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Using DSS to monitor progress toward improvement in maternal health

Using DSS to monitor progress toward improvement in maternal health. William Stones Department of Obstetrics & Gynaecology Aga Khan University, Nairobi. In the next 15 minutes…. The burden of maternal morbidity and mortality Link to neonatal outcomes Three delays

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Using DSS to monitor progress toward improvement in maternal health

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  1. Using DSS to monitor progress toward improvement in maternal health William Stones Department of Obstetrics & Gynaecology Aga Khan University, Nairobi

  2. In the next 15 minutes… • The burden of maternal morbidity and mortality • Link to neonatal outcomes • Three delays • Use of services: understanding at the population level • Potential ‘3D’ based indicators • What obstetricians are doing

  3. Maternal Morbidity: where are the population level data? • Haemorrhage • Eclampsia • Obstructed labour • Ruptured uterus • Obstetric fistula • Sepsis • Unsafe abortion • Puerperal fever • HIV related • Malaria • Anaemia

  4. The link to neonatal outcomes

  5. Problem • Even where MMR is high (eg SSA, Afghanistan) events are uncommon in relation to survey rounds and typical populations covered. How sensitive to ‘progress’? • ? Need to focus on major morbidity as well as mortality- but how to capture? • Link with facility data on major morbidity and deaths • Include well defined morbidities in surveys, eg eclampsia • Neonatal mortality is much more common so more amenable to conventional DSS approach

  6. The Three Delays • In seeking care for a pregnancy complication • In reaching a health facility • In receiving appropriate care once at the health facility

  7. Seeking care: DSS scope • Population level knowledge about maternal and neonatal complications • Bleeding • Blood pressure, fits • HIV, malaria • Cord care, warmth and breastfeeding • Antenatal care • Uptake: visits and quality • Community activation • Panchayati Raj, Asha Sahayogini • Marginalised sub-groups • Village level services

  8. Reaching care: DSS scope • GIS • Transport mapping • Community activation • Cost sharing • Vehicle maintenance • Telecommunications • Seasonality

  9. Care at health facilities: DSS scope • Links to HMIS, facility records • Post discharge survey rounds • Experience of care • Content of care • Population level CS rates and determinants • Community activation • Activism for facility upgrading • Consumer forum • Constituency funds

  10. Cross cutting: skill mix • Who does ANC? • Impact of ‘task shifting’ for ARV rollout • Diversion from maternal health • Potential gains in numbers of staff in post • Skilled attendance at delivery • Can recognise and manage complications • The midwife • Regulatory context • Competencies • Livelihood

  11. Meanwhile the obstetricians are…

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