6 1 Safe Motherhood and SBA Policy

8/8/2019 6 1 Safe Motherhood and SBA Policy

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National Policy onSkilled Birth Attendants


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Supp lement ary to

Safe Motherhood Policy 1998

Government of Nepa lMinistry o f Health a nd Pop ulation

Dep artment of Health Servic esFamily Hea lth Division

July 2006


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National Policy onSkilled Birth Attendantsi


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National Policy onSkilled Birth Attendantsi i i


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Acronyms

AHW : Auxilia ry Hea lth Worker

ANM : Auxilia ry Nurse Midwife

BEOC : Basic Essentia l Obstetric careBEmONC : Basic Emergency Obstetric and Neonata l Care

CEOC : Co mp rehensive Essent ial Ob ste tric c are

CEmONC : C o m p re h e nsiv e Em e rg e n c y O b st e tric a n dNeonatal Care

CTEVT : Centre for Educat ion and Vocat ional Tra in ing

DFID : Department for In ternat ional Development

DHO : Dist ric t Hea lth O ffice

DoHS : Depa rt ment o f Hea lt h Se rvices

EmOC : Em erg enc y Ob ste tric C a re

FCHV : Female Communit y Hea lth Vo lunteer

FHD : Family Hea lth Div ision

HA : He a lth A ssista nt

HFMC : Hea lth Fac ilit y Management Commit tee

HP : Hea lth Post

Go N : Government of Nep al

IEC : In fo rmat ion Educat ion and Communica t ion

MCHW : Materna l and Child Hea lth Worker

MDG : M ille nnium De ve lo p me nt G oa l

MDGP : Doc to r o f Med ic ine in Genera l Prac t ice

MM R : M a te rna l M ort a lity Ra t io

MNH Ma ternal and Newb orn Hea lth

MoHP : M in ist ry o f Hea lth and Popu la t ion

NAN : Nurses Assoc ia t ion of Nepa l

NGO : Non Gove rnment a l Organisa tion

NEPAS : Ne p al Pa e dia tric So c ie ty

NESOG : Nepal Society of Obstetric ians and Gynaecologists

PA Personne l administration

PESON : Pe rina ta l Soc ie ty o f Nepa l

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PHCC : Prim a ry Hea lth Ca re Cen tre

RH Reproductive Health

SBA : Skilled Birt h A ttendant

SHP Sub Hea lth Post

SM : Sa fe Motherhood

SN : Sta ff Nurse

SSMP : Support to Sa fe Motherhood Programme

TBA : Trad it iona l Birth A ttendant

UMN : Un ited Mission t o Nepa l

UNFPA : United Nat ions Fund for Populat ion Act iv it ies

USAID : Un it e d St a t es A g e n c y fo r In te rn a t io n a lDevelopment

VDC : Village Deve lopm ent Comm itt ee

VHW : Villa g e He a lth Wo rke r

WHO : World Hea lth Organisa t ion

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to SBAs, pa rtic ularly in po or area s w ith ma rg inalized pop ulat ions. In

this reg a rd , during the 1990s, Nepa l invested in two c ad res of he a lth

wo rkers to b e responsible for provid ing ma ternal/ child hea lth servic es

and obstetric first aid at the village level- the Maternal and Child

Hea lth Workers (MCHW) and Auxilia ry Nurse Midw ives (ANM). Neithe rc a teg ory of w orker has suc c essfully func tioned as an SBA d ue to a

numb er of fac tors, inc luding: inad eq uate leng th of the midw ifery

component of the training; the training not being competency

based; a lack of adequate c l in ica l t ra in ing and exper ience;

p rofessional a nd soc ial isolation a t p ost; and lac k of support from

the health system to enable MCHWs and ANMs to provide quality

emergency obstetr ic and neonatal care, especially during life-

threatening complications4.

