HIFA informs WHO Guidelines

In 2012, we completed our 2-year collaboration with the Norwegian Knowledge Centre for the Health Services, University of Toronto and WHO Department for Reproductive Health Research: HIFA/WHO Optimising for Maternal and Newborn Health.

This collaboration has demonstrated Proof of Concept of the HIFA Knowledge Base in helping to inform WHO policy guidelines. We:

1. analysed the whole of 1 year (2009) of the HIFA2015 email discussion archive, from which we identified and tagworded 400 HIFA-Voices (verbatim quotes that provide key points).
2. analysed and synthesised more than 600 messages from 2008-2011 that were specifically on issues related to Traditional Birth Attendants. This topic is, to date, the most debated issue on HIFA2015, drawing a wide diversity of perspectives from many different countries.

This major project recruited HIFA volunteers with IT expertise to develop (a) the IT infrastructure for the Knowledge Base and (b) the criteria for extraction and taxonomy for tagwording HIFA-Voices.

As a result of the project, WHO were able to tap into the experiential, practical knowledge of HIFA members in order to help inform the development of a new international WHO guideline on Taskshifting for Maternal and Newborn Health.

The experience demonstrates proof of concept at several levels:
1. We can extract successfully the key points (HIFA-Voices) of a virtual discussion forum involving thousands of participants worldwide.
2. These key points can be meaningfully tagworded and collated in a database, that can be readily interrogated by policy guideline developers.
3. The key points are highly valuable to help inform policy guideline development.

The following testimonial is provided by Dr Simon Lewin, Senior Researcher, Global Health Unit, Norwegian Knowledge Centre for the Health Services and Health Systems Research Unit, Medical Research Council of South Africa, who is a member of the technical team developing the WHO guideline on Optimizing for Maternal and Newborn Health:

The WHO has recently completed a new global guideline on optimizing health worker roles to improve access to key maternal and newborn health (MNH) interventions through task shifting. The guideline focuses on which cadres (including lay health workers, auxiliary nurses, nurses, midwifes, etc.) can safely and effectively deliver a range of key maternal and newborn health interventions. In developing the guideline, the WHO wanted to ensure the inclusion of the views and experiences of programme managers and health care providers working in low and middle income countries. The guideline developers therefore worked closely with HIFA2015 to analyse extracts from HIFA2015 discussions (HIFA-Voices) relating to task shifting in the HIFA2015 Knowledge Base.

“These discussions provided a rich and innovative source of information on how task shifting is experienced in low and middle income settings, and programme managers views of the pros and cons of strategies to optimize health worker roles. The output of this analysis contributed to ensuring that the recommendations made in the guideline are useful and appropriate. In addition, the HIFA2015 discussion list will be an important route for dissemination of the guideline recommendations later this year.

As the HIFA Knowledge Base evolves over the coming years, it has the potential to become a leading source of practical and experiential data to help inform future international guidelines by WHO and other organisations, on a range of issues relating to health systems, human resources for health, and availability and use of health information.”
Simon Lewin, WHO Guideline Group, Optimizing for Maternal and Newborn Health

I’d like to say a big thank you to everyone who contributed to the conversation on traditional birth attendants. It was a very enriching experience for me retrospectively looking at the conversations and how they evolved over time. In total I looked at over 600 messages and I learnt very much from the diverse experiences represented on this forum. I think its wonderful how everyone engages in conversations like this to facilitate knowledge sharing… I’m continuing work on this as an academic paper [...] and hope to submit it to an academic journal in the next 2-3 months.

In the meantime three interesting points that emerged from the messages are:
1. To some degree everyone accepts (in some cases reluctantly) that Traditional birth attendants can, and should probably be leveraged on to play a role within maternal/child health. Opinions on the boundaries of this role vary greatly based on context and past experiences.
2. There seems to be a degree of consensus that involving the TBA is a short to medium term plan whilst we try to find long term solutions to health worker shortages, poor health health system coordination and quality of interpersonal care provided where health workers are accessible.
3. Practices of TBAs whilst still not entirely in line with western allopathic medicine seem to be evolving to make them seem more “professional” and modern in how they carry out their tasks. The best example is how they want women to lie in lithotomy position because this is what obtains within hospitals.

Onikepe Oluwadamilola Owolabi is a PhD candidate at the London Schol of Hygiene and Tropical Medicine, UK. She is also the lead volunteer for development of content on the HIFA Knowledge Base, and is a member of the HIFA2015 Steering Group, 4 February 2013