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St. Michael’s KT team asked to help implement WHO maternal guidelines

Toronto, April 4, 2014

By Evelyne Jhung

Avinash Solomon (left) and Qasim Mohiuddin (right) were originally paired together through the St. Michael’s Nursing Preceptorship Program.
Led by Drs. Sharon Straus and Metin Gülmezoglu (of WHO), the project is the effort of the GREAT Network, which has an executive committee with colleagues from 11 countries – Uganda, Kosovo, Argentina, South Africa, Thailand, Myanmar, Switzerland, Norway, Brazil, the United Kingdom and Canada. (Photo by Yuri Markarov)

One of the many World Health Organization guidelines on maternal, reproductive and women's health recommends the use of the drug oxytocin for the treatment of post-partum hemorrhage, a major cause of death and long-term disability related to pregnancy and childbirth. If a country doesn’t have access to that medication, however, how is it supposed to implement the guideline? Usually it doesn’t, the WHO found.

So the organization approached Dr. Sharon Straus, a global leader in knowledge translation and implementation, to help encourage low- and middle-income countries where maternal and infant morbidity is high to adopt its maternal guidelines.

“When implementing clinical practice guidelines, a one-size-fits-all approach generally doesn’t work,” said Dr. Straus, director of knowledge translation at St. Michael’s. The methodology her team has developed to help these countries implement the WHO guidelines is unique because it encourages local health care workers and policy makers to find their own solutions based on their local needs.

Kosovo was chosen as the team’s first site. More than 95 per cent of mothers there give birth in a health facility, yet they have rates of complications from childbirth greater than many other European countries. During a two-day workshop in Kosovo, Dr. Straus’ team met with local health care professionals, such as obstetricians, health policy makers and midwives, to better understand the local situation with the ultimate goal of having them find their own way of implementing the guidelines.

“In the case of the post-partum hemorrhage guideline, one of the barriers we heard about was a lack of medicine,” said Dr. Straus. “This helped to flag the issue with the Kosovo ministry of health, which wasn’t even aware that some of the clinic centres didn’t have access to oxytocin.”

The project is still in its early stages, with two workshops conducted in Kosovo, but there is strong interest to expand the project to other countries. Dr. Straus’ group will be heading to Myanmar this spring to consult with people there.

“Before implementation can happen, we need to understand the barriers, build consensus amongst all the stakeholders around the table and develop a common strategy for implementation that we all buy into,” she said. “It’s exciting to conduct these workshops because people want to understand how to make this happen and they know we have to do this work up front for implementation to succeed.”

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.