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Prioritizing RH Technologies for Introduction in Crises Settings . Harshad Sanghvi Vice President & Medical Director. Seattle, May 2008. Harmful or Ineffective technologies that have taken off. Ineffective: Various hormonal and non hormonal treatment of threatened abortion Harmful:

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prioritizing rh technologies for introduction in crises settings

Prioritizing RH Technologies for Introduction in Crises Settings

Harshad Sanghvi

Vice President & Medical Director

Seattle, May 2008

harmful or ineffective technologies that have taken off
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

some effective technologies that are languishing
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

defining the need for technologies for rh in crisis settings
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?
a systematic approach to taking innovations to scale
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

developing champions
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

creating champions
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 peersand mentors

slide11

Too many technologies to choose from?

We must first make the Investment case.