Dr. Shafi Bhuiyan :
The Sustainable Development Goals (SDGs) aim to ensure healthy lives and promote well-being for all ages. The main focus of the SDGs is to improve equity to meet the needs of women, children and disadvantaged populations in particular.
Traditionally, a mother nurtures a family through care, support, and love. Hence, the health of a family starts with the health of the mother. Maternal health is often overlooked in many countries, focusing only on treating complications when deemed ‘necessary’. However, contrary to that, maternal health care needs to cover all the aspects of a mother’s health, starting from pre-pregnancy to post-pregnancy extending into childcare.
Globally, the Maternal and Child Health MCH Handbook International Committee’s implementation research established that the MCH handbook is an innovative home-based record that integrates information about maternal and child health into one booklet, including pregnancy, labour, immunization, breastfeeding, nutrition, child growth and development, and diseases. As such, it has proven to be an effective tool in promoting and protecting the health of mothers and children. MCH handbooks are often the only health care guides that facilitate equitable access to primary health care. The handbook will thus help to break the stigma of seeking health care for women and empower women to make informed decisions about their own health and pregnancy.
The handbook was first introduced in Japan in 1948, along with other public health interventions. The handbook has helped Japan become the country with the second-lowest infant mortality rate in the world. Nevertheless, Japan is still identifying new perspectives and potential to use the MCH handbook for early detection of diseases in children (autism, neuron-developmental disorders) and the evaluation of risks for obesity, cardiovascular, endocrine diseases, and mental illness.
The MCH handbook has been adopted in over 42 developed and developing countries worldwide, and has proven its efficacy in enhancing maternal and child healthcare. Mothers with MCH handbooks have been observed as being more knowledgeable of proper antenatal care, good nutritional choices during pregnancy, and possess increased awareness of the importance of immunization. Also, content of the MCH handbook is flexible and easy to edit according to the country’s culture and socio economic status.
The MCH handbook helps service providers and users to understand what comprehensive MCH services entail. With its two-way interface, the handbook also provides mothers with an opportunity to collaborate with healthcare providers. It enables mothers to document their health concerns, symptoms, and timelines to monitor their health progress over time. Simultaneously, it allows healthcare providers to keep records of health services accessed by mothers. This reciprocal exchange of information between the healthcare provider and mothers increases both the provider’s capacity to monitor health status and the patient’s capacity to understand when to seek medical care.
The handbook is recognized for its simplicity, cost-effectiveness, ease of implementation and the aggregation of multiple health knowledge tools and health records. Its simplistic user interface has also demonstrated a huge impact on economic and research value.
Even before the emergence of COVID-19, high-quality and timely maternal healthcare services were unavailable, inaccessible, or unaffordable for millions of women. Now with public health restrictions, there is an excessive burden on the healthcare system. This limits the access to care and negatively impacts women’s and children’s health. As a result, many expecting mothers are likely to end up receiving less than adequate care throughout their pregnancy.
Disruption of essential services might lead to disproportionately greater perinatal losses in areas with high maternal and neonatal mortality, reductions in breastfeeding prevalence and an increase in the number of unvaccinated and under-vaccinated children. All these factors exacerbate the existing inequities in accessing healthcare services. However, the MCH handbook could promote a continuum of care for maternal and child health and bridge the existing gap even during the pandemic. Utilizing the handbook [digital or paper books] also ensures invisible mothers and children become visible. It helps strengthen the healthcare system by allowing women to become active participants in their healthcare.
Globally, the MCH handbook has been used in many countries for over two decades. There are now efforts to develop a digital MCH handbook application, thereby ensuring safe delivery and MCH services locally and globally. The MCH handbook digital application is expected to help reduce delays in decision-making at the family level, as well as delays in arranging quality services at the facility level.
The United Nations Sustainable Development Goals (SDGs) emphasize improving health equity so that ‘No One is Left Behind’. Pilot implementation research from multiple countries has demonstrated that the MCH Handbook is a useful tool for extending the knowledge for better access to quality primary health care, that is affordable and equitable. It could also support the integration of reproductive health into national strategies and promote effective maternal and child health programs. Thus, the MCH handbook provides a platform to improve universal access to health-care services, strengthen human health security and reduce the “unmet need” for the most unprivileged population.
(Dr. Shafi Bhuiyan is an award-winning professor and an internationally recognized-academic/professional leader in global health. He currently serves as the Chair, Board of Directors, Canadian Coalition for Global Health Research and a visiting Professor, Bangladesh University of Health Sciences).
