National Policy on Skilled Birth Attendant, Nepal

Short presentation on National Policy on Skilled Birth Attendant

1. NATIONAL POLICY ON SKILLED BIRTH ATTENDANTS 2006 Supplementary to Safe Motherhood Policy 1998 A summary on Presenter Abinash Poudel

2. BACKGROUND AND RATIONALE The Government of Nepal has a history of commitment to improving maternal and neonatal health , highlighted by the National Safe Motherhood Programme in the Nepal Health Sector Programme Implementation Plan (NHSP-IP 2004-2009). Despite progress, high maternal and neonatal morbidity and mortality rates (539 maternal deaths per 100,000 live births and neonatal mortality rate of 39/1000 live births) persist , mainly attributed to the absence of skilled attendance at birth. In Nepal, only 13 percent of women currently have a health worker present during delivery, and not all of these health workers qualify as SBAs. Considering the challenges, the policy recommends a realistic and achievable national target of 60% of births attended by skilled attendants by 2015 , recognizing the need for practical approaches in the context of Nepal's specific circumstances.

3. Definition of SBA “An accredited health professional-such as a midwife, doctor or nurse-who has been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the postnatal period and in the identification, management and referral of complications in women and newborns.” SBA Policy Statement The main thrust of MoHP towards reducing maternal and neonatal mortality in Nepal is through the Safe Motherhood Programme , including Newborn Care, by improving maternal and neonatal health services at all levels of the health care delivery system and ensuring skilled care at every birth.

4. OBJECTIVES General objective To reduce maternal and neonatal morbidity and mortality by ensuring availability, access and utilization of skilled care at every birth. Specific Objectives 1) To ensure that sufficient numbers of SBAs are trained and deployed at primary health care levels. 2) To strengthen referral services for safe motherhood and newborn care , particularly at the first referral level. 3) To strengthen the pre-service and in-service SBA training institutions to ensure that all graduates will have the necessary skills. 4) To strengthen supervision and support system to ensure that all SBAs are able to provide quality maternal and newborn health care. 5) To develop regulating, accrediting and re-licensing systems for ensuring that all SBAs have the abilities and skills to practice in accordance with the core competencies.

5. STRATEGIES The strategies are organized into different categories, including: Human Resource Development Strengthening SBA Training Sites Deployment and Retention of SBAs Service Provision Enabling Environment Professional Accreditation Licensure and Legal Issues Role of Professional Organizations/Associations Role of Non-Government Sector and Private Sector Institutional Arrangements.

6. Human Resource Development: Short-Term Measures : Providing competency-based training for staff nurses and ANMs to certify them as SBAs. Assessing currently trained staff nurses and ANMs for competencies and offering additional training if needed. Medium-Term Measures : Reviewing and restructuring existing courses such as ANM, staff nurse, B.Sc. nursing, MDGP, and MBBS to include core SBA skills. Long-Term Measures : Initiating a new cadre of Professional Midwives (PM) for safe motherhood.

7. Strengthening SBA Training Sites Rapid expansion of accredited training sites to meet the national target of 60% deliveries conducted by SBAs. Accreditation of all existing training sites (pre-service and in-service) to ensure quality. Deployment and Retention of SBAs: Staffing health posts and sub-health posts with ANMs and staff nurses, with a focus on remote districts. Updating job descriptions for health professionals based on core SBA competencies.

8. Service Provision: Ensuring quality, integrated maternal and newborn health care at primary health care and referral levels. Adding birthing facilities to health posts and sub-health posts. Providing technical supervision for primary health care level SBAs. Enabling Environment Strengthening referral systems, supportive supervision, and effective partnerships with various health workers and community members. Ensuring the availability of essential drugs, supplies, equipment, and proper incentives for SBAs.

9. Professional Accreditation, Licensure, and Legal Issues Establishing a re-licensing system and strengthening the capacity of the Nepal Nursing Council. Developing accreditation guidelines and systems for SBAs, with legal mandates for their defined skills. Role of Professional Organizations/Associations: Developing a system of quality assurance, performance review, and capacity building support for SBAs. Encouraging professional councils to play a lead role in advising the government on matters related to accreditation and registration.

10. Role of Non-Government Sector and Private Sector: Encouraging NGOs, the private sector, and communities to establish maternity hospitals and birthing centers. Mobilizing resources for midwife-led training sites. Institutional Arrangements: Defining the roles of various government divisions and centers, with a lead role for the Family Health Division. Involving the National Health Training Centre in SBA human resource development. Strengthening intersectoral and intra-sectoral linkages for effective policy implementation.

11. Addressing 1 st Delay Policy has enlisted the core skills and competencies of SBAs in Annex 1 which includes: Educate women and their families about the importance of making a birth plan (where the delivery will take place, how they will get there, who will attend the birth and, in case of a complication, how timely referral will be arranged). Assist pregnant women and their families to make a plan for birth. Addressing 2 nd Delay Make arrangements for effective referral.

12. Addressing 3 rd Delay Objectives: To ensure that sufficient numbers of SBAs are trained and deployed. To strengthen the referral system particularly at the first referral . To strengthen the pre-service and in-service SBA training institutions to ensure that all graduates will have the necessary skills. Strategies Human Resource Development Strengthening SBA Training Sites Deployment and Retention of SBAs Enabling Environment Professional Accreditation, Licensure, and Legal Issues Core Skills effective communication, history-taking, screening tests, identification and management of complications, and postnatal care.

13. References NATIONAL POLICY ON SKILLED BIRTH ATTENDANTS 2006, Family Welfare Division, DoHS S. Thaddeus, D. Maine 1994. Too Far to Walk: Maternal Mortality in Context.