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PAC%20IN%20SUBSAHARAN%20AFRICA%20%20%201

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A known diabetic controlled on Lente Insulin and diet. ... the man it was for the benefit of his wife nor could he accept vasectomy. He refused! ... – PowerPoint PPT presentation

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Title: PAC%20IN%20SUBSAHARAN%20AFRICA%20%20%201


1
PAC IN SUBSAHARAN AFRICA 1
  • The New Developments
  • By
  • Dr. Solomon Orero MD
  • Consultant Obstetrician/ Gynaecologist
  • KMET/CSA
  • KENYA
  • February 2003

2
PAC IN SUBSAHARAN AFRICA 2
  • B.A 37 years old para 7 1 LD 5 years ago, last
    abortion a year ago. A known diabetic controlled
    on Lente Insulin and diet. As at 7.2.2003 she had
    been admitted for poorly controlled Diabetic. She
    was 8 weeks pregnant. Her last abortion was an
    elective abortion on an understanding that with 7
    living children, 5 boys and 2 girls. Chronic
    Diabetic poorly controlled and a housewife. This
    time round she would have an elective abortion
    and BTL. Her husband was not in at the time. He
    arrived just when we were in theatre about to
    perform the two procedures!! We did neither of
    the procedures as we were unable to convince the
    man it was for the benefit of his wife nor could
    he accept vasectomy. He refused!!

3
3
  • Issues
  • Decision making in RH and Health in general
  • Decision making linked to economic empowerment
  • Decision making linked to cultural norms and
    practices

4
4
  • A woman who has decided to procure an abortion
    will go ahead and have it irrespective of any
    other opinions to the contrary, the risks to her
    life not withstanding.
  • PROVIDERS

5
5
  • In spite of the high fertility rates in Sub
    Saharan Africa, contraceptive prevalence is very
    low. It has been found that 30 of women control
    their fertility by a combination of
    contraceptives and abortion and 3 use abortion
    only as a means of fertility control.

6
6
  • Unsafe abortion is preventable yet remains a
    significant cause of Maternal Mortality in Sub
    Saharan Africa.

7
7
  • GLOBALLY
  • 53 million abortions occur annually
  • 20 million unsafe abortion occur annually
  • 96 of unsafe abortions in Africa are unsafe
  • 85 of abortions in Latin America unsafe

8
Reasons for Procuring Abortion 8
  • Education career
  • Peer pressure and feared parental reaction
  • Partner pressure, refusing to recognize child
  • Birth spacing or limiting all together
  • Owner of pregnancy
  • Parents, Age mate, Incest

9
Methods used for Procuring Abortion 9
  • Sharp objects
  • Knitting needles, bicycle wires
  • Plant stems
  • Concoctions
  • Strong juices, Liquid soap, overdose of drugs,
    Herbals
  • Vaginally inserted laundry detergents
  • Ground glass gulped as powders

10
Decision Making for Abortion 10
  • When a woman becomes pregnant in Sub-Saharan
    Africa whether or not that pregnancy is wanted
    and the subsequent events that follow may not
    entirely be her decision.

11
The Characteristics of the Woman who has Unsafe
Abortion 11
  • Most likely, student, unemployed, Christian,
    given false identity

12
In Private Sector 12
  • Single, educated, Employed,
  • Married, not known to partner

13
Impact Consequences of Unsafe Abortion
13
  • 30 54 of all Maternal Mortality due to Unsafe
    Abortion
  • 50 62 Bed occupancy of all Gynecological Ward
    Admissions
  • Requires Expert Care to Correct damages
  • Chronic Morbidity
  • Infertility and its Associated Problems in the
    African Context

14
Response and Management of Unsafe Abortion
14
  • In Sub Saharan Africa the distance a woman has
    to walk to access safe abortion services in the
    public health sector is like the distance between
    heaven and earth you have to die to reach there.
    Khama Rogo 1993

15
Response and Management of Unsafe Abortion
15
  • On reflection at some of the answers we have
    given women who seek abortion services in the
    public health sector the statement unfortunately
    is very predictive!

16
Response and Management of Unsafe Abortion
16
  • Mum, young lady, in this hospital we only treat
    women who are already aborting, we dont start it
    here, the law does not allow! The message by
    that answer is clear! Go and induce it by
    whatever means and then come back! The case of
    the women who have suffered unsafe abortion for
    along time has been to say the least unfortunate.
    The waiting time averaged 12 hours quite often
    days to one week, the attitude of the staff
    appalling the efficiency disgusting the
    interaction and communication just simply inhuman!

17
The Evolution of PAC Services in Sub-Saharan
Africa 17
  • Defining and Embracing PAC Services
  • Emergency treatment of those who have suffered
    abortion complications or who potentially can
    suffer life threatening complications
  • Providing Post abortion Family Planning
    counseling and services
  • Referral and linkages of the women who require
    other RH services to the appropriate facilities
    or other practitioners.
  • Community Involvement in RH service including
    Abortion Care services.
  • The embracing of the PAC concept has had the
    effects of-
  • Decentralizing abortion care from theatre to
    procedure rooms
  • Embracing the use of simpler technologies in
    evacuating the uterus of its contents
  • Decentralizing abortion care from the Doctor to
    other appropriate staff
  • Providers shift in attitude
  • Looking at effective ways of providing all the
    components of PAC

18
The KMET Experience 18
  • Abortion Care in the Private Sector
  • The Collaboration between Various Cadres of
    Health Providers
  • The Decentralization of PAC from the Doctor to-
  • the MLPS
  • the CBHWKS
  • The Collaboration between the Private Sector and
    the Public Sector

19
The Evolution of KMET Participating
Practitioners Network
19
  • Consultant Physicians
  • (OB/GYNS)
  • General Practitioners
  • Mid Level Providers
  • (Clinical Officers/Nurse Midwives)
  • Community Based Health Workers
  • (CBDS, TBAS, CHES, Herbalists)
  • Annual Meetings
  • Linkages and cross referrals
  • Respect and attitudinal change

20
19 (1)
21
19 (2)
  • Congressman Jim Greenhood visiting KMET PPNW
    Programme. August, 2002

22
Lessons Learnt from KMET Training 20
  • Dr. Orero during a training session. A
    participatory practical competency based training.

