Skilled birth attendant at home, SHP, HP

1. Skilled birth attendant at home, SHP, & HP Level of competency: A) MCHWs- monitors labour using modified partograph, provides active management of third stage (I/M oxytocin, CCT, & uterine massage, recognise complications, stabilise condition by I/V infusion, I/M-mag sulphate, Oxytocin, & oral antibiotics and makes referral to the appropriate level of facility depending on woman’s condition B) ANM’s - all above plus I/V mag sulphate, antibiotics,

2. Continued….. MCHWs not associated with any professional council, but a permanent employee of MOH with JD (needs revision) Training: A) MCHWs-3.5 month basic course, and 6 weeks competency based MRT B) ANMs- 18 months basic course, and 30 days competency based MRT 500 MCHWs being upgraded to ANMs currently and will be continued 250 SHPs will be upgraded with the provision of labour room

3. Enabling environment EOC kit with essential drugs & equipment Developed guidelines on refill of EOC kit box, & supportive supervision Pairing with TBAs and FCHVs Formation of community level safe motherhood committee Provision of award system based on performance Health management committee in place Supportive supervision/mentoring

4. Continued…. 4. Referral: facilitate the utilisation of emergency fund, manage emergency transport, if possible accompany the woman to the facility, use referral slip, and maintains good relationship with the referred health facilities 5. Advocacy to promote new role of trained MCHWs 6. BPP ( as a BCC tool) to address the first, and second delay 7. M & E: a self assessment monitoring system on quality of care and utilisation has been introduced at the facility level, and district level.

5. SA at the facility level(PHC, district level hospital) Staffed with 1-MO, 1-SN, and 3-ANMs Level of competency: expanded role of nurses in providing a full range of BEOC services and fits with the definition of SA. Regulations: amendment of the council act for the provision of BEOC Existing curricula of all levels of Nursing and ANMs should be revised. In addition in service competency based BEOC training should be given (on going) JD should be revised accordingly

6. 5.Enabling environment Inclusion of essential drugs for EOC in the essential drug list for PHC Ensure regular annual supply of essential drugs and logistics Effective CDP Functional health management committee Provision of fund to purchase essential drugs/equipment/supplies locally Good referral mechanism and feed back for follow up and preparedness for receiving referred cases Provision of exemption/subsidy for poor

7. SA at upgraded district hospital and above Level of competency: Nurses provide a full range of BEOC services, MDGP/Obs provide a full range of B/CEOC services. Regulations: NMA EE: Effective hospital management committee, provision of adequate physical facilities and supplies for CEOC with blood transfusion services M&E: HMIS, EOC utilisation rate, auditing QoC ( revision of HMIS tools for SM in process)