Paradigm Shift in Obstetrics Emergencies Aid
Since 10 or 15 childbirths are complicated by chance; each maternal or neonatal death means there was an emergency that was not acknowledged or handled efficiently. The PACE MULTILEVEL project is addressed to women living in rural areas and indigenous women from different regions in Mesoamerica and is aimed at escalating an innovative system of integrated interventions that ensures that each women seeking for medical aid gets in contact with the First Obstetric Respondent (FOR) and in case there is an emergency, she will enter into the Critical Route of the Survival Chain. The intention is achieve that all aid level are closely related to provide the utmost in quality of care.
About You
About You
First Name
María Laura
Last Name
Casalegno
Facebook Profile
About Your Organization
Organization Name
PACEMD
Organization Website
Organization Phone
00524151527532
Organization Address
5 de Mayo #11, Colonia Allende, San Miguel de Allende
Organization Country
Mexico, GUA
Country where this project is creating social impact
Mexico, GUA
Is your organization a
Non‐profit/NGO/citizen sector organization
How long has your organization been operating?
More than 5 years
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Innovation
Entry Form title
Paradigm Shift in Obstetrics Emergencies Aid
What change do you want to bring to the world?
Since 10 or 15 childbirths are complicated by chance; each maternal or neonatal death means there was an emergency that was not acknowledged or handled efficiently. The PACE MULTILEVEL project is addressed to women living in rural areas and indigenous women from different regions in Mesoamerica and is aimed at escalating an innovative system of integrated interventions that ensures that each women seeking for medical aid gets in contact with the First Obstetric Respondent (FOR) and in case there is an emergency, she will enter into the Critical Route of the Survival Chain. The intention is achieve that all aid level are closely related to provide the utmost in quality of care.
What are the primary activities of your project?
The aim is to provide training by saturation, all suppliers from the different aid levels and within a certain sanitary jurisdiction. Thus everybody share the same language, processes and networks, generating string links among all aid levels and integrating the different institutions throughout the whole Survival Chain .
This method is carried out through modular training based on the experience of the Basic Life Support in Obstetrics (BLSO) y Advanced Life Support in Obstetrics (ALSO) courses. Also is a 2 days workshop (BLSO) is a one day workshop based on scientific evidence where the use of mnemonics and simulations is aimed at developing psycho-motor skills. The initiative includes a formal evaluation/simulation and a certification process. There are strict quality controls and ALSO suppliers and instructors generate and “identity”.
The First Obstetrics Respondent for Communities (PROC) is a derived program that takes concepts from ALSO and BLSO and is aimed at preparing communitarian workers (promoters, auxiliaries and midwives) to provide aid in the first line of contact and to activate the whole Obstetrics Emergency system.
What is innovative about your initiative? How is it a new contribution to the field?
Innovation lays in the program’s approach. It is based on the critical needs of the mother child binomial, on the institutional alignment (Survival Chain) and the effectiveness of the suppliers within the communitarian context. The aim is to optimize the results in the obstetrics emergency aid and in neonatal care. We provide a training program based on teams to sustain this model of paradigm shift in maternal and neonatal healthcare aid.
Training and certification vary from programs focused on suppliers as individuals to training base don patients and team son all the levels of the medical education (PROC, BLSO and ALSO) supported by the respective sanitary jurisdiction to improve service alignment. Training is trans-institutional and emphasizes the use of protocols based on scientific evidence, the use of mnemonics, simulation and certification of competencies.
This strategy proved to be successful in rural contexts in medium income countries with medium income countries such as Mexico where Obstetric emergencies are usually chaotic, even in locations where there are several hospital and resources. The ALSO program in Mexico is part of a federal strategy to reduce maternal mortality.
What stage is your project in?
Operating for more than 5 years
Tell us about the community that you engage? eg. economic conditions, political structures, norms and values, demographic trends, history, and experience with engagement efforts.
