5- Maternal and Child Health MCV Edited (1)

7/31/2019 5- Maternal and Child Health MCV Edited (1)

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Hypertension, post-partum hemorrhage and severe

abortive outcomes are the leadingdirect causes of

maternal deaths

postpartum

hemorrhage, 17.70%other complicationsrelated to pregnancy,

45.10%

pregnancy with

abortive outcome,

10.50%

hypertension

complicating

pregnancy, childbirth

and puerperium,

26.60%

Source: Philippine Health Statistics, 2003


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Most maternal deaths occur during labor, deliveryand the immediate post-partum period

0-1 day 2-7 days 8-14 days 15-21 days 22-30 days 31-42 days

Day of maternal death after delivery

Source: X. F. Li et al., International Joumal of Gynecology & Obstetrics 54 (1996): 1-10

Percent of maternal deaths in developing countries


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0

10

20

30

40

50

60

70

80

1988 1993 1998 2003 2006 2015

UFMR IMR NMR

UFMR and IMR targets are likely to be reachedby2015 but pace of reduction has decelerated due tovery slow decline of NMR


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Neonatal events account for most of thedirectcauses of under-five mortalities

Source: CHERG estimates of under-five deaths, 2000-2003

Under-

nutrition

53%


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Majority of newborns die due to stressfulevents surrounding delivery

50 percent of neonatal deaths occur in

the first two days of life

Day of Life

Numberofdeaths


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Undernutrition, high fertility rates and unmet needs for family

planning aremajor underlying factorsthat worsen morbidity

and mortality outcomes for mothers and children

Nutritional factors

Obvious hunger

Hidden hunger

Fertility factors

High fertility rate

High unmet needs for family planning and

reproductive health Incidental illnesses

Malaria, HIV/STIs, TB, chronic diseases


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Maternal and newborn deaths are influenced by the

place of delivery and who assists in the process

Most mothers prefer to give birth at home with theassistance of TBAs

where mothers and newborns are distanced from life-saving

interventions provided in health facilities by health professionals

during intrapartum period, maternal and neonatal deaths are high

Mothers do not routinely choose to deliver in health

facilities and avail of professional services due to

several barriers hostile hospital system, poor interpersonal skills of staff, financial,

physical, social and cultural constraints are deterrents to actual

service utilization


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Policy Issues and Policy Options

Separate programmatic strategies for mothers andchildren do not address the need to congregate or

integrate actions around labor, delivery and immediate

post-partum where most of the deaths occur

DOH needs to institute a unified strategic framework

for maternal and newborn care that is linked with child

survival strategies and will maximize the delivery ofservice packages and ensure a continuum of care

across the life cycle stages


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Policy and Strategic Thrusts


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4-Tierred Service Delivery Model

1st tier: Community-based teams

2nd tier: Basic EssentialObstetric & Newborn Care

(BEONC)

3rd tier: BEmONC

4th

tier:CEmONC

Catchment

population perfacility

Distance from

any home(travel time)

500,000

125,000

< 2 hours

< 30 mins

Services:

All BEmONC services, blood transfusion,

cesarean section

Parenteral drugs for mothers and neonates,

imminent breech delivery, removal of retained

products of conception; manual removal of retained

placental fragments, BTL, vasectomy, IUD insertion;

neonatal resuscitation, oxygen

Normal spontaneous vaginal

deliveries, antenatal and post-

partum care, essential newborn

care; services for women of

reproductive age; FP, nutritionpackage

Pregnancy tracking, birth planning, home visits and follow-up,

nutrition package; IEC on facility delivery and FP;

communication activities targeted to mothers and their families


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Infrastructure and Service Package Development

First Tier

Community-based teams Womens Health Teams

Second Tier Basic Essential Obstetric and Newborn Care (BEONC)

RHUs/BHSs, birthing facilities, private clinics

Third Tier Basic Emergency Obstetric and Newborn Care (BEmONC)

Selected RHUs, district/core district hospitals, private hospitals

Fourth Tier

Comprehensive Emergency Obstetric and Newborn Care(CEmONC)

Provincial hospitals, regional hospitals, medical centers


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Human Resource Development

TBAs and Community Health Workers Defining roles and incentives in Womens Health Team Training TBAs as professional midwives

Regulating TBA practices

Midwives, Nurses and Doctors

Upgrade skills of midwives, nurses and doctors for BEONC,

BEmONC and CEmONC

Mandates for midwives

Develop as team of professionals Midwives at basic level

Midwives, nurses and doctors at BEmONC and CEmONC


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Information System, Health Education and

Advocacy

Database, information and surveillance system Establishing sensitive indicators for performance and outcomes

Improving data quality, disaggregation, timeliness

Analyzing and acting on data

Health Education and Advocacy

IEC / health education and advocacy

National and local policy makers / decision-makers

TBAs / CHWs

Health professionals (MW/N/MD)

Pregnant women / families


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Financing Schemes

Free access for mothers Minimal or zero co-payment especially for indigents

Cash transfer vouchers for transport

Incentives for institutional and individual providers PhilHealth reimbursement share

Performance-based incentives

Incentives for local government participation PhilHealth capitation fund

Government grants


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Implementing and accelerating a unified strategy to

save mothers, newborns and children is possible

Focusing interventions on the direct causes of deaths Integrating maternal, newborn and child health

interventions

Shifting from home-based TBA-assisted births to facility-based professionally-assisted births

Targeting high-risk and low performing areas to fast trackattainment of goals

Empowering mothers to utilize life-saving packages Developing incentive and disincentive mechanisms to

influence positive behaviors from health providers andconsumers


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Documents

5- Maternal and Child Health MCV Edited (1)