Child Survival & Health Grants_Kathleen Hill_10.14.11
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Child Survival & Health Grants_Kathleen Hill_10.14.11
- 1. EssentialObstetric and NewbornCareCSHGPCOTOPAXI PROVINCE, ECUADORKathleen HillCenter forHumanServices (CHS)
- 3. Cotopaxi Provincial Health System: Fragmented; No continuum of care; Inequitable access; Poor quality of care 1,500 deliveries Ministry of Health (4,000 deliveries) NGOs Privateproviders Social Security ProvincialHospital (Surgery & Blood 4 hours/day) 5 CountyHospitals (Basic EONC 4 hours/day) AmbulatoryHealth Centers (ParishLevel) TBAs (CommunityLevel)(3,000 deliveries)
- 4. Project Overview: Cotopaxi, Ecuador Targeting Vulnerable Parishes for greater Equity: 21/38 Total Parishes in Province: Pregnant women and newborns in parishes where: > 50% population extremely poor > 50% population indigenous Indian Main Project strategies: Mobilize Community and use BCC methods to increase demand for & access to care and to improve household best practices. Create a Community level of EONC care, firmly linked to primary and referral levels of care via “Parish MNH micro-network teams” Improve quality and 24/7 availability of high impact, evidence-based EONC care at all levels, community, primary and referral (including public and private facilities) as part of a “Provincial MNH Network”
- 5. ESSENTIAL OBSTETRIC AND NEWBORN CARE NETWORK, COTOPAXI PROVINCIAL HOSPITALS (2) COMPLETE EONC 24 hours/7days REFERRAL COUNTY HOSPITALS (5) BASIC EONC 24 hours/7days HEALTH CENTERS Homes Communities Social Organizations COMMUNITY EONC TBAs
- 6. Building a Community EONC level of Care Anchored in a Parish Maternal-Newborn “micronetwork”: linking TBAs to health centers MICRONETWORK TEAM IN GUANGAJE PARISH
- 7. TBAS & SKILLED PROVIDERS WORKING TOGETHER AS PART OF A PARISH MATERNAL NEWBORN “MICRONETWORK” TEAM
- 8. TBAs AND COMMUNITY LEADERS IDENTIFY PREGNANT WOMEN USING A PARISH MAP
- 9. STRATIFYING RISK STATUS OF PREGNANT WOMEN IN COMMUNITY TO PRIORITIZE HOME VISITS BY TBA-SKILLED PROVIDER TEAMS
- 10. HOME VISITS BY DOCTOR AND TBAs TO TARGETED PREGNANT WOMEN AND NEWBORNS
- 11. OUR MICRONETWORK TEAM ON THE ROAD TO A HOME VISIT
- 12. MOBILIZING THE COMMUNITY TO IDENTIFY PREGNANT WOMEN AND TRANSPORT EMERGENCIES
- 13. A “KARDEX” OF PREGNANT WOMEN ORGANIZED BY DELIVERY MONTH STANDARD REFERRAL COUPONS COMPLETED BY A TBA WHEN SHE SENDS A WOMAN TO HEALTH CENTER OR COUNTY HOSPITAL
- 14. Cumulative % deliveries in 2011 versus 2010 attended by a parish micro-network team member Pujili County (8 parishes); Denominator=TotalMOH deliveries in 2010. (77% skilled provider-members and 23% trained TBA team-members)
- 15. % early post-partum home visits (first 48 hours) in 2011 relative to expected total County Births provided by a micro-network team-member Pujili County (8 parishes); N= 1,300 births per year in Pujili County(71% skilled provider; 19% trained TBA)
- 17. TBAs and community organizations are an effective source to identify high risk women/newborns
- 18. TBAs are a powerful resource to increase early post-partum home newborn visits
- 19. A “micronetwork” of skilled personnel and TBAs, at the base of an EONC system, is a powerful strategy to deliver high impact, evidence-based interventions. SOME INITIAL CONCLUSIONS
- 20. “THANK YOU FOR NOT LEAVING ME ALONE”
- 22. Overview of CHS-Ecuador Child Survival Project Goal/Impact Reduce Maternal & Newborn Mortality Improve household best practices and a continuum of high-quality community- and facility- maternal newborn services Strategic Objective Results/Outcomes 1 2 3 4 Increase availability of and access to MNH care Improve knowledge & demand for community & facility services; improve household best practices Improve quality of MNC services provided as part of parish micronetworks Improve policy environment
Editor's Notes
