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HD 201: Ontogeny and Parturition Maternal Health Care Delivery System

Dr. Anna Guia O. Limpoco

2 February 10, 2014

I. Introduction II. Maternal Health Care System

A. Maternal Mortality B. MNCHN Service Delivery Network C. PhilHealth

III. Maternal Health Care System in Context A. Equity B. Maternal Health Care for Indigenous People C. Mangyan’s Maternal Beliefs D. Access to Maternal health Services E. Quality in Maternal Care F. The Challenges

This trans is based on Dr. Limpoco’s powerpoint presentation. Notes from the powerpoint file were also added.

I. INTRODUCTION

A health system is the sum total of all the organizations, institutions and resources whose primary purpose is to improve health

A health system needs staff, funds, information, supplies, transport, communications and overall guidance and direction.

It needs to provide services that are responsive and financially fair, while treating people decently

II. MATERNAL HEALTH CARE SYSTEM

Maternal health care delivery system is an “organized services” to provide health care to expectant and nursing mothers

Figure 1. Maternal health care system framework

A. Maternal Mortality

MATERNAL MORTALITY RATIO = (maternal deaths/100,000 live births)

Ratio represents the risk associated with each pregnancy, i.e. the obstetric risk

Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy related to or aggravated by the pregnancy or its management but not from accidental or incidental causes

The MDG target for maternal mortality ratio is 55 per 100,000 live births by 2015

Maternal mortality rate (MMR) in the country remains high and is decreasing very slowly despite the advancements in medicine

Figure 2. Maternal mortality ratio, 1995-2015

Complications of childbirth due to hemorrhage (most common), sepsis, obstructed labor, hypertensive disorders in pregnancy, and complications of unsafe abortion

Only 60% of the births are supervised by a skilled birth attendant

230 deaths per 100,000 live births in 2005

Down to 160 and might decrease to 140 in 2015

But this is still off from the MDG of 55 deaths per 100,000

facility based delivery is encouraged

55% of births are delivered at home, of which 36% are attended to by TBAs (traditional birth attendants) or hilots

B. MNCHN Service Delivery Network

MNCHN Maternal and Newborn Care Health Network

Three levels of care in the MNCHN SDN: 1. Community level service providers

o Give primary health care services o These may include outpatient clinics such as

Rural Health Units (RHUs), Barangay Health Stations (BHS), and private clinics as well as their health staff (i.e. doctor, nurse and midwife) and volunteer health workers (i.e. barangay health workers, traditional birth attendants)

2. Basic Emergency Obstetrics and Newborn Care (BEmONC)

o Capable network of facilities and providers can be based in hospitals, RHUs, BHS, lying-in clinics or birthing homes

o If the BEmONC is hospital based, blood transfusion services which may or may not include blood collection and screening will be provided

o These facilities operate on a 24-hour basis with staff complement of skilled health professionals such as doctors, nurses, midwives and medical technologists

3. Comprehensive Emergency Obstetrics and Newborn Care (CEmONC)

End-referral facilities capable of managing complicated deliveries and newborn emergencies.

Ideally, there is a BEmONC and CEmONC in each municipality

BEmONC Facilities CEmONC Facilities

Six signal OB functions - Give oxytocin (3

rd

stage) - Give

anticonvulsants - Initial dose of

antibiotics

Six signal OB functions

Plus: - Cesarean section - Blood

banking/transfusion - Neonatal

interventions

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Maternal Health Care Delivery System HD 201

- Assisted deliveries - Removal of

retained products of conceptions

- Manual removal of placenta

(resuscitations, neonatal sepsis/infection, oxygen support, management of low birth weight or premature newborn

Table 1. Functions of BEmONC and CEmONC

C. PhilHealth

18 years old and above

Case Rate Form of Payment (Per Case Payment)

This is a provider payment method that reimburses a predetermined fixed rate for each treated case

members will immediately know how much subsidy they can get from PhilHealth for certain medical conditions and surgical procedures in accredited institutional health care facilities

The new case payments shall take effect for all claims with admission dates starting September 1, 2011 in all accredited providers

Surgical Cases Rates (Php)

Maternity Care Package 8,000

NSD Package in Level 1 Hospitals

8,000

NSD Package in Levels 2 to 4 hospitals

6,500

Caesarean section 19,000

Table 2. Case Payments

*NSD normal spontaneous delivery Levels of Hospitals

Classified by PhilHealth and DOH

Level 1 Hospital (Emergency hospital)

o “Very small hospital” o Initial treatment for cases that require immediate

treatment and that provides primary care for prevalent diseases in the area

o General medicine, pediatrics, minor surgeries and non-surgical gynecology, primary clinical laboratory (e.g. CBC, urinalysis, stool exam), pharmacy and first-level radiology (e.g. chest x-ray), nursing care for patients requiring minimal supervised care

