Frontline health care providers in low-resource countries had long relied on clinical guidance from textbooks written in developed countries, even though the books did not apply to their settings. Locally developed materials also in use often were not evidence-based. That’s why Jhpiego partnered with the World Health Organization, UNICEF, the World Bank and United Nations Population Fund to develop Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors, a set of evidence-based clinical guidelines for managing complications of pregnancy and childbirth in low-resource settings.
This user-friendly manual, published in 2000, is arranged by symptoms (e.g., vaginal bleeding in early pregnancy) so that it can be easily used by frontline providers (nurses, midwives and doctors) who may not have access to resource-intensive methods for diagnosing and treating complications. The symptom-based approach makes the manual different from most medical texts, which are arranged by disease. The MCPC manual includes a system of cross-references to facilitate navigation between symptoms and diagnoses. The action steps are based on clinical assessment with limited reliance on laboratory or other tests, and most can be performed in a variety of clinical settings (e.g., district hospital or health center).
The WHO included the manual as a key component of its Integrated Management of Pregnancy and Childbirth (IMPAC) series, a package of guidelines and tools for addressing issues in maternal, newborn and child health. Another manual in the IMPAC series, Managing Newborn Problems: A Guide for Doctors, Nurses, and Midwives, is the companion guide for developing country service providers who care for newborns, and it too was developed with Jhpiego’s technical guidance.
The IMPAC series has become a key reference for frontline clinicians throughout Asia, Africa and parts of Latin America. The MCPC is available in Arabic, English, French, Indonesian, Italian, Russian and Spanish on the WHO website, but it has been translated into more than 17 languages by local governments and nongovernmental organizations. Well-worn copies can be found in clinics and district hospitals, as well as in medical and midwifery schools, around the globe.