- Cotopaxi is a mountainous province located in the central Ecuadorian highlands. The province’s indigenous population amounts to 28% of its inhabitants. The major indigenous nationality is the Kichwa, whose members are organized in approximately 850 rural communities in 40 parishes across 7 counties (or “cantons”) . Economic activity is centered on agricultural and farm production for local, provincial and national markets, as well as handcraft production. Cotopaxi Province has one of the highest numbers of maternal deaths due to obstetric hemorrhage in Ecuador, which is why it was selected by CHS as a project area. --------Cotopaxi Population: 384,499 inhabitants, 67% of which live in rural areas (2001 Census Data)Poverty: 90.47% of poverty based on unmet basic necessities in rural areas (2007 SIISE Data) Integrated System of Social Indicators for EcuadorIndigenous: 28% Indigenous: Kichwa-Panzaleo (2008 CODENPE - Population Projection by Cantons & Parishes): Maternal/Newborn Mortality in Cotopaxi: 2008 Census DataThe main direct causes of mortality and morbidity for children under age 5 include acute respiratory infections and diarrheal disease, often in association with malnutrition. Newborn mortality, with the leading cause asphyxia and infections, represents a sizable proportion of under-five child mortality. LocationThe CHS child survival program is implemented in Cotopaxi Province, a mountainous area located in the central Ecuadorian highlands It contains 7 cantons: Latacunga, La Maná, Pangua, Pujilí, Salcedo, Saquisilí, Sigchos, including 11 urban parishes and 38 rural parishes. Cotopaxi has a population of approximately 384,499 inhabitants, 67% of which live in rural areas.As one of the country’s poorest provinces, Cotopaxi reaches 90.47% of poverty based on unmet basic necessities in rural areas. The province’s indigenous population amounts to 28% of its inhabitants. The major indigenous nationality is the Kichwa-Panzaleo, whose members are organized in approximately 850 rural communities. Political organization is based on the prehispanic system of “Ayllus”, based on social groups formed by nuclear and extended families linked through genealogical ties. Economic activity is centered on agricultural and farm production for local, provincial and national markets, as well as handcraft production.Problem statement: Cotopaxi Province has one of the highest numbers of maternal deaths due to obstetric hemorrhage in Ecuador. The main direct causes of mortality and morbidity for children under age 5 include acute respiratory infections (25.8%) and diarrheal disease, often in association with malnutrition. Newborn mortality, with the leading cause asphyxia and infections, represents a sizable proportion of under-five child mortality. Improving demand, access to, and quality of healthcare are greatly needed to improve health status in Cotopaxi. Targeted Population: The project interventions will be implemented in 21 priority rural parishes that meet at least one of two selection criteria known to be associated with higher risk of maternal newborn mortality: a) > 50% of parish population lives in extreme poverty, b) > 50% indigenous Indian ethnic composition
- Explanation of the graphic as the fragmented Cotopaxi health system High proportion (40%) of deliveries happen at the community level, which had no connection to the formal health systemA little bit about the Technical Strategy:Support the creation of a Referral Network horizontally & vertically with Referral Workshops (including TBAs)Improvement of quality of EONC services at facilities, increase in demand of servicesLevels:National – Provincial – Cantonal – Parish – Communities - Households
- Our central project goal is to reduce maternal and newborn mortality and morbidity in Cotopaxi province through the creation of a highly functioning network of high quality service providers, health extension workers, and social organizations. To do this we are working on 4 strategic lines of action with result-specific strategiesIncrease Access to servicesImprove Quality of servicesImprove Knowledge/Demand for MNC servicesImprove the Policy environment surrounding the coordination between the Formal Health System, Community/Social Organizations, and TBAs--------------Increased availability/ access to a coordinated continuum of high-impact maternal newborn care provided as part of a network of community and facility services. Improved knowledge / demand for evidence-based community and facility MNC services, including improved household health promotion practices.Improved quality of MNC services provided as part of a coordinated network of CHWs and facilitiesImproved policy environment forcoordination among community health workers, health care institutions, and community /social organizations