1.2 Rationa le

The p rop ortion of b irths assisted b y Skilled Birth Att en d a nts is aMillennium Deve lopm ent Indica tor and a key indica tor for assessing

progress towards maternal mortality reduction. As a signatory of

Mi l lennium Declarat ion, GoN is commit ted to achiev ing the

Millennium Develop ment G oa ls (MDG). The two ind ica tors prop osed

by the M DG frame wo rk for mo nitoring p rog ress tow ards MDG 5 a re:

(1) a red uc tion of MM R by three -qua rters betw ee n 1990 and 2015;

and (ii) an increase in the proportion of births attended by skilled

a tten d a nt. The internationa l ta rge ts for the prop ortion o f births

a ttend ed by a skilled a ttend ant c a ll for 80% of a ll births by 2005, 85%

by 2010 and 90% by 2015. How eve r, WHO suggests tha t in c ountries

where the MMR is very high, the goal should be at least 40% of all

births assisted by skilled birth attendants by 2005, 50% by 2010 and60% by 20155. In Nepal, currently only 13 percent6 of women are

atte nde d by a hea lth w orker during de livery, and it is important to

no te t ha t no t a ll of t hese he a lth wo rkers qua lify as SBAs.

Henc e, keeping in mind the c hallenge s related to hum an resourc e

development a nd manag ement , soc io-ec onomic and cul tura l

barriers to ac cessing SBAs, high unm et nee d for em ergenc y ob stet ric

care, and weak referral back-up, this policy recommends the

rea listic , practica l and ac hieva ble na tiona l targe t for the p rop ortion

of b irths at tend ed by a skilled a ttend ant of 60% by 2015.

1.3 Elements of SBA PolicySa fe Mo therhoo d w as iden tified as a p riority p rog ramm e for the

go vernment in the Nationa l Hea lth Policy of 1991; which wa s follow ed

in 1994 by the formula tion of a na tional Safe Mothe rhoo d Polic y that

plac ed emp hasis on:

4 Towards skilled birthattendance in Nepal,Rapid appraisal of thecurrent situation and

outline strategy, WHO,February 2005

5 National SafeMotherhood ActionPlan 2001-2005:Western PacificRegion, WHOSkilled Care at EveryBirth, Report andDocumentation of theTechnical Discussionsheld in conjunction with42nd Meeting ofConsultativeCommittee forProgrammeDevelopment andManagement

(CCPDM), Dhaka,Bangladesh, 5-7 July2005, World HealthOrganisation, RegionalOffice for South-EastAsia, New Delhi

6 Nepal Demographicand Health Survey2001

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Streng thening ma ternity c are, inc luding fa mily p lanning services,

a t a ll levels of hea lth servic e d elivery inc luding the c om munity.

The Na tiona l Sa fe Mo therhood Plan 2002-17 develop ed a long-

term vision to sc ale up the c overage of ma ternal and new bo rn

hea lth ca re a t a ll levels of he a lth ca re d elivery system .

Streng thening the tec hnic al ca pa c ity of maternal health c are

p rovide rs a t a ll levels of the hea lth ca re system throug h training.

The Nationa l Sa fe Mo the rhood Training Strate gy, 2002 foc ussed

on strengthening pre-service and in-service training institutions

to ensure that al l health providers have appropr iate ski l ls

ac c ording to t he na tiona l RH c linica l stand ard 1998.

Deploying a nd providing a pp rop riate supp ort and pe rsonnel for

ea c h leve l of ma ternity servic es wa s an ide ntified ob ject ive.7 The

importance of appropriate human resource as an essential

component for ensuring quality maternal health services was

reiterated in the Nep a l Stra teg ic Plan fo r Huma n Resource s for

Hea lth 2003-2017

This SBA Policy he nc e a dd resses the gaps identified b y the a bove

national Policy and Plan documents.

The SBA p olicy is linked to other nat iona l po lic ies and strate g ies. The

Nationa l Informat ion, Educ at ion and Comm unica tion (IEC) Strat eg y

for Sa fe M othe rhoo d deve lope d in 2003 by the DoHS will be referred

to fo r deve loping p a rtnerships with c om munities, which a re vital for

implem enta tion of the SBA p olic y.

