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Similar to PPT 1 HRP Operational Guidelines.pptx
PPT 1 HRP Operational Guidelines.pptx
- 1. Training of MasterTrainers November 2021
- 2. High Risk Pregnancy •Definition: HRP is a pregnancy complicated by a disease or disorder that may endanger the life, or affect the health of the mother, the fetus or newborn. • Prologue: Receiving quality antenatal, intra natal & postnatal services is one of the reproductive rights of a woman. Each and every one working in the health department is committed to reduce the maternal mortality and to realize the reproductive rights of a women
- 3. Objective & GuidingPrinciple • Prevention of High-Risk Pregnancies • Early detection of HRP and initiation of treatment • Tracking of HRP throughout the pregnancy • Ensuring institutional delivery at higher level facility • Functional referral linkages
- 4. Strategy HRP Strategy Prevention of HRP Early and correct detection ofhigh risk Tracking , follow up and review Manageme nt of HRP Preconception care: All eligible couples Quality ANC: Early registration and quality ANC services to all pregnant woman – Strengthening VHSND Governance, monitoring, SS : State/District/Block/Sector/PRI and others – ANMOL for tracking Skills and Capacity building
- 5. 1. Prevention ofHRP (Preconception care) • Eligible couple: currently married couple wherein the wife is in the reproductive age (i.e. 15 - 49 years of age) aspiring to have a healthy child. • Achieving normal BMI prior to conception • Preventing and treating anaemia with iron and deworming tablet • Periconceptional folic acid and to reduce neural tube defects • Detecting Sickle cell disease and malaria • Quitting tobacco, alcohol to reduce LBW and other complications • Preventing pregnancy in adolescent girls and ensuring optimal inter-pregnancy interval following miscarriage or childbirth • Detecting and treating RTI/STIs before pregnancy following syndromic case management • Detecting and managing chronic diseases before pregnancy – diabetes, hypertension etc • All eligible couples will be screened during annual eligible couple survey and counselling • Once annual screening is well established, preconception care to be integrated with VHSND services
- 6. 2. Early andcorrect detection of high risk (Quality ANC) • Strengthening of VHSNDs for providing quality ANC is essential for quality ANC • Microplanning of VHSNDs to ensure no area is left out • Availability of ANMs and trained to detect HRPs and manage HRP • Availability of all equipment and logistics including examination table at all VHSNDs • Counselling of pregnant woman on the high risk detected, precautions to be taken and birth preparedness for safe delivery
- 7. Protocols for HRPs 1.ANC protocol 2. Hypertensive disorders of pregnancy – PIH, Eclampsia 3. Anemia 4. APH 5. Breech presentation 6. Malaria 7. H/O previous LSCS 8. Sickle cell anemia 9. Gestational Diabetes
- 8. 3. Tracking, followup and review (Governance, monitoring, Supportive supervision) • A nodal person for HRP for implementation to be identified in every block • Sector MO will be overall responsible for HRP implementation • Roles of responsibility of Mitanin, ANM, PHC, FRU, District level and State level will be defined for tracking, follow and review at various levels • System supervisors will visit frequently as per approved supportive supervision plan to monitor VHSNDs and quality of intrapartum care at delivery points/FRUs • All high-risk pregnant mother will be tracked for admissions in FRU/DH/MCs in advance before the EDD • ANMOL and RCH portal date will be analysed to generate list of identified HRPs and used for tracking of all HRPs • Analysis of RCH portal data to identify SHCs with less than 7% of HRP detected and reviewed every month by MO-PHC and BMO • Analysis of RCH portal data to identify sectors with less than 7% of HRP detected and reviewed every month by BMO at block level and CMHO at district level
- 9. Supportive supervision framework •Analyse and review poor performing SHCs . • 3 officials in each block visit VHSND once every week •Analyse and review poor performing SHCs and resistant pockets •Sector MO/MTs/Sector supervisors must be in field during VHSND days • Block nodal for each block • Analyse and supervise poor performing sectors • Identification of poor performing blocks / facilities as per data from RCH portal. • Block nodal officer - 2 visits to VHSND in 2 different sector, 1 block review meeting/month • RCH nodal and RMNCHA consultant – 1 VHSND visit every week in different blocks, one block meeting every month • District nodal for each district • Analyse and supervise poor performing blocks • District Nodal officer – 1 visit to VHSND, I district review State Level District Block Sector
