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ACCELERATED REDUCTION OF MATERNAL AND CHILD MORBIDITY AND MORTALITY ‘CARMMA – CH’ THE ROAD MAP TO 2014. Key priorities for 2012/2013. Things that can be done this year. Commitment Change of attitude Willingness to change Not dependent on increased budgets
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ACCELERATED REDUCTION OF MATERNAL AND CHILD MORBIDITY AND MORTALITY‘CARMMA – CH’THE ROAD MAP TO 2014 Key priorities for 2012/2013
Things that can be done this year • Commitment • Change of attitude • Willingness to change • Not dependent on increased budgets • Can be implemented at District Level • Responsibility • District Manager • CEO • District Clinical Specialists • Hospital Medical Manager
Community Based Interventions • Health Information and Promotion must be provided at household level • Identification, referral and feedback of suspect cases • Indicator: • FP uptake; Early booking before 20 weeks; growth monitoring; breastfeeding • Community Care Givers trained • CCG data captured into DHIS • Target: Early booking 50% • Responsibility: Deputy District Manager – Programmes
Antenatal Care • All ANC sites must initiate ANC at the time pregnancy is diagnosed • Indicator: • ANC attendance < 20 weeks • Target: 50% • Responsibility: PHC supervisor and Clinic Ops manager
Antenatal Care • All ANC sites must provide Calcium carbonate supplementation for all pregnant women from booking • Indicator: • Cases of eclampsia delivered • Hypertensive maternal deaths • Target for KZN <30 deaths for next year 2008-10: 110 deaths) • Responsibility: PHC supervisor and Clinic Ops manager
Antenatal Care • Integrate HIV care into antenatal care • HAART theraphy • PCP and TB prophylaxis • TB screening • Management of opportunistic infections • Indicator: Number of NPRI maternal deaths (target <140); % percentage eligible antenatal clients on HAART before delivery (target >90%) • PHC supervisor/ Ops Manager
Antenatal Care • All District Hospitals should have a plan for a waiting mothers area / maternity waiting home • Indicator: • Number of MWHs • Target for KZN: functioning MWH at 50% of District Hospitals (26), at least 1 per District • Responsibility: CEO and General Manager Infrastructure
Labour care • All hospitals / MOUs should encourage and allow companions for women in labour Indicator: • Institutional policy on companions in labour • Target for KZN: all hospitals / MOUs must have written policy on companionship in labour • Responsibility: Medical manager/ Clinic Ops Manager
Neonatal care • All hospitals should have a functional KMC unit • Indicator: • Babies managed by KMC • Target for KZN: all hospitals must have a policy that stable low birth weight babies are managed by KMC • Responsibility: Medical Manager
Training • All hospitals should be running ESMOE fire drills monthly • Indicator: Number of master trainers • Target for KZN: every hospital must have at least one ESMOE Master Trainer • Indicator: Records of fire drills, numbers of staff completed full ESMOE course • Target: Monthly fire drills in 50% of institutions, 100% of interns completed ESMOE course • Responsibility: Medical Manager
Outreach • All district hospitals must have designated specialists for O+G and neonatology for outreach • Indicator: cell phone and email contact details of designated specialists for outreach available at district hospitals • Target for KZN: 100% district hospitals must have contact details available. • Responsibility: Medical Manager/ General Manager - IT
Referral criteria • All clinics, district hospitals and regional hospitals must have referral criteria for obstetric and neonatal problems • Indicator: referral criteria clearly displayed in maternity and neonatal departments • Target for KZN: 100% of clinics, hospitals • Responsibility: Medical Manager
Referral criteria • Maternity doctor on duty at local (district) hospital must be directly accessible by phone from all clinics in catchment area • Indicator: Contact details of doctors (not just hospital) displayed at clinics • Target for KZN: 100% of clinics • Responsibility: Medical Manager
Referral criteria • Obstetric specialist on-call at regional referral centre must be directly accessible by phone by the medical officers at referring hospitals and clinics in catchment area • Indicator: Contact details of specialists on-call (not just hospital) available at district hospitals • Target for KZN: 100% of District hospitals • Responsibility: Head Clinical Department
Patient transport • Patient transport must be available within 15 min of request • All the listed hospitals must have specialised ambulances on-site • All MOUs must have non-specialised transport • Indicator: Response times • Target: 15 Min • Responsibility: EMS district manager
Maternal and Perinatal Audit • All hospitals must have scheduled PNMMs at least monthly • Indicator: Yearly schedule of PNMM meetings • Target for KZN: 100% of hospitals • Responsibility: Medical Manager
Maternal and Perinatal Audit • PNMM must be attended monthly by at least one of top hospital management and must include setting an action plan and follow-up of previous action plans • Indicator: Minutes of PNMM meetings • Target for KZN: 100% of hospitals • Responsibility: CEO
Maternal and Perinatal Audit • All institutional maternal mortalities to be discussed at the institution within 3 days and an action plan made to prevent recurrence • Indicator: Record of maternal death meeting • Target for KZN: 100% of maternal deaths per District • Responsibility: Medical Manager
PPIP • Each hospital must have a designated PPIP champion, and functional PPIP programme • Indicators: PPIP data forwarded to District quarterly; minutes of 6-monthly hospital PPIP meetings with action plans, and follow-up of previous action plans • Target for KZN: 100% of hospitals • Responsibility: Medical Manager
Women’s Health • All women with HGSIL on Pap smear results must be able to access colposcopy / Lletz service promptly • Indicators: new cases of cancer of the cervix, waiting time for colposcopy appointment • Target for KZN: waiting time for colposcopy appointments per District must be < 1 month • Responsibility: Medical Manager
Women’s Health • Every hospital must be able to offer TOP or refer clients for free TOP service to another service provider • Indicators: Hospital policy on TOP service • Target: 100% of hospitals have policy ensuring access to TOP • Responsibility: CEO
Family Planning • Every hospital conducting deliveries must be able to offer tubal ligation post vaginal delivery before the mother is discharged if she requests it • Indicators: number of post-partum T/Ls • Target: 100% of hospitals conducting post-partum T/Ls • Responsibility: Medical Manager
Family Planning • Every hospital/ clinic must have IUCD available as a contraceptive option • Indicator: Number of IUCD inserted • Target: IUCD insertion trained provider at all hospitals • Responsibility: Medical Manager