Awards

Khurshid Talukder from the Centre for Woman and Child Health in Bangladesh will scale-up their proven approach using a package of 11 service interventions, including antenatal counselling and supportive care during labor, to reduce the cesarean section rate across Bangladesh. Bangladesh has an unnecessarily high cesarean section rate, which can have severe short and long-term health consequences for the mother and child. They developed a multi-service intervention to reduce the rate in their own hospital from 65% to 42% over two years. They will hold workshops at six other large maternity units for tailoring the intervention package to local needs, and train managers and maternity personnel to effectively deliver it in their clinics over an 18-month period. They will evaluate the effect of their approach on reducing cesarean section rates.

Tanya Doherty of the South African Medical Research Council will assess different contracting models for the National Health Insurance, which has been charged with providing universal health services purchased from both the public and private sectors across South Africa, to ensure that cesarean sections are only performed when appropriate and safe. Key challenges are to ensure that rural and over-loaded regional hospitals are able to meet service demands for obstetric care and that inappropriate care practices of the private sector, particularly the high cesarean section rate, are not applied to the entire population. They will perform case studies at four rural and urban district hospitals to evaluate different pricing and remuneration models, such as a global fee irrespective of mode of child delivery and contracting private practitioners for rural areas, and document their effects on the rates and safety of cesarean sections, and overall costs.

Joshua Vogel of the Burnet Institute in Australia will generate evidence to support adoption of the new WHO Labor Care Guide to reduce the rate of cesarean sections and enhance the quality of care during childbirth by developing an implementation strategy for hospitals in India. In many low-middle income settings, women giving birth in busy hospitals are often alone, undermedicated, and inappropriately monitored, which increases the rates of cesarean sections. The WHO Labor Care Guide is a decision support tool for health workers to more effectively monitor labor progress and provide appropriate medical and supportive care. However, it has not been widely adopted. They will hold a workshop with providers, hospital administrators, and women's groups to develop and refine their implementation strategy. They will then conduct a cluster-randomized pilot trial in four maternity hospitals in India to test their strategy and evaluate its effect on the rate of cesarean sections and women's childbirth experiences.

Jody Lori of the University of Michigan in the U.S. will implement a WhatsApp platform for medical staff and community health workers in rural areas in Liberia to communicate with staff at larger hospitals to accelerate the referral and treatment of obstetric emergencies. Liberia has one of the highest maternal mortality rates in the world. Many of the leading medical causes of death, including obstructed labor, are preventable if the women were more quickly referred to higher level care centers where life-saving procedures like cesarean sections can be safely performed. They will test their approach at one referral hospital and 20 rural clinics by training community health workers to better identify obstetric emergencies and refer them on using the WhatsApp platform. At the referral hospital, they will implement an additional triage system to decrease the decision-to-delivery time for women requiring cesarean section, as well as ensuring the women are aware of and involved in the medical decisions.

Thomas Weiser of the Lifebox Foundation in the U.S. will implement their surgical infection prevention program, Clean Cut, in ten maternity hospitals in Ethiopia to reduce infections and other complications of C-sections, which account for around 15% of maternal deaths. To improve the safety of surgery, they developed Clean Cut, which uses training and improved management practices to promote compliance with six key safety standards including sterility of instruments and surgical sites, gowns and gloves, and appropriate use of antibiotics. They will adapt their program to C-sections and perform a stepped-wedge study at 10 hospitals over 24 months involving recruiting and training a dedicated improvement team and developing tailored process plans to implement the program. They will evaluate its effect on compliance with the safety standards and on patient outcomes. Note: This grant is funded by the UBS Optimus Foundation.

Soo Downe of the University of Central Lancashire in the United Kingdom will develop a multi-media program for lawyers and judges who work on medical litigation related to childbirth to help ensure that they understand the evidence on risks and benefits of the procedure as well as legal rights of patients. There has been a large increase in the numbers of cesarean sections across all sectors of society, which is party caused by a fear of litigation. When cases are heard related to non-medically indicated cesarean section in court, the judicial personnel's underlying attitudes about women's rights, and their lack of legal and medical knowledge, leave them unable to ensure compliance with the law. They will assemble an expert team to develop the multi-media program containing materials on the use and outcomes of different modes of birth and then provide it to judges and lawyers in four Indian states to evaluate feasibility and usability and its effect on legal decision making.