Community-Based Life-Saving Skills

1. Community-Based Life-Saving Skills The PRIME II Project Susheela M. Engelbrecht, Midwifery Advisor ACNM/PRIME II

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

3. Section 1 Description of the problem

4. 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.

5. Delays • Delay in recognizing the problem • Delay in deciding to seek care • Delay in arriving at the appropriate facility • Delay in receiving quality care

6. Section 2 Description of the approach

7. 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

8. 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

9. 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

10. 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

11. 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

12. Facility preparation • Standardization of practices at the training site • Preparation of the site for training of community providers • Create partnerships with community providers

13. Section 3 Birth Preparedness

14. 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

15. 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

16. Section 4 • Results from 2 countries: - Guinea - Nicaragua

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

18. 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

19. 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

20. 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)

21. 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

23. 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

24. 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.

25. Questions?