Skilled birth attendant at home, SHP,

1
Skilled birth attendant at home, SHP, HP

• Level of competency A) MCHWs- monitors labour
  using modified partograph, provides active
  management of third stage (I/M oxytocin, CCT,
  uterine massage, recognise complications,
  stabilise condition by I/V infusion, I/M-mag
  sulphate, Oxytocin, oral antibiotics and makes
  referral to the appropriate level of facility
  depending on womans condition
• B) ANMs - all above plus I/V mag sulphate,
  antibiotics,

2
Continued..

• MCHWs not associated with any professional
  council, but a permanent employee of MOH with JD
  (needs revision)
• Training A) MCHWs-3.5 month basic course, and 6
  weeks competency based MRT
• B) ANMs- 18 months basic course, and 30 days
  competency based MRT
• 500 MCHWs being upgraded to ANMs currently and
  will be continued
• 250 SHPs will be upgraded with the provision of
  labour room

3
Enabling environment

• EOC kit with essential drugs equipment
• Developed guidelines on refill of EOC kit box,
  supportive supervision
• Pairing with TBAs and FCHVs
• Formation of community level safe motherhood
  committee
• Provision of award system based on performance
• Health management committee in place
• Supportive supervision/mentoring

4
Continued.

• 4. Referral facilitate the utilisation of
  emergency fund, manage emergency transport, if
  possible accompany the woman to the facility, use
  referral slip, and maintains good relationship
  with the referred health facilities
• 5. Advocacy to promote new role of trained MCHWs
• 6. BPP ( as a BCC tool) to address the first, and
  second delay
• 7. M E a self assessment monitoring system on
  quality of care and utilisation has been
  introduced at the facility level, and district
  level.

5
SA at the facility level(PHC, district level
hospital)

• Staffed with 1-MO, 1-SN, and 3-ANMs
• Level of competency expanded role of nurses in
  providing a full range of BEOC services and fits
  with the definition of SA.
• Regulations amendment of the council act for the
  provision of BEOC
• Existing curricula of all levels of Nursing and
  ANMs should be revised.
• In addition in service competency based BEOC
  training should be given (on going)
• JD should be revised accordingly

6
5.Enabling environment

• Inclusion of essential drugs for EOC in the
  essential drug list for PHC
• Ensure regular annual supply of essential drugs
  and logistics
• Effective CDP
• Functional health management committee
• Provision of fund to purchase essential
  drugs/equipment/supplies locally
• Good referral mechanism and feed back for follow
  up and preparedness for receiving referred cases
• Provision of exemption/subsidy for poor

7
SA at upgraded district hospital and above

• Level of competency Nurses provide a full range
  of BEOC services, MDGP/Obs provide a full range
  of B/CEOC services.
• Regulations NMA
• EE Effective hospital management committee,
  provision of adequate physical facilities and
  supplies for CEOC with blood transfusion services
• ME HMIS, EOC utilisation rate, auditing QoC (
  revision of HMIS tools for SM in process)