Similarly, the Na tiona l Neona ta l Hea lth Stra teg y d eve lope d in 2004

will be a n impo rtant g uide line for de veloping the de tailed strate gic

plan to ad dress the nee ds of the ne wb orn bab ies.

This SBA Polic y is in co nc urren c e w ith the Ne p a l Hea lth Sec to r

Prog ramm e- Imp lementa tion Plan 2004-2009, pa rticula rly with outp ut

one a nd o utput seven.

1.3.1 Definition o f Skilled Birth AttendantAn accredited health professional-such as a midwife, doctor or

nurse-who has been educated and trained to proficiency in the

skil ls needed to manage normal (uncomplicated) pregnancies,

ch i ldb i r th and the postnata l per iod and in the ident i f icat ion,

managemen t and r e fe r r a l o f comp l i ca t i ons i n women and

newborns.8

7 His MajestysGovernment of Nepal,Safe MotherhoodPolicy, Family HealthDivision, DoHS, MoH,July 1998

8 Making PregnancySafer : the Critical Roleof the Skilled Attendant.WHO, ICM, FIGO. 2004

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At the Dhu l ikhe l meet ing 9 on SBAs, held in July 2004, the

rep resenta tives from go vernment, p a rtners and othe r stakeholde rs

agreed tha t in the c onte xt of Nepa l, doc tors, sta ff nurses, midwives

a nd ANMs will be c onside red a s SBAs, provid ed the y p ossess

com pe tenc ies in the c ore skills ident ified b y the me eting (Refer anne x1 for the list o f core skills). The m ee ting a lso rec og nised the nee d to

develop regulating, accrediting and licensing systems to ensure

provide rs have the ab ilities and skills to p rac tise a c cording to na tiona l

standards.

Working Definition o f SBA fo r Nep a l for up to Five Yea rs of App rova l

of this Policy:Those Physicia ns, gyna ec ologists and o bste tric ians and

othe r hea lth pe rsonne l with at lea st 18 months tra ining in ma ternal

and c hild hea lth will be c onsidered as skilled b irth a ttend ants. This

definition sha ll not a pp ly a fter five yea rs of a pprova l of the p olic y.

1.3.2 Com petenc ies Required for SBAsAll hea lth c are p rov ide rs ide ntified above a s SBAs - do c to rs (MBBS,

Ob ste tric ians, MDGP), midwives and nurses (sta ff nurses and ANMs)

wo rking as maternal and newb orn health c are p roviders at all levels

of he a lth system must ha ve com pete nc ies in the c ore skills as defined

in annex-1. In a dd ition to this Ob stet ricians and MDGPs will also have

c om pete nc ies in advanc ed skills as defined in annex 1.1

SBA Policy Statement

The ma in thrust of MoHP tow ards red uc ing ma ternal and neo na ta l

mo rta lity in Nep al is through the Sa fe Mo therhoo d Prog ra mm e,

including Newborn Care, by improving maternal and neonatal

hea lth servic es a t a ll levels of the hea lth ca re delivery system and

ensuring skilled c a re at e very birth.

Objectives of SBA Policy

3.1 General ObjectiveTo reduc e ma ternal and neona tal morbidity and mortal ity by

ensuring a va ilab ility, ac c ess and utilisat ion o f skilled c are a t e very

birth.

2

39 Taking Forward the

Consensus from theUNFPA RegionalWorkshop on SBAs,Dhulikhel, FHD,Department of HealthServices/UNFPA Nepal,July 26-27, 2004

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3.2 Specific Objectives To ensure tha t sufficien t numb ers of SBAs a re trained and

deployed at primary health care levels with necessary

support system.

To streng then referra l service s for sa fe m otherhood and

new born care, pa rticula rly at the first referra l leve l (distric t

hospitals).

To streng then the p re-service and in-service SBA training

institutions to ensure that all graduates will have the

necessary skills as proposed in annex-1.

