Getting the right women and newborns to the right place to get the right care at the right time Loveday.Penn-Kekana@lshtm.ac.uk 1
Skilled birth attendant strategies Go to maternity waiting home ahead of labour 0 1 Routine 2 transport 3 pathways Facility with routine care Facility with routine (or alongside care & midwifery unit) & 1 4 Home Facility with routine Maternity care only CEmOC Waiting BEmOC Home Emergency 4 3 2 transport pathways Campbell OMR, Calvert C, Testa A, Strehlow M, Benova L, Keyes E, Donnay F, Macleod D, Gabrysch S, Rong L, Ronsmans C, Sadruddin S, Koblinsky M & Bailey P. The scale, scope, coverage & capability of childbirth care. Lancet 2016
Easy Journeys • During the day • Attending routine ANC (can be from • Can be planned for multiple providers) • Not too far • Attending 6 week post natal care • Free or low cost • Babies to well baby clinic • Public transport might be available • Getting to a MWH/Relative house near • Woman and baby well facility in later stages of pregnancy • Doesn’t need accompanying 10/1/2019 3
Not So Easy Journeys • Woman referred in ANC (but generally • During the day well) • Can be planned for • Baby referred (but generally well) • Likely to be further away and cost more • Baby referred to other services (but • Public transport might be available generally well) • Other costs incurred • Early post-natal visit • Woman and baby generally well • Doesn’t necessarily need accompanying 10/1/2019 4
Uncomfortable Journeys • Woman in normal labour to a facility to • Can be any time of the day or night deliver • If at night – maybe security issues • Woman home from the hospital after • Might need to arrange or hire private delivering transport – so more expensive • Unwell baby to facility • Body fluids • Urgency • Companion needed • Ergonomics • Women / Baby in pain 10/3/2019 5
Emergency Journeys • Can be any time of the day or night • Pregnant woman seriously ill • If at night – maybe security issues • Woman in a labour with complications home to facility • Might need to arrange or hire private transport – so more expensive • Woman in labour with complications • Body fluids facility to facility • Urgency • Sick & small newborn facility to facility • Companion needed • Ergonomics • Woman/ Baby In Pain • Everyone extremely stressed 10/3/2019 6
• An 8-month pregnant woman had a high fever, headache and abdominal pain and was bleeding. Her mother and husband took her to the dispensary. At the dispensary, the nurse told the family that the facility did not have medicine and equipment to help the patient and referred the mother to a health centre. At the health centre the woman was checked by a nurse who suspected the woman had a stillbirth. At this time, the nurse didn’t tell the mother or the family of the result of her assessment, instead she referred the woman to a district hospital. On the way the woman continued bleeding and to complain about a headache. When she got to the district hospital she was told that her baby had died and that her blood pressure was very high. At this point, the woman became unconscious and a doctor suggested that the patient needed a c/section. One day after the surgery, the woman died.” • Hanson & Shellenberg, 2019 7 10/3/2019
• “Referral problems have been identified as a major contributor to maternal deaths. There was a delay in referring and interfacility transport problems in 32.5%, 55.2% and 79.9% of referrals from community health centres, district hospitals and regional hospitals respectively of women who then subsequently died.” • South African Confidential Enquiry into Maternal Deaths, 2016 10/3/2019 8
10/3/2019 Dead Women Talking by B. Subha Sri and Renu Khanna 9
Key Components of Successful Referral Systems Knowledge of population needs and health system capabilities • • An adequately resourced referral centre Stabilising women & newborns • • Active collaboration between referral levels and across sectors • Formalised communication and transport arrangements • Agreed setting-specific protocols for referrer and receiver including • Supervision and accountability for providers performance Affordable service costs • • Capacity to monitor effectiveness & audits Policy Support • Murray S, Pearson S (2006) Maternity referral systems in developing countries: Current 03/10/2019 10 knowledge and future research needs. Social Science and Medicine 62 (2006) 2205-2215
EngenderHealth Uganda on behalf of What Women Want . 11 10/1/2019
Key Problems • Not clear whose responsibility maternal transport and emergency transport is • Over and under referral – tensions between facilities • Facilities not networked • Not wanting a death in the facility • Ambulance not available, not working, don’t have petrol, in the wrong place, cost too much • Keeping a patient until funds run out/really can’t do anything else • Patients not stabilized/ cared for during journeys 10/3/2019 12
RESPECTFUL MATERNITY CARE: The Charter THE UNIVE VERS RSAL AL RIGHTS S OF CHILDBEARING WOMEN Category of Disrespect and Abuse i Corresponding Right 1. Physical abuse Freedom from harm and ill treatment 2. Non-consented care Right to information, informed consent and refusal, and respect for choices and preferences, including companionship during maternity care 3. Non-confidential care Confidentiality, privacy 4. Non-dignified care (including verbal Dignity, respect abuse) 5. Discrimination based on specific Equality, freedom from discrimination, equitable attributes care 6. Abandonment or denial of care Right to timely healthcare and to the highest attainable level of health 7. Detention in facilities Liberty, autonomy, self-determination, and freedom from coercion
RESPECTFUL MATERNITY CARE: The Charter THE UNIVE VERS RSAL AL RIGHTS S OF CHILDBEARING WOMEN Category of Disrespect and Abuse i Corresponding Right 1. Physical abuse Freedom from harm and ill treatment 2. Non-consented care Right to information, informed consent and refusal, and respect for choices and preferences, including companionship during maternity care WHAT SHOULD THIS LOOK LIKE FOR 3. Non-confidential care Confidentiality, privacy MATERNAL TRANSPORT, EMERGENCY 4. Non-dignified care (including verbal Dignity, respect TRANSPORT AND REFERRAL? abuse) 5. Discrimination based on specific Equality, freedom from discrimination, equitable attributes care 6. Abandonment or denial of care Right to timely healthcare and to the highest attainable level of health 7. Detention in facilities Liberty, autonomy, self-determination, and freedom from coercion
Care-Seeking & Referral CoP • Join the Care-Seeking & Referral CoP: https://communities.harpnet.org/care-seeking-and- referral/join • Visit our Care-Seeking & Referral CoP page on the Health Research Program site at https://www.harpnet.org/care-seeking_and_referral_community_of_practice/ • Learn more about our webinars here https://www.harpnet.org/care-seeking-referral- community-of-practice-webinars/ 10/3/2019
THANK YOU. This presentation was made possible by the support of the American People through the United States Agency for International Development (USAID) under the terms of the Coordinating Implementation Research to Communicate Learning and Evidence (CIRCLE) contract AID-OAA-M-16-00006. CIRCLE is implemented by Social Solutions International, Inc., in partnership with Forum One. Views expressed are not necessarily of USAID or other affiliated institutions. 10/1/2019
Recommend
More recommend
