Global Programme, Zanzibar 20060302

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IMPACT OF EMERGENCY OBSTETRIC CARE NEEDS
ASSESSMENTS IN LATIN AMERICAN REGION Dr.
Javier Dominguez Quality on Reproductive Health
Services LAC Regional Advisor
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OUTLINE

• BACKGROUND
• PROCESS INDICATORS
• EmOC ASSESSMENT IN SELECTED LAC COUNTRIES
• SOME CONCLUSIONS

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• BACKGROUND

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BACKGROUND (1)

• Maternal mortality affects not only women, but
  also their families and communities, and the risk
  of an infant dying increases significantly with
  the mothers death.
• The death of a woman of reproductive age also
  brings significant economic losses and setbacks
  to community development.
• From human rights, economic and public health
  perspectives, mobilizing resources to combat
  maternal mortality is imperative.

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BACKGROUND (2)
UNFPA actions for contributing to the maternal
mortality reduction focus on the three-pronged
strategy of
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BACKGROUND (3)
FAMILY PLANNING (within the context of RH
integral services)
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BACKGROUND (4)
SKILLED ATTENDANCE AT BIRTH (all deliveries)
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BACKGROUND (5)
EMERGENCY OBSTETRIC CARE (accessible for all
women)
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BACKGROUND (6)

• These strategies are essential for achieving the
  MDGs, and this presentation will focus on
  activities that UNFPA has been contributed to in
  some LAC countries related with EmOC,
  particularly the measurement of process
  indicators about the availability and use of EmOC
  services.

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• PROCESS INDICATORS

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NEW PARADIGM IN REDUCING MM

• This new paradigm is based on the fact that all
  pregnancies are at risk
• Most obstetrical complications cannot be
  predicted, nor prevented, but they CAN be treated
  successfully with good, timely medical care
  (Maine, 1993).
• Shift of focus, from pregnancy/ANC to delivery/
  care at childbirth. Therefore, readiness is key,
  accompanied by quality of obstetric care.

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EFFECTIVE INTERVENTIONS EXISTTHEY NEED TO REACH
MORE PEOPLE
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MM CAN BE REDUCED THROUGH
Reducing the possibility of unwanted pregnancies
Reducing the possibility of developing
complications during pregnancy
Reducing the possibility of dying for obstetrics
complications
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EmOC A MARKER OF SKILLED CARE

• SKILLED
• Need universally accepted definition focus on
  human resources working in an enabling
  environment
• Skilled attendant is capable of attending a
  normal birth.
• To recognize, manage and transfer the patient
  in case of complications.
• Real ability to refer.
• Skilled care is about systems and support.

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EmOC A MARKER OF SKILLED CARE

• There is a strong supporting evidence that EmOC
  should be an essential component of programs
  aimed at reducing maternal mortality (Paxton, et
  al., 2005)
• Health facilities that provide certain medical
  services, including antibiotics, blood
  transfusions and Caesarian sections, can save
  nearly all women with obstetric complications
  (Maine and Chavnik, 2002)

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SIGNAL FUNCTIONS (1)

• EmOC refers to a series of signal functions
  performed in health-care facilities that can
  prevent the death of a woman experiencing
  complications of pregnancy (UNICEF, WHO, UNFPA,
  1997).

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SIGNAL FUNCTIONS (2)

• EmOC signal functions include
• Administer parenteral antibiotics,
• Administer parenteral oxytocic drugs
• Administer parenteral anticonvulsivants
• Perform manual removal placenta
• Perform removal of retained products
• Perform assisted vaginal delivery
• Provide blood transfusions
• Provide Caesarean sections

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PROCESS INDICATORS (1)
Although impact indicators such as maternal
mortality rates and ratios remain useful,
especially in making international comparisons,
the practicality of process indicators has made
them popular in recent years as a means of
monitoring as they are both sensitive to change
and easy to maintain in data collection systems.
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PROCESS INDICATORS (2)

• EmOC process indicators are
• Number of facilities offering EmOC
• EmOC geographic distribution (2)
• Percentage of deliveries with skilled attendants
• Percentage of women with complications treated in
  EmOC facilities
• Caesarean-section rate
• Case fatality rates

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• EmOC ASSESSMENT IN
• SELECTED LAC COUNTRIES

