple steps can improve the health of an entire family.
Sethobane commonly accompanies patients through their entire pregnancies to make sure they get prenatal care and deliver their children in a safe environment, with trained medical staff at the ready.
The results are encouraging: At the clinic in Bobete, the number of facility-based deliveries has increased 370 percent since 2009.
“We are not going to accept any maternal deaths,” said Dr. Hind Satti, PIH country director for Lesotho. “It takes commitment and teamwork to make this happen.”
When Parters In Health/Lesotho (PIH/L) staff found Matsepiso (pictured above), she had barely survived 36 hours of obstructed labor at home without a skilled health care provider. Her pelvis was broken, her baby was dead, and she had developed an obstetric fistula—an abnormal opening—which not only prevented her from moving, but also caused her partner to reject her. Matsepiso was alone, and her life was ruined at age 19.
What Matsepiso needed was a proper hospital with surgeons, an operating theater and anesthesia, antibiotics and a blood bank, but there was no such thing anywhere near her village. After complicated negotiations with hospitals closer to Lesotho, PIH/L was able to arrange for free treatment in an Ethiopian hospital (an 8 hour trip by plane), where she remained for treatment for one year.
Matsepiso returned to her village and has since given birth to a healthy baby. Furthermore, she joined our team of community health workers, working with PIH/L to provide high-quality maternal care to prevent such injuries from happening again.
We cannot afford to medevac every woman who needs it, but we equally can’t afford for mothers to die in delivery, orphaning their other children to be raised—or not—by someone else. This is why Partners In Health works to improve the system that failed Matsepiso, by make it safer for women to give birth in the first place: by offering family planning services and comprehensive pre- and postnatal care, by getting women to clinics to deliver their babies, and by providing access to emergency obstetrical care so when a narrow young woman like Metsepiso is in difficulty, a doctor can intervene, save her life and save her child.
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