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And it is heavily invested in nurses.

A multimillion-dollar organization, Jhpiego (pronounced ja-pie-go) is led by a nurse, Leslie Mancuso, PhD, RN, FAAN. It employs many nurses on its 600-plus staff, working in 55 countries to train and empower nurses and other health workers all over the world. In many of the countries served by Jhpiego, nurses are the main healthcare providers, says Mancuso, president and CEO.

Well-Known Globally

A nurse for 31 years, Mancuso became Jhpiego's top officer 7 years ago after working more than a decade with Project HOPE. One of her goals has been to increase the organization's public profile which has been under-recognized, despite Jhpiego's affiliation with well-known Johns Hopkins University, Baltimore.

"Throughout Africa and Asia - India, Nepal, Indonesia, Ethiopia and Kenya - people know what Jhpiego is," Mancuso told ADVANCE. "The reason: We believe in helping nurses, midwives and doctors learn how to better care for their women and children. Someone will approach me and say, 'You trained me in maternal health,' or 'That's how I learned about mothers' health,'" Mancuso said.

Describing Jhpiego as a healthcare innovator and capacity-building organization, Mancuso and staff work side-by-side with healthcare leaders and government officials in under-developed countries to create standards and protocols, and educate and train care providers. About 125 members of Jhpiego's team are stateside, headquartered in Baltimore, while the majority of its staff is overseas.

Many of Jhpiego's doctors and nurses are native to the host countries, training others as they were trained. However, Jhpiego does offer careers for U.S. nurses as well, on the technical or program sides of healthcare. Opportunities range from managing one of Jhpiego's programs for an entire country to training nurses and midwives in rural, less developed areas. Nurses must be willing to work in the field, and it helps if they can speak a foreign language.

Giving Providers the Tools

Teaching is a huge part of Jhpiego's mission. "Rather than conducting all of the training or developing a program, when we go into a country we develop the capacity of the local people to train and support their country's program," explained Barbara Deller, MPH, RN, CNM, Jhpiego's senior technical advisor for maternal and newborn health.

Jhpiego utilizes nurses, physicians, midwives and others to work with countries to develop strategies to combat their healthcare issues. The organization may first conduct an initial assessment with local health officials to find out why women and children aren't getting care they need. Then they begin to develop supportive policies and standards, strengthen education at nursing and medical schools, and train and support healthcare workers in a country.

The team may train healthcare providers to perform tasks like attending a birth or providing long- or short-term contraceptives. They in turn train others. Other nurses in the field teach community health workers newborn care, such as how to resuscitate newborns who aren't breathing at birth.

Getting Results

Deller said Jhpiego estimates it has trained more than 200,000 healthcare workers in the past 35 years. Yet it's hard to assess the exact number impacted by the effort because of what she calls a "cascading effect" of trainers training others.

For example, when the organization began work in Afghanistan, 467 midwives served about 23 million people in a country where women don't go to male healthcare providers. It was essential a large number of nurse midwives be trained while maintaining standards of care, according to Deller. Midwifery schools were opened in rural areas, curriculum developed, faculty trained and clinical teaching sites constructed.

"I always say our mission is simple," said Mancuso. "We're trying to prevent the needless deaths of women and their families."

Modern-Day Tragedy

Sadly, this maternal and child mortality continues in the 21st century. One woman dies every minute due to pregnancy-related causes in some parts of the world. The main cause during childbirth is uncontrolled bleeding, Mancuso explained. In addition, a woman dies every 2 minutes of cervical cancer. And tragically, communicable, often preventable, diseases are the main cause of death in children worldwide.

"That's one of the really striking things. What is killing mothers or babies doesn't require high-tech solutions," said Deller. "They are things that are very much in the reach of people."

In many countries where Jhpiego works, it is a challenge for women to get proper healthcare. Often the country's few physicians work exclusively in the city, said Mancuso. "You've got to look to nurses, midwives and community health workers to provide the majority of healthcare."

Grabbing the Moment

Jhpiego helps countries come up with creative, affordable solutions to put protocols in place and train community healthcare workers to provide as much care as possible on the spot.

Thanks to the organization's efforts in places like Indonesia and Nepal, Jhpiego has shown that community volunteers working with nurses and midwives can be trained to provide pregnant women with misoprostol during their eighth month of pregnancy. The drug can be taken after delivery to prevent postpartum hemorrhaging (PPH), the leading cause of maternal mortality. Last spring the Global Health Council awarded Jhpiego's Harshad Sanghvi, MD, vice president and medical director, the 2009 Award for Best Practices in Global Health for 25 years of work addressing PPH.