SBA

SBA : 

SBA 1/21/2011 1 Dr. Naval Asija

Missing Midwives : 

Missing Midwives Bulletin of the World Health Organization Print version ISSN 0042-9686 Bull World Health Organ vol.86 no.4 Genebra Apr. 2008 doi: 10.1590/S0042-96862008000400003    Achieving Millennium Development Goal 5: is India serious? Dileep MavalankarI; Kranti VoraI,1; M PrakasammaII ICenter for Management of Health System, Indian Institute of Management, Vastrapur, Ahmedabad 380015, India IIAcademy for Nursing Studies, Hyderabad, India 1/21/2011 2

Slide 3: 

In the 1960s, India created a cadre of two-year trained rural midwives called "auxiliary nurse midwives" (ANMs) to provide maternal and child health services. They substantially fitted the definition of skilled birth attendant. Unfortunately, their designation as "auxiliary" undermined their status and function as midwives After 1966, under pressure from international agencies, the role of ANMs in India changed from midwifery to family planning and immunization.7 Sri Lanka had a similar cadre of workers called "public health midwives" with a focus on delivery care, which contributed significantly to reducing maternal mortality. 1/21/2011 3

Slide 4: 

Lack of qualified midwives is a major human resource constraint for providing locally accessible skilled delivery care for rural women. Any country with a political commitment to reducing maternal mortality has to concentrate on well-trained midwives in the hospital and the community. Conversely, India ignored the development of a midwifery cadre, which has led to persistent dependence on traditional birth attendants for deliveries and a high maternal mortality rate. India also abolished the posts of institution-based midwives, replacing them with general nurse midwives. Nurses were rotated in all the departments of the hospital, thus they did not develop any expertise in midwifery, and the training programmes exclusively for midwifery were stopped. As a consequence, although female nurses and ANMs are automatically registered as midwives, there are no professional/skilled midwives in India. 1/21/2011 4

YOUR OPINIONS : 

YOUR OPINIONS 1/21/2011 5

Skilled Birth Attendant : 

Skilled Birth Attendant An accredited health professional- (midwife, doctor or nurse) Educated and trained to achieve proficiency in the skills needed for: Managing normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period Identification, management and referral of complications in women and newborns. Does not include TBA, even if trained. 1/21/2011 6

Maternal Deaths: Causes : 

Maternal Deaths: Causes 1/21/2011 7

Neonatal Deaths: Causes : 

Neonatal Deaths: Causes 1/21/2011 8

4 delays in Obstetrics : 

4 delays in Obstetrics Problem identification Decision making Reaching facility Providing emergency care 1/21/2011 9

GoI’s Skilled Attendance at Birth (SAB) Initiative : 

GoI’s Skilled Attendance at Birth (SAB) Initiative Ante-natal Care and Skilled Attendance at Birth by ANMs, LHVs and SNs Pregnancy Care and Management of Common Obstetric Complications by Medical Officers Life Saving Anaesthetic Skills for Emergency Obstetric Care: Training Programme for MBBS Doctors Operationalizing First Referral Units Operationalizing a Primary Health Centre for Providing 24-Hour Delivery and Newborn Care under RCH-II Setting up Blood Storage Centres at First Referral Units With the ‘Guidelines for Ante-natal Care and Skilled Attendance at 1/21/2011 10

SBA at Community Level: Additional Strategies : 

SBA at Community Level: Additional Strategies Permission to use drugs for prevention of PPH. Permission to use drugs in emergency situations before referral Permission to perform basic procedures at community level in emergency situations 1/21/2011 11

Additional Drugs and Interventions Approved for the SBA : 

Additional Drugs and Interventions Approved for the SBA Discussion with print out 1/21/2011 12

Slide 13: 

SBA TRAINING 1/21/2011 13

Training Plan : 

Training Plan 1/21/2011 14

Slide 15: 

1/21/2011 15

Key Steps in Rolling out of the Training (District level) : 

Key Steps in Rolling out of the Training (District level) Selection of District Trainers for each Training Institute Identification of training site Batch Size Identification of the potential trainees Estimation of Training Load Training Calendar Training Duration Training Methodology Certification of the Trainees Monitoring of the Training Budgeting of SBA Training Involvement of Private Facilities in SBA Training 1/21/2011 16

Slide 17: 

THANKS 1/21/2011 17

REFERENCES : 

REFERENCES PPT: State Institute of Health & Family Welfare, Jaipur; GOOGLE: HELP TAKEN Guidelines for operationalizing SBA training, MOHFW Facilitators guide, for conducting SBA Training, MOHFW 1/21/2011 18