Proposed Strategy for Skilled Care at Birth in INDIA

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Proposed Strategy for Skilled Care at Birth in
INDIA

• April 20, 2004

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Community Level SBAShould be Able to Perform

• Anti-convulsants (Mag sulph)
• Oxytocics
• Third stage Active Management
• MRP -
• Management of Eclampsia
• Basic Neonatal Resuscitation
• Recognition of Cervical Tears (not manage)
• NO IV Antibiotics Prolonged labour/malpresentat
  ion

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Training Implications

• Class 10 or graduate 12-15 mths including min.
  50 deliveries (102020) can address other RH
  problems
• 15-18mths can add childhood care nutrn
• If unemployed ANM or Staff Nurse 6 mths
  specially for hands-on
• If BSc Nurse 1-3 mths

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BEmOC - Facility-based SBA Functions

• All of above IV Antibiotics prol labour
• Repair of tears
• Assist Vaginal Delivery (vacuum NOT forceps)
• Eclampsia stab. referral (NOT mgnt)
• Basic neonatal resus (NOT advanced)
• NOT preparation for blood transfusion
• NOT C-Section Preparation

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Training Implications Facility

• ADD
• Class 10 or graduate Add 6 mths
• Unemployed ANM or Staff Nurse add 6 mths
• BSc Nurse add 3 months
• If MBBS Doc. If doing delivery, add 1 mth if not
  add 3 mths
• FOR ALL 20 vacuum deliveries (5 105)

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Operational Issues

• REGISTRATION after exam INC will approve
  curriculum State Nursing Council/Bd will conduct
  exam State Nursing Council will give
  registration
• TRAINING Govt will train (eg in ANM schools),
  entrance exam on aptitude/leadership

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Operational Issues (contd)

• MONITORING Study/Survey/Rap Assess Coverage,
  Effectiveness, Quality, Client Satsfn Develop
  Indicators Intensive for 2 5 years
• REFERRAL Self-identified backup facility
  referral to public system not mandatory
• PAYMENT Self- sustained cadre self-set charges
  based on market if govt uses as a service
  provider, then reimburse as per a set rate
• ESTABLISHMENT one-time initial grant from Govt.
• LEGISLATION/POLICY Ex prescribing antibiotics,
  oxytocics, IV infustion etc.

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THANK YOU