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Caroline Homer, University of Technology Sydney

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Newborn survival and perinatal health in resource-constrained settings in Asia and the Pacific: Applying Global Evidence to Priorities Beyond 2015 …

Newborn survival and perinatal health in resource-constrained settings in Asia and the Pacific: Applying Global Evidence to Priorities Beyond 2015
12 April 2013

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  • 1. Maternal  health  care  in  the  western  Pacific:  The  role  of  midwives    Caroline  Homer  Faculty  of  Health  UTS                    
  • 2. Objec9ves  •  Discuss  the  role  of  midwives  in  newborn  survival  •  Discuss  training,  standards  and  advocacy  across  the  Pacific  to  strengthen  midwifery      
  • 3. Saving  newborn  lives  ….  •  Saving  newborn  lives  means  star9ng  with  women  •  The  provision  of  care  that  is:  –  Safe  and  effec9ve    –  Accessible  –  RespecJul  –  Based  on  evidence  •  Need  a  workforce  to  deliver  the  care  
  • 4. Maternal  mortality  Source:  SoWMR,  2011  
  • 5. Giving  birth  safely  is  largely  a  privilege  of  the  rich  Source:  UN  MDG  report  2012  
  • 6. •  Nearly  two  thirds  of  births  in  the  developing  world  are  a>ended  by  skilled  health  personnel  •  Lots  of  quesBons  about  what  consBtutes  ‘skilled’  Source:  UN  MDG  report  2012  
  • 7. Source:  SoWMR,  2011  
  • 8. More  pregnant  women  are  receiving  care  with  the  recommended  frequency,  but  gaps  sBll  exist  in  regions  most  in  need  Source:  UN  MDG  report  2012  
  • 9. Fewer  teens  are  having  children  in  most  regions,  but  progress  has  slowed  Source:  UN  MDG  report  2012  
  • 10. Family  planning  •  Plays  a  cri9cal  role  in  reducing  maternal  mortality  •  Has  child  health  benefits  too  –  Less  women  are  pregnant  –  Greater  spacing  between  births  
  • 11. Reasons  that  newborns’  die  •  Birth  asphyxia  •  Preterm  or  low  birth  weight  •  Infec9on  
  • 12. Saving  newborn  lives  …  •  Cross  the  con9nuum  –  pre-­‐pregnancy  care  –  pregnancy  care  –  care  in  labour    –  care  at  birth  and  immediately  aXer  birth  –  care  in  the  early  days  and  weeks  
  • 13. Preven9ng  preterm  birth  or  s9llbirth  PrevenBon  or  improvement   EffecBve  intervenBons  Prevent  preterm  births   smoking  cessaBon  Prevent  sBllbirths   balanced  protein  energy  supplementaBon  screening  and  treatment  of  syphilis  intermi>ent  presumpBve  treatment  for  malaria  during  pregnancy  birth  preparedness  emergency  obstetric  care  elecBve  inducBon  for  post-­‐term  pregnancy  Improve  survival  of  preterm  newborns  prophylacBc  steroids  in  preterm  labor  anBbioBcs  for  PROM  delayed  cord  clamping  vitamin  K  supplementaBon  at  birth  case  management  of  neonatal  sepsis  and  pneumonia  room  air  (vs.  100%  oxygen)  for  resuscitaBon  hospital-­‐based  kangaroo  mother  care  early  breasUeeding  thermal  care  
  • 14. All  interven9ons  need  …    •  A  professional  workforce  – Midwives  – Community  health  workers  – Specialist  services  •  Family  and  community  health  care    – Village  health  volunteers  •  A  func9onal  integrated  health  system  – Commodi9es  – Communica9on  and  referral  
  • 15. The  role  of  midwifery  •  Properly  trained  and  supported  midwives  can  deliver  many  of  the  interven9ons  needed  to  improve  maternal  and  newborn  health  •  The  lives  and  health  of  millions  of  women  and  newborns  could  be  saved  with  greater  investments  in  midwives,  emergency  midwifery  and  obstetric  care  and  family  planning  
  • 16. WHO’s  essenBal  care  packages  and  the  role  of  midwifery  competencies  across  the  conBnuum  of  care  State  of  the  World’s  Midwifery  Report.  Adapted  from  WHO  (2010)  recommended  ‘Packages  of  Interven9ons  for  Family  Planning,  Safe  Abor9on  Care,  Maternal,  Newborn  and  Child  Health’  and  ICM  (2010)  Essen9al  competencies  for  basic  midwifery  prac9ce  
  • 17. Obstacles  to  midwifery    •  Scarcity  of  midwives  –  few  midwives  at  hospitals  or  health  centres,  especially  in  rural  areas  •  Lack  of  high  quality  midwifery  educa9on  •  Poor  regula9on  •  Lack  of  professional  recogni9on  and  status    •  Lack  of  support  for  con9nuing  professional  development  •  Poor  health  system  infrastructure    –  supplies  of  drugs  is  oXen  limited    
