Health System Interventions for Improving Access to Skilled Birth Attendance

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Health System Interventions forImproving Access
to Skilled Birth Attendance
Dr. Dinesh Agarwal, M.D. Technical Adviser
(Reproductive Health),UNFPA, INDIA
Last Updated October 12, 2009
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Scope of Presentation

• Importance of strengthening Heath Systems in
  achieving goals of SBA
• Priority Issues for attention in Health systems
  
• Conclusions

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Role of Heath Systems

• Improved pregnancy outcomes( both maternal and
  newborn) depends on factors other than skilled
  attendants alone!Enabling Environment is
  crucial!!
• Equity in outcomes(income,regional and gender)
  and client satisfaction - important goal
• Primary Health care focus is crucialcloser to
  clients
• Access for quality essential obst care through
  effective referrals- Public-private partnerships

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Supportive Policy Environment

• MDG/ICPD/national Policy Mandate
• Legislations/Regulations for delegation of skills
  at decentralised levels of service delivery
• License use of drugs /appropriate technology for
  the frontline workers
• Human Resources development policy for achieving
  SBA goals
• Partnership Role of Professional
  Associations(Medical/Nursing)

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Issues in Health Systems-Inputs

• Human Resources. Development,Accreditation,
  deployment, pre-service and continuing
  education,supervision and accountability
• Standards , Protocols and referral systems
• Infrastructure Labour rooms/OTs/Blood storage
• Equipments/supplies
• Communication Cell phone/Tele Medicine
• Transport Community/Institutional
• Financing options for protecting poor.User
  Fees/Community Financing/Insurance/Vouchers

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Issues in Health Systems-Processes

• Availability and Access( 24x7)
• Referral MechanismsSelf/Home based
  SBA/Institutional
• Communication activitiesImportance of
  SBA/dangersigns
• Technical Quality of careAdherence to standards
• Team Approach
• Peer Reviews/QA circles/Audits
• Establishing MIS

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Essential Features of Effective Referral System

• An Adequately Resourceful Referral Centre (
  Receiving Referrals) identified for each SBA
• Communication and Feedback System
• Designated and dependable Transport
• Clinical Protocols indicating cutoffs for
  referrals
• Team Work between Referral Levels
• Mechanisms to ensure that patients do not bye
  pass referral levels (graded user fees-to reduce
  congestion at higher levels of care)

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Strengthening Referrals Self Referrals
Focus on 4 Delays
Focus During ANC-Organise Demand side

• Delay in Recognizing complications
• Delay in Deciding to Seek Care

Mobilize Community Efforts for dedicated
transport

• Delay in Reaching

Readiness of Facilities

• Delay in Receiving Appropriate Care

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Strengthening Referrals Institutions
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Issues in Health Systems-Outcomes

• Measure/Monitor outcomes
• SBA coverage/equity
• C section rates/obst CFR
• Maternal Mortality
• Neonatal deaths
• Client Satisfaction

MIS/Rapid Assessments/Surveys/Operations Research
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Conclusions

• POLICY ISSUES Changes in Legislations/Delegation/
  Licensing/PPP
• INPUTS HRD/Standards,Infrastructure,financing
• PROCESS Referrals/Access/MIS/QA
• OUTCOMES MIS/Rapid assessments/Surveys