International Activities

Alfred W. Brann, Jr. MD
Director
Neonatal/Perinatal Medicine and Systems Development

Brian McCarthy, MD
Principle Investigator 
Perinatal Epidemiology and Continuous Quality Improvement

The World Bank ranks problems in reproductive health and maternal and perinatal care as one of the top four contributors to the global burden of preventable death, illness and disability. All societies depend on their next generation for survival, social security, and economic development. Reduction in maternal, perinatal, and infant mortality rates are major targets in the United Nations Sustainable Development Goals (SDGs). These rates are excessive in low resource settings in both developed and developing countries. Current medical knowledge and skills exist today that can reduce this excessive and tragic mortality; - it needs only to be shared and implemented worldwide. The science associated with implementation must be the major focus if we are to achieve the SDGs.

The Global Collaborating Center in Reproductive Health (GCC/RH) at the Woodruff Health Sciences Center of Emory University was created in 1981 to explore causes of, and develop solutions to, the high rates of fetal- infant mortality in the state of Georgia. GCC/RH is a working partnership of three Atlanta institutions: the Woodruff Health Sciences Center, the National Centers for Disease Control and Prevention (CDC), and the Georgia Department of Public Health.

The VISION of GCC/RH is to improve every family’s opportunities for a healthy and wanted pregnancy with a healthy outcome for every mother and child – and following childbirth, the mother and infant are alive and healthy, and the child is safe and loved.

The MISSION of GCC/RH is to serve the people who serve the people. Through continuing medical education and country-specific projects: a.) knowledge encapsulated in the “Systems Solution” approach and b.) skills in the use of the Maternal and Infant Matrix Storyboard Methodology (MIM/SBM), the principle tool used in the Implementation Science of reproductive health and maternal and perinatal care, are passed on to health professionals and decision makers, enabling them to sustain these efforts on their own.

Over the past 30 years, Fellows of the GCC/RH have participated in improving Georgia’s Regional Maternal and Perinatal Healthcare Delivery System (MPHCDS) using transparent perinatal surveillance to guide continuous quality improvement of maternal and perinatal care. The GCC/RH’s focus has been twofold: a.) to identify evidence-based interventions known to improve the survival of the interdependent “triad” of the mother, fetus and newborn infant – the “Systems Solutions” approach; and b.) to expand interdisciplinary competence to put that approach into clinical practice – the “Implementation Science” uses the unique Maternal-Infant Matrix Storyboard Methodology which enables the conversion of data into information for intervention. The key to the implementation of the “Systems Solution” approach has been the competence of the interdisciplinary team of Fellows who have experience in the following disciplines: primary health care for women including child spacing; perinatal surveillance; nurse midwifery and nursing; maternal/fetal and neonatal/perinatal medicine; public health management; and the economic, ethical, cultural, and societal aspects of health.

Because of GCC/RH’s approach in implementing what is known to improve maternal and perinatal care – the Systems Solution” approach, the Center has been asked to provide similar consultation and assistance to over 30 member states from all regions of the World Health Organization. The member states are first, second and third tier countries described by the U.N. including: Jamaica, Cuba, Mexico, Columbia, Argentina, Jordan, the West Bank and Gaza, Ethiopia, Uganda, Tanzania, Greece, Romania, Poland, Russia, the Republic of Georgia, Armenia, Moldova, Afghanistan, Kazakhstan, Uzbekistan, China and Indonesia.

Major past international projects have included:

Making Pregnancy Safe Projects in multiple member states; the International Collaborative Effort on Perinatal and Neonatal Morbidity and Mortality; and United Nations Relief and Works Agency (UNRWA) consultations in the West Bank, Gaza, and Jordan.

The GCC/RH’s central research project involves the leading cause of feto-infant mortality in Georgia and Mississippi. This project is studying the role of inter-pregnancy care and its effect on reducing recurrent very preterm and/or very low birthweight births.

Recent and active international projects being supported by the Center include: Saving Mothers, Giving Life (SMGL) program in Uganda (2013-18); providing technical support and training to the African Epidemiology Network (AFENET) in developing its capacity in a unique maternal and perinatal surveillance system; “Helping-Babies-Breath” Program in Nigeria; the Afghanistan Health Initiative; and implementing the U.S.-Russia Implementation Science Collaborative in Reproductive Health in Tatarstan, one of the citizen-to-citizen health projects of the Dartmouth Conference sponsored by the Kettering Foundation.

• Knowledge concerning the components of the “Systems Solution” approach. The eight critical components (a thru h) of a country-specific system include: (a) primary health care for non-pregnant women of reproductive age; (b) an innovative perinatal surveillance system; (c) comprehensive and coordinated perinatal healthcare services at three levels; (d) use of international evidence-based guidelines for perinatal care; (e) post graduate education for perinatal health professionals; (f) international public health standards and managements practices; (g) public policy and health care laws; (h) and biomedical ethics and professionalism.
• Skills in the use of the five steps of the MIM Storyboard: (a) Describe the components and assess the performance of their existing MPHCDS, using data from their existing surveillance system; (b) Design and assist in implementing their new MPHCDS using all components of the “Systems Solution” approach, including the development of a perinatal surveillance system; (c) Monitor and evaluate their emerging MPHCDS; (d) Improve their MPHCDS through Quality Improvement Projects (QIP); and (e) Perform Quality Improvement Collaboratives throughout the system.

Current Goals

The GCC/RH’s activities are guided by the desire to:

1. Expand its broad interdisciplinary competence in the “Systems Solution” approach and Implementation Science in reproductive health and maternal and perinatal care. Consultants from both domestic and international agencies are being sought to become GCC/RH Fellows. This will strengthen the Center’s ability to assist state departments of health and universities in the U.S. and ministries of health and universities around the world in meeting U.N. Sustainable Development Goals Three new sections on Maternal Mortality and Morbidity, Biomedical Ethics; and Tele-Medicine have been added to enable GCC/RH Fellows and interested perinatal health professionals around the world to participate in the Center’s expanding collaborative network.
2. Develop additional Endowment and create a Discovery Fund. In 2014, Drs. Ann and Frank Critz established The Alfred W. Brann, Jr. Chair in Reproductive Health and Perinatal Care in the Emory University School of Medicine for the GCC/RH. Additional Endowment and a Discovery Fund are currently being sought to support activities that include: (a) an educational fellowship for a designated GCC/RH global scholar; (b) a biannual workshop - Closing the Gap in Reproductive Disparities; (c) research to prevent recurrent preterm births; (d) an enhanced role of Nurse-Midwifery in the GCC/RH’s Mission; and (e) Cross-Cultural research and education in the Bio-Ethics in Reproductive Health.