World Health Organization

1. World Health Organization Collaborating Center in Reproductive Health Emory University Woodruff Health Sciences Center The National Centers for Disease Control and Prevention (CDC) Georgia Department of Human Resources Division of Public Health Alfred W. Brann, Jr., MD, Director Woodruff Health Sciences Center Emory University Brian McCarthy, MD, Principal Investigator The National Centers for Disease Control and Prevention

2. Collaborating Center in Reproductive Health Vision Every woman should have the opportunity, if she desires, to experience a wanted pregnancy that results in a full-term normal baby, and following childbirth that she is alive and healthy and her infant is healthy and safe in the context of family and community.

3. Women’s Health • Education • Gender Issues • Religion • Culture/Society/Family

4. Women’s Health • Political Stability • Economy/Financial Security • Health Care System • Government Structure

5. NEED • More than 50% of the infant deaths annually occur during the first week afterbirth. • This is largely a consequence of a poorly functioning health care delivery system that results in the poor health of women, and poorly managed pregnancies and births.

6. NEED • Knowledge and skills exist today that can reduce by some 50% the excessive rates of both maternal and infant mortality. • This is possible if there are appropriate attitudes and if there is a functioning modern maternal and perinatal health care delivery system.

7. Collaborating Center in Reproductive Health Mission …to serve the people who serve the people... by enabling health professionals in ministries of health, departments of health, or universities to build a foundation of sustainable knowledge and skills in health services research through education using a state or country-specific health project at the level of the Health District.

8. The Balashikha Project MISSION • To dramatically improve U.S.-Russia relations through a public/private initiative addressing “the most acute problem facing Russia – “its declining population” (V. Putin, 2001).

9. The Balashikha Project WHY • Russia’s new births are not at replacement levels. Outmigration, decreasing adult lifespan (less than 59 years) and high infant mortality all contribute to its declining population.

10. The Balashikha Project WHAT • Create a sustainable reduction in population decline by decreasing infant mortality by 50% in a significant sized health region in Russia.

11. The Balashikha Project WHERE • City of Balashikha and the Moscow Oblast, Russia

12. The Balashikha Project HOW • Establish a maternal and perinatal health care delivery system (using an internationally integrated set of health strategies) in the Moscow Oblast to significantly reduce infant mortality, and serve as a model for the Russian Federation.

13. Levels of the Health Care Delivery System (HCDS) Informal • Skill • Knowledge • Attitude • Resources • Management • Manpower • Materials • Money Formal Inter- sectoral

14. The Balashikha Project • Components of a Maternal and Perinatal Health Care Delivery System • The Moscow Region Perinatal Center • Evidence-based Perinatal Guidelines • Modern Perinatal Surveillance System

15. The Balashikha Project • Components of a Maternal and Perinatal Health Care Delivery System • Continuous Quality Improvement Program • International Public Health Practice • Postgraduate Education-Distance Learning • Public Policy and Legal Assistance

16. The Balashikha Project Microsoft Health Care Application SoftwareVertical Health Initiatives such as Word, Excel, etc. such as HIV/AIDS, Polio, etc. Operating SystemsHealth Care DeliverySystem on which all Application on which all Vertical Health Software is placedInitiatives are placed.

17. The Balashikha Project WHO • The following partners have brought about the Balashikha Project.

18. The Balashikha Project WHO • Future of Russia Foundation ($2,000,000 in seed capital) • Rotary Club of Atlanta ($20,000) • Rotary Club of Stowe, VT ($20,000) • Elfin Society of General Electric Company (estimated $2,000,000 in Russia)

19. The Balashikha Project • Moscow Oblast Ministry of Health (Governor Gromov committed $3,000,000) • USAID ($500,000 – Global Development Alliance) • World Health Organization Collaborating Center in Reproductive Health (intellectual capital)

20. The Balashikha Project WHY SHOULD AMERICANS HELP RUSSIA? • Good health is a bedrock issue for building a democratic society and is essential for economic development. • Russia, with an educated and aspiring domestic workforce, can become one of our most important trading partners. • Russia is a strong ally of the U.S. in the war on terrorism. • Our support creates another level of mutual trust and respect.

21. The Balashikha Project “I thinknothing our generation could do is more important than getting Russia into the fold of ‘successful’ countries, and nothing worse could happen than to lose it.” Dr. Howard Mette, Rotarian and CCI/PEP Volunteer, Youngstown, Ohio, 2000

23. NEED The status of the health of the infant is dependent on the status of health of the woman and the pregnant woman.

