Key priorities for 2012/2013

ACCELERATED REDUCTION OF MATERNAL AND CHILD

MORBIDITY AND MORTALITY‘CARMMA – CH’

THE ROAD MAP TO 2014

Things that can be done this year• Commitment• Change of attitude• Willingness to change• Not dependent on increased budgets• Can be implemented at District Level• Responsibility– District Manager– CEO– District Clinical Specialists– Hospital Medical Manager

Community Based Interventions• Health Information and Promotion must be provided at

household level• Identification, referral and feedback of suspect cases• Indicator:

– FP uptake; Early booking before 20 weeks; growth monitoring; breastfeeding

– Community Care Givers trained– CCG data captured into DHIS

• Target: Early booking 50%• Responsibility: Deputy District Manager – Programmes

Antenatal Care

• All ANC sites must initiate ANC at the time pregnancy is diagnosed

• Indicator:• ANC attendance < 20 weeks• Target: 50%• Responsibility: PHC supervisor and Clinic Ops

manager

Antenatal Care• All ANC sites must provide Calcium carbonate

supplementation for all pregnant women from booking

• Indicator:– Cases of eclampsia delivered– Hypertensive maternal deaths– Target for KZN <30 deaths for next year 2008-10: 110

deaths)

• Responsibility: PHC supervisor and Clinic Ops manager

Antenatal Care

• Integrate HIV care into antenatal care– HAART theraphy– PCP and TB prophylaxis– TB screening– Management of opportunistic infections

• Indicator: Number of NPRI maternal deaths (target <140); % percentage eligible antenatal clients on HAART before delivery (target >90%)

• PHC supervisor/ Ops Manager

Antenatal Care

• All District Hospitals should have a plan for a waiting mothers area / maternity waiting home

• Indicator:– Number of MWHs

• Target for KZN: functioning MWH at 50% of District Hospitals (26), at least 1 per District

• Responsibility: CEO and General Manager Infrastructure

Labour care

• All hospitals / MOUs should encourage and allow companions for women in labour Indicator:

• Institutional policy on companions in labour• Target for KZN: all hospitals / MOUs must have

written policy on companionship in labour• Responsibility: Medical manager/ Clinic Ops

Manager

Neonatal care

• All hospitals should have a functional KMC unit

• Indicator:• Babies managed by KMC• Target for KZN: all hospitals must have a

policy that stable low birth weight babies are managed by KMC

• Responsibility: Medical Manager

Training

• All hospitals should be running ESMOE fire drills monthly

• Indicator: Number of master trainers• Target for KZN: every hospital must have at least one

ESMOE Master Trainer• Indicator: Records of fire drills, numbers of staff

completed full ESMOE course• Target: Monthly fire drills in 50% of institutions, 100%

of interns completed ESMOE course• Responsibility: Medical Manager

Outreach

• All district hospitals must have designated specialists for O+G and neonatology for outreach

• Indicator: cell phone and email contact details of designated specialists for outreach available at district hospitals

• Target for KZN: 100% district hospitals must have contact details available.

• Responsibility: Medical Manager/ General Manager - IT

Referral criteria

• All clinics, district hospitals and regional hospitals must have referral criteria for obstetric and neonatal problems

• Indicator: referral criteria clearly displayed in maternity and neonatal departments

• Target for KZN: 100% of clinics, hospitals• Responsibility: Medical Manager

Referral criteria

• Maternity doctor on duty at local (district) hospital must be directly accessible by phone from all clinics in catchment area

• Indicator: Contact details of doctors (not just hospital) displayed at clinics

• Target for KZN: 100% of clinics• Responsibility: Medical Manager

Referral criteria

• Obstetric specialist on-call at regional referral centre must be directly accessible by phone by the medical officers at referring hospitals and clinics in catchment area

• Indicator: Contact details of specialists on-call (not just hospital) available at district hospitals

• Target for KZN: 100% of District hospitals• Responsibility: Head Clinical Department

Patient transport

• Patient transport must be available within 15 min of request

• All the listed hospitals must have specialised ambulances on-site

• All MOUs must have non-specialised transport • Indicator: Response times• Target: 15 Min• Responsibility: EMS district manager

Maternal and Perinatal Audit

• All hospitals must have scheduled PNMMs at least monthly

• Indicator: Yearly schedule of PNMM meetings

• Target for KZN: 100% of hospitals• Responsibility: Medical Manager

Maternal and Perinatal Audit

• PNMM must be attended monthly by at least one of top hospital management and must include setting an action plan and follow-up of previous action plans

• Indicator: Minutes of PNMM meetings• Target for KZN: 100% of hospitals• Responsibility: CEO

Maternal and Perinatal Audit

• All institutional maternal mortalities to be discussed at the institution within 3 days and an action plan made to prevent recurrence

• Indicator: Record of maternal death meeting• Target for KZN: 100% of maternal deaths per

District• Responsibility: Medical Manager

PPIP

• Each hospital must have a designated PPIP champion, and functional PPIP programme

• Indicators: PPIP data forwarded to District quarterly; minutes of 6-monthly hospital PPIP meetings with action plans, and follow-up of previous action plans

• Target for KZN: 100% of hospitals• Responsibility: Medical Manager

Women’s Health

• All women with HGSIL on Pap smear results must be able to access colposcopy / Lletz service promptly

• Indicators: new cases of cancer of the cervix, waiting time for colposcopy appointment

• Target for KZN: waiting time for colposcopy appointments per District must be < 1 month

• Responsibility: Medical Manager

Women’s Health

• Every hospital must be able to offer TOP or refer clients for free TOP service to another service provider

• Indicators: Hospital policy on TOP service• Target: 100% of hospitals have policy

ensuring access to TOP• Responsibility: CEO

Family Planning

• Every hospital conducting deliveries must be able to offer tubal ligation post vaginal delivery before the mother is discharged if she requests it

• Indicators: number of post-partum T/Ls• Target: 100% of hospitals conducting post-

partum T/Ls• Responsibility: Medical Manager

Family Planning

• Every hospital/ clinic must have IUCD available as a contraceptive option

• Indicator: Number of IUCD inserted• Target: IUCD insertion trained provider at all

hospitals • Responsibility: Medical Manager