Access to SBA at Island level Home

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Access to SBA at Island level (Home)

• MALDIVES

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Advantages

• Maximum 2-4 births a month/island
• Home delivery- at 10 now, and on the decrease
• Free of charge- all costs in emergency
• Health Master Plan- a CHW or nurse mid- wife in
  all islands by 2005. Realistic by 2007.

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Problems

• FHWs TBAs- competencies- none on the list
• Delays- decision making by FHWs
• No Birth Preparedness Plan- for emergencies
• Referral lack of skills to identify
  complications
  
• Transportation
• - lack of availability (24 hrs.)
• - dependent on weather
• - cost

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Strategy

• Maintain educational standard of FHWs who join
  course
  
• Revision of FHWs Curriculum
• - currently already new curriculum includes
  most on list.
  
• - need to include Manual evacuation of
  placenta- onwards of list
  

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• Upgrading of existing FHWs and nurse aides in
  midwifery including skills on list
  
• Already planned for July 2004
• Deployment Strategy- retain trained FHWs in
  islands rotation of health workers
  
• TBAs- currently no further training. Phasing out
  (also employed by govt. therefore no incentive to
  encourage home- delivery)
  
• Strengthen utilisation of existing Home- Based
  Mothers Card
  

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Access to SBA at Atoll level(Facility)

• MALDIVES

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Advantages

• 85 of atolls have EmOC
• At max. 2 hrs. traveling distance
• 10-15,000 people/EmOC facility
• Full list of competencies available
• 1- 3,000 people/Basic EOC
• Institutional delivery at 90

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Problems

• Availability yes.
• But, accessibility problems
• - transportation (delay in reaching facility)
• - delay in referral/decision from islands
  (linked to lack of sufficient training of FHW
  TBAs)
  

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Strategy

• Systematic and continuous refreshers for health
  care providers in facilities especially in
  Management of Complications and Childbirth
  

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Cross- Cutting StrategiesIsland- Atoll
level(Home- Facility level)

• National Standards Guidelines/Protocol on SBA,
  midwifery skills
  
• Standard Guideline on Referral stretching from
  island- atoll- central level. Include private
  sector (only one pvt. facility for delivery in
  the whole country)
• - basic referral
• - EmOC referral

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• Establish surveillance system to ensure
  continuous M E
  
• Address Transportation problems
• - Community involvement (Island Development
  Committees, Womens Development Committees)
  
• - discussions with private sector (e.g. nearby
  resorts, industrial islands, companies)
  

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• BCC- families and husbands
• - on Birth Preparedness- ANC, delivery
  transport, budgeting, PNC..

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THANK YOU