Getting the right women and newborns to the right place to get the - - PowerPoint PPT Presentation

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Getting the right women and newborns to the right place to get the right care at the right time

Loveday.Penn-Kekana@lshtm.ac.uk

Campbell OMR, Calvert C, Testa A, Strehlow M, Benova L, Keyes E, Donnay F, Macleod D, Gabrysch S, Rong L, Ronsmans C, Sadruddin S, Koblinsky M & Bailey P. The scale, scope, coverage & capability of childbirth care. Lancet 2016

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Emergency transport pathways

Skilled birth attendant strategies

Facility with routine care only Facility with routine care & Facility with routine care BEmOC CEmOC (or alongside midwifery unit) & Home Maternity Waiting Home Go to maternity waiting home ahead of labour

Routine transport pathways 1

• Attending routine ANC (can be from

multiple providers)

• Attending 6 week post natal care
• Babies to well baby clinic
• Getting to a MWH/Relative house near

facility in later stages of pregnancy

• During the day
• Can be planned for
• Not too far
• Free or low cost
• Public transport might be available
• Woman and baby well
• Doesn’t need accompanying

Easy Journeys

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• Woman referred in ANC (but generally

well)

• Baby referred (but generally well)
• Baby referred to other services (but

generally well)

• Early post-natal visit
• During the day
• Can be planned for
• Likely to be further away and cost more
• Public transport might be available
• Other costs incurred
• Woman and baby generally well
• Doesn’t necessarily need accompanying

Not So Easy Journeys

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• Woman in normal labour to a facility to

deliver

• Woman home from the hospital after

delivering

• Unwell baby to facility
• Can be any time of the day or night
• If at night – maybe security issues
• Might need to arrange or hire private

transport – so more expensive

• Body fluids
• Urgency
• Companion needed
• Ergonomics
• Women / Baby in pain

Uncomfortable Journeys

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• Pregnant woman seriously ill
• Woman in a labour with complications

home to facility

• Woman in labour with complications

facility to facility

• Sick & small newborn facility to facility
• Can be any time of the day or night
• If at night – maybe security issues
• Might need to arrange or hire private

transport – so more expensive

• Body fluids
• Urgency
• Companion needed
• Ergonomics
• Woman/ Baby In Pain
• Everyone extremely stressed

Emergency Journeys

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• An 8-month pregnant woman had a high fever, headache and abdominal pain and was
• bleeding. Her mother and husband took her to the dispensary. At the dispensary, the

nurse told the family that the facility did not have medicine and equipment to help the patient and referred the mother to a health centre. At the health centre the woman was checked by a nurse who suspected the woman had a stillbirth. At this time, the nurse didn’t tell the mother or the family of the result of her assessment, instead she referred the woman to a district hospital. On the way the woman continued bleeding and to complain about a headache. When she got to the district hospital she was told that her baby had died and that her blood pressure was very high. At this point, the woman became unconscious and a doctor suggested that the patient needed a c/section. One day after the surgery, the woman died.”

• Hanson & Shellenberg, 2019

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• “Referral problems have been identified as a major contributor to maternal deaths.

There was a delay in referring and interfacility transport problems in 32.5%, 55.2% and 79.9% of referrals from community health centres, district hospitals and regional hospitals respectively of women who then subsequently died.”

• South African Confidential Enquiry into Maternal Deaths, 2016

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Dead Women Talking by B. Subha Sri and Renu Khanna

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Key Components of Successful Referral Systems

• Knowledge of population needs and health system capabilities
• An adequately resourced referral centre
• Stabilising women & newborns
• Active collaboration between referral levels and across sectors
• Formalised communication and transport arrangements
• Agreed setting-specific protocols for referrer and receiver including
• Supervision and accountability for providers performance
• Affordable service costs
• Capacity to monitor effectiveness & audits
• Policy Support

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Murray S, Pearson S (2006) Maternity referral systems in developing countries: Current knowledge and future research needs. Social Science and Medicine 62 (2006) 2205-2215

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EngenderHealth Uganda on behalf of What Women Want.

Key Problems

• Not clear whose responsibility maternal transport and emergency transport is
• Over and under referral – tensions between facilities
• Facilities not networked
• Not wanting a death in the facility
• Ambulance not available, not working, don’t have petrol, in the wrong place, cost too

much

• Keeping a patient until funds run out/really can’t do anything else
• Patients not stabilized/ cared for during journeys

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The Charter

Category of Disrespect and Abuse i Corresponding Right 1. Physical abuse Freedom from harm and ill treatment 2. Non-consented care Right to information, informed consent and refusal, and respect for choices and preferences, including companionship during maternity care 3. Non-confidential care Confidentiality, privacy 4. Non-dignified care (including verbal abuse) Dignity, respect 5. Discrimination based on specific attributes Equality, freedom from discrimination, equitable care 6. Abandonment or denial of care Right to timely healthcare and to the highest attainable level of health 7. Detention in facilities Liberty, autonomy, self-determination, and freedom from coercion

RESPECTFUL MATERNITY CARE: THE UNIVE VERS RSAL AL RIGHTS S OF CHILDBEARING WOMEN

The Charter

Category of Disrespect and Abuse i Corresponding Right 1. Physical abuse Freedom from harm and ill treatment 2. Non-consented care Right to information, informed consent and refusal, and respect for choices and preferences, including companionship during maternity care 3. Non-confidential care Confidentiality, privacy 4. Non-dignified care (including verbal abuse) Dignity, respect 5. Discrimination based on specific attributes Equality, freedom from discrimination, equitable care 6. Abandonment or denial of care Right to timely healthcare and to the highest attainable level of health 7. Detention in facilities Liberty, autonomy, self-determination, and freedom from coercion

RESPECTFUL MATERNITY CARE: THE UNIVE VERS RSAL AL RIGHTS S OF CHILDBEARING WOMEN

WHAT SHOULD THIS LOOK LIKE FOR MATERNAL TRANSPORT, EMERGENCY TRANSPORT AND REFERRAL?

Care-Seeking & Referral CoP

• Join the Care-Seeking & Referral CoP: https://communities.harpnet.org/care-seeking-and-

referral/join

• Visit our Care-Seeking & Referral CoP page on the Health Research Program site

at https://www.harpnet.org/care-seeking_and_referral_community_of_practice/

• Learn more about our webinars here https://www.harpnet.org/care-seeking-referral-

community-of-practice-webinars/

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THANK YOU.

This presentation was made possible by the support of the American People through the United States Agency for International Development (USAID) under the terms of the Coordinating Implementation Research to Communicate Learning and Evidence (CIRCLE) contract AID-OAA-M-16-00006. CIRCLE is implemented by Social Solutions International, Inc., in partnership with Forum One. Views expressed are not necessarily of USAID or other affiliated institutions.

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