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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

Community-Based Life-Saving Skills

The PRIME II Project

Susheela M. Engelbrecht, Midwifery Advisor

ACNM/PRIME II

safe motherhood
Safe Motherhood
  • PRESENTATION OUTLINE
    • Description of the problem
    • Description of the approach
    • Birth preparedness
    • Experiences from 2 countries - Guinea - Nicaragua
slide3

Section 1

Description of the problem

why do women die
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.
delays
Delays
  • Delay in recognizing the problem
  • Delay in deciding to seek care
  • Delay in arriving at the appropriate facility
  • Delay in receiving quality care
section 2
Section 2

Description of the approach

goals
Goals
  • 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
community provider cp training
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
skills taught to cps
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
training of community mobilizers
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
community partnerships
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
facility preparation
Facility preparation
  • Standardization of practices at the training site
  • Preparation of the site for training of community providers
  • Create partnerships with community providers
section 3
Section 3

Birth Preparedness

elements of a bp plan
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
complication readiness plan
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
section 4
Section 4
  • Results from 2 countries:

- Guinea - Nicaragua

health indicators
Health Indicators

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

guinea
Guinea
  • 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
results guinea
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
results guinea20
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)
results guinea21
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
jinotega province nicaragua
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
results nicaragua
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.