24. NEED • The vast majority of men and women wish to have children. • All societies depend on their next generation for their survival, well being, success and social security.

25. NEED • Pregnancy and childbirth are the only normal physiologic processes associated with a risk of death. • Women (unlike men) are exposed to this risk of death during pregnancy and childbirth.

26. NEED • Finally, the health care system supporting pregnancy and childbirth is the one through which we must all pass, whether it is a good or bad system.

27. NEED • Problems in reproductive health affect many lives and families. • The morbidity and disability in both mother and child who receive suboptimal health care have devastating and permanent consequences. • These individual consequences further adversely impact society and its ability to not just survive but thrive.

28. Collaborating Center in Reproductive Health Focus The CCRH addresses one of the four top health problems facing the state of Georgia and the World - the complex health problems of reproductive-age women, pregnant women, and infants during the perinatal period of life.

29. Health Services Research- The systematic study of whether current medical and other relevant knowledge is effectively used to improve the health of a community under an existing set of conditions.

30. DATA…... INFORMATION…... INTERVENTION

31. Interventions for Reducing Mortality • Women’s and Maternal Health • Maternal and Fetal Care • Neonatal Care • Infant Care

32. The “Opportunity Gap”- The potential for reduction in excessive mortality based on a comparison between rates already achieved by one sub-population in a defined geographical area with those experienced by the remaining population.

33. NEED • The problems leading to high rates of mortality and morbidity are not randomly distributed – women who are economically and intellectually disadvantaged have, along with their infants, the highest mortality rates, regardless of whether they live in a third-world country or in third-world conditions in a developed country.

34. NEED • Any further significant reduction in infant mortality will need to focus on improving the health of the woman. • This will involve (1) changing the frequency of premature infant births, and (2) decreasing neonatal deaths, with a particular focus on the early neonatal period (1st week).

35. Georgia’s Six Perinatal Regions Hospital Perinatal Center

36. Management -a process for planning, implementing, and evaluating an organized response to a defined problem.

37. Management Process Performance Assessment Problem Definition Monitoring & Evaluation Intervention Are we doing the right thing? Are we doing things right?

38. The Management Cycle in Maternal and Child Health Care PROBLEM DEFINITION A Standard • High Risk vs. Lower Risk • Problem Description • Identification of Risk Factors • Identification of High Risk Groups

39. The Management Cycle in Maternal and Child Health Care Performance Evaluation Guidelines • Four Essential Questions to Be Asked: • What is supposed to happen? • What do people think is happening? • What do people say is happening? • What is really happening?

40. The Management Cycle in Maternal and Child Health Care INTERVENTION • What are they doing? vs What should they do? • Coverage • Referral Pattern • Matching Skill • Altering Risk Factors • Training/Education • Planning/Policy • The five R’s • The right person • At the right place • At the right time • Doing the right thing • Doing it right

41. The Management Cycle in Maternal and Child Health Care MONITORING & EVALUATION A Standard • Evaluation = Measurement & Comparison • Outcome • Process • Community Education • Training • Use of Appropriate Technology

42. Surveillance- a dynamic process which collects, analyzes, and responds to data on the occurrence and distribution of events in a defined population within a geographical area.

43. Data Surveillance System System of Data Analysis System of Data Collection A - Adaptable R - Responsive C - Cost Effective S - Simple System of Response

44. You can not manage... What you do not measure.

45. We are data rich… But information poor.

46. DATA…... INFORMATION…... INTERVENTION

47. Total Cohort Accountability • “Every pregnancy counts… • so account for every pregnancy.” • “Every newborn has weight… • so weigh every newborn.”

48. Perinatal Health Care Surveillance System Integrated Management Performance Assessment Problem Definition System of Data Analysis System of Data Collection A - Adaptable R - Responsive C - Cost Effective S - Simple System of Response Intervention Monitoring & Evaluation Are we doing the right things? Are we doing things right?

49. Conceptual Framework for Action Trigger Symbols • Model for the HCDS • Perinatal Surveillance Principles • Management Process

50. NEED • The World Bank (in a 1993 publication ―Investing in Health) described GOOD HEALTH as essential for economic development throughout the world and made two major recommendations.