1. Prioritizing RH Technologies for Introduction in Crises Settings Harshad Sanghvi Vice President & Medical Director Seattle, May 2008

2. 2 Harmful or Ineffective technologies that have taken off Ineffective:  Various hormonal and non hormonal treatment of threatened abortion Harmful:  Routine Episiotomy Wasteful:  Therapeutic course of antibiotics for prophylaxis after CS Less effective, harmful and more costly  Routine EFM  Routine GA for CSections  Diazepam, lytic cocktail, for eclampsia Source: Wright 2003

3. 3 Some effective technologies that are languishing FP/RH Emergency contraception Post exposure prophylaxis Implants, DMPA, IUDs Maternal and newborn Health Magnesium suphate to prevent Eclampsia Partogram Vacuum extractor Laryngeal mask for safer GA

4. 4 Defining the need for technologies for RH in crisis settings  Is the problem a major public health concern?  Is there a high demand for a technology solution?  Is there a readily available (or can be developed) solution?  Will the solution have a significant impact on correcting the problem  Is the solution feasible to implement  Are the limitations of the solution acceptable?

5. 5 Is there an already existing technology?

6. 6 PPH related Technologies NeedPotential TechnologyCrisis Settings PPH detectionBrass V drape, Pad PreventionMisoprostol, Oxytocin in Uniject TreatmentMisoprostol Hydrostatic (condom) Tamponade Safe TransferAntishock Garment Retained PlacentaIntra umbilical Oxytocin “Cool” storage for Oxytocin ?,

7. 7 Other Technologies that have Great Potential NeedPotential Technology AbortionMisoprostol Treatment of Incomplete abortion Misoprostol Mixed level of skills of Providers Job aids. Talking “books” or practice guides Training and standardization Distance and E learning Technologies Diagnostic tests that yield immediate results ?

8. 8 A systematic approach to taking Innovations to Scale  Disseminating audience specific information  Developing champions  Addressing resistance  Encourage ownership by allowing for reinvention, modification  Allaying anxiety: Demonstrating through Videos, simulations, drills and on patients  Visits to high performing sites  Training ( inservice, preservice)  Developing and implementing standards of care  Monitoring progress, rewarding success In healthcare, invention and research is hard, but changing practices is even harder. Berwick 2003

9. 9 Developing Champions Characteristics of early adopters:  Opinion Leaders - trusted by colleagues  Locally well-connected  Often “first on the block” to try new things: willing to risk criticism  Often chosen as leaders or representatives Source: Ryan and Gross 1943; Rogers 1995

10. 10 Creating Champions Mid career Professionals who  Understand the evidence basis for key innovations  have become proficient and capable users  Have introduced and practice the Innovation in their setting  Can demonstrate it and teach the skill  Have advocacy and leadership skills At each stage of this process: candidates develop and implement an action plan that is monitored by peers and mentors

11. 11 We must first make the Investment case. Too many technologies to choose from?

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