MOVING TO ACTION: Identifying Responses
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Transcript of MOVING TO ACTION: Identifying Responses
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MOVING TO ACTION:Identifying Responses
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Learning objectivesBy the end of this session, participants will be able to:
• Identify actions appropriate to data presented • Use the action tool and support its
implementation • List ‘evidence based actions’• Prioritise actions in a systematic way
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Taking action to reduce avoidable maternal deaths is the reason for conducting
MDSR
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What are appropriate actions?
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Scenario • A 21-year old had her 3rd baby at home. • Her first baby died after a difficult delivery. Her second baby
was premature and survived.• During this pregnancy, she attended antenatal care at the
local health centre. • She started bleeding 1 hour after delivery of a healthy baby.
The local skilled birth attendant (SBA) came within 1 hour. • She found the woman very pale and collapsed and gave her
oxytocin and then misoprostil. • The SBA suggested moving the woman to the local
hospital , an hour away, as the bleeding continued. The husband did not agree and the woman died
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Practical exercise
• Work on your own• Consider the 9 possible actions
listed on pg. 22 in the workbook• List the 3 actions you think would
be most effective in this case
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?
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What are evidence based actions?Actions for which there is over whelming evidence that
maternal mortality and morbidity will be prevented if they are followed.
• Usually refer to clinical actions, based on trials• Individual cases should be assessed to see if “best
practices” were carried out or not• If not, appropriate action should be taken to ensure
these are implemented to prevent further deaths• Ethiopian Guidelines (FMOH) for A/N and
intrapartum care provide details
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General
• Family planning• Iron• HIV• Malaria• SBA and Birth
preparedness• Health
education & promotion
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Eclampsia
• Diagnosis and treatment of high blood pressure
• Magnesium Sulphate
• Timely delivery
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Haemorrhage
• Active management of third stage of labour
• Misoprostil• Blood transfusion
(dependent on environment)
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Sepsis
• Clean delivery• Antibiotics for
prolonged ruptured membranes at term
• Antibiotics for C/S • Avoid prolonged
delivery
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Abortion
• Availability of safe abortion
• Availability of post abortion care including safe MVA or D&C and i/v antibiotics
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Obstructed labour
• Facility delivery after 12 hours of labour
• Use of partograph• Availability of C/S
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Non clinical actions
• Not all problems identified during the review and analysis have clinical solutions
• Actions in the community e.g. Changing health-seeking behaviour, addressing transportation, reducing costs of accessing care, also play a role.
• Innovative solutions come about through community participation in identifying and carrying out actions likely to be successful.
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Prioritising!
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Which actions?
• Not all problems can be tackled simultaneously• Prevalence – how common is the problem?• Feasibility of carrying out the action – are there
extra staff available? Is it technologically and financially possible?
• What is the potential impact of the action? – If successfully implemented how many
women would be reached and how many lives saved?
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Prioritisation Exercise
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Prioritisation Action Prevalance Feasibility Potential impact
Iron is available- anaemia is eliminated
Commend and empower SBA
Family planning to prevent unwanted pregnancy
Guidelines re ANC available
EMONC training re AMTSL + PPH
SBA attendance at delivery- community education
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(Facilitated Discussion)• Which action(s) address the most prevalent
problems• Which action(s) are most feasible? (Why or
why not?)• Which action(s) will deliver the most impact?
• Reminder that prioritisation is subjective and best done in a multi disciplinary team including community members ( especially non clinical)
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Group exercise using action tool6 groups of 5-6 eachDetails and scenario in WorkbookExercise simulates facility
committeeAction tool completed for the
scenario described