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International
Why do we need ALARMcourse ?
Objectives :1. Qualification
2. Standard of care3. Reduction of MMR&PMR through EmOC
International
Political Statement
SMI (1989) – Indonesia to reduce MMR450 half (in 2000)
MPS (2001)Every pregnancy should be wantedEvery complication
should have
proper care90% of delivery by skilled attendants
International
ReasonsHigh MMR & PMR
Standard
GuidelinesTraining
International
FACTSMMR 228/100.000CBR = 2.65.2 million deliveries/year 57%
CPRUnmet need 9%63% delivery by Skilled
attendants75% of Hospitals have OG
60.000 midwives deployedin villages
PMR 30%o150.000 Perinatal
deaths/year
QUALITY OF
ATTENDANTS ?POVERTY (50%)7000 HC+bed
underutilized
International
Deaths could be prevented
Pregnancy - LabourComplications mildComplications severe
deaths
Target : Skilled attendants thatcompetence in dealing
withcomplication (EmOC)
TRAINING
International
MMR
Indonesia 228(2010)
Subang district 110Bali 88Lombok 120East Java (selected) 55
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Technology
Postpartum hemorrhage AM3+Misoprostol
Eclampsia MgSO4 + NifedipineSepsis antibioticUnwanted pregnancy
safe abortion
+ PACProlonged labour partogram,
CS,vacuum ext.
International
Healthy Indonesia 2010
MMR 125IMR 15ANC 1 =95%, ANC 4 =80%Skilled attendant cov. 90%80%
Complications should be properly
cared
InternationalColaboration of Ob-Gyn & Midwives
Improve quality ofcare
Standard of trainingprogram
Extension of trainingto every districts(400+)
Monitoring &evaluation
InternationalCooperation
KONSILKedokteran
POGI/IDI
DinasKesehatan
KOLEGIUM
RumahSakit
LulusanSpOG
Lisensi
POGICabang
REGISTRASI SERTIFIKASI
RE-SERTIFIKASINilaiKredit- ALARM- Buku LOG, dsb
REKOMENDASI
International
Figure: ALARM certified Spesialist will be involved in the
training ofEmOC for Health centres nurses, doctors and midwives
EmOC(BEONC)
Midwives
ALARMCourse
Ob-Gyn
International Rekomendasi atau Updating
Internasional :• WHO (RHL), SOGC, RCOG (NICE atau
NICE Clinical pathway), ACOG, GFMER.Indonesia :• POGI, HKFM,
PONED-PONEK, HTA
Kemkes
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International What is evidence-based medicine?
“Evidence-based medicine is the integration ofbest research
evidence with clinical expertiseand patient values ”
- Dave SackettPatient
Concerns
ClinicalExpertise
Bestresearchevidence
EBM
International
Elements of Evidence-based HealthCare
BestEvidence
PatientPreferenceand Values
ClinicalSituation
Practitioner's clinical experience
InternationalMedicalschools
P r o
f e s s
i o n a
l
O r g a n
i z a t i o n s
Professionals
Standard ofprofessional conduct:
Competence Acc ountabi lit y
Alt ruism
CollegialityEthics
Clinical governance:
Education & trainingClinical effectiveness Acc ountabi lit
y
R & DClinical audit
Risk management
CPD
Healthcare
Standards of care
Health systems Internationalues ons: ac s versus
Decisions(Quality of Evidence versus Strength of
Recommendations)
Decision
Facts“Evidence” Values
Practicality Costs
Low, Moderate, orHigh Quality
Evidence
Weak or StrongRecommendation
(for or against)
International
OrganizationHeadquarter
15 centresMedan, Jakarta,
Semarang,Surabaya &Makassar...........
MALANG
Quality control3-4 training
program/centre/year
Trainers : ALARMcertified faculty forEmOC (Beonc)
International
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