23
20 (1)
  • Participants practical session during PAC
    training

24
20 (2)
  • PD Monica during a class PAC training session

25
20 (3)
  • PAC room rearranged simply for use after
    training in a public facility Designed by KMET

26
20 (4)
  • A cupboard for storage in a training facility
    Designed by KMET

27
Lessons Learnt from KMET 20 (5)
  • PAC in the private sector is doable.
  • Quality training in all elements of PAC is
    mandatory
  • It is possible to MLPS and Doctors together under
    the same programme KEY to success supportive
    facilitative supervision, monitoring and
    evaluation
  • CBHWKs can be good advocates for PAC and FP
    especially ECP
  • All cadres of health providers in RH can come
    together and discuss RH issues

28
20 (6)
  • A simplified procedure bed for MVA

29
20 (7)
  • KMET Established a model Clinic in a Peri-urban
    Kisumu City

30
20 (8)
  • KMET collaborate with many partners PIWH, PPFA
    Bucks county Pennsylvania

31
Comparisons and Replications 21
  • Sub-Saharan African Countries
  • Ghana Ghana midwives
  • Uganda PRIME DISH
  • Kenya PRIME I, II, III, UNFPA, Engender
    Health, AMKENI, MOH
  • Ipas/MYWO

32
Study Tours To KMET
  • Students for choice USA
  • Ethiopia Ipas
  • Ipas Chapel Hill NC
  • Zimbambwe, Uganda, Nigeria, Mozambique, Sudan,
    Cameroun

33
COBAC 23
  • PIWH/CSA - COBAC 1996 2000
  • Research on community Based Abortion Care
  • Results Peer Review Journal
  • Dramatized Koso and Naki
  • Film/ Video The Great Betrayal

34
Themes for Discussion after the Video 24
  • Decision making on abortion the dilemma of the
    victim
  • The cost of accessing safe and unsafe abortion
  • The role of men in abortion care as culprits,
    financiers, support in its various forms
  • The role of clinical service providers either as
    perpetrators of the high incidence of unsafe
    abortion or as potential promoters of safe
    abortion care services
  • The roles of informal providers in abortion care
    The herbalists, the CBDS, the CBHES, the CBHWKS,
    the TBAs.
  • The role of Gate Keepers in the community in
    abortion care
  • The role of the community itself in abortion care
  • The role the legal system and policies in
    Abortion care

35
The Post Research Intervention Opportunities
25
  • Putting PAC services in place through physical
    facilities improvement in both the public and
    private sector
  • Training of Clinical Service Providers in
    comprehensive Post Abortion Care Services
  • Community sensitization, education and
    mobilization by using the established structures
    of CBDS, Herbalists, TBAs, Government
    Administrative Structures, CBOs and organized
    groups especially women groups
  • Advocacy at the community level for timely
    utilization of health services for RH services
  • Development of IEC materials
  • Continuous follow up monitoring and evaluation

36
The Evolving COBAC Intervention Model- 26
  • This model aims at community level initiatives
    with the sole focus on-
  • Complimenting and strengthening existing PAC
    efforts
  • Collaborate with the MOH, Community Social and
    Health care networks
  • The whole intervention is geared towards
    addressing Abortion issues and their contribution
    to Maternal Mortality. At the community level
    initiative we are addressing the community norms,
    values and attitudes, discussing laws and
    policies regarding abortion, their
    interpretation, Health service provision.

37
The Policy Arena 27
  • Safe motherhood
  • The ICPD platform of action
  • Advocacy campaigns
  • The legal Environment
  • The services provision, availability and
    sustainability

38
28
  • M.A. 18 yrs old, a house girl works 450 Kms from
    home. Got pregnant. Had an unsafe abortion. Who
    did it could not differentiate the anus from the
    vagina. Destroyed anus, rectum, bladder, uterus,
    intestines. The woman lost her uterus, fertility,
    and to add insult to injury she ended up with a
    permanent COLOSTOMY! She survived but at what
    cost? Another preventable statistics. My heart
    bled for her as we repaired what was left of her
    womanhood

39
29
  • YES movement forward 2 decades later
  • Progress to a large extent in pilot programmes
  • ACCESS/special populations
  • Support/ NGOS/ Religious Based Organizations
  • Sustainability
  • Legal environment
  • Integration
  • Adoption of technological change
  • EOC Guidelines include PAC

40
Way Forward 30
  • Overcome culture of silence
  • Condemnation from sex
  • The issues of war health
  • Scaling up
  • Process
  • Resource mobilization
  • Attitude
  • Challenge
  • Legal environment
  • Existing social groupings
  • Training, supervision, M E
  • Introduction of PAC in Basic MLPS training
    Institutions
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