To streng then sup ervision a nd sup port system to ensure

tha t a ll SBAs are a b le to p rovide qua lity ma ternal and

newb orn health ca re a cc ording to the na tiona l stand ard

and p rotoc ol.

To d eve lop regula ting, a c c red it ing a nd re-lice nsing

systems for ensuring tha t a ll SBAs ha ve the ab ilities and

sk i l l s to p rac t ise in accordance w i th the core

c omp etenc ies propo sed in a nnex-1.

Strategies

To ensure skilled c a re a t every birth, rap id expansion of a c c red ited

SBA training sites and c ap ac ity enhanc em ent of trainers in order to

ensure qua lity training is impera tive. Dep loyment of SBAs a t p rima ry

health care levels to promote their availability for all families and

ensuring SBAs a re supported and rec og nised by the c om munities

a re c ruc ial issues to b e add ressed . Henc e, w ith a long-term vision,

Mo HP identifies the follow ing strate g ies:

4.1 Human Resource DevelopmentA c ontinuum of prope rly func tioning ma ternal and neona tal health

service s based on the ava ilab ility of SBAs ha ving a ll nec essa ry skills

and ab ilities a t the PHC leve l, w ill ta ke time. Therefo re, a pa rt from

having a medium and long-term strategy, a short-term strategy is

also required.

4.1.1 Short-Term (in-service) MeasuresThe e xisting sho rt-term c ourses (midw ifery refreshe r, BEOC ) and one-

year post basic diploma course in midwifery will be reviewed and

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upd at ed in order to ensure tha t the revised c urriculum c onta ins c ore

skills for SBAs as defined in annex-1.

a. Staff Nurses / ANMsSta ff nurses and ANMs current ly working in the health care system

who ha ve not rec eived a dditiona l midw ifery training, and ne wly

appointed staff nurses and ANMs, will receive competency

based tra ining on the c ore skills as defined in anne x-1, and will

be c ertified as SBAs.

The sta ff nurses and ANMs c urren tly wo rking in the hea lth care

system w ho ha ve rece ived a dd itiona l midw ifery tra ining w ill be

assessed for co mp etenc ies aga inst the skills defined in a nnex-1

and if deem ed c om pe tent, will be c ertified as SBAs.

Tho se w ho a re unsuc c essful in c erta in skills in the a b o ve

assessme nt w ill be allowed to undertake further tra ining in orderto m ee t the ag ree d c ore skills (and to be c ertified as SBA)

through structured onsite training.

All sta ff nurses working in prima ry hea lth c ent res and sta ff nurses

providing maternity services at district hospitals will have the

op portunity to rec eive o ne yea r of Post Basic M idwifery tra ining

in order to q ua lify them as SBAs (Nurse Mid wife) and e na b le

them to b e p rom ote d to Senior Nurse Midw ife.

b. Doc tors

Doc tors (MBBS) providing sa fe mo therhood and new born ca re

a t Basic Essentia l Ob ste tric Ca re (BEOC ) service sites (PHCC andDistrict Hospital) will be supported to develop competency in

the c ore skills as defined in annex-1. Simila rly, doc to rs p roviding

sa fe motherhood and newb orn c are a t Com prehensive

Essential O bste tric Ca re (CEOC ) service sites at ma ternity units/

departments of distr ict , zonal, regional and central level

hospitals, who are competent in the core skills (as defined in

Annex 1) will be supported for ad vanc ed SBA training (refer to

annex1.1).

4.1.2 Med ium-Term (Pre-service) MeasuresThe c urrent ANM c ourse w ill be reviewed , and will be restruc tured as

a two-year course in order to ensure that all ANMs attending thec ourse d eve lop c om pete nc y in the skills de fined in annex-1.

The midwifery sec tion of the current sta ff nurse (PCL) and B.Sc . nursing

c ourse will be revised and ad justed to inc lude c ore e lem ents of SBA

skills.

