Community Health Worker training session, Lesotho
In September of 2012, Dr. Hind Satti and the Partners In Health Lesotho team published a paper in PLoS One (an international online journal) on the Maternal Mortality Reduction Project. Please take a minute to read a summary of this paper below, written by Christian Hague of Partners In Health:
Lesotho Maternal Mortality Reduction Program Results
Background: In the mountain regions of Lesotho, women must often travel hours or even days by foot to access medical care. This lack of access leads many pregnant women to deliver their babies at home, far from the life-saving care of a medical facility. As a result, there are 1,155 maternal deaths for every 100,000 live births, giving Lesotho one of the highest maternal mortality ratios in the world. One in every 31 women in Lesotho will die in childbirth at some point during her life.  Women in Lesotho have an average of 3.3 children, so each maternal death contributes to an orphan crisis with an estimated 200,000 orphans out of a population of 970,000 children under age 18.1
To more aggressively and effectively prevent maternal deaths in Lesotho, PIHL and the Ministry of Health and Social Welfare began the Maternal Mortality Reduction Program (MMRP) in 2009. The MMRP aims to expand access to facility-based prenatal care and delivery by conducting active outreach to pregnant women in the communities PIHL serves. The backbone of the MMRP is a team of community health workers who accompany women throughout their pregnancy, ensure that they attend prenatal appointments, and encourage them to deliver their babies at the health center. These community health workers are rigorously trained, supervised, and receive regular training updates and monthly performance-based pay for their work.
The Status Quo in Global Health: In many remote regions around the world, maternal health is provided only at local health centers, which may be several hours’ walk for many pregnant women who need care. The lack of community-based follow-up in many of these poor communities causes women to deliver their children at home, where they are more vulnerable to poor outcomes or death as a result of a complicated pregnancy or delivery.
How PIH is Innovating: A recent publication by Dr. Hind Satti and others showed that, after establishing the MMRP at Bobete health center, PIHL made great progress in getting women to the health center for prenatal care and delivery. The average number of prenatal care visits at the health center increased from
20 to 31 per month. The number of facility-based deliveries increased from 46 in the year preceding the program to 178 in the first year of the program, and 216 in the second year (Figure 1). During the first two years, PIHL transported 49 women who were experiencing complications in pregnancy or delivery to the local district hospital for care. Not one woman who was enrolled in the MMRP died during this time. These positive results show that comprehensive, integrated, community-based care can be delivered to pregnant women living in extreme poverty in difficult-to-access areas, and can help those women deliver their babies safely.
The comprehensive care that PIHL provides as part of the MMRP is unlike anything that existed before the program. By getting pregnant women into the clinic for initial prenatal visits, PIHL is able to provide routine prenatal care, HIV testing and treatment, and a wide range of other essential services, including:
- HIV counseling and testing at initial prenatal visit (unless known to be HIV-positive) and at subsequent visits for patients who test negative
- Cotrimoxazole prophylaxis to prevent pneumonia in HIV-positive women who require it
- Initiation of antiretroviral prophylaxis for HIV-positive women
- Testing for syphilis at initial prenatal visit and again at 36 weeks
- TB screening, and treatment as needed, at each prenatal visit
- Hemoglobin testing for anemia at initial prenatal visit and 6 weeks later
- Tetanus toxoid vaccine (at least 3 doses for first pregnancies)
- Health education on topics such as HIV, nutrition, signs of labor, and newborn care
- Identification of high-risk pregnancies and instructions to deliver at district hospital
How PIH is Impacting Global Health: PIH is exploring ways to use the lessons learned from the MMRP at other PIH country sites, enabling us to build on the great innovations from Lesotho. Furthermore, we have made our MMRP training materials freely available to partners and other organizations doing similar work in Lesotho and beyond. These measures will ensure this innovative program will pave the way for others to make progress in bettering the health of the destitute sick around the world.
 Satti H et al. Comprehensive approach to improving maternal health and achieving MDG 5: Report from the mountains of Lesotho. PLoS One. 2012;7(8):e42700.
 Lesotho Demographic and Health Survey, 2009.