Policy review on the management of pre-eclampsia and eclampsia by community health workers in Mozambique

1 March, 2019

(Note: This is another, very common example where a paper from a non-English-speaking country is available only in English. HIFA is campaigning for change so that the abstract is routinely available in the language of the country where the research took place.)

This new study notes: 'Despite the evidence that hypertensive disorders of pregnancy contribute significantly to maternal mortality in Mozambique and that blood pressure assessment and management of hypertension can prevent morbidity and mortality due to pre-eclampsia [10], the absence of policy prevented the development of tools and trainings to appropriately equip CHWs to identify and manage these complications'. Citation, abstract and comments from me below.

CITATION: Policy review on the management of pre-eclampsia and eclampsia by community health workers in Mozambique

Salésio Macuácua, Raquel Catalão, Sumedha Sharma, Anifa Valá, Marianne Vidler, Eusébio Macete, Mohsin Sidat, Khátia Munguambe, Peter von Dadelszen, Esperança Sevene and the CLIP Working Group

Human Resources for Health201917:15



Background: Pre-eclampsia is one of the leading causes of maternal death in Mozambique. Limited access to health care facilities and a lack of skilled health professionals contribute to the high maternal morbidity and mortality rates in Mozambique and indicate a need for community-level interventions. The aim of this review was to identify and characterise health policies related to the role of CHWs in the management of pre-eclampsia and eclampsia in Mozambique.

Methods: The policy review was based on three methods: a desk review of relevant documents from the Mozambique Ministry of Health (n = 7), contact with 28 key informants in the field of health policy in Mozambique (n = 5) and literature review (n = 699). Policy documents obtained included peer-reviewed articles, government and institutional policies, reports and action plans. Seven hundred and eleven full-text documents were assessed for eligibility and included based on pre-defined criteria. Qualitative analysis was done to identify main themes using content analysis.

Results: A total of 56 papers informed the timeline of key events. Three main themes were identified from the qualitative review: establishment of the community health worker programme and early challenges, revitalization of the CHW programme and the integration of maternal health in the community health tasks.

In 1978, following the Alma Alta Declaration, the Mozambique government brought in legislation establishing primary health care and the CHW programme. Between the late 1980s and early 1990s, this programme was scaled down due to several factors including a prolonged civil war; however, the decision to revitalise the programme was made in 1995.

In 2010, a revitalised programme was re-launched and expanded to include the management of common childhood illnesses, detection of warning signs of pregnancy complications, referrals for maternal health and basic health promotion. To date, their role has not included management of emergency conditions of pregnancy including pre-eclampsia and eclampsia.

Conclusion: The role of CHWs has evolved over the last 40 years to include care of childhood diseases and basic maternal health counselling. Studies to assess the impact of CHWs in providing services to reduce maternal morbidity and mortality are recommended.

Comments (NPW):

1. What do we know about training of CHWs to prevent/manage pre-eclampsia and eclampsia in other LMICs? This was not explored in the paper.

2. On a different but related question: To what extent are CHWs in different countries trained to manage childbirth? I am thinking that CHWs would normally refer women to have facility-based delivery, and yet it seems likely that any individual CHW will find him/herself in the position of being the main person responsible for a home-based delivery.

Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org