1. MEETING HEALTH SYSTEMS CHALLENGES RELATED TO EMERGENCY OBSTETRIC CARE B Subha Sri, MPS Course, July 2010

2. Maternal death – Medical causes Hemorrhage Hypertensive disorders Sepsis Obstructed labour Unsafe abortion Which woman will develop complications cannot be predicted in advance – High risk approach not enough. Skilled birth attendance with access to Emergency Obstetric Care for all women.

3. Types of Emergency Obstetric Care Basic Emergency Obstetric Care 1) Administer parenteral antibiotics 2) Administer parenteral oxytocic drugs 3) Administer parenteral anticonvulsants for preeclampsia and eclampsia 4) Perform manual removal of placenta 5) Perform manual removal of retained products (e.g., manual vacuum aspiration) 6) Perform assisted vaginal delivery Comprehensive Emergency Obstetric Care All (1 to 6) functions included in basic EmOC plus: 7) Perform surgery (e.g., cesarean section) 8) Perform blood transfusion

4. Characteristics of quality EMOC Good quality EmOC involves a state of readiness which enables the team to respond to unforeseen emergencies efficiently and continually, while protecting rights of the client

5. Readiness Achieving and maintaining a state of preparedness for provision of quality EmOC – 24 X 7 service – Staff with requisite skills – Willingness – Available and functional equipment and supplies – Adequate infrastructure

6. Response Avoid third delay Prompt care Appropriate Accepted technical quality

7. Rights – related to highest attainable standards of health Patient rights – Access to EmOC services and continuity of care – Safe (competent) EmOC – Information and informed choice – Privacy and confidentiality, dignity, comfort, and expression of opinion Provider rights – respect, dignity, and freedom to express their opinion – Positive work environment – Maintenance of skills – Information and training – Supplies, equipment, infrastructure

8. Quality of EmOC Quality improvement is an improvement in the level of performance of a key process It involves Measuring current performance Finding out ways to improve performance Implementation of newer and better methods

9. Principles of Quality Improvement Staff involvement Client mindset consideration Focus on systems and processes rather than persons’ shortcomings Cost consciousness and efficiency Continuous learning, capacity building Tapping internal resources

10. Steps in Quality Improvement Gathering and analysing data Developing action plan Implementing solutions Review of progress and suggestions

11. Critical steps in EmOC

12. PROCESS INDICATORS FOR EmOC (UNICEF, WHO, UNFPA) 1) Number of EmOC facilities For every 5,00,000 population At least 4 Basic EmOC facilities At least 1 Comprehensive EmOC facility 2) Geographic distribution Minimum level is met in subnational areas 3) Percentage of births in EmOC facilities At least 15% of all births in the population take place in EmOC facilities

13. PROCESS INDICATORS FOR EmOC (UNICEF, WHO, UNFPA) 4) Met need for EmOC – All women with obstetric complications are treated in EMOC facilities No. of women with obstetric complications treated in EmOC facilities _______________________________ 15% of estimated live births in catchment area – Based on assumption that 15% of live births are associated with a major obstetric complication

14. PROCESS INDICATORS FOR EmOC (UNICEF, WHO, UNFPA) 5) Caesarean section rate – Not less than 5% and not more than 15% of all births in the population are by caesarean section. 6) Case fatality rate – Not more than 1% of women with obstetric complications admitted to comprehensive EmOC facilities die.

15. Quality in EmOC can mean Improving the Readiness, Response and Rights Improving performance on the Process Indicators