Transcript Emergency Management of Reproductive Health

Reproductive Health
In
Emergency Management
Dr. Nahida Al-Lawati
DCH, MRCGP [INT], MSC Community
Gynaecology and Reproductive Health
What are the elements of the
reproductive health?
• Safe motherhood, including emergency obstetric
care;
• Family planning;
• Prevention and care of STD and HIV;
• Sexual violence (against females);
What are the priorities in the emergency?
1. Re-establish normal services as soon as
possible
2. To have clear guidance for local staff of the
case management of individuals whose
treatment has been disrupted or delayed
If significant delay in the resumption of
normal services is expected, temporary
reproductive health services may need to
be established to meet existing and
evolving needs.
What is the impact of disasters and
emergencies on the components of
reproductive health programs?
• High mortality rates among women and
children;
• Increase in STD and HIV/AIDS;
• Increase in unsafe abortion;
• Increase in morbidity related to high
fertility rates and poor birth spacing
1. Reproductive Health need assessment to
identify the type and the extent of
reproductive health services needed by
the affected population.
Demographic Profile:
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Total population
Number of women of reproductive age
Number of children 0-15 years
Number of children 0-5 years
Number of female headed households
Estimated number of pregnant women
Health Status
• Crude birth rate
• Maternal Mortality Rate/Ratio
• Total Fertility Rate
Available services and resources:
• Extent and condition of existing health
facilities
• Staffing and coverage
• Inventories of equipment, drugs, and
commodities
2. Setting Priorities:
• List the problems observed through the
assessment exercise.
• Consider each problem in terms of:
prevalence, seriousness, feasibility of
control, community acceptance.
• Score each problem and identify the
problems that have ranked highest.
3. Setting Goals and Objectives:
• Acute emergency phase
• Post-emergency phase
Acute Emergency Phase:
Goals:
• Co-ordinate and implement the MISP
• Prevent excess neo-natal and maternal
morbidity and mortality
Objectives:
• Promote clean home deliveries by providing
clean delivery kits.
• Organise a 24 hour referral system for obstetric
emergencies
• Identify qualified and experienced staff to coordinate reproductive health services.
Post-Emergency Phase:
Goals:
• Reduce levels of maternal mortality and morbidity in the
population
• Reduce the levels of unmet needs for contraception.
Objectives:
• Improve medical staff skills at the referral clinic level
within 6 months.
• Ensure local clinic is well equipped with materials and
equipments to handle obstetric emergencies by the end
of the third month.
• Procure sufficient and appropriate contraceptives for
post emergency needs within three months.
4. Detailed Plan of Action:
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What are the activities
How they will be conducted
When
By whom
Goal
Services
Strategy
Activities
Who will
deliver
Decrease
Maternal
Mortality
1.
Antenatal
Care
Improve
recognition
and response
to high risk
mothers at
community
levels
a) Train
outreach
workers
(TBAs &
CHWs)
Nurses/midw 1 wk training for
ives
15 outreach
workers within 3
months
b) Conduct
IEC
campaigns
on necessity
of ANC visits
TBAs and
CHWs
Nurses/midw
ives
Community
organizers
Weekly public
broadcast
Monthly
women’s group
Daily home visit
Increase skills a) Train
and resources midwives &
at the referral doctors
hospital
Local
obstetricians
& senior
nurse/midwi
ves
National level
EOC training
within 3 months
b) Regular
supply of
EOC drugs
& materials
Logistic staff
Order & procure
locally every
month
2.
Emergency
Obstetric
services
How, When
5. Considering Constraints and
Changes
• Cultural taboos about discussing human
sexuality
• The prevalence of high-risk sexual
behavior
• Discriminatory social practices
• Reproductive health care is not considered
a priority as people are focusing only on
their immediate survival needs.
6. Identifying resources:
• Human resources: adequate and welltrained staff, from the affected population.
• Material resources: should rely mainly on
local resources.
Safe Motherhood
Human
resources
Health workers from the affected population,
traditional birth attendants, nurse/midwives,
physicians (for emergency obstetric care)
Material
resources
For maternity ward in clinic: drugs, dressings,
fluids…
For home deliveries: delivery kits,
transportation…
For pregnant mothers and breastfeeding
mothers: additional food….
Monitoring and Evaluation
• Regular monitoring is necessary for
reviewing the progress of each activity in
reaching the objectives.
• In detecting reproductive health needs.
• Two or three indicators should be selected
for each activity.
• Various tools: forms, registers, reports,
etc.
• Evaluation of the concerned program
provides important lessons about
designing future activities.
• Help donors to determine the impact of
their investment.
• Results should be shared with all project
participants, partners and beneficiaries.
• Pre-defines goals, objectives and
indicators should serve as the basis for the
evaluation.
Thank You