Presentation by Gillian Dalgetty (University of Leeds) on ReBUILD Responsive Fund project on Obstetric Referral in the Cambodian Health System given at internal programme webinar, 9th Sept 2015.
Respectful maternity care (RMC) is a universal human right that is due to every childbearing woman in every health system. Women’s experiences with maternity caregivers can empower and comfort them, or inflict lasting damage and emotional trauma. While many interventions aim to improve access to skilled birth care, the quality of relationships with caregivers during maternity care has received less attention. Evidence suggests that in countries with high maternal mortality, the fear of disrespect and abuse that women often encounter in facility-based maternity care is a more powerful deterrent to use of skilled care than commonly recognized barriers such as cost or distance. WRA launched a global campaign to promote a clear standard for RMC that is rooted in international human rights. Working with other global organizations, WRA produced a ground breaking consensus document, the Respectful Maternity Care Charter: the Universal Rights of Childbearing Women,
Respectful maternity care (RMC) is a universal human right that is due to every childbearing woman in every health system. Women’s experiences with maternity caregivers can empower and comfort them, or inflict lasting damage and emotional trauma. While many interventions aim to improve access to skilled birth care, the quality of relationships with caregivers during maternity care has received less attention. Evidence suggests that in countries with high maternal mortality, the fear of disrespect and abuse that women often encounter in facility-based maternity care is a more powerful deterrent to use of skilled care than commonly recognized barriers such as cost or distance. WRA launched a global campaign to promote a clear standard for RMC that is rooted in international human rights. Working with other global organizations, WRA produced a ground breaking consensus document, the Respectful Maternity Care Charter: the Universal Rights of Childbearing Women,
Innovative Participatory Health Education ‘IPHE’ ™ An approach for QUALITY and RELEVANCE of health professional education
Dr. Khalifa Elmusharaf, PhD Researcher in health system & Policy
Head of Reproductive & Child Health Research Unit 'RCRU’
University of Medical Sciences & Technology
Overview:
Why is the integration of family planning (FP) and HIV/AIDS services important and how does it relate to the right to health?
What models of service integration are currently being implemented in Kenya?
What are the successes, outcomes and lessons learned from clients and providers in Kenya?
What can you do to advocate for the integration of FP and HIV/AIDS services and halt the feminization of AIDS?
Disclaimer: While this presentation focuses specifically on the integration of family planning services and HIV/AIDS testing and counseling services, it is important to note that this is just one example that falls within a more comprehensive approach to service integration. To address the AIDS epidemic, health systems must integrate HIV/AIDS services for prevention, care and treatment with non-HIV services such as primary care, maternal and child health, and reproductive health services, including family planning. Additionally, HIV/AIDS services should be connected to social and community-based services that address underlying determinants for health such as poverty, unemployment and legal inequalities.
CORE Group Fall Meeting 2010. WHO/UNICEF - Joint Statement Service Delivery & Program Implications, - Winnie Mwebesa & Stella Abwao, Save the Children.
"The quality of patient care is directly correlated to the degree to which our nurses are active and empowered through the use of the professional practice model." Read the East Tennessee Children's Hospital 2015 Nursing Annual Report.
How, and in what ways, are rates of contraceptive use and induced abortion linked? What reasons do women give for contraceptive (non-)use for a terminated pregnancy?
HEALTHCARE PROFESSIONALS NEED TO USE THERAPEUTIC LIES FOR PROVIDING MENTAL AND PSYCHOLOGICAL SUPPORT TO THE ELDERLY SERVICE USERS. By OnlineAssignmentsHelp.com
In this presentation we look at the role of induced abortion in country's transitions from having high rates of fertility to low rates of fertility. It draws on micro-level data from Zambia to explore macro-level trends.
Running Head: CLINICAL REFLECTION 1
4
CLINICAL REFLECTION
Clinical Reflection
Ashleigh Jacquez
Patty Hanks Shelton School of Nursing
Clinical Reflection
The clinical site that I am going to discuss is a local elementary school. There is a single school nurse that provides the care. The care that the nurse provides varies based on what is needed by the students when they come and see her. Examples of care given include assessment of physical injuries, administration of medication for both acute and chronic conditions, and making referrals when necessary. Referrals can be to primary care providers or specialists. The nurse also provides screening for issues including vision, hearing, and scoliosis. She may also provide screening for unusual circumstances, such as child abuse. The nurse also acts as a consult to the teachers and other faculty, giving advice and information when needed. She also discusses the kids’ health with their parents, and teaches the parents how to best continue care at home. Lastly, the nurse is a teacher to the students. She teaches them about their bodies and how they will change as they get older. She teaches them how to care for their bodies and how to care for their mental state. She fosters a sense of independence and autonomy, so that the kids can make their own decisions and can be confident when doing so. The nurse is also very important for mental and emotional health and is “integral to the academic success of the nation’s 74 million youth under the age of 18” (Willgerodt, Maughan, 2018, p. 232).
