Scaling up ma within the context of sa services in nepal
This presentation is the property of its rightful owner.
Sponsored Links
1 / 17

Scaling Up MA within the Context of SA Services in Nepal PowerPoint PPT Presentation


  • 71 Views
  • Uploaded on
  • Presentation posted in: General

Scaling Up MA within the Context of SA Services in Nepal. Indira Basnett, MD, MPH Ipas /Nepal Country Director Expanding Access to Medical Abortion: Building on Two Decades of Experience Lisbon, Portugal March 2-4, 2010. Background in Nepal.

Download Presentation

Scaling Up MA within the Context of SA Services in Nepal

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Scaling up ma within the context of sa services in nepal

Scaling Up MA within the Context of SA Services in Nepal

Indira Basnett, MD, MPH

Ipas/Nepal Country Director

Expanding Access to Medical Abortion:

Building on Two Decades of Experience

Lisbon, Portugal

March 2-4, 2010


Background in nepal

Background in Nepal

  • Maternal Mortality Ratio was 539/100,000 live births in 1996

  • The abortion was legalized in 2002

  • Before legalization, 50% of all maternal deaths were due to abortion related complications

  • The latest MMR (2008) is 281/100,000

  • Nepal’s target is to reduce MMR to 134 by 2015


Services public private

… Services – public & private

Female CH Volunteers - 48,000

Sub Health Posts – 3126

MA

Health Posts- 677

Primary Health Center -35/209

Public hospitals- 89, NGOs & private clinics

=106

MVA

2nd Tri

Specialized hospitals-14

Tertiary level maternity hospital-1

Ce


Scaling up ma within the context of sa services in nepal

Advocacy

MoHP

MoHP

Training

curriculum

development

Policy

MOHP

Professional obs/gyn

society

Ipas

IEC materials

development

MoHP

Service delivery

Regional/district

health authorities

Project management

Ipas/TCIC

PSI and Ipas

All listed CAC service providers

Public & private

Training

Operations

Research

MoHP

Gynuity

Product

availability

Sun Pharma

Ipas

CREHPA

PSI, Concept


Scaling up ma within the context of sa services in nepal

An incremental and systematic approach to scaling up MA

Integrating MA to

all approved centres (public, NGOs and private)

Community midwives -SBAs & CEM for EE

FCHVs -

counselors

Clinical trial

&

Introductory

Period

2007-2009

Private sector and pharmacists


Fchvs counselors

FCHVs –counselors

FCHVs learning how to use urine tests for early detection of pregnancy

Training materials for FCHVs


Counseling and iec materials

Client & stakeholder brochures

Counseling and IEC materials

Counseling materials


Referral card and safe abortion logo

Referral Card and Safe Abortion Logo


Of ma v s mva

% of MA v/s MVA

Medical abortion scale up strategy approved in November 2009

Source: HMIS/MoHP 2008-2009


Outcomes of medical abortion

Outcomes of medical abortion

Source: HMIS/MoHP 2008-2009


Post ma complications usg

Post MA complications & USG

Source: SA logbook & client profile record 2008-2009


Lessons learned

Lessons learned

System related: (MA pilot findings 2008-2009 in six districts)

  • Government leadership encourages public-private-NGOs partnership

  • Approved protocol protects providers for any adverse events

  • Training MLPs (RN and ANMs) ensures women friendly clinic

  • Female community health volunteers empower women to make timely decision for their RH needs

  • MA drug availability & distribution is possible through the public-private system

  • ‘’No blame approaches’’ for auditing AEs inspires team spirit and strengthens the capacity of health facility to handle complicated cases


Lesson learned

Lesson learned

Client’s perspectives: (client exit interview in 36 MA pilot sites 2008-2009 in six districts)

  • Consulting FCHVs to confirm their suspected pregnancy

  • MA service delivery closer to their community

  • Telephonic conversation for assessing abortion status (complete/incomplete)

  • Women with Prolapse Uterus prefer (non vaginal route)


Lessons learned1

Lessons learned

Service provider’s (physicians and nurses) perspectives: (interview with 68 trained providers on MA 2008-2009 from six pilot districts)

  • Feel confident minimum with 20 MA cases

  • Understanding a difference between ‘’process’’ vs ‘’procedure’’ is critical

  • Training should be combined with clinical practicum and with real clients

  • How to handle women seeking TOP with HIV positive and undergoing TB treatment ??


Conclusion

Conclusion

The success rate without USG and routine hemoglobin test in a population with high prevalence of anemia is an example of great importance for MA implementation in other low resource countries.


Visit us online at www ipas org medicalabortion or write to medicalabortion@ipas org

Visit us online atwww.ipas.org/medicalabortionor write [email protected]


  • Login