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In September, the World Health Organization published its first comprehensive guidelines on home-based records related to the health of mothers and their children, an example of which is the maternal and child health handbook.

These guidelines recommend the use of home-based records and show, using various research results, that their use allows mothers and children to reliably receive care that is essential for preventing deaths and living healthy lives. With these guidelines, it can be said that the efficacy of home-based records such as maternal and child health handbooks has been internationally recognized.

JICA Senior Advisor Keiko Osaki

"I think recognition is growing of two facts: One, that when the mother herself maintains a record of everything from conception to birth and childcare by consistently using a maternal and child health handbook, it allows her and her child to receive the care they need. And two, that this leads to improved health for mother and child," said Japan International Cooperation Agency (JICA) Senior Advisor Keiko Osaki, who is involved at JICA in the introduction, development and implementation of maternal and child health handbooks in partner countries.

Ms. Osaki published papers on the results of research conducted in various countries on maternal and child health handbooks and participated as an external partner in the development committee for these guidelines, which is made up of experts on maternal and child health from around the world. She provided information on JICA's experiences in introducing, developing and implementing maternal and child health handbooks.

"JICA has spoken up at international meetings and other events to advance the development of guidelines on home-based records with various speakers from international agencies and national governments," Ms. Osaki said.

The importance of continuous care from pregnancy to birth, and from newborn to young child

A "child card" used in Tajikistan before the introduction of maternal and child health handbooks

In almost every country, there are home-based records in the form of cards or booklets on which records are written of pregnancy, childbirth, postpartum care, and children's vaccinations and nutrition, often in separate formats. The content and formats differ from country to country as well, however, and there is no international consensus on what home-based records should look like. There have been shortages, and "in some cases, antenatal care record cards have run out, and health workers simply scribbled the next examination date on a piece of paper, tore it out and handed it to the pregnant woman," Ms. Osaki said.

The introduction and development of maternal and child health handbooks in various countries involve integrating separate home-based records into one. It is conceivable that the trend of consolidating records related to the health of mothers and their children will advance more smoothly due to the publication of these guidelines. If records are kept in one book in the home at all times and can be shown during examinations, it is easier for a mother and her child to receive continuous care from a health care practitioner.

Concerning lifelong health, a key point is whether a person can reliably receive continuous care during the foundational time from the fetal period to early childhood. This contributes to the Sustainable Development Goal "Ensure healthy lives and promote well-being for all at all ages."

Developing a maternal and child health handbook that suits a country's unique situation

It has been about 20 years since Ms. Osaki joined as an expert JICA's impending project to introduce, develop, and promote effective use of a maternal and child health handbook in Indonesia. She wanted to work on international cooperation in the health care field from the viewpoint of the beneficiaries. "I never thought I'd get this deeply involved in maternal and child health handbooks," she said.

In Indonesia, there was a lack of knowledge and preparation necessary for pregnancy, childbirth and childcare on the part of mothers and their families, not to mention a slowness to discover bad signs in pregnant women and lateness to transport them to medical facilities. This situation needed to improve. That's why "there are entries in the maternal and child health handbook to plan where childbirth will take place, and who will take the mother to the medical facility and how, to be filled out in advance," Ms. Osaki said. Information such as how to make baby food using local ingredients also was included. "It was not a simple matter of translating the Japanese maternal and child health handbook."

In Indonesia, about 5 million maternal and child health handbooks are issued per year. A 2010 survey confirmed that mothers and children who used maternal and child health handbooks had a higher use rate of maternal-and-child-health services than those who did not use the record books.

"Indonesia has begun an initiative for sharing its experiences with the maternal and child health handbook with countries that are developing their own and engaging in mutual learning with them. I want to continue supporting that," Ms. Osaki said. So far people in charge of mother-and-child health in 14 countries — including Afghanistan, Uganda, Kenya, Tajikistan, Laos, Vietnam, Myanmar, Palestine and East Timor — have participated in training in Indonesia.

It's not just about making and distributing; if no one uses them, it doesn't mean anything

JICA Senior Advisor Keiko Osaki, right, has a meeting with public health center personnel in charge of maternal and child health in West Kalimantan, Indonesia.

"When a country says it wants to introduce maternal and child health handbooks, I always say, 'If you simply distribute them, they're just paper. Are the government and health workers prepared to use them?'" Ms. Osaki emphasizes that the critical thing with maternal and child health handbooks is for government officials and health workers to think well about how they will be used to improve health services for mothers and children.

When Ms. Osaki was twice dispatched long term as an expert to Indonesia, she took her young child with her. When she took her Indonesian maternal and child health handbook to a health checkup, she was impressed with the health workers' service. "They explained everything well," she thought.

Because developing and introducing a maternal and child health handbook is a matter of creating or redesigning part of the health care service system in that country, it's sometimes difficult to work things out with the many stakeholders, "and I was often beaten down," Ms. Osaki said with a wry smile. "The thing that motivates me, however, is that mothers always look happy to have their maternal and child health handbooks in every country."

Profile
Keiko Osaki
JICA senior advisor (health and medicine)
Born in Kanagawa Prefecture. After learning about the politics and economics of developing countries at university, she aimed to work in international cooperation toward developing countries in the field of health care, and specialized in international health sciences in graduate school. In 1995, she began her involvement in JICA's effort to develop and introduce maternal and child health handbooks in Indonesia. JICA is now involved in assistance to develop, introduce and support the effective use of maternal and child health handbooks in many countries including Afghanistan, Burundi and Tajikistan.