1. Three Days of Discussion on MCH Handbook
The 10th International Conference on the Maternal and Child Health (MCH) Handbook was held between 23rd-25th November, 2016, at U Thant International Conference Hall, United Nations University (23rd November) and JICA Ichigaya (24th, 25th). It was hosted by the International Committee on the MCH handbook in collaboration with the Japan International Cooperation Agency (JICA), UNICEF Tokyo, the United Nations Population Fund (UNFPA) Tokyo Office, and the Health and Development Service (HANDS). This resulted in a large conference gathering of around 400 people from 38 countries and regions all around the world. Important figures who are difficult to meet, even in their own countries, such as vice ministers of Afghanistan, Palestine, Vietnam, and the Director General of Community Health of Indonesia came together to have a discussion focusing solely on the MCH handbook. After three days of heated discussions from morning to evening, the participants developed a sense of fellowship, forming bonds transcending different cultures, religions, and viewpoints to share the MCH handbook, which cares for maternal and child health. Thanks to the enthusiasm of our participants, we were able to strongly contribute to the creation of a global network aiming to improve maternal and child health, through the MCH handbook.
2. Various Viewpoints Discussed at the Symposium and Thematic Sessions
In the opening session, after a speech delivered in English by Her Imperial Highness The Princess Akishino, a message from Prime Minister Abe was read out, and greeting speeches were given from Yasuhisa Shiozaki (Minister of Health, Labour and Welfare), Mikio Mori (Deputy Director-General of International Cooperation Bureau Ministry of Foreign Affairs of Japan), Shinichi Kitaoka (President of JICA), Tewodros Melesse (Director-General of the International Planned Parenthood Federation (IPPF) and Keizo Takemi (a member of the House of Councilors). Two keynote speeches, by the ambassador to the Republic of Cameroon and the author, followed. Mr. Keizo Takemi (a member of the House of Councillors) shared his episode of discovering his MCH handbook from inside the family Buddhist altar, followed by other speeches in similar vein, which reflected the general air of enthusiasm.
The symposium was held with triple themes: "The MCH Handbook in Japan, past, present and future," "No one left behind: The continuum of maternal, newborn and child health care: Global trends and implications," and "Scientific evidence of the MCH Handbook's effectiveness." The history of almost 70 years of reforms made and challenges facing the MCH handbook in Japan was related from the viewpoint of both sides: health care workers and mothers. The countries and regions where they publish and promote the MCH handbook, such as Ghana, Mongolia, the Netherlands, and Palestine, have emphasized the role of the MCH handbook as a trump card for continuous care to provide seamless support throughout the mother's phases of pregnancy, parturition, and the child's phases of newborn, and infancy. The latest results of studies measuring the effects of the MCH handbook were released from Mongolia, Cambodia, and Indonesia. This was sharing scientific evidences of improved knowledge level of mothers resulting in healthier behavior patterns. In the panel discussion "The MCH Handbook as a 'Global Common Good'," WHO, UNICEF, UNFPA, and JICA discussed its role as Home-based Records (HBR) in regard to the standardization of maternal and child health.
At the thematic session titled "To Promote MCH Handbooks for marginalized populations," the role of the MCH handbook subsuming the disabled, refugees/immigrants, minorities, and the poor was discussed, as well as the issue "To ensure the sustainability of the MCH Handbook program" regarding human resource development, reinforcement of health system, and securing revenues. In the other thematic session "To develop the Digital MCH handbook," participants talked about the management of health information and the development of MCH handbook apps.
On the last day, "The Tokyo Declaration" was adopted by all, confirming the greatness of the MCH handbook which has the potential to empower people to solve the issues of our society. At the closing ceremony, Deputy Ministers of Public Health of Afghanistan and Palestine mentioned what they had learnt and gained from the conference and expressed their gratitude. Professor Miriam Were, the recipient of the first Hideyo Noguchi Africa Prize, praised the greatness of the MCH handbook which was first conceived of in Japan and is now being disseminated worldwide. Finally, the conference ended successfully promising to meet again in Thailand at the 11th International Conference on Maternal and Child Health (MCH) Handbook, which will be held in 2018.
We had dedicated support from a great many volunteers, students, and enterprises right from the preparation stage of the conference. Moreover, we had sponsorship, support, and donations from numerous academic organizations, public bodies, private enterprises, and individuals. I would like to use this opportunity to express my deepest gratitude for this.