Mexico has 110.000 inhabitants, 17% of which live in rural areas. These 19.000.000 people mainly live in the states located in the south of the country such as Chiapas, Oaxaca and Guerrero and are indigenous and poor people.
Usually, 155 of childbirths take place outside medical premises. As we move to the south of the country, this percentage increases drastically: in2005 it was 39% in Oaxaca and 42% in Chiapas and Guerrero. The percentage of satisfied need regarding obstetric emergencies in Guerrero was just about 37% (said needs are defined as the adequate aid from the percentage of deliveries that may get complicated by chance). Almost 60% of women in Oaxaca, who die, try to reach a hospital.
Consequently, there is need to improve the coordination between the units of a sanitary jurisdiction and the aid as from the First Obstetrics respondent and the following aid levels. Obstetric emergencies require an aid system.
Share the story of the founder and what inspired the founder to start this project
The PACE program is directed by el Dr. Haywood Hall. He is and emergency physician, Ashoka fellow and an acknowledged social entrepreneur. His inspiration was born after being present in a terrible accident in a route in Mexico. After observing the way the emergency acted he decided to found PACE within the main objective of training the suppliers to maximize care and quality of aid. Time went by and the demand increased, In addition to all the advances and the impacted achieved by PACE and the implementation of all the programs, the main challenge faced was the inacceptable rates of maternal deaths that mainly affect the poorest regions of the country such as the states in the South as well as the Sate of Mexico since it is the state with highest population.
Since many deaths occurred within the health services due to the lack of training to the staff on obstetrics emergency aids, PACE decided that it should get involved in said problem and implement strategies that manage to generate a change of culture and a paradigm shift in maternal care and aid. Thus in 2006, PACE started implementing the ALSO Program developed and licensed by the American Academy of Family Physicians (AAFP) and carried out in more than 47 countries. As from its beginning training has been provided to thousand of family physicians, gynecologist-obstetricians nurses and midwives among others.
Social Impact
This Entry is about (Issues)
Please describe how your project has been successful and how that success is measured
The program has achieved an impact in terms of number of trained suppliers. Throughout these 6 long years more than 3000 suppliers in the whole Mexican territory have been trained.
The method to assess and monitor the impact is based and will be based on:
1. Suppliers Survey to ALSO, BLSO y PROC suppliers about experiences in handling obstetric emergencies.
2. Indicators such as obstetric morbidity (near miss), mortality, use of magnesium sulfate, use of blood products, cesarean childbirth rate, APGAR score at 5 minutes, APEO, admission to UCI and UCIN, use of vacuum or forceps
3. Indicators to measure the process’ efficiency: activation of the survival change to solve obstetric emergencies.
How many people have been impacted by your project?
1,001- 10,000
How many people could be impacted by your project in the next three years?
More than 10,000
Winning entries present a strong plan for how they will achieve growth. Identify your six-month milestone for growing your impact
Set up the program within the southern Mexico region, Chiapas State. We would set up a PACE Center there which would be the base for the future dissemination of the program in different regions.
Task 1
Set up a PACE center in Chiapas, Mexico to cover the south of the country.
Task 2
Start providing training by levels in the south of Mexico (first level: midwives, second level: paramedics, third level, physicians and nurses).
Task 3
Carry out the same training tasks in different states Within southern Mexico such as as Guerrero and Oaxaca.
Identify your 12-month impact milestone
Disseminate the project and programs in the north of Guatemala within the aim of expanding the coverage area to other Mesoamerica regions in the future.
Task 1
Start providing training by levels in the north of Guatemala (first level: midwives, second level: paramedics, third level, physicians and nurses).
Task 2
Continue providing training in different regions in Guatemala
Task 3
Develop relationships with the Guatemalan government and with different institutions (for example universities) to continue the expansion throughout the whole country.
How will your project evolve over the next three years?
