Reducing Maternal Mortality: EmOC Services for Afghan Refugee Women in Pakistan

1
Reducing Maternal Mortality EmOC Services for
Afghan Refugee Women in Pakistan

• IRCs Health Program Serving Afghan Refugees in
  Pakistan
• Dr Tila Khan, Health Coordinator
• Tilakhan.Ahmadzai_at_pakistan.theirc.org
• 92-300 8593615

2
Project Area Map
MMR 1,700
MMR A/R 101
MMR 340
3
Current IRC-Operated Health Facilities

• 2 Basic EmOC centers
• Hangu, est. June 1996
• serving 44,000 refugees
• Darsamand, est. Sept 2003
• serving 52,300 refugees
• In addition, approximately 50,000 local
  population in each area
• 8 Basic Health Units
• 1 dental clinic

4
Location of EmOC Facilities

5
Goal and Objectives

• Goal
• To reduce maternal morbidity and mortality by
  effective responding to emergency obstetric care
  needs of target population
• Objectives
• Increase level of community awareness regarding
  EmOC services.
• To improve access to basic and comprehensive EmOC
  services

6
Each facility has

• Labor and delivery rooms
• Room for general examination
• Office
• Staff accommodations
• Running water, toilets for patients, patients
  attendants and for staff
• Electricity with generator for back up
• Ambulance for transportation with incubator for
  transportation of newborn baby (if needed)
• Four beds and 3 delivery tables in each facility
• Equipment, drugs and other supplies

7
Staff Per Facility
8
Staff of the facilities

9
Services

• Manage Normal deliveries and Obstetric
  Complications, including Post Abortion Care
• Six Basic EmOC Signal Functions
• referral to hospital if needed
• Outpatient care for Ob/Gyn problems
• Immediate newborn care, referral to hospital (if
  needed)

10
Thal Health Committee
11
Effective Linkages between
12
Monitoring and Evaluation

• Health Information System, Using UN Process
  Indicators monitor progress over time
• Maternal death audit
• Use of Checklists monitor supplies, skills and
  procedures
• Meetings
• Mid-term evaluation

13
Births by Skilled Staff 1996-2007
14
Complications Managed in Basic EmOCs
15
Met Need in the 2 EmOCs 2004-2007
16
of Cesarean Section and case Fatality in CEmOC
Facility
17
Changes in Maternal Mortality over time
18
Neonatal Mortality Rate (per 1,000 live births)
19
Lessons Learned

• Success factors
• Effective linkage of EmOC with other PHC
  components
• Significant community involvement and awareness
• Staff skills and interaction contribute to
  services utilization
• Basic EmOC is more effective in reducing
  mortality if supported by efficient comprehensive
  EmOC
• Role of skilled staff is more important in EmOC
  services as compared to general PHC

20

• THANKS