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EmOC NEEDS ASSESSMENT (1)

• During the last 5 years UNFPA has contributed in
  performing EmOC needs assessments with the
  governments of
• Nicaragua
• El Salvador
• Honduras
• Paraguay
• Venezuela
• Dominican Republic

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UN PROCESS INDICATORS
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NICARAGUA
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RESULTS / ACTIVITIES

• RESULT 1
• MoH basic EmOC facilities (6) and integral EmOC
  facilities (4) strengthened

• Accreditation of facilities providing basic and
  integral EmOC services
• Coordination between basic and integral EmOC
  services strengthened
• Rehabilitation of 10 health units

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RESULTS / ACTIVITIES

• RESULT 2
• Quality and coverage of EmOC services in selected
  areas increased

• Knowledge and skills of health personnel
  strengthened
• Quality improvement programme implemented in EmOC
  facilities
• Epidemiological surveillance system strengthened

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RESULTS / ACTIVITIES

• RESULT 3
• Access and demand of EmOC services increased in
  selected areas

• Community and institutional articulation
  strengthened
• Community and women organizations empowered
• Health education activities strengthened at
  community level

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QUALITY IMPROVEMENT
Calidad de Atención

• Quality Circles
• Analysis of maternal mortality and morbidity
• Evaluation of EmOC services
• Monitoring of commodities and equipment
• Analysis of referrals within the local health
  system

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COMMUNITY PARTICIPATION
For contributing in transportation of women with
obstetric complications
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OF DELIVERIES IN EmOC FACILITIES NICARAGUA
2000-2003
Recommended level 15
Fuente registros unidades de salud
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OF OBSTETRIC COMPLICATIONS ATTENDED IN EmOC
FACILITIES Nicaragua 2000-2003
Recommended level 100
Fuente registros unidades de salud
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CASE FATALITY RATE Nicaragua 2000-2003
Fuente registros unidades de salud
Recommended level lt 1
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EL SALVADOR
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ADVOCACY ACTIVITIES

• Results used for dialogue with
• Ministry of Health and other officials
• National and local health managers
• Health personnel at the local level
• Researchers and university teachers
• Non-governmental organizations
• International agencies

INTERAGENCY WORKSHOP FOR DESIGNING THE 2004-2009
NATIONAL STRATEGIC PLAN FOR MATERNAL MORTALITY
REDUCTION
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NATIONAL STRATEGIC PLAN FOR MATERNAL MORTALITY
REDUCTION2004-2009
OBJECTIVE -1 PUBLIC POLICIES ANG LEGAL FRAMEWORK
IN PLACE   OBJECTIVE-2 INFORMATION SYSTEMS FOR
MATERNAL MORTALITY SURVEILLANCE STRENGTHENED AND
OPERATING   OBJECTIVE-3 HEALTH PROMOTION
PROGRAMMES FOR MATERNAL MORTALITY
PREVENTION   OBJECTIVE-4 QUALITY MATERNAL AND
CHILD SERVICES DISTRIBUTED AND OPERATING
ACCORDING TO LOCAL NEEDS
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HONDURAS
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MAIN RESULTS

• Strategic interagency partnerships
• South-South cooperation among LAC countries
• Timely technical assistance
• Advocacy activities
• Costing models for strategic interventions

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• SOME CONCLUSIONS

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CONCLUSIONS (1)
)

• Monitoring progress with indicators like Maternal
  Mortality rates and ratios are difficult and
  expensive to obtain and are often inaccurate.
• In many poor countries with limited vital
  registration systems, tracking these numbers
  accurately is a nearly impossible task.

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CONCLUSIONS (2)

• Process indicators are easier to track and can be
  used to show changes in those activities or
  circumstances that are known to contribute to or
  prevent maternal death.
• These indicators have become an invaluable tool
  to monitor progress in program implementation and
  effectiveness.
• Taken together these indicators offer a picture
  of the availability, quality and use of services.
  

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DR. JAVIER DOMINGUEZ DEL OLMO
HOMERO 806 COL. POLANCO MEXICO, D. F.
11550 Tel. [phone] Fax 52
55 52037575 Email dominguez_at_unfpa.org Interne
t www.unfpa.org