Mejora de la salud Materno Infantil en Gambo
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Existes diversas maneras de colaborar con el hospital de Gambo: Haciendo una donación A través de Teaming donando 1€ al mes en alguno de nuestros proyectos https://www.teaming.net/alegria A través de Migranodearena realizando una donación puntual a alguno de nuestros proyectos “Mi compromiso con Gambo es de por vida. Gambo tiene que seguir existiendo, no puede dejar de existir. Está haciendo una gran labor. Sin embargo, el imprescindible no soy yo. Los imprescindible son ellos, los auténticos héroes invisibles “ Quiero destacar el gran trabajo de las auténticas heroínas, las imprescindibles. Nosotros tan sól estamos para que llas puedean escirbir su propia historia. Las auténticas heroínas son ellas
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Mejora de la salud Materno Infantil en Gambo
- 1. Mejora de la salud materno-infantil en la región de Gambo (Etiopía) a través de la formación de una red de asistencia primaria liderada por mujeres Iñaki Alegria ialegriak@gmail.com Pediatrician Medical Director Gambo General Rural Hospital
- 2. Haati Takkallee Lubbuu kenuuf lubbuu dhabuu hin qabdu! Zero Mothers will Die giving life Maternal, Newborn and Child Health Integrated Project (MNCHIP)
- 3. Zero Mothers will die giving life
- 4. • Maternal Death is a social injustice • When a mother death, she is not dying only by medical reasons, her death is a social injustice
- 5. Background Maternal mortality is a tragedy • Untimely death • Increased infant and child mortality • Consequences of orphan age • Represent 30% of deaths in women of reproductive age • Above 99% of these deaths are easily preventable.
- 6. Justification for MPDSR • MCH remains a key national health priority • Ethiopia’s maternal mortality rate is estimated to be 412/100,000 live births = 11,000 deaths per year • The perinatal mortality rate is estimated to be 46/1000 births = 87,000 neonatal deaths & 97,000 still births per year • MPDSR is part of the HSTP as a strategy to reduce avoidable deaths
- 7. Leading causes of direct maternal mortality 80% in Ethiopian contact Unsafe abortion Obstetric hemorrhage Hypertensive diseases of pregnancy Obstructed labor Sepsis
- 8. The National Newborn and Child Survival Strategy (2015/16-2020) Reduce under five mortality • from 64/1,000 • to at least 29 /1,000 Infant mortality rate • from 44/1000 • to 20/1000 Neonatal mortality rate • from 28 • to 11/1,000
- 9. Objectives General objective: • To improve the status of pregnant mother, newborn and under 5 children through provision of better quality of MCH services in the catchment area Specific objectives • To ensure effective universal coverage of high impact neonatal and child survival interventions with special focus on the poorest and marginalized sections of the population in the region.
- 10. Objectives • Eliminate preventable maternal and perinatal mortality acting on the 3 three delay model • To train and support skilled birth attendance • Strengthen referral procedures for risk pregnancies, complicated deliveries and newborn • Awareness creation in rural community promoting FANC, delivery at health facilities, PNC • Creating a Maternal and Perinatal Death Surveillance Response
- 11. Aim • To reduce maternal and perinatal mortality and morbidity by the next strategies: – Quality training for skilled birth attendants – Quality systems; strengthening coordination and referral system Hospital-HC-HP – Quality institutions
- 12. Health Centers and Health Post Woreda Health Centers Health Post Arsi Negele Basako Ilala Boye Yedala Gambelto Aga Ashoka Besequ Ilalaa Bombaso Rayii Gambelto Lephis Kelo Duro Adaaba Tita Danshe Gode Duro Gonde Gurate Meraro Hawilo
- 13. Health Centers and Health Post Woreda Health Centers Health Post Qore Beta Wontesha Bata Wontesha Hunduka Kumbi Jema Sardo Koma Sadhe Qore Bata Wontesha Bole Hilensa Doda Dayyu Hunduka Kumbi Jema Sardo Shire Obensa Waji Ibsana
- 14. Health Centers and Health Post Woreda Health Centers Health Post Qore Gobe Ekka Dayu Gofingira Chocha Koma Sadhe Saimana Shifa Waji Ibsama Shiree Dhogata Basaku Maja Yadale Shire Haragesa Shire Kombolcha Webo Kaka Lencha Ansha Lencha Ansha Tulu Kore Saimana Gadala Bulchana Hukuko
- 15. Health Centers and Health Post Woreda Health Centers Health Post Heban Arsi Goljota Argedda Sheldo Buku Weildiya Dawe Degaga Shopha Bultum Meti Ambogoda Sada Meti Mexi Sambaro Rogicha Tuffa
- 16. Direct Beneficiaries Pregnant and Lactating Mothers Newborns Under 5 Health Workers
