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Community-Based Life-Saving Skills. The PRIME II Project Susheela M. Engelbrecht, Midwifery Advisor ACNM/PRIME II. Safe Motherhood. PRESENTATION OUTLINE Description of the problem Description of the approach Birth preparedness Experiences from 2 countries - Guinea - Nicaragua.

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Community-Based Life-Saving Skills

The PRIME II Project

Susheela M. Engelbrecht, Midwifery Advisor


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Safe Motherhood


    • Description of the problem

    • Description of the approach

    • Birth preparedness

    • Experiences from 2 countries - Guinea - Nicaragua

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Section 1

Description of the problem

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Why do women die?

  • The factors that prevent women from getting the life-saving health care they need include:

    • Distance from health services;

    • Cost (direct fees as well as the cost of transportation, drugs, and supplies);

    • Multiple demands on women’s time;

    • Women’s lack of decision-making power within the family;

    • Poor quality services, including poor treatment by health providers, which makes women reluctant to use services.

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  • Delay in recognizing the problem

  • Delay in deciding to seek care

  • Delay in arriving at the appropriate facility

  • Delay in receiving quality care

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Section 2

Description of the approach

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  • Reduce the number of maternal and newborn deaths by expanding access of life saving measures and techniques to women in remote areas

  • Increase the number of births attended by skilled providers

  • Reduce delays in transporting women with obstetric emergencies and newborns with emergencies by establishing local transport systems and resources

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Community Provider (CP) Training

  • Development of CP trainers and curriculum

  • Training of CPs in a reference facility

  • Creating partnerships between CPs and service providers

  • Procurement of equipment for CPs

  • Integration of newly trained CPs into their communities

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Skills taught to CPs

  • Helping families to prepare for births and complications

  • Recognizing danger signs

  • Infection prevention

  • Routine care during childbirth and of newborn

  • Assisted delivery of the placenta

  • External bimanual compression of uterus

  • Compression of a perineal or vaginal laceration

  • Uterine massage

  • Newborn resuscitation

  • Prevention and treatment of shock

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Training of Community Mobilizers

  • Causes of maternal death

  • Responding to maternal deaths

  • Organizing the community around SM issues

  • How to prepare a birth preparedness plan

  • How to prepare a complication readiness plan (antepartum, intrapartum, postpartum, newborn)

  • Importance of male participation / involvement

  • Family planning for postpartum women

  • Documentation of interventions

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Community Partnerships

  • Emergency planning at the community, household and individual level

  • Community mediators

  • Recognition of danger signs

  • Community surveillance systems

  • Community agreement on setting up mutual funds

  • Identification of a means of emergency transport

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Facility preparation

  • Standardization of practices at the training site

  • Preparation of the site for training of community providers

  • Create partnerships with community providers

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Section 3

Birth Preparedness

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Elements of a BP Plan

  • Make plans for the birth

  • Decide upon these issues when making the birth plan:

    • Place of birth

    • Chosen skilled provider

    • How to contact the provider

    • How to get to the place of birth

    • Who will be the birth companion

    • Who will take care of the family while the woman is absent

  • Prepare the necessary items for birth

  • Save money

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Complication Readiness Plan

  • Recognise danger signs

  • Establish a savings plan/scheme

  • Make a plan for decision-making in case an emergency occurs while the chief decision-maker is away

  • Arrange in advance for transportation in case of emergency

  • Arrange for a blood donor in case of need

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Section 4

  • Results from 2 countries:

    - Guinea - Nicaragua

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Health Indicators

Source: Maternal Mortality in 1995: Estimates developed by WHO, UNICEF, UNFPA. World Health Organization, Geneva, 2001.

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  • Pop est/ 7,775,065 (July 2002 est.)

  • Sparsely populated (9.1 inhabitants/km)

  • Intervention in Mandiana Prefecture

  • In collaboration with Save the Children / USA / Guinea, ADRA, PRISM Project, MOH

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Results - Guinea

  • Increase in percent of assisted births (82% in 2002; 61% in 1997)

  • Increase in the percent of referred cases (69% in 2002; 23% in 1997)

  • Increase in antenatal care coverage (71% in 2002; 41% in 1997)

  • Functional system of transportation between all subprefectures

  • Functional supervisory system

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Results - Guinea

  • All communities have emergency transport system, including signing agreements with taxi drivers and the hospital for use of the ambulance

  • 73 Village Health Committees developed (657 members).

  • 73 mutual funds (100% of communities) established with a total of 60 millions FrG (02/03)

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Results - Guinea

  • 11 health centres equipped with radios (World Bank funds)

  • Mandiana District Hospital equipped with an ambulance (World Bank funds)

  • New maternity block under construction at the Mandiana District Hospital (World Bank funds)

  • Mandiana District Hospital has a fund that can be used to advance money to women coming in with obstetric emergencies

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Jinotega Province, Nicaragua

  • Pop est/ 4,812,569 (July 2000 est.)

  • Intervention in Jinotega

  • In collaboration with: Project Hope, PCI, Wisconsin-Partners of the Americas, MSH (PROSALUD), Quality Assurance Project

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Results - Nicaragua

  • In the 32 project areas:

    • 78% of communities have emergency obstetric and neonatal care community committees

    • 56% of communities have organized emergency transportation systems

    • 25 % of communities have emergency funds set aside

    • 81% of the communities have a census of pregnant women

    • 47% of the communities have implemented birth preparedness and complications readiness plans.