The delegation of tasks in the era of e-health to support community interventions in maternal and child health: Lessons learned from the PACT-Denbaya project

  • Medecine et Sante Tropicales, Volume 27, No. 4, Year 2017

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Study Justification:
The PACT-Denbaya project aimed to improve the health of mothers and children in rural communities by delegating obstetric-gynecologic and pediatric tasks, supported by teleconsultations. This study was conducted to evaluate the effectiveness of this approach in reducing maternal and child mortality rates in remote areas.
Highlights:
– The study took place in 6 community health centers in the Dioïla health district in Mali.
– General practitioners and midwives received a week-long training program in the management of common problems in the field and the use of teleconsultation and tele-education platforms.
– 17 healthcare providers participated in the training sessions to strengthen their capacity in gynecology-obstetrics and pediatrics.
– The evaluation of knowledge and indicators compared with the baseline data showed a decrease in maternal and child mortality rates.
– User satisfaction with the telehealth services was high.
– The study suggests that the delegation of tasks, supported by telehealth, can significantly improve maternal and infant health in remote areas.
Recommendations:
– Conduct a long-term impact study to further validate the positive results.
– Expand the delegation of tasks approach to other rural communities in Mali and potentially in other countries.
– Invest in the development and implementation of teleconsultation and tele-education platforms to support healthcare providers in remote areas.
– Strengthen the training programs for general practitioners and midwives in gynecology-obstetrics and pediatrics.
Key Role Players:
– General practitioners
– Nurse-obstetricians
– Midwives
– Experts in pediatrics and obstetrics/gynecology
– Telehealth technology providers
– Community health center staff
– Policy makers and government officials
Cost Items for Planning Recommendations:
– Development and implementation of teleconsultation and tele-education platforms
– Training programs for healthcare providers
– Equipment and infrastructure for telehealth services
– Monitoring and evaluation of the impact of the delegation of tasks approach
– Expansion of the approach to other rural communities
– Research and development for long-term impact study

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study describes the PACT-Denbaya project and its positive impact on maternal and child health in rural communities. It provides details about the methods used, including the delegation of tasks and teleconsultations. The evaluation of knowledge and indicators, as well as user satisfaction, support the effectiveness of the project. However, the abstract mentions the need for a long-term impact study to reinforce the results, indicating that further research is required. To improve the strength of the evidence, conducting a long-term impact study would be recommended.

The PACT-Denbaya project (Program for community access to telemedicine for families) aimed to help improve the health of mothers and child in rural communities through the delegation of obstetric-gynecologic and pediatric tasks, supported by teleconsultations. This operational research took place in 6 community health centers in the Dioïla health district in Mali. Our method was based of the delegation of tasks, supported by teleconsultations. Experts in pediatrics and obstetrics/gynecology provided a week-long training program to general practitioners and midwives, in the management of the most common problems in the field and in the use of the “Bogou” teleconsultation and “Dudal” tele-education platforms to ensure exchanges and follow-up. Overall, 17 healthcare providers, that is, general practitioners, nurse-obstetricians, and midwives participated in sessions to strengthen gynecologyobstetric and pediatric capacity in the field. The evaluation of knowledge and of the indicators compared with the baseline of 8359 pregnancies and 1991 documented deliveries and of user satisfaction showed that this type of service resulted in decreased maternal and child mortality. In view of these results, we can deduce that the delegation of tasks, when it is supported by telehealth, encounters no resistance from the specialists and contributes to the significant improvement of maternal and infant health in remote areas. A long-term impact study is necessary to reinforce these results.

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The PACT-Denbaya project recommends the delegation of tasks supported by teleconsultations to improve access to maternal health. This approach involves training general practitioners and midwives in rural communities to manage common obstetric-gynecologic and pediatric problems. They receive a week-long training program by experts in these fields and have access to teleconsultation and tele-education platforms. The evaluation of this approach has shown a decrease in maternal and child mortality rates, indicating its effectiveness in improving maternal and infant health in remote areas. Further long-term studies are needed to reinforce these results. This recommendation was published in the journal Medecine et Sante Tropicales in 2017.
AI Innovations Description
The recommendation from the PACT-Denbaya project to improve access to maternal health is the delegation of tasks supported by teleconsultations. This approach involves training general practitioners and midwives in rural communities to manage common obstetric-gynecologic and pediatric problems. They are provided with a week-long training program by experts in these fields, along with access to teleconsultation and tele-education platforms. The evaluation of this approach showed a decrease in maternal and child mortality rates, indicating its effectiveness in improving maternal and infant health in remote areas. Further long-term studies are needed to reinforce these results. This recommendation was published in the journal Medecine et Sante Tropicales in 2017.
AI Innovations Methodology
The methodology used to simulate the impact of the main recommendations of the PACT-Denbaya project on improving access to maternal health involved the following steps:

1. Selection of study sites: The study was conducted in 6 community health centers in the Dioïla health district in Mali. These sites were chosen to represent rural communities with limited access to maternal health services.

2. Training program: General practitioners and midwives in these rural communities were trained in the management of common obstetric-gynecologic and pediatric problems. The training program lasted for one week and was conducted by experts in these fields.

3. Teleconsultation and tele-education platforms: The healthcare providers were provided with access to teleconsultation and tele-education platforms, namely the “Bogou” teleconsultation and “Dudal” tele-education platforms. These platforms facilitated communication and follow-up between the healthcare providers and the experts.

4. Participation and capacity building: A total of 17 healthcare providers, including general practitioners, nurse-obstetricians, and midwives, participated in the training sessions to strengthen their capacity in gynecology-obstetrics and pediatrics.

5. Evaluation: The impact of the delegation of tasks supported by teleconsultations was evaluated through various indicators, including maternal and child mortality rates. The evaluation compared the indicators with the baseline data of 8359 pregnancies and 1991 documented deliveries. User satisfaction was also assessed.

6. Results: The evaluation showed a decrease in maternal and child mortality rates, indicating the effectiveness of the delegation of tasks supported by teleconsultations in improving maternal and infant health in remote areas.

7. Long-term impact study: To reinforce these results, the researchers recommended conducting a long-term impact study. This study would provide further evidence of the sustained effectiveness of the delegation of tasks and telehealth interventions in improving access to maternal health.

The findings and recommendations of this study were published in the journal Medecine et Sante Tropicales in 2017.

Statistics:
Citations: 4
Authors: 7
Identifiers:
DOI: 10.1684/mst.2017.0727
ISSN: 22613684
Research Areas:
Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Technology and Innovations, Workforce
Study Countries:
Mali
Study Design:
Cohort Study
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