Delivery care in Quang Ninh province, Northern Vietnam : resources and access to safe care.

Every mother and child has the right to survive childbirth which requires skilled birth attendants together with referral and available emergency obstetric care (EmOC). The objective of the study was to describe delivery care routines at different levels in the health care system in Quang Ninh province, Northern Vietnam. The design was cross sectional using a structured questionnaire. Two districts in Quang Ninh province with 40 Community Health Centres (CHC), three district hospitals and one region hospital was included in the study, in total 138 (CHC n=105 and hospitals n=33) health care providers participated. In our study 20% (CHC) of the health care providers assisting deliveries at CHC were midwives and health care provider’s in our study further report to have assisted at less then 10 deliveries/year (81% of respondents at CHC). Findings show that the health care provider’s routines and care for women during labour and delivery vary and that there is a need for re-training and that women in labour should be cared for by health care providers with adequate training like midwifery. In our study CHC had poor resources to provide basic or comprehensive EmOC. Our findings indicate that there is a need for re-training in delivery care among health care providers and since the number of deliveries at CHC is few they should be handled by someone who is a skilled birth attendant. Our findings also show a variation in care routines during labour and delivery among health care providers at CHC and hospital levels and this also show the need for re-training and support from proper authorities in order to improve maternal and newborn health.

Building a Learning Architecture : e-Learning and e-Services

With the rapid advancement of the webtechnology, more and more educationalresources, including software applications forteaching/learning methods, are available acrossthe web, which enables learners to access thelearning materials and use various ways oflearning at any time and any place. Moreover,various web-based teaching/learning approacheshave been developed during the last decade toenhance the capability of both educators andlearners. Particularly, researchers from bothcomputer science and education are workingtogether, collaboratively focusing ondevelopment of pedagogically enablingtechnologies which are believed to improve theinfrastructure of education systems andprocesses, including curriculum developmentmodels, teaching/learning methods, managementof educational resources, systematic organizationof communication and dissemination ofknowledge and skills required by and adapted tousers. Despite of its fast development, however,there are still great gaps between learningintentions, organization of supporting resources,management of educational structures,knowledge points to be learned and interknowledgepoint relationships such as prerequisites,assessment of learning outcomes, andtechnical and pedagogic approaches. Moreconcretely, the issues have been widelyaddressed in literature include a) availability andusefulness of resources, b) smooth integration ofvarious resources and their presentation, c)learners’ requirements and supposed learningoutcomes, d) automation of learning process interms of its schedule and interaction, and e)customization of the resources and agilemanagement of the learning services for deliveryas well as necessary human interferences.Considering these problems and bearing in mindthe advanced web technology of which weshould make full use, in this report we willaddress the following two aspects of systematicarchitecture of learning/teaching systems: 1)learning objects – a semantic description andorganization of learning resources using the webservice models and methods, and 2) learningservices discovery and learning goals match foreducational coordination and learning serviceplanning.

Healthcare providers balancing norms and practice : challenges and opportunities in providing contraceptive counselling to young people in Uganda - a qualitative study

BACKGROUND: Pregnancies among young women force girls to compromise education, resulting in low educational attainment with subsequent poverty and vulnerability. A pronounced focus is needed on contraceptive use, pregnancy, and unsafe abortion among young women. OBJECTIVE: This study aims to explore healthcare providers' (HCPs) perceptions and practices regarding contraceptive counselling to young people. DESIGN: We conducted 27 in-depth interviews with doctors and midwives working in seven health facilities in central Uganda. Interviews were open-ended and allowed the participant to speak freely on certain topics. We used a topic guide to cover areas topics of interest focusing on post-abortion care (PAC) but also covering contraceptive counselling. Transcripts were transcribed verbatim and data were analysed using thematic analysis. RESULTS: The main theme, HCPs' ambivalence to providing contraceptive counselling to sexually active young people is based on two sub-themes describing the challenges of contraceptive counselling: A) HCPs echo the societal norms regarding sexual practice among young people, while at the same time our findings B) highlights the opportunities resulting from providers pragmatic approach to contraceptive counselling to young women. Providers expressed a self-identified lack of skill, limited resources, and inadequate support from the health system to successfully provide appropriate services to young people. They felt frustrated with the consultations, especially when meeting young women seeking PAC. CONCLUSIONS: Despite existing policies for young people's sexual and reproductive health in Uganda, HCPs are not sufficiently equipped to provide adequate contraceptive counselling to young people. Instead, HCPs are left in between the negative influence of social norms and their pragmatic approach to address the needs of young people, especially those seeking PAC. We argue that a clear policy supported by a clear strategy with practical guidelines should be implemented alongside in-service training including value clarification and attitude transformation to equip providers to be able to better cater to young people seeking sexual and reproductive health advice.