SBA

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SBA

  1. 1. Skilled Birth Attendant (SBA) State Institute of Health & Family Welfare, Jaipur
  2. 2. Skilled birth attendant n An accredited health professional- (midwife, doctor or nurse) n Educated and trained, with skills needed for: n Managing normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period n Identification, management and referral of complications in women and newborns. n Does not include TBA, even if trained. SIHFW: an ISO 9001: 2008 certified institution 2
  3. 3. Why Skilled attendance at birth n Most of the obstetric complications are unpredictable n Timely and life saving support and intervention are a must n Absence of midwifery skills- Increased chances of casualty SIHFW: an ISO 9001: 2008 certified institution 3
  4. 4. Maternal Deaths – Causes Indirect Severe causes Bleeding Other 19% 25% direct causes 8% Infections 15% Obstructed Labour Unsafe 8% Abortion Eclampsia 13% Source-WHO report-2005 12% SIHFW: an ISO 9001: 2008 certified institution 4
  5. 5. Neonatal deaths – Causes Cord Infections 2% Other Birth causes Injuries 18% 3% Diarrhoel Diseases 4% Prematurity 51% Congenital Acute malfunction Respiratory s Infection 5% 17% Source-WHO Report-2005 SIHFW: an ISO 9001: 2008 certified institution 5
  6. 6. 4 delays in Obstetrics n 4 delays in n problem identification n decision making n reaching facility n providing emergency care SIHFW: an ISO 9001: 2008 certified institution 6
  7. 7. Interventions that can help n Skilled attendance at birth n Comprehensive BEmOC & EmOC n Organized referral transport system to access these facilities SIHFW: an ISO 9001: 2008 certified institution 7
  8. 8. Skilled Birth Attendant-Training n UNICEF n GOI revised the guidelines, enlarged the scope n Included in the PIP of NRHM SIHFW: an ISO 9001: 2008 certified institution 8
  9. 9. Training: Objective n To improve intra-partum and new born care services in institutions. n Develop understanding, knowledge and skills of birth attendant SIHFW: an ISO 9001: 2008 certified institution 9
  10. 10. Training outcomes Development of skill and confidence Health facilities- -Increased role of health providers -Qualitative services Reduce IMR ( MDG 4) and Improve maternal health (MDG 5) SIHFW: an ISO 9001: 2008 certified institution 10
  11. 11. Skill required Ø Care during pregnancy Ø Care during labour and delivery Ø Care after delivery Ø Essential new born care SIHFW: an ISO 9001: 2008 certified institution 11
  12. 12. Skill development n Care during pregnancy – 4 ANC visits n BP measurement and diagnosis of pre- eclampsia n HB estimation/ proteinuria/ glucosuria n Position of fetus n Auscultation of fetal heart rate and diagnosis of fetal distress n Counseling n Birth preparedness SIHFW: an ISO 9001: 2008 certified institution 12
  13. 13. Skill development n Care during labour and delivery- Intra partum care n Monitoring progress of labour through partographs (timely refer) n Fetal heart rate n Progress of labour-cervix dilation and contractions n Maternal conditions- BP and Pulse n use drugs for prevention of PPH. n use drugs in emergency situations before referral n perform basic procedures at community level in emergency situations 13 SIHFW: an ISO 9001: 2008 certified institution
  14. 14. SIHFW: an ISO 9001: 2008 certified institution 14
  15. 15. Skill development n Care after delivery – post partum care n Assessment of mother for PPH/ sepsis/ eclampsia n Initiation for breast feeding n Essential new born care n Immediate management – wiping, drying, placing n Assessment and management of asphyxia n Keeping the baby warm n Skin to skin contact with mother/ kangaroo mother care SIHFW: an ISO 9001: 2008 certified institution 15
  16. 16. The important skill n Early recognition and management of common obstetric complications n Ante partum hemorrhage n Pre-eclampsia n Obstructed labour n Post partum hemorrhage n Convulsions/ seizures n Post partum sepsis n Use tablets and injections to prevent emergency/ before referral e.g. n Tab. Misoprostol (APH) n Inj. Magsulf (Eclampsia) 16 SIHFW: an ISO 9001: 2008 certified institution
  17. 17. Training methodology n Theory- n Interactive sessions, presentations and discussion n Demonstration and simulated practice on mannequins n Intensive hands on- n ANC OPD n Labour rooms for delivery and new born care n Post natal wards n Laboratory 17 SIHFW: an ISO 9001: 2008 certified institution
