Strengthening Health Systems: the Role of Maternal Health - - PowerPoint PPT Presentation
Strengthening Health Systems: the Role of Maternal Health Indicators Woodrow Wilson International Center Global Health Initiative 8 March 2010 Helen de Pinho MBBCh, MBA, FCCH With acknowledgements to Patsy Bailey, Samantha Lobis, Lynn
Woodrow Wilson International Center Global Health Initiative 8 March 2010 Helen de Pinho MBBCh, MBA, FCCH
With acknowledgements to Patsy Bailey, Samantha Lobis, Lynn Freedman
Health services Workforce Information for decision making Essential drug supply and logistics Financing and resource allocation Leadership and governance
Source: WHO. (2000).
develop complications
be predicted or prevented
Complication Hours Days Hemorrhage Postpartum 2 Antepartum 12 Ruptured uterus 1 Eclampsia 2 Obstructed labor 3 Infection 6
Time Between the Beginning of a Complication and Death
75% occur in the first week (3 million)
Source: Lawn JE et al. (2005).
Asphyxia Preterm/Low Birth Weight
Facility
Community
Focused antenatal care Emergency Obstetric Care Postpartum/post natal care for Mother and Baby, and IMNCI Skilled attendance at birth Family planning Health education during pregnancy birth planning Skilled attendance at birth Pre- pregnancy
Pregnancy Delivery Postpartum, post natal
Postpartum/Post natal care for mother and baby, Identifying/referring newborn illness Family planning
PMTCT
engagement and mobilization
package of high quality interventions
for services women and children being free at the point of use
Endorsed by G8, 2009
and childbirth complications
unwanted pregnancies an half of the unsafe abortions
FP services
Endorsed by G8, 2009
Availability Are there enough facilities providing EmOC? Are they well distributed? Utilization Are enough women using these facilities? Are women with obstetric complications using these facilities? Are sufficient critical services being provided? Quality of Care Is the quality of the services adequate? What services needed in addition to EmOC?
Availability: Are there enough facilities providing EmOC?
Indicator (1) Minimum acceptable level Number of EmOC For every 500,000 population facilities: — Basic — 5 EmOC facilities where at least 1 is Comprehensive — Comprehensive
Santos et al. Improving emergency obstetric care in Mozambique: The story of Sofala. IJGO, 2006: 190-201.
Availability: Are facilities well distributed?
Indicator (2) Minimum acceptable level Geographic distribution Minimum level is met in sub-national areas
Paxton et al The United Nations Process Indicators for emergency obstetric care: Reflections based on a decade of experience 2006 I
125% 72% 52% 52% 51%50% 46%42% 39% 38% 25% 21% 19%19% 17%17% 15% 8% 0% 0% 20% 40% 60% 80% 100% 120% 140% Z a i r e L u n d a S H u i l a K u a n z a N C u n e n e L u n d a N N a m i b e B e n g
i c
u a n z a S N a t i
a l B e n g u e l a C a b i n d a M a l a n g e U í g e B i é H u a m b
u a n d a K u a n d
MoH – Angola Needs Assessment report
Utilization: Are women using these facilities?
Indicator (3) Minimum acceptable level Percentage of births in Countries should set their facilities own acceptable level
10 20 30 40 50 60 70 80 E s t e l i M a n a g u a C a r a z
u e v a S e g
i a R i v a s L e ó n G r a n a d a T
a l C h i n a n d e g a M a d r í z R A A S M a s a y a J i n
e g a M a t a g a l p a B
c
A A N C h
t a l e s R í
a n J u a n EmOC Non-EmOC
Utilization: Are women with obstetric complications using these facilities?
Indicator (4) Minimum acceptable level Met need for EmOC % of women with At least 100% of women complications treated with obstetric complications in facilities treated in facilities (15% of all births expected to have complications)
0% 5% 10% 15% 20% 25% 30% 35% 2000 2002 2003 2004 2005 Met need for EmOC
Met need for EmOC
Santos et al. Improving emergency obstetric care in Mozambique: The story of Sofala. IJGO, 2006: 190-201.
0% 10% 20% 30% 40% 50% 60%
EmOC Non-EmOC MoH – Angola Needs Assessment report
Utilization
Are sufficient critical services being provided? Indicator (5) Acceptable levels Cesarean section rate Not less than 5% and not more than 15%, as a proportion of all births in the population Calculation = Caesarean sections performed in EmOC Facilities total expected live births in area
EmONC Baseline Assessment, MOH, 2009
9.9% 7.1% 2.6% 0.6% 0.7% 0.7% 0.7% 0.4% 0.4% 0.2% 0.1% 0.0% 0.0% 5.0% 10.0% 15.0% 20.0% H a r a r i A d d i s A b a b a D i r e D a w a N a t i
a l T i g r a y G a m b e l a B e n i s h a n g u l
u m u z S N N P O r
i y a A m h a r a S
a l i A f f a r
Quality of care: Is the quality of the services adequate?
Indicator (6) Acceptable level Direct obstetric case fatality Less than 1% rate (DOCFR)
2.0% 3.0% 3.5% 0.9% 1.9% 1.7% 0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0% 3.5% 4.0% Gisarme, Rwanda Muanza, Tanzania Sofala, Mozambique Baseline Follow up
Quality of care: Is the quality of the services adequate?
Indicator (7) Acceptable level Intrapartum and very early To be determined neonatal death rate
Country Intrapartum + very early neonatal deaths Women who delivered Intrapartum & very early neonatal death rate Cusco, Peru 2004 164 19,191 0.85% S E Asian country 2008* 625 83,708 0.75%
*283 intrapartum stillbirths excluded due to unspecified BWT
What services are needed in addition to EmOC?
Indicator (8) Acceptable level Proportion of maternal deaths No set acceptable level due to indirect causes
Source: MOH, UNICEF, UNFPA, WHO. (2007). Preliminary Results.
Causes of maternal deaths Direct obstetric causes of maternal deaths
Health services Workforce Information for decision making Essential drug supply and logistics Financing and resource allocation Leadership and governance Are enough facilities providing EmONC services? Do facilities have adequate numbers of health workers with the right mix of life-saving skills? Does HMIS capture key information for monitoring utilization of EmONC? Are essential drugs in stock and equipment functional? Is the distribution of resources across facilities equitable? Are policies, protocols, and good practices being implemented?
How can the EmOC Indicators measure the WHO Health System Strengthening building blocks?
Slide source: P Bailey