- 18. Institutions Beneficiaries • 10 HC and catchment area • 40 HP • Gambo General Rural Hospital • Zone Health bureau • 3 Woredas Health Bureau • Community catchment area
- 19. Activities • Health Centers Supportive supervision – Strengths – Gaps – Weakness – Necessities – 2009 Baseline Data – 2010 Action Plan
- 20. Support on Trainings • Neonatal Resuscitation • Safe Delivery • Emergency referral system • Infant and Young Child Feeding program • BEmONC • Kangaroo Mother Care (KMC)
- 21. • Rules, regulations, policies, protocols, standards, statistics Health Bureau • physicianHospital • nurses Health Centers • Health Extension Workers Health Posts • elderly, religious fathers Community
- 22. Hospital Health Centers Health Posts Community Supportive supervision, Feed-back Referral system
- 23. Strength PHCU Network in MNCHIP •HP-> HC -> HospitalReferral system •Hospital -> HC -> HP Supportive supervision system •By phone support contactTelemedicine
- 24. • Physicians, nurses• Rules, regulations, policies, protocols, standards, statistics • Health Extension Workers • Elderly, religious fathers Community Health Post Health Centers, Hospitals Health Bureau
- 25. Comittes • MNCHIP Committee • MPDSR Committee • Nutrition Committee • HTC
- 27. The way to maternal death 1st Delay: Delay in seeking care 2nd Delay : Delay in reaching care 3rd Delay: Delay in receiving care
- 29. 1st Delay Delay in seeking care • Family poverty • Lack of recognition of danger signs of newborns infants • Unaware of the warning signs of problems during pregnancy • Did not know where to go • Had no one to take care of other children • Reliant on traditional practice/medicine • Lack of decision to go to health facility
- 40. La vida al riu Riu de vida
- 41. 2nd Delay Delay in reaching care •Transport was not available •Transport was too expensive •No facility within reasonable distance •Lack of road access
- 44. 3rd Delay Delay in receiving care • Delayed arrival to next facility from another referring facility • Delayed management after admission • Fear of abuse and maltreatment by medical personnel • Human error and incorrect administration of treatment • Delayed initial evaluation after admittance • Delayed transfer of patients to appropriate treatment center • Lack of medical equipment and supplies
- 45. All mother Gestational age Pregnant Labour In risk With complications Mother Mortality
- 46. Strategy for Mother’s Survival Advancement of the status of women Birth planning Community Based Prenatal services Delivery by trained birth attendants Essential obstetric functions Facilities for emergency transport Mother survival
- 47. All mother Gestational age Pregnant Labour In risk With complications Mother Mortality Advancement of the status of women Birth planning Community Based Prenatal services Delivery by trained birth attendants Essential obstetric functions Facilities for emergency transport
- 48. 1st Delay - Action Delay in seeking care • Family poverty • Lack of recognition of danger signs of newborns infants • Unaware of the warning signs of problems during pregnancy • Did not know where to go • Had no one to take care of other children • Reliant on traditional practice/medicine • Lack of decision to go to health facility Improving seeking care • Awareness creation on community promoting FANC, Delivery at health facility • Health Education Program • Health education on Danger Signs during pregnancy • Strenght Health Extensions Workers Network at Health Post level • Collaboration with community midwives and leaders
- 49. 2nd Delay Delay in reaching care • Transport was not available • Transport was too expensive • No facility within reasonable distance • Lack of road access Improving reaching care • Training of local health extension workers in prenatal and child delivery treatment • Availability of ambulances in the case of complications detected in consultation • Strenght referral system • Health Post • Health Center • Hospital • Hospital emergency phone avaliable at 24h
- 50. 3rd Delay Delay in receiving care •Delayed arrival to next facility from another referring facility •Delayed management after admission •Fear of abuse and maltreatment by medical personnel •Human error and incorrect administration of treatment •Delayed initial evaluation after admittance •Delayed transfer of patients to appropriate treatment center •Lack of medical equipment and supplies Improving receiving care •Improving Skill •Capacity building •Training on main causes of maternal and perinatal Death •Helping Babies Breathe •Helping Mothers Survive •Referral system criteria •Correct and timely administration of treatment •Patience, respect, and compassion by personnel when dealing with patients •Qualified personnel •Timely initial evaluation after admittance •Timely referrals •Access to needed equipment and supplies •MPDSR Committee