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The MDGP c ourse w ill be up dated for SBA skills and adva nc ed SBA

skills (anne x- 1 and 1.1)

The O bstet ric s and Gynaec ology sec tion o f the c urrent M BBS c ourse

will be review ed and a d justed to include c ore eleme nts of the SBAskills (annex-1).

4.1.3 Long-Term (Pre-service) MeasuresMoHP is in the p roc ess of initiating a new c adre of Profe ssiona l Midw ife

(PM)10 as a c ruc ial human resource for sa fe mo therhood , provid ing

servic e a nd lead ership in midw ifery for the c ountry.

4.2 Strengthening SBA Training SitesAll existing training sites (p re-service and in-service ) w ill undergo the

proc ess of a c c red itation. Rap id expa nsion of the numb er of new

accredited training sites will be a priority to ensure production ofc om pe tent SBAs for in order to ac hieve the na tional targe t of 60%

deliveries c onduc ted b y SBAs.

4.3 Deployment and Retention of SBAsAc c ording to the Huma n Resource Stra teg y11 of 2003, eac h hea lth

post will be sta ffed by two ANMs and a sta ff nurse; and ea c h sub -

hea lth p ost will b e sta ffed b y two A NMs by 2017. As a p art of

d ec en tralisa tion, an y ad d it iona l req uirem ent fo r SBAs w ill b e

addressed loca lly to e nsure round the c lock (24 hours a day) provision

of delivery service s.

Job desc rip tions of d oc tors, sta ff nurses, midw ives and ANMs will beupd ate d ac c ording to the c ore c omp etenc ies ide ntified for SBAs

(annex-1).

Priority fo r posting of ANM with SBA skills will go t o remo te d istrict s.

4.4 Service ProvisionQua lity servic es as a c ontinuum of integ rate d c are a t prima ry hea lth

care and referral levels will be ensured in conformity with the

evide nc e b ased Nationa l Sta nda rd a nd Proto c ol. This will enta il

p rovision of essential ma ternal and new born health ca re a t prima ry

hea lth ca re level by SBAs, and whe n c om p lica tions oc c ur, at referra l

leve ls (BEOC and CEOC sites).

4.5 Enabling EnvironmentMaternal and neonatal health outcomes will only be improved if

the SBA is sup ported by: strong refe rra l ba c k-up b y a d istric t hea lth

10Towards Skilled BirthAttendance in Nepal:Rapid Appraisal of theCurrent Situation andOutline Strategy, WHO,February 2005, It isproposed that thisprogramme will be ofthree year durationwith entry requirementof 10+2 and thetrainees as far aspossible be selectedand recruited from and

by their owncommunities, to ensurethat these midwiveswill take upassignments wherethey are most needed.They should be skilledto deal with normalpregnancy, birth andpostpartum (includingneonatal) care andidentification andreferral ofcomplications ofmother and baby. Theymust also know atminimum first linemanagement, but

when referral remainsproblematic, they willneed more skills tomanage complicationsto a large extent.

11 Nepal Strategic Planfor Human Resourcesfor Health 2003-2017,MoH, April 2003

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tea m, inc luding supportive supervision; effec tive p a rtnerships with

othe r hea lth wo rkers suc h as the HA, AHW, MCHW, VHW, hea lth

vo luntee rs (FCHV), other no n-forma l c a re g ivers like TBAs, and the

c om munity; ava ilab ility of essential d rugs, supp lies and eq uipme nt;

adequate systems for communication and referrals, safety andsec urity, and sufficient incent ives to c om pensa te fo r the p rofessiona l

and soc ial isolat ion tha t is often a rea lity of remo te p ostings.

To improve outc ome s and enc ourage skilled birth attend anc e a t

an inc rea sed numb er of de liveries, a birthing fac ility will be added

to a pp rop riate he alth posts and sub -health posts.

Tec hnica l supervision w ill be p rovide d for prima ry hea lth ca re leve l

SBAs by a Nurse M idw ife/ Professiona l Midw ife working a t the PHCC

or d istric t ho sp ital.

