Care-Seeking & Referral for MNCH Community of Practice webinar - Shared screen with speaker view
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Hello from Boston in US
Morning/Afternoon, all! Looking forward to the conversation!
Good morning, afternoon and evening to everyone!
To join the CoP, register here https://communities.harpnet.org/care-seeking-and-referral/join
Good Morning / Good Afternoon from Kampala Uganda
An interesting perspective on this inter-connectedness of the system are described in this recent paper about Shanghai (although data from 2010): https://pubmed.ncbi.nlm.nih.gov/33141176/
We put the links to three papers in this series - including the paper written by Dr Vergara - in the invite.
Developing a Common Understanding of Networks of Care through a Scoping StudyAndy E Carmone, Katherine Kalaris, Nicholas Leydon, Nicole Sirivansanti, Jeffrey M Smith, Andrew Storey, Address Malatahttps://www.tandfonline.com/doi/full/10.1080/23288604.2020.1810921Building Trust to Save Lives in a Metro Manila Public-Private Network of Care: A Descriptive Case Study of Quirino Recognized Partners in Quezon City, PhilippinesMaria Theresa Martinez Vergara ,Eleanor Angulo de Vera, Andy E. Carmonehttps://www.tandfonline.com/doi/full/10.1080/23288604.2020.1815473?src=recsys
Alison Morgan, GFF Secretariat
if emergency referral is needed for >15% of births it is no longer emergency but is really a routine service and perhaps our framing of referral as an emergency has been the reason why it hasn't worked - if 2020 has taught us one thing is that advance emergency preparedness is not what gets prioritised. If instead we assumed that intrapartum referral is to be expected in many cases then we might embed referral in the way we embed other routine care
Alison. I love this frame shift.
Getting to know each other - please describe who these people are in more detail. I have worked in systems where we did this on the individual provider level and in systems where it is organizational.
Really sensible and comprehensible framing, Alison.
A routine part of the system that often needs to be activated in a time sensitive (emergency) way?
We will share the slides & recording at this page https://www.harpnet.org/care-seeking-referral-community-of-practice-webinars/
Sharing with attendees too:The book "Leave No One Behind" may be of relevance(?) - reviewed here:https://hodges-model.blogspot.com/search?q=lnobThanks.
Please join our Community of Practice at this link https://communities.harpnet.org/care-seeking-and-referral/join
Thanks Sara, looks great!
these frameworks are very relevant to many areas, I wish more people used them. We helped develop a very similar model around congenital heart disease in Kerala, focusing on newborns. Paper is forthcoming - A Population Health Approach to Address the Burden of Congenital Heart Disease in Kerala, India. And here is the Kerala government's website for the program http://hridyam.kerala.gov.in/
thank you so much for organizing this, very useful information
Thanks for the acknowledgment of the BetterBirth study and the framing of “systemness,” Jeff! Here is the link to the report in case helpful to participants: https://betterbirth.ariadnelabs.org/
I deeply appreciate the Dr. Vergara’s point about the human skills needed to set up the network and the resources (financial and otherwise) to make this work.
Joined CoP TY
Do people have questions for Jeff and Dr Vergara.
Please type here
Thanks to all the webinar participants who joined our CoP!!
Alison Morgan, GFF Secretariat
Thanks for great presentation Dr Vergara - really helpful to hear that connecting health facilities is not just about providing transport connections but that the respect and relationship connections between facilities/HWs are as (or more) important
What was the change in your referral rate overall? Did you define “appropriate referrals”? If so, how? What was the change in rate of appropriate referrals?
Thank you for the presentation, Dr. Vergara! As part of the network conversation, was there feedback provided back to front line facilities/clinicians as women moved from higher levels of care back to the community?
Thanks for the great presentation! I would be curious to hear how Dr. Vergara could envision scaling-up this model. Considering the importance of relationship-building (and how this is very context specific), how would you recommend using or adapting this approach across health systems at a larger scale?
Just want to add my thanks for a really interesting presentation. In an ideal world, early detection of risk for ob complications would consistently happen. But in the real world, and in some settings, this may not be feasible. And risks for newborns may not be identified at birth. Given this, might we think about an expanded view of emergency transport, i.e. that there is a spectrum of need for actual transport in some settings and situations? Welcome your thoughts on this.
Alison Morgan, GFF Secretariat
yes to hubs....When is a skilled birth attendant not a skilled birth attendant? When they work alone...
Thanks for the great presentation!
Thank you for this important webinar and fascinating discussion. What are your thought about the potential of focusing more on a governance lens in relation to the networks of care. Helen Schneider’s recent paper on district governance for MNCH makes a compelling case to shift focus from the technical elements to the governance aspects which seem very central to the work that was presented here. https://www.tandfonline.com/doi/full/10.1080/23288604.2019.1669943 and sorry for reposting but wanted to go to all attendees too :)
Thank you Mary! I was just going to say - how do we institutionalise this within the existing governance structures -MOH, districts, etc.
What information and how did the patient health information move with the patient?
Could Dr. Vergara speak to payment for care? How was this addressed for deliveries in midwife clinics vs hospital? Does insurance cover these costs regardless?
Support Sara’s question. We worked in a system where we paid MWs the same fee for an appropriate referral and a delivery.
I can't stress more the importance of relationships, it's the cornerstone of any successful work. they also make it harder to scale. Can you speak about that?
A great point, Loveday.
Thanks for this presentation. I was also going to mention how much cost factors into these networks, especially if there are public and private facilities with different capabilities. Higher level facilities may be geographically accessible but still not part of the same public "network" and women/newborns may be 'detoured' to further facilities.
Agree Loveday! It might not be a specific budget line - but it does cost in terms of people time. And if there are not enough health workers, is there even time for a cup of tea to build relationships?
The slides & recording will be available at this page https://www.harpnet.org/care-seeking-referral-community-of-practice-webinars/
Agree! relationship- and trust- building takes time, which has a cost to the whole health system
PAULINO-MORENTE, Joanna Marie
Very informative discussion, Dr. Vergara!
Excellent discussions!! Thank you!!
Thank you all! Looking forward to the continuation of the CoP on CareSeeking & Referral.
Join here https://communities.harpnet.org/care-seeking-and-referral/join
The BMGF has just commissioned the IR on Networks of Care and it will start in the coming months. So the results of the IR won't be available for some time. However, the case studies in the journal supplement are available now.
Thank you all. If I can help publicise anything..?
Should we plan something as a group for AlignMNH conference?
Thanks for a terrific conversation! I look forward to more to come, and getting involved :)
Elizabeth - SSi
Thank you Loveday for your Championing of this effort!
congrats for this!
Elizabeth - SSi
Thanks All - great converssation