Global Presence

In January 2002, Management Sciences for Health (MSH) was one of only 34 programs to receive the World Bank's highly competitive 2002 Development Marketplace awards. MSH, with its partner the Manicoré Municipal Secretary of Health, is using funding from the award to help increase access to quality primary health care services in the Brazilian municipality of Manicoré.

In Manicoré, the only hospital is located in the town center, which is a prohibitive distance from most of the municipality's rural population. Travel can take up to several days by boat. Community Health Workers and Traditional Birth Attendants help to address health problems in some river communities, but their work is often constrained by a lack of needed supplies and resources. Other issues in the municipality, such as the lack of basic infrastructure, a substandard educational system, and a stagnant economy, further exacerbate the problems associated with Manicoré's health system.

The consequences of the system's inadequacies are particularly evident in the area of reproductive health. Official health statistics indicate that of all registered births in Manicoré, more than 50% of the women receive little or no prenatal care during their pregnancies, and nearly 25% of births occur outside the hospital. Although there is no official data on maternal deaths, the infant mortality rate is the third highest in the state at 48 deaths per 1,000 live births.

Management Sciences for Health's project activities correspond with Brazil's national priorities for health service delivery, and are being carried out both in the town center and in 12 selected river communities with very limited access to health services. The project is in the process of designing an integrated system of quality maternal health care delivery that links Community Health Workers and Traditional Birth Attendants at the community level, and is helping to ensure better health care for women by developing emergency procedures, including a cellular telephone system, a small speedboat for rapid transport of at-risk women, and floating clinics that periodically visit river communities.

Using a participatory development approach, the program is empowering both health consumers and providers and establishes a continuum of quality maternal health care for women living in Manicoré. By increasing access to quality maternal and child health services, the project will contribute to a reduction in maternal mortality and morbidity, thereby enabling women to lead more productive lives and help to strengthen their families and their communities.

Next year, the project intends to extend activities to some of the other 213 river communities within the municipality and eventually to other municipalities within the state. Furthermore, in collaboration with project participants, MSH will document and disseminate information about project activities, focusing on the effectiveness of the unique partnerships among NGOs, public institutions, and private enterprises as a means of improving maternal health outcomes in remote river communities in the Amazon.