Universidad Peruana Cayetano Heredia

BRIGHTER FUTURESImproving maternal and child health

through innovative models for the uptake of POCTs

Why focus on mothers and children?

• Every year more than half a million women die from complications related to pregnancy and childbirth

• This means that one woman dies every minute

• Women are the foundation of their families, the educators and often, the only economic support

• Good antenatal care (ANC) is key• ANC requires a basic diagnostics package: HIV,

syphilis, anemia, glucose, malaria, protein and leukocytes

• In developing countries, there is poor ANC coverage and poor quality ANC

• Accompanying tests are often not available and results are not given in an opportune manner

Simple actions can improve MCH

• They are not available for the conditions needed or they are too complex

• We still don’t understand: – People’s needs, communities’ needs– Interface with IT (e.g. cell phones) – How to involve communities in implementation– How to implement in different environments – How to broaden their use (expansion)– Sustainability and costs

POCTs could help, but…

• To identify needs, costs, barriers and opportunities for the introduction of POCTs in ANC and child health care.

• To develop and evaluate a social business model for the introduction of POCTs, which could work in different environments, is designed for sustainability and has a positive impact on communities

Brighter Futures: Project goals

Community

Policy, laws, regulatory,

surveillance, logistics

Health guidelines

Health providers

Policy Makers

Market opportunities

(Private sector)

Technologies

New POCTsIT (cell

phones)

Model

Validation

Innovative model

“Brighter Futures”

Improvement of MDG 4, 5

and 6

Environment and structural

support for introduction of

POCTs in maternal & child

health Understand:

•Demand

•Supply

•Facilitators and challenges

Framework

• 3 sites– Ventanilla (Coast)

• Alt: 55m/a.s.l• Mat mortality: 55.3• Population 75,000

– Quispicanchis (Andes)• Alt: 3158 m/a.s.l• Mat mortality: 271.2• Population 30,000

– Yurimaguas (Jungle)• Alt: 148 m/a.s.l• Mat mortality: 180.1• Population 63,000

Total Population

28 807 034

76% urban

Sites

•Census of health establishments: services, tests and flows

•23 focus groups (10 MH, 13 CH) with 153 community members

•32 in-depth interviews with local health providers

•6 workshops with experts in maternal and child health

•15 interviews with local entrepreneurs

•2 workshops with entrepreneurs at national level

•Household survey with 1,200 community members

•Critical review of international and national MH/CH guidelines

Methodology

• Health providers believe in technologies• Communities believe in diagnostics (hx. and payment)• Access through health centers and local posts• Local champions• High penetration of cell phones• Success with POC syphilis• Private sector & Public sector• Some POCs in development

Opportunities

• Regulatory Issues• Requirement of local “distributors” : increase prices!

• Logistic issues • purchase system• Distribution• Waste management

• Health workers´ “fears” • Roles, power, costs

• Limited knowledge about diagnostics and attributes• Guidelines do not include POC/dx• Lack of POC now for the Maternal package!!!

Barriers

The most important diagnostic testsneeded for maternal health

Community members

• Anemia• Urinary infection• Hepatitis

Local health providers

• Anemia• Urinary infx

(E.coli)• Preeclampsia• Syphilis&HIV

National experts

• Preeclampsia • Urinary infx

(E.coli)• Asymptomatic

bacteriuria

•A package with all ANC tests as POCT:HIV, Syphilis, Hto, Glu, Urine & preeclampsia

Beauty consultants

Medical support

Referral

Explore needs of their clientsOffer orientation and counselingPOCs: Sample, testing and resultsRefer for management

POCs & Electronic support

cel phones/tabs

Transmission of results in real time

Result interpretation, support for health consultants, recommendations

Pregnant women: beauty and healthy!

Allow Beauty consultants to improve their income and status

Beauty consultant business model in process

Muchas Gracias!!