Organiza(on

of Maternity Services,
Emergency Obstetric Care, Woman
and Child Friendly Hospital Ini(a(ve
Umar A M
13 07 15
 Objec(ves
Types of facili(es oering maternity services
Requirements for organizing a maternity
centre
Women and Child friendly hospitals (IMNCH,
SURE-P MCH)
Components and recommenda(ons for EONC
FANC
 Background
2015 - MDG target year
Indicators for MDGs that are directly related
to health
How other MDGs key into the health related
MDGs
 Relevant Sta(s(cs
MMR 576/100,000
NNM 37/1,000
IMR 69/1,000
U5MR 128/1,000
75% of NN deaths & of 63% childhood deaths
are preventable
ORGANIZATION OF MATERNITY
SERVICES
 Levels of Maternity Care
Federal FMOH
responsible for policy and technical support to the
overall health system
interna(onal rela(ons on health mabers
the na(onal health management informa(on
system
provision of health services through the ter(ary
and teaching hospitals and na(onal laboratories.
Organiza(on of Maternity Services
State (SMOH)
secondary (and some ter(ary) hospitals
regula(on and technical support for primary
healthcare services.
Local Government (PHC)
comprehensive health centre
three doctors
Oer PHC services & some 2 clinical care services.
comprehensive health centre per local government
area.
Organiza(on of Maternity Services
primary health care centre
staed by medical ocers or NYSC doctors (where
available); community health ocers (CHOs) with
nursing/midwifery background; senior and junior
community health extension workers, laboratory
and pharmacy technicians, oering basic
preven(ve and cura(ve services.
1 per ward
 health clinics or health posts
Community or village level
served by community health extension workers
(CHEWs) and Junior CHEWs) who are expected to
work in the community 80% of the (me, and 20%
in the health facility.
 Maternity Centres
Geographic loca(on
Land
Access
Facili(es
ANC, PNC, FPC
Laboratory, theatre, blood transfusion services, USS
Manpower
Equipment
Sphyg, steth stadiometer, weighing scale, examina(on
couches
Delivery beds, theatre equipment
 Licensing bodies
Hospital, corpora(on
Sta
NHIS, HMO
WOMEN AND CHILD FRIENDLY
HOSPITAL INITIATIVE
 Background
Events in pregnancy, delivery & within 48hrs
have impact on Maternal & Infant mortality
Introduc(on of high-impact, low-cost
interven(ons could lead to a signicant
reduc(on in mortality among vulnerable
groups in the popula(on.
 The Concept of IMNCH
It is a holis(c approach which replaces the
compe(ng calls for mother or child
It integrates maternal, newborn and child health
services, with other key programmes, such as,
HIV/AIDS, malaria and immuniza(on.
Reorganiza(on and reorienta(on of the health
system to ensure the delivery of a set of essen(al
interven(ons which will provide a con(nuum of
care for women, neonates and children
High coverage of the target groups by punng
services in the same facility.
 Concept of IMNCH
Interven(ons take into considera(on the
state-specic budget, logis(c constraints,
technical exper(se, and social /cultural
factors.
 Priority Areas for Ac(on
Focused antenatal care
Intrapartum care
Emergency obstetric and newborn care
Rou(ne postnatal care
family planning/child spacing
Newborn care
Infant and young child feeding (IYCF
Preven(on of malaria
 Priority Areas for Ac(on
Rou(ne immuniza(on
Preven(on of mother-to-child transmission of
HIV (PMTCT)
Management of common childhood illnesses
and care of HIV-exposed or infected children
Preven(on and management of childhood
malnutri(on
Water hygiene and sanita(on
EMERGENCY OBSTETRIC CARE
 EOC
Most causes of MM are preventable
Direct causes haemorrhage, obstructed
labour, infec(on (sepsis), unsafe abor(on and
eclampsia.
Indirect causes malaria, HIV and anaemia
For every woman who dies, 15 to 30 women
suer from chronic illnesses or injuries as a
result of their pregnancies e.g.Obstetric stula
 Standards for EmOC
Comprehensive EmOC
Basic EmOC FuncCons FuncCons
Performed in a health Requires an opera(ng
centre without the need for theatre and is usually
an opera(ng theatre performed in district
IV/IM an(bio(cs hospitals
IV/IM oxytoxics All six Basic EmOC
IV/IM an(convulsants funcCons plus:
Manual removal of placenta Caesarean sec(on
Assisted vaginal delivery Blood transfusion
Removal of retained Care of sick & LBW
products newborns
Basic Neonatal
resuscita(on.
 Indicators for EOC
Indicator Acceptable level
Availability of emergency There are at least ve
emergency obstetric care
obstetric care: basic and facili(es (including at least one
comprehensive care comprehensive facility) for
facili(es every 500 000 popula(on
All subna(onal areas have at
Geographical distribu(on of least ve emergency obstetric
emergency obstetric care care facili(es (including at
facili(es least one comprehensive
facility) for every 500 000
Propor(on of all births in popula(on
emergency obstetric care (Minimum acceptable level to
be set locally)
facili(es
 Indicators for EOC
Met need for emergency 100% of women es(mated
obstetric care: propor(on to have major direct
obstetric complica(ons are
of women with major direct treated in emergency
obstetric complica(ons who obstetric care facili(es
are treated in such facili(es The es(mated propor(on of
Caesarean sec(ons as a births by caesarean sec(on
in the popula(on is not less
propor(on of all births than 5% or more than 15%
Direct obstetric case The case fatality rate among
fatality rate women with direct obstetric
complica(ons in emergency
obstetric care facili(es is
less than 1%
 Indicators for EOC