3. What we learned from the International Conference on Maternal and Child Health Handbook
(1) Establishment of a global MCH handbook network
International organizations such as WHO, UNICEF, and United Nations Population Fund, JICA specialists and counterparts (affiliates), high-ranking government officials such as Deputy Ministers and Generals, Researchers from Universities, and NPO/NGOs have all indicated great interest in the MCH handbook as one of the specific measures of Sustainable Development Goals (SDGs) such as Universal Health Coverage: UHC and "No one left behind." A favorable wind is blowing globally for the MCH handbook. There are even reports that WHO is preparing a guideline regarding Home-based Records (HBR). We would like to see progress towards realizing of incorporation of the outcome of the International Conference on the MCH Handbook to the standardization of the international society without missing any good opportunities.
(2) Sincerity and acuteness of participants from developing countries
Deputy Ministers and General-level high-ranking government officials of developing countries fully participated in the conference, focusing on the MCH handbook over the three days. Most of them had great expectations for the MCH handbook to decrease the mortality rates of expectant and nursing mothers and newborns by health education and changes in behavior patterns. At the same time, they saw that the MCH handbook is a great practical example of continuous care when aiming to improve the quality of maternal and child medical service by altering the consciousness and strengthening the mother-child bond. As a matter of fact, we had prepared a large venue for the thematic session discussing digital MCH handbooks, assuming it would be the most popular. However, our assumption proved to be mistaken and most participants from developing countries joined the thematic sessions discussing sustainability and minorities. In developing countries, although digitization is in progress, they were actually looking for a realistic way to provide a paper-based MCH handbook in a sustainable way to people including minorities rather than thinking about future issues concerned with development of digital MCH handbooks.
(3) Return for Japan from the International Conference on MCH Handbook
As the 10th International Conference on MCH Handbook was held in Japan this time, a lot of specialists involved in maternal and child health in Japan such as pediatricians, obstetricians, nurses, and midwives took part even though they lacked experience in global health issues. Most of them were surprised at the fact that the conference was set up for three days just to discuss the single topic of the MCH handbook. In Japan, it is rare for an academic society to hold a symposium on the MCH handbook. This is because the MCH handbook is already so much a part of our daily lives that it seems unnecessary to discuss it in an academic setting. However, the issues and problems of maternal and child health and local health care in the world and Japan became clear as we got to the bottom of the matter at the International Conference on MCH handbook by focusing solely on the MCH handbook. For example, to improve the quality of MCH handbook program, human resources to provide maternal and child health service must be active in remote areas and information of maternal and child health, which is the outcome, must be shared. There is no doubt that it is closely related to global issues such as developing human resources for health care and their optimal allocation and building a network of maternal and child health information. One of our participants told us excitedly, "There's always something more to learn about the MCH handbook!"
A speech made by a Japanese mother who told the audience how "As mother of a low-birth-weight baby, the MCH handbook seemed to be harsh" touched the hearts of many participants. To fulfill our goal to leave no one behind with the MCH handbook and mother and child health care service, new ideas came up such as disseminating and improving the paper-based MCH handbook while also using the digital version, which may make it possible to live alongside various minority groups.
Japan was the first country in the world to make the MCH handbook, about 70 years ago. Currently, it is published in 39 countries around the world. Maybe we should not just be striving to maintain the conventional style with its long history, but should learn something from the enthusiasm of participants from developing countries who talk passionately about their MCH handbooks. The MCH handbooks of other countries tend to be more colorful and user friendly compared to Japan's and above all, the aims for a MCH handbook need to be easy to understand for the users: mothers, fathers, and children.
For MCH handbooks in Japan, the format of the records of health checks and vaccinations are fixed by the Ministry of Health, Labour, and Welfare to be utilized at all local governments, but other pages are left to the local governments to compile freely. MCH handbooks are not for medical personnel or government offices. It is an important record for children and parents as well as being a bond between parent and child. It is possible for the local governance and parents and children to cooperate and create a MCH handbook that meets the local needs. I hope that MCH handbooks in Japan will develop significantly in the future by returning the outcome of this year's International Conference on MCH handbook to Japan.
Yasuhide Nakamura