The program has had a positive impact in Mexico which enabled its expansion and spreading. We believe that if you set up the center in Chiapas and develop relationships with the different regional and national governments, the program may be expanded to the rest of countries in Mesoamerica. We are already supported by different entities both government and non-government organizations to achieve the objective of generating a change in the aid offered in obstetric emergencies.
Sustainability
What barriers might hinder the success of your project and how do you plan to overcome them?
There might be economic, political or cultural barriers. PACE center has learned to overcome different situations thanks to the presence of volunteers and to the effort of physicians (from Mexico and USA). In addition, we have taken advantage of the internal programs to support finances. We have recently registered as PACE Salud Global e Internacional I the United Stated, to be able to apply for grants from USAID and other foundations. Last, but not least we have provided training to the staff of the Secretary of Health and in this manner we can follow a replication model of our programs.
Tell us about your partnerships
PACE centers is supported by different entities such as: National Center for Gender equality and Reproductive Health (CNEGySR) of the Secretary of Health of Mexico Federal Government; secretaries of health from several Mexican states (Chiapas, Guerrero and Oaxaca); Texas University, American Association of Family Physicians; International Federation of Emergency Medicine, among others. In addition, as PACE’s Director Dr. Haywood Hall was appointed Ashoka fellow he has developed good partnerships with other fellows, for example Diana Damian Director of the FOCA Organization based in Chiapas Mexico.
Current annual budget of project, in US dollars
$100,000‐250,000
Explain your selections
The project is financed by internal programs and Workshops address to the state and federal government, in this manner a replication and sustainability model can be sustained which allows expansion and dissemination not only of the maternal health and neonatal programs but also of the Training programs on medical emergencies.
How do you plan to strengthen your project in the next three years?
The project is already in an advanced and expansion phase. However, the fact of setting up a PACE center in the south of the country would allow an increased dissemination of our programs not only in Mexico but in the entire Mesoamerica, thus establishing our innovation of paradigm shift in obstetric emergency aid.
Challenges
Which barriers to health and well-being does your innovation address?
Please select up to three in order of relevancy to your project.
PRIMARY
Lack of access to targeted health information and education
SECONDARY
Lack of physical access to care/lack of facilities
TERTIARY
Health behavior change
Please describe how your innovation specifically tackles the barriers listed above.
A través del Proyecto de capacitación Multinivel se logra interrelacionar todos los niveles de atención y las diferentes instituciones involucradas en el manejo de una emergencia obstétrica logrando con esto, estrechar las distancias en el acceso a la capacitación existente en los diferentes niveles. Además, abordando una capacitación comunitaria se lograría generar cambios en las conductas sanitarias a través del empoderamiento de los diferentes actores de la cadena de supervivencia.
How are you growing the impact of your organization or initiative?
Please select up to three potential pathways in order of relevancy to you.
PRIMARY
Influenced other organizations and institutions through the spread of best practices
SECONDARY
Grown geographic reach: Within host country
TERTIARY
Grown geographic reach: Multi-country
Please describe which of your growth activities are current or planned for the immediate future.
Recientemente se han establecido fuertes relaciones con las Secretarías de Salud de algunos de los estados de México involucrados en el Proyecto. Así se está logrando expandir el alcance geográfico regional.
De todas formas, creemos fundamental el establecimiento del Centro PACE en el sur de México para así poder lograr la actividad terciaria que sería alcanzar un crecimiento en otros países de la región mesoamericana.
Do you collaborate with any of the following: (Check all that apply)
Government, NGOs/Nonprofits, Academia/universities.
If yes, how have these collaborations helped your innovation to succeed?
Estas colaboraciones han ayudado a expandir el proyecto, a darle mayor difusión y han brindado un respaldo institucional importante, permitiendo un reconocimiento por parte de las autoridades del país. Esto hace que el Programa PACE esté siempre a la vanguardia en lo que a Capacitación en Emergencias Médicas respecta.
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