- 10. 4. Management ofHRP (Skills and Capacity building) • Well defined treatment protocols for health care workers and specialists • Ensuring minimum of 1 ANC and 1 USG under guidance of specialist of all HRPs, through PMSMA or teleconsultation • No HRP delivery will be conducted in SHC/HWC • Clinical helpline to be established for ANMs, staff nurses and MOs for technical guidance • Training of block level master trainers for HRP/District master trainers can train the entire district • Modular incremental learning approach to train ANMs/SNs during sector level meetings • SBA/BEmOC/CEmOC/LSAS – training, refresher training • Training of supervisors – for Supportive supervision
- 11. Implementation • District RMNCHAConsultant overall responsibility – under the guidance of RCH Nodal and CMHO • The ANM must ensure availability of diagnostic test kits, drugs & consumables as per micro plan for VHSND, outreach & fixed day services - CMHO responsible for procurement and supply • LMP register should be maintained by all Mitanin – visit eligible couples before VHSND day for early history of missed period and ensuring early ANC • Eligible couple register – with ANM, line list with mitanin – all eligible couples to be mobilized to VHSND • Due list before every VHSND – with Mitanin and ANM • ANC every month for all pregnant woman
- 12. Implementation • Ensure regularand timely entry of data – ANMOL/RCH Portal - ANM and BDM • Line listing of HRP to be maintained by, Mitanin, ANM and PHC MO • EDD calendar – of all pregnancies in the coming month for institutional deliveries, of HRPs for delivery at FRUs – update every week – ANM, PHC MO • PMSMA – • all pregnant woman for USG at PMSMA, • all HRPs for every ANC • use JSSK for free services during ANC
- 13. Roles and responsibilitieswithin a sector Mitanin LMP Register House visit of eligible couples – day before VHNSD Mobilize PW to VHSND as per due list Escort HRP to PMSMA Escort HRP to Birth waiting homes at FRU prior to EDD ANM VHSND Micro plan Conduct VHSND Identification of HRP Due list EDD list Counselling of danger signs MO-PHC Leadership PHC VHSND microplan SC wise review of HRP SS visits mandatory Arrange referral during ANC and for delivery
- 14. Supportive Health Systems •Functional referral linkages – each HRP will be linked to nearest FRU irrespective of inter district or interstate border • Birth waiting homes at delivery points – priority at FRUs/DHs for HRPs • Maternal Death Surveillance and response to review every maternal death
- 15. Referral mechanism • Reviewthe existing ambulances based on time to care approach • 108/102 and ambulances of health facilities – optimally used • JDS and JSSK funds – reimbursement of cost if 102/108 not available based on approved rate/km • Private vehicles can be empaneled for referral – JSSK/JDS funds • Referral slip with treatment details before referral of all referrals from any HF • I/C of HF responsible to ensure availability of staff at referral facility before referral • The HF receiving referral should inform the facility from where PW had referred after discharge/outcome • The higher facility should do referral audit of lower facilities and report every month
- 16. Use of technology •104 helpline may be used for tele counselling of HRP’s in order to ensure at least 8 ANC services to each HRP. • 104 will also ensure post referral follow-up of HRP cases from PMSMA . • Call center for continued support – The districts may plan to establish a centralized call center at district headquarter manned by ANM or SN . The responsibility of the call center will be to do follow up on HRP’s in terms of their condition & guide them on importance of further checkups . • The call center will also provide details of nearest referral point to the beneficiaries if need be. • WhatsApp groups to be created at district/Block, & below the block level at facilities for prompt communications.
- 17. • HRP treatmentprotocols • VHSND – SS tool • HRP monitoring checklist • At SHC • At Sector • At PHC • At Block • At District/State Tools to be made available for HRP
- 19.