Round 4 Innovators

Our plan is to scale up a proven e-voucher program covering the costs of maternity care and SMS reminders in order to reduce financial and informational barriers to care and to dramatically increase skilled facility-based deliveries. Specifically, we plan to (1) double the rates of institutional and skilled deliveries; (2) increase the rates of antenatal and postnatal care, particularly the number of women who receive four or more antenatal visits; (3) improve the quality of care delivered by incentivizing CHWs; and integrate our vouchers with a Government health financing plan.

The problem identified is the low uptake of MNCH services in Muslim communities in Northern Nigeria (NDHS 2008 and 2013). Misinformation and mis-perceptions preached by Islamic scholars on Islamic precepts on family planning, child-spacing, breastfeeding, immunization and child rearing practices contribute to this situation. In our previous SLaB project the dRPC identified 14 Islamic scholars and 28 apprentices who preached against MNCH interventions and transformed them into champions for correct messages and practices.

The six-week well-baby visit is crucial to the health of the postpartum mother and her baby. For the infant, the visit includes growth monitoring and crucial immunizations. Many mothers also accept family planning (FP) at this time (typically DMPA or pills in sub-Saharan Africa). After the six-week visit, the follow-up schedule for both immunization and FP includes three more visits during the first year, but not a single one of these six visits overlaps!

Postpartum Hemorrhage (PPH), the leading cause of maternal mortality worldwide, affects 14 million women and claims 150,000 lives annually. 99% of deaths occur in low-resource settings, where the majority of women give birth at home. The primary cause of PPH is uterine atony (80% of cases) and treatment includes administering uterotonic drugs to induce contraction and applying pressure on the uterine surface to minimize blood loss.

Brain injury and death from severe neonatal jaundice is a preventable global health tragedy. Despite the relative simplicity of the cure, blue light phototherapy, rapid deployment of this treatment in rural, low resource areas of India has proven to be logistically challenging due to high equipment cost, distribution difficulties, and unreliable line power. Infants requiring phototherapy must be transported to urban referral facilities, often traveling for many hours. The resulting treatment delay places these newborns at high risk for adverse outcomes.

Oxygen saturation (SO2) is known as the 5th vital sign – a simple yet important reading strongly associated with various deadly neonatal complications during birth or postnatal care, including birth asphyxia and childhood pneumonia. Affordable oximeters are nearly non-existent in most first-level clinics where the majority of mothers and babies are initially treated – even present in some tertiary facilities, they are not suited for newborns due to a clip design and requirement of constant disinfection which is not realistic in the resource-poor regions.

Oxytocin injection is the standard of care for the management of postpartum haemorrhage. Universal access to this essential medicine is currently limited in resource poor settings due to the requirement for refrigeration, consumables (needles, syringes etc.) and trained medical personnel for storage and administration. To address these roadblocks, Monash is seeking to develop an affordable heat-stable, self-contained, simple to administer inhaled delivery system for oxytocin.

Postpartum hemorrhage (PPH) continues to be a major cause of maternal mortality globally, especially in low-resource settings where most women lack access to quality, assisted delivery by skilled birth attendants and are at high risk for suffering PPH. PPH can be effectively prevented by the intramuscular delivery of oxytocin (WHO’s preferred drug of choice for PPH prevention) but issues with oxytocin stability and the administration route have limited its availability in low-resource settings.

The overarching focus of PharmAccess is on improving access to affordable and quality maternal and child health care for low-income families in Nigeria. The essence of PharmAccess comprises an integrated approach of complementary initiatives that increase resources, efficiency and effectiveness within the healthcare system. Through quality improvement, loans for healthcare providers, and health insurance, the demand for and supply of care is stimulated.

Preeclampsia (PE) is a disease without targeted treatments. We propose a simple strategy to solve this problem: we will establish a cell-based assay to screen clinically-available, mostly generic and inexpensive, drugs that may have a therapeutic effect on PE. To do this, we will utilize new scientific knowledge, showing that anti-angiogenic factors released from the placenta trigger maternal vascular injury essential for the development of PE.

Hemorrhage is the leading cause of maternal mortality in the first trimester across Sub-Saharan Africa, often due to ectopic pregnancies. Over 20,000 of cases occur in Ghana with 87% of these becoming ruptured ectopic pregnancies. During a ruptured case, 1/3 of the mother’s blood pools in her abdomen causing acute anemia and a high risk for mortality. Due to a lack of donor blood and appropriate equipment, the women’s own blood must be transfused through a procedure that relies on a soup ladle and gauze.

Still birth and birth hypoxia remain challenge for many developing countries including India. Appropriate monitoring is important to detect the at-risk mothers and fetuses for complicated labour, fetal distress, birth hypoxia, still birth and neonatal death. Cardiotocography (CTG) is widely used for monitoring in later pregnancy and during labor to detect at-risk mothers and fetuses. CTG device or Doppler FHR monitor is not available at most of the public health facilities in India.

Substandard medicines account for approximately $75B of a $962B global pharmaceutical market and over 100,000 preventable deaths annually leading to tremendous financial loss and emergence of long-term drug resistance. Estimates indicate that 30-50% of all antimalarials are substandard. Additionally, while oxytocin has demonstrated high efficacy in saving lives of at-risk mothers, it routinely fails quality tests. Production and sale of substandard drugs are indicators of a compromised health system that greatly undermine health programs.

Every day, 750 pregnant women, 7200 fetuses, and 8200 newborns die – almost uniformly from preventable causes. Over 99% of those deaths occur in less developed countries, often shortening the lives of individuals who have been unable to access effective health care (either at all or in time). Generally, women die from complications of pregnancy and childbirth that lead either to low (bleeding, prolonged labour, and sepsis) or high (hypertension) blood pressure, as well as intercurrent illnesses (HIV, malaria, and tuberculosis).