  18. 18. Level I – Training of trainers n Conducted at- n Midwifery Resource Center (Janana Hospital, Jaipur) n Now at - Action Research and Training for Health ( ARTH-Udaipur) n Participants- n PHN/ NT (HFWTC/DTC/GNMTC/ANMTC) n SN (labour room) n Training duration- n 15 days (theory & practical sessions) 18 SIHFW: an ISO 9001: 2008 certified institution
  19. 19. The trained trainers- n MRC- nJuly 06 – September 07 n 11 batches n 136 trained n ARTH- n March 08 – November 09 n 9 batches n 158 trained SIHFW: an ISO 9001: 2008 certified institution 19
  20. 20. Level II-Training of birth attendants n Conducted at- n Theory- HFWTC/ DTC/ GNMTC/ANMTC n Practical- DH/SDH/CHC n 15 districts - 2 practical venue developed n Training schedule- n Theory – 6 days n Practical – 15 days n With 2 practical venue- training – 21 days n 1 practical venue – training – 36 days SIHFW: an ISO 9001: 2008 certified institution 20
  21. 21. Training of birth attendants n No. of Participants- n 16 (new guidelines recommend 4-8) n Divide into two practical batches of 8 each n Participants n prime focus – ANMs n Model Sub-centers n Sub centers n PHC n LHVs and SN of identified FRU and 24 x 7 PHC n Ayush doctor/ compounders SIHFW: an ISO 9001: 2008 certified institution 21
  22. 22. SBA trainings: Progress n 07-08 n 1236 trained in 72 batches n 08-09 n 1976 trained in 126 batches n 09-10 (till Dec.) n 1469 trained in 89 batches SIHFW: an ISO 9001: 2008 certified institution 22
  23. 23. Training Sites S.no. District Theory site Practical Site 1 Ajmer Beawar DH 2 Alwar Alwar DH/ CHC-Rajgarh 3 Banswara Banswara DH/ CHC-Partapur 4 Baran Baran DH 5 Barmer Barmer DH/ CHC-Balotra 6 Bharatpur Bharatpur DH/ CHC- Kumher 7 Bhilwara Bhilwara DH 8 Bikaner Nokha CHC-Nokha 9 Bundi Taleda DH 10 Chittorgarh Chittorgarh DH/ CHC-Nimbaheda 11 Churu Churu DH/ CHC-Ratangarh 23 SIHFW: an ISO 9001: 2008 certified institution
  24. 24. Training Sites S.N District Theory Practical o 12 Dausa Dausa DH 13 Dholpur Dholpur DH 14 Dungarpur Dungarpur DH/ CHC-Sagwara 15 Ganganagar Ganganagar DH 16 Hanumangarh Hanumangarh DH/ CHC-Bhadra 17 Jaipur Jaipur CHC- Bassi/ Kotputli/ Chomu 18 Jaisalmer Jaisalmer DH 19 Jalore Jalore DH/ CHC-Ahore 20 Jhalawar Jhalawar DH 21 Jhunjhunu Jaipur CHC- Bassi/ Kotputli/ Chomu 22 Jodhpur No trainings conducted 24 SIHFW: an ISO 9001: 2008 certified institution
  25. 25. Training Sites S.No. District Theory Practical 23 Karauli Karauli DH 24 Kota Kota JK Lon 25 Nagaur Nagaur DH 26 Pali Pali DH/ SDH-Sojat City 27 Pratapgarh Pratapgarh DH 28 Rajsamand Rajsamand DH/ CHC-Nathdwara 29 S.Madhopur S.Madhopur DH 30 Sikar Sikar DH 31 Sirohi Sirohi DH 32 Tonk Tonk DH 33 Udaipur Salumbar PDMC/ CHC-Salumbar 25 SIHFW: an ISO 9001: 2008 certified institution
  26. 26. Monitoring of SBA trainings n SIHFW – Nodal agency n Monitoring cell established with support of n UNICEF – funds n DM&HS SIHFW: an ISO 9001: 2008 certified institution 26
  27. 27. Monitoring cell n Nodal Officer n SBA Coordinator n State level monitors n Zonal Facilitators n District Supervisors SIHFW: an ISO 9001: 2008 certified institution 27
  28. 28. Activities n Monitor the trainings n Ensuring quality of trainings n Develop formats for monitoring and reporting n Reporting to UNICEF and DM&HS on the progress of trainings SIHFW: an ISO 9001: 2008 certified institution 28
  29. 29. Monitoring Checklist Ø Training site preparedness – Ø Availability of trainers Ø Supplies –modules/ mannequins/ instruments/ partographs Ø Classroom observation- Ø Gaps in teaching/ interaction/ interest/ teaching methods Ø Assess learning through Ø Theory – questions Ø Practical – hands on Ø Boarding & lodging for participants SIHFW: an ISO 9001: 2008 certified institution 29
  30. 30. Challenges n Simultaneous trainings/ programs n Supportive lag- CMHO/RCHO/DPM n Resistance from hospital staff SIHFW: an ISO 9001: 2008 certified institution 30
  31. 31. We hope to move towards n Skilled birth attendants at all levels of health facilities n Well equipped and functioning Sub- centers n Reduction of MMR and IMR SIHFW: an ISO 9001: 2008 certified institution 31
  32. 32. Thank You For more details log on to www. sihfwrajasthan.com or contact : Director-SIHFW on sihfwraj@yahoo.co.in

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