01 Emergency Obstetric care

Emergency Obstetric care

To Avert Death and Disability…

To Avert Death and Disability…

…We Need to Ensurethat Women have Access To…

…We Need to Ensurethat Women have Access To…

Emergency Obstetric CareEmergency Obstetric Care

(EmOC)(EmOC)

How Can We Improve Access

to EmOC?

How Can We Improve Access

to EmOC?

By making sure health facilities provide the

services needed to save women’s lives.

By making sure health facilities provide the

services needed to save women’s lives.

Eight key functions “signal” a facility’sability to provide EmOC

Eight key functions “signal” a facility’sability to provide EmOC

EmOC Key FunctionsCover These Services:

EmOC Key FunctionsCover These Services:

• Antibiotics (intravenous or by injection)

• Oxytocic Drugs (intravenous or by injection)

• Anticonvulsants (intravenous or by injection)

• Manual Removal of Placenta

• Removal of Retained Products• Assisted Vaginal Delivery• Surgery (Cesarean Section)• Blood Transfusion

Basic and Comprehensive EmOC FacilitiesBasic and Comprehensive EmOC Facilities

• Antibiotics (intravenous or by injection)• Oxytocic Drugs (intravenous or by injection)• Anticonvulsants (intravenous or by injection)• Manual Removal of Placenta• Removal of Retained Products• Assisted Vaginal Delivery


BASICBASICEmOC Facilities Provide the First Six Services

Basic and Comprehensive EmOC FacilitiesBasic and Comprehensive EmOC Facilities


COMPREHENSIVECOMPREHENSIVEEmOC Facilities Provide All Eight Services

• Surgery (Cesarean Section)• Blood Transfusion

Continuum of Care

• From Mother to Newborn• From EmOC to EmONC• From Community to Facility• MCH Centres under NRHM:– level 1 (24x7 delivery)– Level 2 (BEmONC)– Level 3 (CEmONC)

THE GOOD NEWSTHE GOOD NEWSNot all these functions need hospitals and doctors

Well-trained nurses and midwives can perform most functions at Basic EmOC Facilities

An Important Point for Resource Poor Areas

An Important Point for Resource Poor Areas

How Can We Tell We Are Making a Difference?

How Can We Tell We Are Making a Difference?

If we know we have provided enough EmOC…If we know we have provided enough EmOC…

…and if we know that these services are being used by women suffering obstetric complications…

…and if we know that these services are being used by women suffering obstetric complications…

WE CAN BE CONFIDENT THAT WE ARE SAVING WOMEN’S LIVES

WE CAN BE CONFIDENT THAT WE ARE SAVING WOMEN’S LIVES

How Do We Know Which Women

Will Experience Complications?

How Do We Know Which Women

Will Experience Complications?

WE DON’TWE DON’T

…But we do know that of any population of pregnant women at least 15% will experience an obstetric complication

…This is as true of pregnant women in the US and Europe as of women in Africa, Asia and Latin America

Nobody Knows Why This Happens.It is a Fact of Life.

Nobody Knows Why This Happens.It is a Fact of Life.

Can We Really Tellif Services Are Functioning?

Can We Really Tellif Services Are Functioning?

In 1991, United Nations Children’s Fund (UNICEF) and Columbia University developed 6

Process Indicators to do just that.

In 1991, United Nations Children’s Fund (UNICEF) and Columbia University developed 6

Process Indicators to do just that.

These were issued by UNICEF/WHO/United Nation’s Population Fund (UNFPA) in 1997:

Guidelines for Monitoring Availability and Use of Obstetric Services

These were issued by UNICEF/WHO/United Nation’s Population Fund (UNFPA) in 1997:

Guidelines for Monitoring Availability and Use of Obstetric Services

…And Are Being Used?…And Are Being Used?

In general, process indicators show you the changes in the conditions that lead to an outcome

(such as death or disability)

In general, process indicators show you the changes in the conditions that lead to an outcome

(such as death or disability)

Process IndicatorsProcess Indicators

Access to…Access to…

THE 6 PROCESS INDICATORSTHE 6 PROCESS INDICATORS

tell us about changes in:tell us about changes in:

Utilization of…Utilization of… and Quality of…and Quality of…

EmOC ServicesEmOC Services

EmOC Process Indicators1. For every 500,000 population, there should be at least: 1

Comprehensive EmOC Facility & 4 Basic EmOC Facilities

2. Geographical Distribution of EmOC Facilities: EmOC Facilities should be well-distributed to serve 500,000 people

3. Proportion of All Births in EmOC Facilities: At Least 15% of All Births in the Community Should Take Place in EmOC Facilities

4. Met Need for EmOC Services: At Least 100% of Women Estimated to Have Obstetric Complications Should Be Treated in EmOC Facilities

5. Cesarean Sections as a Percentage of All Births

1. Minimum: 5% Maximum: 15%

6. Case Fatality Rate: Proportion of Women with Obstetric Complications Admitted to a Facility Who Die: Maximum Acceptable Level: 1%

INDICATOR #1INDICATOR #1

For every 500,000 population,there should be at least:

For every 500,000 population,there should be at least:

