1. Optimizing the delivery of key interventions to attain MDGs 4 & 5 through task-shifting (Optimize4MNH) RECOMMENDATIONS for HEALTH PROFESSIONALS A. Metin Gülmezoglu World Health Organization

2. Health worker categories  Lay health workers  Auxiliary –nurses –nurse-midwives  Nurses  Midwives  Associate clinicians (Non-physician clinicians) –Associate clinicians –Advanced level associated clinicians  Non-specialist doctors 2

3. "[The authors] have shown, unequivocally, that appropriately trained midlevel providers are able to do both surgical and medical abortions as competently as are doctors in relatively low- resource settings where the need is greatest." Yap-Seng Chong and Eng-Kien Tan Comment, Lancet Special cases: abortion  Abortion provision by mid-level providers is being addressed through a separate guideline developed by RHR department and is not included this process.  Guideline panel was convened in July 2011 and the guideline is currently going through GRC and publication clearance 3

4. Special cases  HIV-PMTCT questions were addressed –The recommendations made by this panel will feed into a more comprehensive guideline that is in progress led by the HIV/AIDS department  Regulatory aspects of task-shifting programmes is being considered by HSS/HRH as a separate guideline. In the Opt4MNH guideline, these issues are highlighted in the evidence frameworks 4

5. Special cases: Contraception  Contraception questions will be addressed by this panel. –HRP/RHR and The Reproductive Health Supplies Coalition (RHSC) will support a follow-up finalization and operationalization meeting dedicated to contraceptive task-shifting/sharing –This meeting will take place in Geneva on 26 June 2012 5

6. 6 Key interventions Promotional interventions for maternal and newborn health Distribution of oral supplements Initiation and maintenance of antiretroviral treatment or antiretroviral prophylaxis for pregnant women and for prevention of HIV infection in infants Undertaking of external cephalic version (ECV) Delivery of injectable antibiotics for preterm pre-labour rupture of membranes (pPROM) Continuous support during labour Delivery of specific childbirth interventions Postpartum haemorrhage related interventions Vacuum extraction Intravenous fluid for resuscitation Bimanual uterine compression Suturing for genital lacerations Manual removal of placenta Prevention and treatment of postpartum haemorrhage Pre-eclampsia/eclampsia related interventions Antihypertensive use for high blood pressure Delivery of loading dose of magnesium sulphate to prevent eclampsia Delivery of maintenance dose of magnesium sulphate to prevent eclampsia Delivery of loading dose of magnesium sulphate to treat eclampsia Delivery of maintenance dose of magnesium sulphate to treat eclampsia Management of puerperal sepsis using antibiotics before referral Delivery of neonatal resuscitation Initiation and maintenance of kangaroo mother care Delivery of antibiotics for neonatal sepsis

7. Recommendation categories 1. Recommend 2. Recommend with (targeted) monitoring and evaluation 3. Recommend only in the context of rigorous research 4. Recommend against 7