Paths Toward Solution of Healthcare Issues throughInternational Joint Research

Caroline Homer
Co-Program Director – Maternal and Child Health, Burnet Institute
Visiting Professor of Midwifery – University of Technology Sydney@CarolineHomerIn all health systems in the world• We all face similar challenges– Increased demand for quality services– Limited resources to fund services– Challenges in the use of evidence to drive
practice– Shortages in health workforces especially
midwives and nurses– Overuse and underuse of services

Underuse and overuse of services• Overuse is difficult to measure and has not been
well characterised• Overuse is likely to cause physical, psychologicaland financial harm to patients• Overuse deflects resources from public health andother social spending in both low-income and highincome countries• Overuse occurs across a wide range of healthspecialties
Brownlee et al. The Lancet: Right Care Series(2017). http://dx.doi.org/10.1016/
S0140-6736(16)32585-5

Types of overuse• Overuse of medication• Antibiotics – antimicrobial resistance• Overuse of screening tests• Inappropriate use of cancer screening• Overuse of diagnostic tests• Often endoscopes and colonoscopies are cited• Site of care delivery• Unnecessary hospital admissions

Too little too late – too much too soon
• What do we do too much of?

• What do we not do enough?

Too much too soon in maternity care

The Lancet’sMaternal
HealthSeries(2016)

Caesarean section as an example• Caesarean section (CS) can save women’s andinfants’ lives and should be universally accessible• The large increase in CS use, often for non-medical
indications, is of concern given the risks for both
women and children

Estimated frequency of and trends in caesarean
section use, as a proportion of livebirths
between 2000 and 2015

Boerma, et al Lancet
2018; 392: 1341–48

Miller et al. The Lancet. http://dx.doi.org/10.1016/
S0140-6736(16)31472-6

Optimising caesarean section• Interventions targeted atwomen• Interventions targeted athealth professionals• Interventions atorganisations andsystems

What can health systems do?
• What can you do?
– Implement evidence-based clinical practiceguidelines– Undertake audits and provide feedback– Implement collaborative models of care

• Maybe this is relevant to other interventions?

Can we use research to make change?
• Audit what is happening• Work with consumers to identify problems– Ask consumers what is important to them
– Co-design changes• Look at the international literature and globalmovements

Lancet Series on Midwifery - 2014
• Developed in the wider global context• Post-Millennium Development Goals agenda• Sustainable Development Goals

Universal Health Coverage
Saving Newborn Lives
Health workforce development
Addressed the global realities of maternal and newborn
health• Beyond saving lives - improving the quality of care••••• Available for free:https://www.thelancet.com/series/midwifery

Quality Maternal and Newborn Health Framework• Developed a framework for care needed bychildbearing women and infants– identifying what, how, and who• Used framework to analyse practices in the scope of
midwifery services and identify outcomes improvedby midwifery careWhat is quality maternal and newborncare?

Renfrew et al. (2014) The Lancet 384: 1129–45.

Quality Maternal and Newborn Care
Framework

Renfrew et al. (2014) The Lancet 384: 1129–45.

Quality Maternal and Newborn Care
FrameworkRenfrew et al. (2014) The Lancet 384: 1129–45.

Quality Maternal and Newborn Care
Framework

Organisation of care: Available, accessible,acceptable, good-quality services—adequateresources, competent workforce
Continuity, services integrated acrosscommunity and facilities

Renfrew et al. (2014) The Lancet 384: 1129–45.

Quality Maternal and Newborn Care
Framework

Values: Respect, communication, community
knowledge, and understanding
Care tailored to women’s circumstances andneeds

Renfrew et al. (2014) The Lancet 384: 1129–45.

What is quality maternal and newborn care?

Philosophy: Optimising biological,psychological, social, and cultural processes;
strengthening woman’s capabilities
Expectant management, using interventions
only when indicatedRenfrew et al. (2014) The Lancet 384: 1129–45.

Quality Maternal and Newborn Care
Framework

Care providers: Practitioners who combine
clinical knowledge and skills with interpersonaland cultural competence
Division of roles and responsibilities based onneed, competencies, and resources
Renfrew et al. (2014) The Lancet 384: 1129–45.

Next paper in the Midwifery Series

Ranking of research topics by overall priority scoreInterconnection of research priorities
Understanding
how effectivemodels of carework, including
skilledmidwifery

Optimization ofphysiologicalprocesses
across thechildbearing
continuum

Developmentand validationof outcome
measures that
capture shortand longer
term wellbeing

Why are we trying to address these issues?
•

Improve health•

Improve global health•Contribute to the Sustainable Development Goals

A global opportunity

SDG 3 – Improve HealthSDG 5 – Address gender equity

How can our research address the SDGs
• Ask new and relevant questions– Focus on questions from the perspective of patients andcommunities– Remember to address overuse and underuse• Recognise the health system is a complex eco-system– understand organisational change, human behaviour,
pattern recognition• Focus on the way care is delivered in innovative models ofcare that best use the health workforce• Incorporate consumers of health care in co-design of services• Focus on quality for allWhat can you do?
• Ask new questions – ones that will have impact• Collaborate nationally and internationally• Think big – interventions rather than descriptions• Be committed to improvements in your healthsystems• Evaluate and publish• Disseminate success and failures• Support and mentor others• Work together with professional associations,
government and policy makers

Thank you