  • 18. Components  of  effec9ve  midwifery  EducaBon  –  developing  and  maintaining  competencies  RegulaBon  –  protec9ng  public  and  professionals  Professional  associaBons  —  giving  midwives  a  voice  
  • 19. Strengthening  midwifery  in  PNG  Controversy  over  these  data  –  household  survey  data  show  MMR  increasing  form  360  to  733  per  100,000  live  births  from  1996-­‐2006    PNG  needs  to  triple  -­‐  quadruple  its  midwifery  workforce  Source:  SoWMR  2011  
  • 20. Maternal  and  Child  Health  Ini9a9ve  •  Funded  by  AusAID  –  Ini9ally  2  year  project  •  Undertaken  by  WHO  PNG  •  UTS  WHO  Collabora9ng  Centre  sub-­‐contracted  to  provide  par9cular  ac9vi9es  including  recruitment,  employment  and  monitoring  and  evalua9on  
  • 21. Aims  •  Improving  maternal  and  child  health:  by  equipping  midwives  and  midwifery  educators  with  appropriate  and  up-­‐to-­‐date  knowledge  and  competencies  •  Increasing  the  quality  of  the  health  workforce:  by  contribu9ng  to  improving  the  quality  of  midwifery  training  •  Improve  services  in  priority  provinces:  by  increasing  obstetric  service  delivery  in  two  regions  
  • 22. Capacity  building  in  midwifery  educa9on  •  Four  midwifery  schools  in  PNG    –  University  of  PNG  in  Port  Moresby  –  Pacific  Adven9st  University  in  Port  Moresby  –  Lutheran  School  of  Nursing  in  Madang  –  University  of  Goroka  •  8  interna9onal  midwives  recruited  to  each  of  the  schools    
  • 23. Improving  maternity  care  in  the  districts  •  Two  obstetricians    for  district  hospitals  –  St  Mary’s,  Vunopope    –  Kundiawa    •  Provide  clinical  care,  teaching  and  mentoring  to  PNG  medical  officers  nurses  and  midwives  
  • 24. Other  parts  of  (E)RA…  •  RegulaBon  –  The  PNG  Nursing  Council  is  working  towards  na9onal  accredita9on  of  midwifery  educa9on  and  na9onal  registra9on  of  midwives  •  AssociaBon    –  The  PNG  Midwifery  Society  has  been  reinvigorated,  joined  ICM  and  is  in  a  twinning  program  with  the  Australian  College  of  Midwives  
  • 25. Collabora9ons  for  training,  standards  and  advocacy  across  the  Pacific        •  Midwifery  associa9ons  and  donors  working  together  –  NZ  College  of  Midwives  –  Australian  College  of  Midwives  –  UNFPA  –  World  Vision  –  Others  
  • 26. Midwifery  Educa9on     QualificaBonLength  of  programmeTotal  hrs. Theory  hrs. Clinical  hrs.Fiji Post  Grad  Diploma   52  wks 1960 680 1280KiribaB Post  Grad  Cert   35  wks 1065 490 575PNGDegree  Degree  Degree  52  wks  52  wks  50  wks2789  1992  20001344  312  7201445  1680  1280Samoa Post  Grad  Diploma   52  wks 1120 480 640Solomon  IslandsAdv  Dip  Nursing  (Midwifery)  52  wks 1169 504 665Tonga Cer9ficate 40  wks     Not  available Not  available Not  availableVanuatu DiplomaNot  available    Not  available Not  available Not  available
  • 27. Midwifery  in  the  Pacific  •  Lack  of  appropriate  legisla9on,  regula9on  and  scope  of  prac9ce  for  midwifery    •  Countries  agree  on  the  need  for  midwifery  competencies  that  are  contextualised  for  the  Pacific  and  include  a  primary  health  care  focus  •  There  was  also  a  strong  call  from  Pacific  countries  to  have  a  standardised  midwifery  program  that  could  be  used  across  Pacific  countries  or  where  midwives  could  be  educated  for  mul9ple  countries      Source:  AUT  Mary  MacManus  ,  JCU  Kim  Usher    SPCNMOA  –  PHRHA  Nov  2012  
  • 28. Midwifery  -­‐  mee9ng  global  standards  •  ICM  Essen9al  Competencies  for  Basic  Midwifery  Prac9ce    •  ICM  Global  Standards  for  Midwifery  Educa9on  •  ICM  Global  Standards  for  Midwifery  Regula9on  •  And  more  ….  
  • 29. Pacific  Society  for  Reproduc9ve  Health  •  Collabora9ve  network    •  Mee9ng  in  Samoa  in  July  to  progress  this  work  
  • 30. Finally  ….  •  Bold  steps  are  needed  to  ensure  that  “every  woman  and  her  newborn  have  access  to  quality  midwifery  services”  (Ban  Ki  Moon  2011)  •  Saving  newborn  lives  starts  in  pre-­‐pregnancy  and  goes  across  the  con9nuum  •  Strengthening  the  midwifery  workforce  is  a  key  to  saving  newborn  lives