Life-saving medications delivered to rural women in Nepal

02/20/2018
Community Health Workers in Nepal help provide vital medications for rural areas.

Each year, the Master of Health Care Delivery Science at Dartmouth College designates a scholarship for a Cambridge Health Alliance (CHA) physician leader to design and implement an Action Learning Project to complete the degree. Projects are focused on applying classroom concepts to real world challenges in healthcare.

Kirsten Meisinger, MD, MHCDS ’18, is spearheading a project in Nepal with One Heart World-Wide (OHW) to redesign the supply chain using cell phone technology for lifesaving labor and delivery medications. Dr. Meisinger is the medical staff president at CHA and a regional medical director for the Somerville region.

Problem

In rural Nepal, over 70 percent of births occur at home and not in the hospital. Postpartum hemorrhage (PPH) causes 25 percent of maternal deaths and is preventable with the right medicine. Women who experience PPH in Nepal are 100-times more likely to die than European women with the same diagnosis.

The Nepali government provides medicines to reduce death from PPH and infection. Additionally, the country supports Community Health Workers (CHWs) who provide maternal and neonatal health care, including the administration of medications.

These medications were unavailable 65 percent of the time in Nepal, despite being provided by the government. This is largely because supplies in rural areas are unreliable, meaning CHWs do not have predictable access to medicines when needed. This unreliability is partly due to the current supply chain system, which is outdated and paper-based.

Solution

Packaging the Process InfographicIn partnership with the government of Nepal and local non-profit organization OHW, efforts are underway to modernize the ordering component of the medication supply chain through a mobile cell phone-based system. The project is being piloted in the Terhathum region with three medications - chlorhexidine, misoprostol and oxytocin.

Early results show that CHWs are utilizing the new ordering process with 100 percent compliance and the number of health posts with medications at or below the minimal acceptable amounts have been reduced to below 10 percent! The goal is to improve access to lifesaving medications, getting the right medicine to the right moms and babies, at the right time, which may ultimately save lives.

Next Steps

Efforts are being made to expand the number of medications ordered through the mobile process and expansion of the project to other regions of the country. Currently, some medications are lost or expired in transit because the medication delivery system is as unreliable as the old ordering system. Additional concerns exist around storage and medication integrity. Lots to do still! The team plans to continue the project past the end of the MHCDS degree, if you are interested in contributing or collaborating, contact Dr. Meisinger at kmeisinger@challiance.org.

Cambridge Health Alliance

Contributed By: Cambridge Health Alliance

Cambridge Health Alliance is an academic community health care system committed to serving all members of our communities. We have expertise in primary care, mental health and substance abuse, and caring for diverse and complex populations. CHA patients receive high quality care in convenient neighborhood locations, and have seamless access to advanced care through CHA’s affiliation with Beth Israel Deaconess Medical Center. With over 140,000 patients in Cambridge, Somerville Everett and Boston’s Metro North, CHA is working hard to offer the integrated services its communities need now, and in the future.