Intrapartum and very early

neonatal death rate.
Propor(on of maternal
deaths due to indirect
causes in emergency
obstetric care facili(es

 Limita(ons to Access of EOC
Delay in deciding to seek care
Delay In reaching care
Delay in receiving care at facility
Delay Common causes Key intervenCons

First delay Woman not recognized as Improve awareness of

needing EmOC obstetric danger signs
among women, men and
families.
Involve TBAs in early
recogni(on and (mely
referral of women with
obstetric emergencies

Second delay Woman arrives late at Improve referral system,

facility including communi-
ca(on capacity and
transport mechanism.
Implement community
nance and transport
schemes.
Delay Common causes Key intervenCons

Third delay Facility is not staed and Improve coverage of

equipped to provide EmOC EmOC to meet the
services or woman is not minimum requirement
able to access the services (e.g., four basic and one
upon arrival comprehensive EmOC
facili(es for every
500,000 people).
Improve quality of
EmOC, clients sa(sfac-
(on and 24/7 coverage.
Improve u(liza(on of
EmOC services by
reducing barriers and
ensuring equitable
assess.
FOCUSED ANTENATAL CARE AND
OTHER STRATEGIES
 FANC
Defn of ANC
Quality of care over quan(ty
Minimum of 4 visits with at least 1 per
trimester
Low resource interven(ons
Referral of high risk pa(ents
 Goals of FANC
Early detec(on and treatment of problems
and complica(ons
Addressing complica(ons and diseases, such
as HIV/AIDS, malaria
Birth preparedness and complica(on
readiness, and
Basic health promo(on through sound
nutri(on and preven(ve measures.
 Ways to Increase ANC
Increase pa(ent uptake and access to ANC
services.
Overcome socio-cultural and gender-based
constraints. E.g, antenatal care providers
should be female in areas where religious
prac(ces and tradi(on seriously restricts the
movement of women.
Male partner & religious leader involvement.
 Intrapartum care
Monitor the progress of labour with the
partograph
ac(ve management of the third stage of
labour and postpartum care of mother
suppor(ve care and pain relief
newborn resuscita(on
 Immediate postnatal care of the newborn
baby (eg, thermal protec(on, cord care,
ini(a(on of exclusive breast-feeding within
one hour)
The preven(on of mother -to- child
transmission of HIV interven(ons including
an(retroviral therapy are essen(al.
 Postnatal Care
Promo(on, protec(on and support for breast-
feeding
detec(on of complica(ons (eg, breathing,
infec(on, preterm complica(ons, birth injury,
other malforma(ons, jaundice).
Infec(on preven(on and control
Informa(on and counseling on home care
Breast-feeding hygiene
 Postnatal Care
Advice on dangerous signs
Emergency preparedness and follow-up.
Immuniza(on
Sleeping under insec(cide-treated nets (ITN)
Proper cord and eye care Administra(on of
vitamin K
 Family Planning
Recognizing missed opportuni(es
Re-introducing FP in the on-going and basic
reproduc(ve health services
Pre/in-service training of community based
resource persons
Male involvement
Provision of equipment
Strengthening community par(cipa(on
 Family Planning
Building consensus among key stakeholders
(religious leaders and men)
Addressing the family planing needs of
vulnerable popula(ons young people,
displaced persons, refugees in war/conict
situa(ons
Opera(onal research (service barriers)
Ensuring commodity security
Sustained nancing
?
 Summary
Maternal, infant mortality are problems
Nigerias Maternity services are organized into
primary, secondary and ter(ary levels
EOC is an essen(al component of MCH
Advocacy, male and tradi(onal ruler
involvement will improve acceptance of MCH
interven(ons.
 Further Reading
IMNCH strategy, FMOH Abuja 2007
NDHS 2013
Monitoring emergency obstetric care: a
handbook, WHO 2009
Millenium project goals, targets and
indicators