Improving the use of Maternal Health Commodities through Guideline Implementation in Low and Middle Income Countries

Session: New Approaches for Persistent Problems: Improving Availability of Life-saving Commodities for Women and Babies

Presenter: Dina Khan, World Health Organization
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LMICs experience complex challenges around the uptake and implementation of evidence-based clinical practice guidelines. In the context of the UN Commission on Life Saving Commodities, we aimed to reduce maternal and infant morbidity and mortality in LMICs by encouraging stakeholders to appropriately implement clinical practice guidelines and optimize the use of oxytocin, misoprostol and magnesium sulfate at the bedside.   Through the use of a unique knowledge translation (KT) approach that includes exploration of country-specific priorities, barriers, and facilitators, we partnered with four LMICs (Uganda, Tanzania, Ethiopia and Myanmar) to develop a tailored and ready-to-use implementation strategy to enhance guideline uptake locally. A multiphase approach was used. . In consultation with country partners, relevant local stakeholders (e.g. health care providers, administrators, researchers/academics, policymakers) were identified and engaged. WHO guidelines were selected based on local priorities for improving use of oxytocin, misoprostol and/or magnesium sulfate. To identify priorities, barriers, facilitators and options for guideline implementation, we conducted online surveys, and held country workshops using focus group discussions, a group nominal technique and RAND appropriateness methods with local stakeholders. Contextualized implementation strategies were developed and are being implemented. Ongoing resources and coaching support are also being provided.   Our unique KT approach aimed to address current challenges associated with use of maternal health commodities in LMICs. LMIC stakeholders were supported in identifying and assessing the contextual factors that affect guideline use, as well as in developing a tailored implementation action plan. There were significant similarities in challenges to guideline implementation across the four countries that can aid other countries in their efforts. We have developed a range of implementation resources and tools (www.greatnetworkglobal.org) for LMICs to use and adapt, in order to implement guidelines at local level in an evidence-based way.