Safe motherhood

Safe motherhood programme of nepal

1. SAFE MOTHERHOOD Aakash Jayswal Batch 2017 NGMC

2. Introduction Safe motherhood is A series of initiatives practices, protocols & service guidelines designed to ensure that women receive high quality gynaecological , family planning, prenatal, delvery and postnatal care in order to achieve the optimum level of health of mother and infant. PILLARS OF SAFE MOTHERHOOD

3. BACKGROUND Initiated in 1997 Safe Motherhood Policy - 1998 National Safe Motherhood Program (2002-2017) Safe Motherhood and Neonatal Health Long Term Plan (2006-2017)

4. GOALS To reduce maternal and neonatal morbidity and mortality To improve the maternal and neonatal health through preventive and promotive activities as well as by addressing avoidable factors that cause death during pregnancy, childbirth and postpartum period.

5. 5 th MDG – To reduce Maternal mortality by 75% and universal access to reproductive health SDG 3 : Good Health and well being By 2030 , reduce the global Maternal mortality ratio To less than 70 per 100,000 live births By 2030, end preventable deaths of newborns and children under 5 years of age with countries aiming to reduce NMR to as low as 12 per 1000 LB And U5MR to at least as low as 25 per 1000 LB

6. 3 DELAYS DELAY IN SEEKING CARE DELAY IN REACHING CARE DELAY IN RECEIVING CARE

7. STRATEGIES Promoting birth preparedness and complication readiness including awareness raising and improving preparedness for funds, transport and blood transfusion. Expansion of 24 hours birthing facilities alongside Aama Suraksha Programme promotes continuum of care from ANC to PNC. The expansion of 24-hour emergency obstetric care services (basic and comprehensive) at selected health facilities in all districts.

8. MAJOR ACTIVITIES in 2076/77 Community level maternal and newborn health interventions 1.    Birth Preparedness Package ( jeevansuraksha flipchart and card) 2. Distribution of Matri SurakshaChakki ( misoprostol 600mcg ) to prevent postpartum haemorrhage (PPH) in home deliveries 3. Through FCHV, public health system promotes Birth preparedness and complication readiness (preparedness of money, SBA /facilities for the delivery, transport and blood donors). Promote Key ANC/PNC services (Iron, Td, Albendazole , etc), self-care (food, rest, no smoking and no drinking  alcohol, including pregnancy and post-partum period), Promote essential new born care, Identification and prompt care seeking for danger signs during pregnancy, delivery, post-partum and newborn period

9. Aama and the New born Program            The Government of Nepal introduced demand side intervention in maternal health with the aim of encouraging institutional delivery. The Maternity Incentive Scheme, launched in 2005 and designed to share the cost of transportation to health facility. In 2009, in addition to transport incentive user fees were removed from all types of delivery care, known as the Aama Programme . In 2012, 4 ANC incentives programme (introduced in 2009) was merged with Aama Programme . In FY 2073/74, the free new born care programme (introduced in FY 2072/73) has been merged to the Aama programme .

10. Aama programme and has the following provisions For women delivering their babies in health institutions : Transport incentive for institutional delivery NPR 3,000 in mountains districts, NPR 2,000 in hills districts NPR 1000 in Tarai districts Incentive for 4 ANC visits NPR 800 to women on completion of four ANC visits Free institutional delivery services : A payment to health facilities for providing free delivery care. For a normal delivery NPR 1,000 or 1,500. For complicated deliveries NPR 3,000 For C- sections (surgery) NPR 7,000. Anti-D administration for RH - ve mothers NPR 5,000. Laparotomy NPR 7,000 to both public and private facilities.

