“Determining Response Capacity in Obstetric and Neonatal Emergencies ”

1. “Determining Response Capacity in Obstetric and Neonatal Emergencies ” Alfonso Villacorta MD , Miguel Gutierrez MD, Jhony Juarez MD, Enrique Guevara MD 30th Annual Conference, Global Health Council Washington, DC May 29, 2003 PATHFINDER INTERN ATIONAL & CATALYST CONSORTIUM

2. SITUATION IN PERU Maternal mortality in Peru is very high with a rate of 185 deaths per 100,000 live births. • The main causes of maternal mortality are: • Pregnancy-induced hypertension (13%) • Hemorrhages (48%) • Infections (10%) • Unsafe Abortions (7%)

3. SITUATION IN PERU • 58% of labors are attended in health facilities. In rural areas, only 24% are attended in a health facility. • Nearly 50% of maternal deaths take place in health facilities. • The response capacity of health facilities to control maternal mortality and neonatal emergencies is unknown.

4. Improving Quality of Services for Obstetric and Neonatal Emergencies in Public Health Facilities in five Regions of Peru Purpose: To contribute to the reduction of maternal and perinatal mortality by improving reproductive health care services for obstetric and neonatal emergencies in 24 health facilities of 5 departments of the Peruvian jungle.

5. Principal Activities • Assessments • Sensitization • Training courses • Improved quality of the workplan • Supervision and monitoring

6. Assessment Objectives • Identify the response capacity of health facilities based on obstetric and neonatal functions. • Identify the prevalence of obstetric and neonatal emergencies in the health facilities selected. • Identify the protocols used for obstetric and neonatal emergencies.

7. Assessment Objectives • Identify activities performed in the health facilities related to the client’s satisfaction and reproductive rights. • Identify the use of perinatal information systems.

8. What is the importance of assessing the response capacity of health facilities in the case of obstetric and neonatal emergencies? • To contribute to the improvement of the service network organizationfor a timely referral. • To determine the lack of resources needed to provide health care in appropriate conditions.

9. To identify critical aspects of clinical procedure management and training requirements with the use of indicators. • To gather information on available resources and results indicators.

10. WHAT IS THEMETHODOLOGY DEVELOPED IN PERU TO CONDUCT RESPONSE CAPACITY ASSESSMENTS? • Methodology is quantitative, based on a descriptive analysis of the data. • Data recollection formats were applied to determine the existing resources. Formats were different according to facility type and obstetric and neonatal functions that the facility is able to perform.

11. The response capacity was measured by answering 2 questions: • What resources does the health facility have in order to accomplish specific obstetric and neonatal functions? • Considering the existing resources, how are the procedures being done?

12. What resources does the health facility have? Two variables are considered: 1.1 Resources: Human Resources, equipment, instruments, disposable material, pharmacy, laboratory, transport, communication, etc 1.2 Obstetric and Neonatal Functiones (ONF) Primary Functions (health posts) Basic Functions (health center) Essential Functions (hospitals) Intensive Functions (hospitals with Intensive Care Units)

13. INSTRUMENTS: • Checklist for obstetric and neonatal functions by each facility type. • Software for obstetric and neonatal functions

14. INSTRUMENTS:Software for obstetric and neonatal function

15. FUNCION OBSTETRICA Y NEONATAL ESENCIAL RECURSO TOTAL DISPONIBLE ACTIVIDADES N° N° % Consulta prenatal esencial 110 83 75% Atención del parto distócico o complicado y RN con complicaciones 359 252 70% Extracción manual de placenta complicada 101 86 85% Atención del aborto incompleto 87 72 83% Atención de la hipertensión inducida por el embarazo moderada- severa y eclampsia 210 171 81% Atención de la hemorragia severa y shock hipovolémico 217 179 82% INSTRUMENTS:Software for obstetric and neonatal function

16. INSTRUMENTS:Software for obstetric and neonatal function

17. 2. Considering the existing resources, how are the procedures being done? Process and output indicators are being considered for each of the obstetric and neonatal activities. Initially, only hospitals having ostetric and neonatal functions were considered.

18. INSTRUMENTS: • Computerized clinical history and database • 2. Software for indicators obstetric and neonatal function Essencial (EONF)

19. INSTRUMENTS:Software for indicators obstetric and neonatal functionEssencial

20. How can the methodology be applied in other resource-poor settings to determine the response capacity of various level health facilities?

21. Steps: Identify the health facility for patient referrals. • Define the obstetric and neonatal functions that each facility should provide, and utilize the existing format for collecting data. 3. Adapt the software to any country.

22. RESULTS Response capacity of 31 health facilities.

23. RESULTS The response capacity assessment was conducted 226 health facilities in Huanuco. The average response capacity was 44.5%.