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Using DSS to monitor progress toward improvement in maternal health

Explore using DSS to track progress in maternal health, focusing on morbidity, mortality, and neonatal outcomes. Understand the Three Delays framework, link to facility data, and address major morbidities.

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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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