In the next five years, MIHI will expand its work in the various districts of the country's Central Province to strengthen the maternal and infant care delivery systems. The initiative incorporates evidence based and effective interventions in tackling specific diseases (e.g., AIDS, malaria), and addresses problems in the maternal and infant health-care system by expanding women's access to quality antenatal and delivery care.
Critical components of the initiative include:
(1) An advanced midwife training program to provide skilled obstetric and newborn care
(2) Upgrades of selected Zambian health centers and hospitals; and
(3) Development of an integrated system of health facilities and transport for women and infants.
This comprehensive MIHI approach is novel, in that it: (a) intervenes on an entire system of care, rather than focusing on discrete diseases, specific approaches, or singular facets of the health-care system; and (b) involves a unique working collaboration between the First Lady of Zambia, Zambian government agencies, Zambian hospitals, and several Harvard-affiliated teaching hospitals; who all work closely with Zambian communities.
The initiative consists of three major activities that are closely aligned with the Millennium Development Goals. Phase I of this initiative will serve a district in the Central Province of Zambia. The Zambian government, informed by data from a needs-assessment conducted by the MIHI monitoring and evaluation team will select the district. During its second phase, the initiative will expand to the entire Central Province.
1. Integrating and upgrading the maternal and infant health delivery system: MIHI plans to develop integrated systems of maternal and infant health care, using the concept of levels of care, in each district. A district system will include a hospital that can provide comprehensive emergency obstetric care (e.g., C-section, blood transfusion) and 4 health centers that can provide basic emergency obstetric care as well as antenatal services. The initiative involves either upgrading existing facilities, or placing new, prefabricated modular units adjacent to existing facilities. Upgraded health centers will have adequate amounts of properly-stored obstetric and pediatric medications, including MgS, Oxytocin, Misoprostol, anti-malarial, anti-bacterial and anti-HIV medications and immunizations. With their modern and attractive design, the health centers will make mothers feel safe and comfortable. This 'system' of hospital and health centers will match health needs with the appropriate level of care, bringing improved healthcare closer to the homes of the mothers and babies who need it, and serve more patients overall.
2. Advanced midwife training program: The advanced maternal and infant midwife (AMIM) curriculum centers on non-surgical, and surgical, emergency obstetrical care and integrates other topics known to improve maternal and infant health outcomes (e.g., antenatal care with emphasis on malaria, HIV/AIDS, tetanus immunization). The program will be taught using case studies, simulation, and clinical integration. Midwives in this training program will also receive training in community outreach and leadership. The AMIM curriculum will be pilot-tested with the first cohort of midwives and refined for subsequent cohorts. This training program aims to train 30 midwives per semester, and in five years, will train at least 300 advanced midwives. This increase in effective, local human resource capacity will help strengthen the health system of Zambia and our active faculty presence will elevate the country's capacity for training new midwives by doubling the annual number of graduates. In addition, MIHI is developing a continuing education program for all midwives to help guarantee the initiative's long-term success.
3. Antenatal care and community outreach: Activities 1 & 2 can only be effective if Zambian families are aware of, willing to seek, and able to get to appropriate medical care. Using basic public health principles and social marketing schemes, we will design and implement this system so that it responds to local norms, perceptions, and needs. We will work with community leaders and neighborhood networks to improve knowledge of the availability of care at the health centers. A comprehensive transportation strategy will include a 'travel' plan for women during their antenatal care visits to help women receive timely and appropriate care at health centers and hospitals.
The first class of 15 to 20 trained midwives will staff the upgraded health centers in the pilot district (phase I) with the district hospital being staffed by at least three providers skilled in comprehensive emergency obstetric care and anesthesia services. The Harvard hospitals-based team will work closely with the Zambian Ministry of Health, and other partners, to implement the system, troubleshoot, and jointly find solutions.
Anticipated Launch: September 26, 2007
Tthe MIHI was written in as line item in Republic of Zambia's national budget
Formal MIHI limited company by guaranty set up in Zambia in September that includes U.S. and Zambian board directors; Core field staff and medical volunteers mobilized in Zambia; Due diligence/original epidemiology study completed by our medical epidemiologists on the capacity of health centers in Zambia; Birthing center construction set to begin.
First cohort of midwifes trained in emergency obstetrical care.
Completion of selected birthing centers.
SEEKING: Investment capital, donations, grants, in-kind corporate donations (e.g., 4x4 vehicles) and professional services (e.g., legal, accounting) that will allow MIHI to complement existing strengths - highly-trained medical and public health faculty, significant administrative operating capacity, and tight alignment with, and commitment from, Zambia's government. Specifically, they are seeking investments totaling $2 million, which will allow them to expand the number of districts served in the Central Province.