The p rovision of a deq ua te e ssential d rugs, equipme nt a nd supp lies

for qua lity c a re w ill be ensured .

To e nsure round the c loc k co verage o f de live ry service s by SBAs a t

primary health care facil it ies, accommodation near the facil ity

should b e e nsured by the Health Fac ility Ma nag eme nt Co mmittee

(HFMC) a nd or co mmunity ba sed forum/ group.

4.5.1 Professional Accreditation, Licensure and Legal IssuesAn impo rtant com pone nt of the enab ling e nvironm ent for SBAs is

proper regulat ion based on legislat ion (rules and regulat ions

go verning p rac tice ). Med ica l and Nursing Co unc ils will be responsible

for ac c red itation o f tra ining institutions and the c ourse.

A re-lice nsing system will be e sta b lished . In this rega rd, the c apac ity

of Nepa l Nursing Counc il must b e streng thene d as a p riority.

Ac c red itation g uidelines and system will be d eve lope d . Professional

councils and MoHP will be responsible for ensuring effective

enforc eme nt of the ac c red itation system.

Under the ac c red itation frame wo rk SBAs must be lega lly mand at ed

to p erform the skills ou tlined in the SBA c urricu lum and inc lude d in

the ir job -de sc riptions.

4.6 Role of Professional organisations/ assoc iationProfessiona l orga nisa tions/ assoc iations, in c ollab ora tion w ith

MoHP, will de velop a system of q ua lity a ssuranc e, p erforma nc e

review and c apac ity build ing suppo rt for SBAs.

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Professional c ounc ils (med ica l and nursing) will be enc ourag ed to

take a lead role in advising MoHP on matters pertaining to the

reg istra tion of nursing a nd midw ifery prac titione rs and ma intaining

the professional standards in their p rofession, and to advise and ma ke

recommendations to the concerned authority on accreditation of

training institutions and the c ourse.

4.7 Role of non-government sector and private sectorNGOs, the private sec tor and c omm unities will be enc ourag ed to

estab lish ma ternity hosp itals and c om munity based ''birthing c entres''

by mo b ilising their ow n resources. These fa c ilities c ou ld b e used as

mid wife led t raining sites.

4.8 Institutional ArrangementsThe Mo HP, Dep a rtmen t o f Hea lth Service s w ith its releva nt Divisions

and Ce ntres, has a role to play in the implem enta tion o f this SBA

Policy. How eve r, Family Hea lth Division the fo c a l division fo r the sa fe

motherhood and newb orn c are program me will have the lead role.

The implem enta tion o f this SBA Policy w ill be reflec ted in the c om ing

Five Yea r Plan und er a eg is of FHD. The HR/ PA d ivision of Mo HP will

take the lead role for huma n resource m ana gement, and pa rticularly

the SBAs. The Na tiona l Hea lth Training Ce ntre (NHTC) w ill ta ke lea d

ro le for SBA hum a n resou rc e d eve lop me nt . The ro les a nd

respo nsibilities of the ed uc a tion m inistry a nd Co unc il for Tec hnica l

Educ a tion a nd Voc a tiona l Training (CTEVT) will be re-enfo rced in

streng the ning sta nd a rds of tra ining institutions and the SBA c ourse.

The roles and responsibilities of the he a lth fac ilities w ith reg a rd toma ternal health and newb orn ca re servic es must b e up da ted

according to the needs of programme implementat ion. Inter-

sec toral and intra -sec toral linkag e w ill be streng thene d in order to

fac ilitate the imp leme ntation o f this po lic y.

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National Policy onSkilled Birth Attendants 10


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Annex - 1

Core skills and abilities of Skilled Birth Attendant (SBA)All skilled b irth a ttend ants (SBA) m ust ha ve the c ore m idw ifery skills12.

All SBAs a t a ll leve ls of the hea lth system m ust ha ve skills and ab ilities

to p erform a ll the c ore func tions listed below :

1. Comm unica te effectively, to provide holist ic "wome n-ce ntred"

care.