1 Comprehensive EmOC Facility4 Basic EmOC Facilities

1 Comprehensive EmOC Facility4 Basic EmOC Facilities

INDICATOR #2INDICATOR #2Geographical Distribution

of EmOC FacilitiesGeographical Distribution

of EmOC Facilities

EmOC Facilities should be well-distributed to serve 500,000 people

EmOC Facilities should be well-distributed to serve 500,000 people

Minimum: 1 Comprehensive and 4 Basic EmOC FacilitiesMinimum: 1 Comprehensive and 4 Basic EmOC Facilities

INDICATOR #3INDICATOR #3Proportion of All Births

in EmOC FacilitiesProportion of All Births

in EmOC Facilities

At Least 15% of All Births in the Community

Should Take Place in EmOC Facilities

At Least 15% of All Births in the Community

Should Take Place in EmOC Facilities


Met Need for EmOC ServicesMet Need for EmOC Services

At Least 100% of Women Estimated to Have Obstetric Complications Should Be

Treated in EmOC Facilities

At Least 100% of Women Estimated to Have Obstetric Complications Should Be

Treated in EmOC Facilities


Cesarean Sections as a Percentage of All Births

Cesarean Sections as a Percentage of All Births

Minimum: 5%Maximum: 15%Minimum: 5%Maximum: 15%

INDICATOR #6INDICATOR #6Case Fatality RateCase Fatality Rate

Proportion of Women with Obstetric Complications

Admitted to a Facility Who Die:

Proportion of Women with Obstetric Complications

Admitted to a Facility Who Die:

Maximum Acceptable Level:

1%

CALCULATING ALL 6 INDICATORSCALCULATING ALL 6 INDICATORS

Gives you an indication of where the problems lie and where action is needed.

Also, these indicators are sensitive to change: within months, you can know if your project is making a difference.

Gives you an indication of where the problems lie and where action is needed.

Also, these indicators are sensitive to change: within months, you can know if your project is making a difference.

ACCESS TO EmOCACCESS TO EmOCProblems:

Does Indicator # 1 show you need more EmOC facilities?

Does Indicator # 2 show you need better distributed EmOC facilities?

Problems: Does Indicator # 1 show you need

more EmOC facilities?

Does Indicator # 2 show you need better distributed EmOC facilities?

Action: Most countries already have

enough facilities; they may just need to upgrade services to ensure 1 Comprehensive and 4 Basic EmOC facilities per 500,000 population.

Action: Most countries already have

enough facilities; they may just need to upgrade services to ensure 1 Comprehensive and 4 Basic EmOC facilities per 500,000 population.

UTILIZATION OF EmOCUTILIZATION OF EmOC

Does Indicator # 3 show that births in your EmOC facilities are fewer than 15% of all births in the population?

Does Indicator # 4 show that “Met Need” is less than 100% (i.e., that not all women who experience obstetric complications are using EmOC facilities)?

Does Indicator # 5 show that less than 5% of all births in the population are by Cesarean section?

Does Indicator # 3 show that births in your EmOC facilities are fewer than 15% of all births in the population?

Does Indicator # 4 show that “Met Need” is less than 100% (i.e., that not all women who experience obstetric complications are using EmOC facilities)?

Does Indicator # 5 show that less than 5% of all births in the population are by Cesarean section?

ProblemsProblems

UTILIZATION OF EmOCUTILIZATION OF EmOC

Do you have enough qualified staff?

Do you need to train staff on management of emergency obstetric complications?

Does hospital management need improvement?

What is the supply situation like?

What is the equipment situation like?

Do you have enough qualified staff?

Do you need to train staff on management of emergency obstetric complications?

Does hospital management need improvement?

What is the supply situation like?

What is the equipment situation like?

If all the above is in place, conduct focus groups in the community to find out why women are not

coming for care

If all the above is in place, conduct focus groups in the community to find out why women are not

coming for care

Action: Collect More Information First

Action: Collect More Information First

QUALITY OF EmOCQUALITY OF EmOC

Does Indicator # 6 show that more than 1% of women treated for obstetric complications are dying at your EmOC facilities?

Does Indicator # 6 show that more than 1% of women treated for obstetric complications are dying at your EmOC facilities?

Problem:Problem:

QUALITY OF EmOCQUALITY OF EmOC

Find out if your EmOC facilities are really functioning

Check staff numbers, skills, management capacity, supplies and equipment

Lobby your health ministry for more support—and get the community to lobby with you

Find out if your EmOC facilities are really functioning

Check staff numbers, skills, management capacity, supplies and equipment

Lobby your health ministry for more support—and get the community to lobby with you

Action:Get More Information

Action:Get More Information

Any Country Can Avert

Maternal Death and Disability

if it Makes Good EmOC

Any Country Can Avert

Maternal Death and Disability

if it Makes Good EmOC

Available and Accessibleon Time

Available and Accessibleon Time

ReferencesReferences

Loudon I. 1991. On maternal and infant mortality 1900–1960. Soc Hist Med 4(1): 29–73.

Maine D. 1991. Safe Motherhood Programs: Options and Issues. Columbia University: New York.

UNFPA and AMDD. 2002. Reducing Maternal Deaths: Selecting Priorities, Tracking Progress, Distance Learning Courses on Population Issues. Turin: UN System Staff College.

UNICEF/WHO/UNFPA. 1997. Guidelines for Monitoring the Availability and Use of Obstetric Services. UNICEF: New York.

Health & Medicine

01 Emergency Obstetric care