Level 2 Hospital (Non – departmentalized hospital)

o “small hospital” o Community hospitals o General medicine, pediatrics, surgery,

anesthesia, obstetrics and gynecology, first level radiology, pharmacy

o Nursing care for patients needing immediate supervised care

Level 3 Hospital (Departmentalized hospital)

o “big hospital” o District hospitals, community hospitals o All clinical services provided by Level 2 hospitals o Specialty clinic care, tertiary clinical laboratory

(e.g. cultures), pharmacy, second level radiology o Nursing care for patients needing total and

intensive care o with ICU

Level 4 Hospital (Teaching and training hospital)

o “very big hospital” o Regional hospital o All clinical services provided by Level 3 hospitals o Specialized form of treatment, intensive care and

surgical procedures o Tertiary clinical laboratory, third level radiology

(MRI, CT scan), pharmacy o Nursing care for patients needing continuous and

specialized critical care

o Example: PGH, St. Luke’s o Lecturer:

- Hospitals with psych wards and rehab department may be classified as 3 or 4

- Level 3 hospitals are departmentalized; level 4 hospitals are departmentalized with teaching

Note: Private insurers (e.g. Intellicare, Maxicare) are also

included in the framework

III. MATERNAL HEALTH CARE SYSTEM IN CONTEXT

A survey about women’s health services was done

last 2005 in Cambodia, Vietnam and Philippines

It focused on three important issues that makes women utilize maternal health services (i.e. Equity, Access and Quality)

A. Equity

Prioritizing and ensuring the delivery of services to the disadvantaged sector especially the

economically and socially deprived

A significant number of pregnant women don’t have access to trained maternal health care provider because of social and financial reasons

The disadvantage sector usually consult untrained birth attendants resulting to higher morbidity and mortality

As indicators of equity, registry of patients must include those who: o Belong to ethnic, minority or migrant groups o Live at or below poverty level o Are homeless

B. Maternal Health Care for Indigenous People

Mangyans still feel like they are not well taken care of in government health facilities

Differences in their cultural beliefs and the services that the health facilities offer

To solve this barrier, ethnic women are made to adapt to the maternal and child care system rather than the maternal and child care services being responsive to the culture of the population they serve

C. Mangyan’s Maternal Beliefs

Mangyans do not go to the health center to deliver because of socio-economic, geographical and cultural differences

Supernatural beings or evil spirits constantly figure in Mangyan beliefs around pregnancy, delivery and new born care

If the baby is delivered without complications, it means that the couple is faithful to one another

If the placenta comes out late, one has to admit that they have been unfaithful to their partner

Sees the death of a baby to be the will of God and not a result of lack in maternal care and medicines

During labor, the woman does not usually tell her husband that contractions have commenced due to fear of not being able to deliver the baby

Only the husband assists his wife when she is delivering the baby by pushing from the back

The mother delivers her baby either standing or kneeling while holding on to a rope with a skirt to catch her baby

Pregnant women are not allowed to go outside during pregnancy believing evil spirits will take the baby

They don’t take ferrous sulphate because of its color and they think it’s a bad spirit

They don’t take a bath since this protects them from evil spirits

D. Access to Maternal Health Services

Accessibility means the service must be provided in appropriate time and geographical setting

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Maternal Health Care Delivery System HD 201

The proposed indicator is that the service must be given at a place geographically favorable to its recipients

Mangyans have to travel so far that they prefer to just give birth in their homes

There should be a system that will allow them to meet us halfway through childbirth prediction

E. Quality in Maternal Care

Quality refers to the manner and result of delivery of maternal health service

Outcome must be optimum reproductive health o Functional and emotional status o Good medical outcomes o Patient satisfaction

Facilities designed for need and community’s capacity

Process conform to social norm and medical standard

Training on culture sensitive maternal and newborn care among the health personnels

Sessions on quality care and check on awareness/guidelines

Some compromises that can be made: o Health stations beside a structure similar to their

home (balay Mangyan) o They should check-in one month before

schedules delivery o The husband will still assist delivery but there will

be a team ready just in case

Table 3. Tabular presentation of scores of local physicians regarding the provision of quality health care

In summary, the level of awareness to Clinical Practice Guidelines (CPG) is high

However their attitude toward CPG implementation is low and has been showed to be negatively correlated with awareness.

F. The Challenges

Lack of political commitment

Some politicians are not ready to have projects in their area

Projects are not funded by the government

Minimal resource allocation

Lack of training for health workers o Interpersonal communication skills o Information dissemination o Education and motivation activities for the

general public

Low social status of women

One Eight, Dominate!

End of Transcription

Gab: Mabuti pa sa lotto, may pag-asang manalo… Riza: Hi 2018! Happy Valentine’s Day! Hi HD 201 groupmates! Dabes kayo.