In isolated areas characterised by deep and chronic poverty, access to basic health services, in particular perinatal care, is of serious concern. A shortage of qualified health workers makes the follow-up of pregnancies and giving birth in good conditions almost impossible. Maternal mortality is mainly due to postpartum haemorrhage and hypertensive diseases, while neonatal mortality is mainly caused by obstructed labour, birth asphyxia and complications of prematurity. The project aims to adequately deal with each of these situations.
In these settings with difficult access to quality health care, mothers and their babies are the most vulnerable, particularly at birth. Tdh is committed to their survival and wellbeing. It is with this background that we have developed a perinatal health programme in Mali in order to reduce stillbirths as well as neonatal and maternal mortality.
A pilot project with success
Our SIMESON pilot project was tested in Mali’s Macina health district between October 2016 and October 2017 and continues today. "Mali is one of the countries where it is most dangerous to give birth. There are only three qualified health workers per 10,000 inhabitants. Neonatal and maternal mortality rates are among the highest in the world. Nearly 60% of deliveries are not properly attended, in some remote areas this figure reaches 99%," explains Riccardo Lampariello, Tdh's health programme manager. During the testing period, the results were more than encouraging. For a year, a SIMESON Mobile Unit of two midwives trained 68 health workers at 21 health centres in the district.
According to the external evaluation of the Swiss Tropical and Public Health Institute, the practical performance levels of all health workers in all the health centres increased dramatically from 37.4% to an encouraging 82.8%. SIMESON has particularly led to impressive improvements in the identification and management of postpartum hemorrhage, newborn asphyxia and low birth weight baby care. These results led Tdh to be awarded the Balzan Prize in 2018. With a budget of one million Swiss francs, this prestigious award has enabled the SIMESON training model to be extended to the entire region of Segou in Mali this year.
Training health workers to make a difference
As quality of care at birth is strongly determined by health workers' skills, it is essential to develop and maintain these competencies through regular trainings. Practical trainings can be performed on mannequins to learn and improve procedures that allow mothers to give birth safely and newborns to adjust seamlessly to their new lives. These medical simulation techniques make it possible to repeat and control stressful situations without endangering patients' lives. This method, used already a lot in large centres, is now made available by Tdh to birth attendants in peripheral settings: our mobile staff visits every health centre of a whole health district at least once a month to run practical and individual trainings.
We are scaling up the project across the whole Ségou health region and to enlarge the package of essential gestures in order to bring the greatest safety to each childbirth. There will be new modules targeting other important causes of maternal mortality such as eclampsia.
SIMESON is now also located in the Kurigram district of Bangladesh, where the objective is to increase the number of unaccompanied births by qualified personnel from the current 42% to 98% by 2030. No less than 20,000 women and as many children will be able to benefit from this project in Bangladesh thanks to Tdh. Terre des hommes also wants to develop SIMESON in Nepal.
This project has been designed to respond to global challenges and to be replicated in other countries and contexts. The project will be standardised in a SIMESON Training Manual that contains all the technical, teaching, administrative, monitoring and assessment guidelines.