The population that this service provides care for is primarily students. The school is pre-kindergarten to fifth grade. The kids can be aged anywhere from four to twelve years old. The school nurse can also provide care to the faculty if needed. The students mostly come from middle-to-upper class families. All ethnicities are represented in the school, but the population is mostly white.
The most common illnesses that are seen by the school nurse are acute. Examples of this include the flu, strep throat, and undiagnosed “stomach bugs.” The nurse can give over the counter medications, but they must ensure to have all of the students’ allergies on file and confirmed to ensure no adverse events. Medications that can be given include Claritin, Tylenol, and cough drops. The nurse must double check the appropriate dosage, especially because this can vary for each student given the level of physical development. The nurse can give prescription medications, but must have a doctors’ orders and have to speak with the parents to confirm all of the details. Common indicated medications include ADHD medications, asthma medications, and insulin. However, school nurses are not able to administer narcotics regardless if there is a prescription. The nurse does do the three medication checks ...
Similar to Obstetric Referral in the Cambodian Health System - What Works? (20)
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3. Maternal Health in Cambodia
One of highest MMR rates in Asia
Weak referral identified as one cause
Policy priorities
Reducing maternal mortality
Improving quality of health service delivery
Ongoing reform of the Operational District system
4. Obstetric Referral in the Cambodian Health System –
What Works?
4 objectives
Investigate delivery journeys to and back from
public healthcare facilities for pregnant rural
women
Identify existing positive resources in the public
system
…
7. Investigating Positive Journeys
What works NOW
Birth experiences < last 2 years
Rural province ….
30 interviews with stakeholders involved in referral
Pregnant women
Their family members (husbands, mothers)
Community based volunteers
Midwives and doctors
Health centre / hospital leaders
Snowball recruitment
Thematic Framework analysis
8. (Husband’s story). His wife was pregnant with their first child, contractions started at
around 9:00am. He brought his wife to the HC, arriving around 10:00am. He called the
midwife via the number posted on the wall. When she arrived, she examined the woman and
said that the cervix was just 1cm dilated so the couple should wait at the HC. The midwife
allowed him, his mother-in-law and sister-in-law into the delivery room and the baby was
born at 6:00am the next morning... Suddenly, the woman had so much bleeding. The midwife
phoned DRH to inform them of a referral at around 7/8am. Two midwives stayed with his
wife and the HC director drove the (HC) ambulance. The midwives constantly checked his
wife’s condition and kept calling DRH to prepare to stop the bleeding when they arrived.
DRH staff used a wheelchair to greet his wife – he lifted his wife from the ambulance to put
her in it. His mother-in-law carried the baby. Both entered ICU with staff, who called to a
more skilled midwife to assist. Had that midwife not come on time, the DRH staff were
planning to refer further. Staff didn’t inform the family about his wife’s condition but
taught him how to clean his wife and what medicine to buy for her. During the stay at the
hospital, the family was not asked to fill any form except to pay 50,000Riel ($12.5) room
fee. Before discharging the woman, staff advised them to take the given medicine and not
have fire-roasting. Many relatives came to visit the woman at home.
9. Existing Positive Resources…
Facilities exist and function
Awareness of where to go to give birth
Staff follow a philosophy of care
Proactive referral: community HC onward
Effective teamwork within and between facilities
Active partnership between health system and family
Strong support provided by husbands, brothers
Community wide collaboration at time of/after birth
Proactive, confident and transparent hospital leadership
SOA status?
10. Limitations
Can be read as examples of ‘best practice’ –
can’t say its widespread
Subject to usual caveats on interviews
11. So What?
Important balancer to referral literature in LIC
that emphasises barriers, problems and deficits
Necessary to acknowledge and recognise that
procedures are followed, medical staff can be
wonderful, co-operation and teamwork can be
found
Interviewees made some very specific
recommendations (e.g. on facility design)
Need to disaggregate SOA/non SOA - may be
an implication that don’t need to pay for
performance
Editor's Notes
When talking about Cambodia certain aspects of the country’s history and daily life tend to be emphasised over other things – these include
Genocide 75-79
Vn occupation 79-89
Obstetric Referral in the Cambodian Health System - What Works?