2. Take h isto ry , perfo rm physica l examina t ion a nd spec if ic

sc reening tests as req uired , inc luding volunta ry counselling a nd

testing for HIV, and provide ap propriate ad vic e/ guida nc e.

3. Educa te women and their families abo ut the importance of

ma king a birth p lan (where the d elivery will take plac e, howthey will get there, who will attend the birth and, in case of a

c om plica tion, how t imely referra l will be a rrange d ).

4. Assist pregna nt women a nd their families to make a p lan for

birth.

5. Ide ntify c om plic ations in mothers and newb orns, pe rform first

l ine management ( inc lud ing per formance of l i fe sav ing

procedures and administration of life saving drugs according

t o t h e n a t i o n a l p r o t o c o l w h e n n e e d e d ) a n d m a k e

arrange me nts for effec tive referra l.

6. Perform vag inal examination and interpret the f indings.

7. Identify the onset of labour.

8. Monitor maternal and foeta l well-be ing d uring lab our and

provide supp ortive c are.

9. Record materna l and foe ta l we ll-be ing on a par tograp h,

ide ntify ma ternal and foeta l distress and take ap propriate

ac tion, inc luding referral whe re required .

10. Ide ntify de layed progress in lab our and take ap propriate a ction

including referral where appropriate.

11. Manage normal vaginal delivery.

12. Mana ge the third stage o f lab our ac tively13.

13. Assess the newb orn a t b irth and give immed iate ca re

14. Ide ntify any life threa tening c onditions in the newb orn and take

essential life-saving m ea sures inc luding , whe re nec essary, ac tive

12 Making PregnancySafer: the critical role ofthe skilled attendant, Ajoint statement by

WHO, ICM and FIGO,2004.

13 Active management ofthird stage of labourincludes: using oxitocicdrugs, clamping andcutting the cord, andapplying controlled cordtraction.

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resuscitat ion as a component of the management of birth

asphyxia, and refe rral a s approp riate.

15. Identify haemorrhag e a nd hyp ertension in labo ur, provide first line

management (including life saving skills in emergency obstetriccare where neede d), and if req uired ma ke effective referral.

16. Provide postnatal ca re to w omen a nd their newb orns and post

abortion care where necessary.

17. Assist wo me n and their new borns in initiating a nd e sta blishing

ea rly and exclusive b rea stfeed ing, inc luding educ ating wom en

and their families and othe r helpers in ma intaining suc c essful

breastfeeding.

18. Ide ntify c omp lic ations (illnesses and c ond itions) d etrimenta l to

the health of mo thers and their new borns in the p ostna ta l period

and provide first-line ma nag eme nt ac c ording to the na tiona l

cl inical protocol, and i f required make arrangements for

effec tive referra l.

19. Supervise non-skilled and sem i-skilled a ttend ants, includ ing TBAs,

MCHWs and p a rame dic s, in order to ensure tha t the c a re they

provide during pregna ncy, c hildb irth a nd ea rly postpa rtum is

of goo d quality.

20. Provide a dvice , counselling a nd servic es on p ostpa rtum fam ily

planning and refer if need ed .

21. Educ ate w ome n (and the ir families) on how to p revent sexually

transmitted infections including HIV

22. Collec t and repo rt relevant d ata , c ollab orate in data ana lysis

and ca se aud its

23. Prom ote a sense of sha red resp onsibility/p a rtnership with

individual women, their family members/supporters and the

c omm unity for the c are of wom en a nd new bo rns throug hout

pregna ncy, childb irth and the p ostnata l period

SBAs working a t the p rima ry hea lth fac ilities in rem ote a rea s with

limited ac c ess to BEOC / CEOC fac ilities should a lso be ab le to do

the following:

24. Use vac uum extrac tion in vaginal deliveries

25. Perform ma nual vac uum aspiration for the mana gem ent of

incomplete abortion.

26. Repa ir vaginal tears

27. Perform manual remova l of plac enta

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6 1 Safe Motherhood and SBA Policy