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A: Children die from pneumonia and from sepsis, but we have the antibiotics to treat these.
A: The Democratic Republic of Congo, Ethiopia and Nigeria have the highest death rates in Africa for mothers and children. Q: A commentary in the Lancet in December last year criticized the 2005 World health report on maternal and child health for inadequate consultation of stakeholders. A: Often women and children are the first to suffer when the access to health-care services is disrupted. Major cause of death among children under five years of age and neonates in the world, 2000-03. A global mining group conducted a shutdown and major overhaul of a large item of production plant to maintain its availability and operational utilisation. The shutdown involved the inspection, replacement or repair of those components that were worn or damaged or where their expected remaining life was less than 35,000 hours of use. The principal objectives set for the shutdown and the actual performance are shown in Table 1.
The testing and refurbishment program involved a large number of work items, all of which had to be coordinated and scheduled.
While the budgeting exercise tried to predict the replacement costs for components that had reached the ends of their expected lives, it was less successful in predicting the cost to replace or repair components that were found by inspections to have failed or to be degraded. Broadleaf was commissioned to facilitate a workshop that reviewed and analysed both the successes and failures of the shutdown and refurbishment project. There were 22 participants in the workshop, from the mining company and its principal contractor. Because the shutdown project was complex and involved a large number of sub-projects, and because most of the stakeholders were each only involved in one sub-project or element, it was important to ensure that all participants were properly briefed before the workshop. We therefore established the context in a similar manner to the way we would prepare for a risk assessment. Workshop participants were encouraged to stand up and add material to the flipchart sheets. The Broadleaf facilitator created and projected the workshop output as the analysis progressed. After initial introductions and an outline of the process, the key element structure was followed to brainstorm a list of successes and failures.
Despite components from original equipment manufacturers (OEMs) not being compliant, detected these and modified them.

Once the workshop had generated successes and failures for each key element, these were grouped for further analysis under a series of ten issues. We used fish bone analysis, employing the ‘4 P’ (People, Place, Process and Policy) methodology (see Figure 2), to help the participants to derive root causes. The review generated 62 separate lessons that the workshop participants agreed the mining group should learn.
It was obvious that some of the issues that arose made life very difficult for the project team and if they had not been resolved quickly, with ingenuity and hard work, significant delays and therefore substantial production loss would have occurred. Even the relatively simple form of root cause analysis used here (fish bone analysis) can be powerful and highly productive when the exercise is facilitated well. We were asked to assist in the post-investment review of a large oil and gas development that had started operation. One of our clients operates sites that must comply with local environmental legislation that requires any releases of waste above threshold levels to be reported promptly to the regulator. Piles of debris and destroyed buses cover the ground at Page Middle School April 17, 2011 in Gloucester, Virginia.
Traveling has a major impact on what I do, cause all over the world I'm meeting all kinds of people.
Jason Mraz Quote“Traveling has a major impact on what I do, cause all over the world I'm meeting all kinds of people. Every year, 136 000 maternal and more than 1.1 million newborn deaths occur in India alone. Unfortunately, at the time the article came out in the Lancet we were still in the process and some of the consultation meetings had not yet taken place. Care must continue after delivery for the mother and infant and appropriate service links must be made with child care and family planning services. This came to light in Kenya when we launched a training programme called Beyond the Numbers, which helps countries document the causes of maternal death, count the women who die in childbirth and establish ways to bring the right solutions to communities. If these components were not replaced or repaired preventive maintenance analyses indicated there was a high likelihood of failure that would lead to significant downtime and production loss.
A systematic root cause analysis process was used to determine the causes for a range of events and the lessons that should be learned.
Our involvement stopped when step 5 was complete and the group went on to generate the action plan itself.
Agreed nominees presented the background to each key element and the facilitator recorded the suggested successes and failures on flipcharts for each case.

These analyses were recorded using MindManager™ software and projected to make them visible to participants.
Table 3 is a summary of all the issues analysed with some example lessons learned in each case. With shutdowns costing tens of millions of dollars, the return from this investment of time would be considerable if all the lessons were applied for all similar projects across the group. Some of these arose out of successful elements of the project while others involved aspects that did not go as well as they should. Despite the costs incurred, if the intended work had not been completed, then the future availability of a crucial plant item and the revenue that depends on its continued operation would have been at risk.
We conducted root cause analyses to understand how the investment performed in relation to the expectations set at the time it was approved, extract lessons and develop actions that would lead to improved outcomes in future investments. To discover images and hq pictures, type your search terms into our powerful search engine box or browse our different categories. We never had a World health report that enjoyed this level of consultation, so the criticism was a bit premature. Often the policy-makers are not aware of the numbers because a lot of women deliver at home, die at home and are not being counted.
The group then used these to define actions aimed at preventing such failures and repeating such successes at future, similar shutdowns.
The Broadleaf facilitator used a laptop computer with a video projector and large screen so that all participants could follow and contribute to the analysis. For each issue the completed fish bone was used to extract lessons and to suggest actions that should be considered by the group.
Although overall the shutdown was considered a success, it cost over twice the budget estimate. The company wanted to examine the root causes for a small selection of incidents, with the aim of identifying general lessons from them and specifying areas in which the business could improve its performance. Middle-income countries, such as Botswana, Namibia and South Africa are also experiencing setbacks and need mainly guidance on policy-making.

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