11. Incentives to health service provider : For deliveries: A payment of NPR 300 to health workers for attending all types of deliveries to be arranged from health facility reimbursement amounts Newborn Care Programme Provision Free sick new born care: a. For sick newborns : 4 different types of package (Package 0, Package A, B, and Package C) for sick newborns case management. reimbursed to health facility . The cost of package of care include 0 Cost for Packages 0, and NPR 1000, NRP 2000 and NRP 5000 for package A, B and C respectively. maximum of NPR 8,000 (packages A+B+C), depending on medicines, diagnostic and treatment services provided. b. Incentives to health service provider : A payment of NPR 300 to health workers for providing all forms of packaged services to be arranged from health facility reimbursement amounts..

12. . Nyano Jhola Programme Launched in 2069 To protect newborns from hypothermia and infections 2 set of clothes ( Bhoto , daura napkin & cap) 1 set wrapper , mat for baby 1 gown for mother

13. Rural Ultrasound Programme The Rural Ultrasound Programme aims for the timely identification of pregnant women with risks of obstetric complication to refer to comprehensive emergency obstetric and neonatal care (CEONC) centres . Trained nurses (SBA) scan clients at rural PHCCs and health posts using portable ultrasound. Women with detected abnormalities such as abnormal lies and presentation of the foetus and placenta previa are referred to a CEONC site for the needed services. This programme is being implemented in the remote district

14. Safe abortion services To make safe abortion services available, accessible and affordable to all women with unwanted pregnancies. 4 key components of comprehensive abortion care as: Pre and post counselling on safe abortion methods and post-abortion contraceptive methods; Termination of pregnancies as per the national protocol; Diagnosis & treatment of existing reproductive tract infections; Provide contraceptive methods as per informed choice and follow-up for post-abortion complication management

15. . Emergency Referral Fund It is estimated that 15 percent of pregnant women will develop serious complications during their pregnancies and deliveries, and 5 to 10 percent of them will need caesarean section deliveries (WHO, 2015) A total of 7,500,000 Rupees was allocated to six Provinces to support women when needed. Additional 12,000,000 Rupees was allocated for the hospitals in the districts through 7 provinces to support transport fares women who could not afford referral to high facility (nearby CEONC facilities)

16. R e productive Health Morbidity Prevention and management Program Management of Pelvic Organ Prolapse Cervical cancer screening and prevention training Obstetric Fistula management

17. Human resources NHTC provides training on SBA, ASBA, Anaesthesia assistant, operating theatre management, family planning (including implants and IUCD), CAC and antenatal ultrasonography . In 2075/76, 668 SBA, 26 ASBA were trained by NHTC and NAMS. By the end of 2076/77 a total of 10,388 SBAs and 234 ASBAs have been trained FWD continues to monitor the deployment of doctors (MDGP, OBGYN, ASBA) and AAs, and inform DOHS and MOH as necessary for appropriate transfer. This has resulted in improved functionality of CEONC services.

18. Expansion and quality improvement of service delivery sites 24/7 service delivery sites like birthing centres , BEONC and CEONC sites at PHCCs, health posts and hospitals. By the end of 2076/77 CEONC services were established in 72 districts Onsite clinical coaching and mentoring By 2076, 528 Municipals of 51 districts implemented on-site clinical coaching /mentoring programme to enhance knowledge and skill of SBA and non-SBA nursing staffs providing delivery services at BC/BEONC and CEONC service sites.

19. PNC home visit (micro planning for PNC) . Till FY 2076/77, It has been expanded in to 229 Municipals from 40 districts to strengthen PNC services by mobilizing MNH service providers from health facilities to provide PNC at women’s home.

20. Eligibility Criteria: The incentives and services are available to the Nepali citizen especially the pregnant mother and newborn Required Documents : Only the Nepali nationals are eligible for this service hence, a copy of the Nepali citizenship need to be presented to claim incentives and services under this programme . Service Availability : Available in all public health facilities  with birthing facility Newborn are eligible to receive the free sick newborn care in the programme implemented major hospitals. The plan is to roll out throughout the country

21. REFERENCES   www.fhd.gov.np www.dohs.gov.np Annual-Report-FY-2076-77 who.int/ safemotherhood NDHS 2016