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INNOVATIONS FOR AATAINMENT OF MDGs 4 &5 SYMPOSIUM 10 TH JANUARY 2013

INNOVATIONS FOR AATAINMENT OF MDGs 4 &5 SYMPOSIUM 10 TH JANUARY 2013. WRAP UP AND WAY FORWARD ON MATERNAL HEALTH NDAVI wa MUIA. Outline MATERNAL HEALTH STATUS IN KENYA CONCEPTUAL FRAME WORK CONTEXT: 1 st , 2 nd and 3 rd Delays INTERMEDIATE: 1 st , 2 nd and 3 rd Delays

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INNOVATIONS FOR AATAINMENT OF MDGs 4 &5 SYMPOSIUM 10 TH JANUARY 2013

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  1. INNOVATIONS FOR AATAINMENT OF MDGs 4&5 SYMPOSIUM 10TH JANUARY 2013 WRAP UP AND WAY FORWARD ON MATERNAL HEALTH NDAVI wa MUIA

  2. Outline • MATERNAL HEALTH STATUS IN KENYA • CONCEPTUAL FRAME WORK • CONTEXT: 1st, 2nd and 3rd Delays • INTERMEDIATE: 1st, 2nd and 3rd Delays • PROX: 3rd Delays

  3. MATERNAL HEALTH STATUS IN KENYA • Pop:40m; 9.6m WRA; 6-8% pregnant=600000-800000 (about 1m) • Regional differentials/disparities • MMR 488/100,000 Live Births: • SBA 44%: • ANC 92% ONCE, 47% 4 TIMES: • LATE ATTENDANCE FOR ANC: • TRENDS IN MATERNAL CARE: 1999-50%, 2008/9-43%:

  4. FAMILY PLANNING • UNMET NEED FP 26% • CPR (7%-1977/8, 33%-39% 1993 -2003, 46% 2008/9) • Adolescent & youth: 30% • 18% of 15-19 yr olds are child bearing • 21 % of women suffered sexual violence. • Provision of youth friendly services still a great challenge.

  5. AVAILABILITY OF DELIVERY SERVICES • SERVICES FOR • Normal delivery: 30% • C/S: 5% • ANC, normal delivery and C/S: 5% • Vacuum extractor in delivery facilities: 6% • Vacuum aspirator in delivery facilities: 36% • Management of obstetric emergencies low

  6. QUALITY OF MNCH SERVICES • Competencies in: • Management of normal labour and use of the Partograph: • Management of obstetric emergencies: identification and management of: • postpartum haemorrhage: • Preeclampsia /eclampsia: • Prematurity

  7. PRIORITY INTERVENTIONS • Training • Provision of equipment & supplies • Scaling up of the HIIs at all levels • Supportive supervision • Community level awareness

  8. HIGH IMPACT INTERVENTIONS ??????

  9. WAY FORWARD A CONCEPTUAL FRAMEWORK

  10. Contextual determinants • Government/political commitment • Constitution and Legislation: chapter 4 on the Bill of Rights- articles 26 and 43.+ • Amelioration and elimination of all inequities/inequalities/disparities • Professional regulations: MPDB, Nursing Council • Policy direction on high impact interventions: education, poverty eradication, economic improvements for communities/women, • 2005 the year of the partogram (MP&ND)

  11. Resource allocations: devolution and quality/ appropriate utilization • Human: (no more 1 midwife for 8 women in labour) • Financial: devolution • Infrastructure, equipment/supplies: delivery & newborn / newborn resuscitation care units (no more 3 women in labour on one bed), suction tubes, infection prevention requirements; laboratory infrastructure • Transport /communication-elimination of the 2nd delay

  12. Socio-economic / cultural development • DRH and its leadership role in management of MNCH services: training (MEPI), provision of equipment & supplies, scaling up of the HIIs at all levels, supportive supervision, community level awareness-elimination of the 1st delay • Availability of facility infrastructure for MNCH services including BEOC/CEOC • Advocacy: role of professional organizations and unions, FBOs, NGOs, civil societies etc to promote women’s sexual and reproductive rights • Elimination / abandonment of harmful SRH practices

  13. Intermediate determinants • Access to and quality of SRH services • Leadership in maternity and newborn units: labour ward, infection control teams, clinical audit teams, task forces ….. • 24/7 hotlines • Availability and appropriate application of guidelines / protocols / SOPs for obst. emergencies: partogram, infection prevention protocols, PPH, PE/E, BEOC / CEOC guidelines • Elimination of the 3rd delay • Guidelines on promotion of training in sexuality in reproductive health

  14. Sexual/Reproductiveand Health behavior • Avoidance of too early (initiation of child bearing), too many, too frequent and too late: • Sexuality: not directly and deliberately addressed in the symposium • FP behavior and escalation of CPR • Use of services for ANC, labour / delivery and postpartum / post natal period • Elimination of the 1st delay

  15. Proxy determinants • Pregnancy: SR behavior intendendness/planned status of a pregnancy • Management of pregnancy / labour / puerperium / postpartum. • Innovations on leadership in our units/facilities • Appropriate use of management guidelines and protocols / SOPs: prevention of 3rd delay • Development and management of complications • Competencies in identification and management: role of guidelines and protocols / SOPs: prevention of 3rd delay

  16. Sikomo

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