1. Key priorities for 2012/2013 ACCELERATED REDUCTION OF MATERNAL AND CHILD MORBIDITY AND MORTALITY ‘CARMMA – CH’ THE ROAD MAP TO 2014

2. Things that can be done this year Commitment Change of attitude Willingness to change Not dependent on increased budgets Can be implemented at District Level Responsibility – District Manager – CEO – District Clinical Specialists – Hospital Medical Manager

3. Community Based Interventions Health Information and Promotion must be provided at household level Identification, referral and feedback of suspect cases Indicator: – FP uptake; Early booking before 20 weeks; growth monitoring; breastfeeding – Community Care Givers trained – CCG data captured into DHIS Target: Early booking 50% Responsibility: Deputy District Manager – Programmes

4. Antenatal Care All ANC sites must initiate ANC at the time pregnancy is diagnosed Indicator: ANC attendance < 20 weeks Target: 50% Responsibility: PHC supervisor and Clinic Ops manager

5. Antenatal Care All ANC sites must provide Calcium carbonate supplementation for all pregnant women from booking Indicator: – Cases of eclampsia delivered – Hypertensive maternal deaths – Target for KZN <30 deaths for next year 2008-10: 110 deaths) Responsibility: PHC supervisor and Clinic Ops manager

6. Antenatal Care Integrate HIV care into antenatal care – HAART theraphy – PCP and TB prophylaxis – TB screening – Management of opportunistic infections Indicator: Number of NPRI maternal deaths (target 90%) PHC supervisor/ Ops Manager

7. Antenatal Care All District Hospitals should have a plan for a waiting mothers area / maternity waiting home Indicator: – Number of MWHs Target for KZN: functioning MWH at 50% of District Hospitals (26), at least 1 per District Responsibility: CEO and General Manager Infrastructure

8. Labour care All hospitals / MOUs should encourage and allow companions for women in labour Indicator: Institutional policy on companions in labour Target for KZN: all hospitals / MOUs must have written policy on companionship in labour Responsibility: Medical manager/ Clinic Ops Manager

9. Neonatal care All hospitals should have a functional KMC unit Indicator: Babies managed by KMC Target for KZN: all hospitals must have a policy that stable low birth weight babies are managed by KMC Responsibility: Medical Manager

10. Training All hospitals should be running ESMOE fire drills monthly Indicator: Number of master trainers Target for KZN: every hospital must have at least one ESMOE Master Trainer Indicator: Records of fire drills, numbers of staff completed full ESMOE course Target: Monthly fire drills in 50% of institutions, 100% of interns completed ESMOE course Responsibility: Medical Manager

11. Outreach All district hospitals must have designated specialists for O+G and neonatology for outreach Indicator: cell phone and email contact details of designated specialists for outreach available at district hospitals Target for KZN: 100% district hospitals must have contact details available. Responsibility: Medical Manager/ General Manager - IT

12. Referral criteria All clinics, district hospitals and regional hospitals must have referral criteria for obstetric and neonatal problems Indicator: referral criteria clearly displayed in maternity and neonatal departments Target for KZN: 100% of clinics, hospitals Responsibility: Medical Manager

13. Referral criteria Maternity doctor on duty at local (district) hospital must be directly accessible by phone from all clinics in catchment area Indicator: Contact details of doctors (not just hospital) displayed at clinics Target for KZN: 100% of clinics Responsibility: Medical Manager

14. Referral criteria Obstetric specialist on-call at regional referral centre must be directly accessible by phone by the medical officers at referring hospitals and clinics in catchment area Indicator: Contact details of specialists on-call (not just hospital) available at district hospitals Target for KZN: 100% of District hospitals Responsibility: Head Clinical Department

15. Patient transport Patient transport must be available within 15 min of request All the listed hospitals must have specialised ambulances on-site All MOUs must have non-specialised transport Indicator: Response times Target: 15 Min Responsibility: EMS district manager

16. Maternal and Perinatal Audit All hospitals must have scheduled PNMMs at least monthly Indicator: Yearly schedule of PNMM meetings Target for KZN: 100% of hospitals Responsibility: Medical Manager

17. Maternal and Perinatal Audit PNMM must be attended monthly by at least one of top hospital management and must include setting an action plan and follow-up of previous action plans Indicator: Minutes of PNMM meetings Target for KZN: 100% of hospitals Responsibility: CEO

18. Maternal and Perinatal Audit All institutional maternal mortalities to be discussed at the institution within 3 days and an action plan made to prevent recurrence Indicator: Record of maternal death meeting Target for KZN: 100% of maternal deaths per District Responsibility: Medical Manager

19. PPIP Each hospital must have a designated PPIP champion, and functional PPIP programme Indicators: PPIP data forwarded to District quarterly; minutes of 6-monthly hospital PPIP meetings with action plans, and follow-up of previous action plans Target for KZN: 100% of hospitals Responsibility: Medical Manager

20. Women’s Health All women with HGSIL on Pap smear results must be able to access colposcopy / Lletz service promptly Indicators: new cases of cancer of the cervix, waiting time for colposcopy appointment Target for KZN: waiting time for colposcopy appointments per District must be < 1 month Responsibility: Medical Manager

21. Women’s Health Every hospital must be able to offer TOP or refer clients for free TOP service to another service provider Indicators: Hospital policy on TOP service Target: 100% of hospitals have policy ensuring access to TOP Responsibility: CEO

22. Family Planning Every hospital conducting deliveries must be able to offer tubal ligation post vaginal delivery before the mother is discharged if she requests it Indicators: number of post-partum T/Ls Target: 100% of hospitals conducting post- partum T/Ls Responsibility: Medical Manager

23. Family Planning Every hospital/ clinic must have IUCD available as a contraceptive option Indicator: Number of IUCD inserted Target: IUCD insertion trained provider at all hospitals Responsibility: Medical Manager