- 51. The Interventions at the Three Levels
- 52. • Focused Ante Natal Care • Trainings – BEmONC – ENC – HBB – IMNCI – IYCF • Respectful Maternity Care • Accessibility • Strengthening Primary Health Care Unit • Community Workers • Women Empowerment
- 53. Partnership • Federal Ministry of Health (FMoH) • Oromia Regional Health Bureau (ORHB) – West Arsi Zone Health Office(WAZHO) • Health Sector Transformation Plan (HSTP) • Ethiopian Catholic Church (ECC) • MPDSR • World Health Organization (WHO) • USAID
- 58. Zero Mothers will die giving life
- 60. Activities • ANC – Ante Natal Care • PMTCT • Labor and Delivery • PNC – Post Natal Care • Maternity Waiting Area • Trainings • Mother Health Education • Mother to Mother Program • FGM • Referral System • Seminars • Meetings • Mentorship • Exchange Material • EPI
- 61. ANC • Mother Health Education • Nutritional Screening • Testing – Hemoglogin – Syphilis – Hepatitis B and C – HIV
- 62. ANC • Estimating Gestational Age • Checking – Weight – MUAC – Blood Pressure • Screening for Risk Pregnancy • Referring to Obstetrician if Necessary • Next Appointment
- 63. Labor and Delivery • Deliveries by skilled health Professional – SVD – Instrumental Delivery by Vacuum – Cesarean Section
- 64. NICU • CPAP • Phototherapy • KMC – Kangaroo Mother Care • Oxygen • Incubator • Pediatrician • GP • Pediatric Nurses
- 65. Causes of Neonatal Mortality conigenital anomaly 3% Prematurity 11% Neonatal infections 34% Birth Asphyxia 48% Other 4% Causes of neonatal mortality, study conducted Jimma, 2014
- 66. Maternal Death Causes The immediate clinical or medical reason for the woman’s death, classified as a direct or indirect maternal death Determinants The “causes of the causes” or factors that increase the woman’s risk of dying from a specific cause
- 67. Maternal Death Causes The immediate clinical or medical reason for the woman’s death, classified as a direct or indirect maternal death Determinants The “causes of the causes” or factors that increase the woman’s risk of dying from a specific cause
- 68. Review of Classifications Direct Causes (≈75%) Obstetric causes during pregnancy, childbirth and the post-partum period, such as: • Haemorrhage • Hypertensive disorders • Infection • Obstructed labour • Abortion Indirect Causes (≈ 25%) Medical conditions that can be aggravated through pregnancy, such as: • HIV (including TB and pneumonia) • Malaria • Anaemia • Heart conditions Social, cultural & environmental factors across a woman’s life course affect risk for direct & indirect causes of death
- 69. Perinatal Death Causes The immediate clinical or medical reason for the foetal or neonatal death classified as a -Ante partum, -Intra partum, -post partum Determinants Cause The “causes of the causes” or factors that increase the foetal or neonatal risk of dying from a specific cause
- 70. Perinatal death: Review of Classifications Causes of still Birth Maternal cause – Obstructed labour – Ruptured Uterus – Pre-eclampsia/ Eclampsia – APH (Placenta previa or abruption) – Obstetric Sepsis and – Others Fetal causes – Intrapartum Asphyxia – Cord Accident – Congenital Anomalies and – Other Causes of Neonatal Deaths – Complications due to Prematurity – Asphyxia – Sepsis/pneumonia/meningitis – Lethal congenital anomaly and – Other Social, cultural & environmental factors across the fetal and neonate life course affect risk for fetal and neonatal cause of death
- 71. Causes of Neonatal Death Ethiopia Global Source: CHERG/WHO/UNICEF for distribution of causes of neonatal and under-five deaths (published in Liu et al, Lancet 2014). Source: WHO Global Health Observatory, 2014 (19). Estimates are rounded, and therefore may not sum to 100%.
- 72. Ante Natal Care waiting area
- 73. Ante Natal Care follow-up
- 74. Labor and Delivery Room
- 76. Maternity Ward
- 77. Ante Natal Care visit
- 78. Post Natal Care follow up
- 79. High Blood pressure screening on ANC
- 80. ANC visit
- 81. Gambo Rural Hospital Main Door entrance
- 82. Cesarean Section
- 83. Neonatal Resuscitation corner on Delivery room
- 86. NICU – Neontal Intensive Care unit
- 88. Rural and Modern ambulance
- 89. Receiving referrals from rural Health Centers
- 90. Essential Newborn Care - ENC
- 91. ENC
- 92. Maternity Ward
- 93. Health Education in ANC