Transcript Slide 1
CPAC IN KENYA WHERE WE ARE By Dr Solomon Orero (MD,MMED,IMH) The Origin of PAC The history of legalization of abortion care From the 1950s This is not visible in the African Continent and Latin America Arguments for legalization Maternal mortality and morbidity The public Health Platform and resources The Sexual reproductive Health and Rights Platform The Landmark Decisions in Abortion Care The USA 1973 Judicial ruling-How it has since affected the rest of the world The 1984 Mexico policy and its impact-The “Gag Rule” The 1994 Landmark ICPD The Mexico City Liberalization of abortion Law-GIRE PAC The term PAC first articulated in 1991 The Historical origins of PAC The logic of inclusion of PAFP The logic for the inclusion of referrals and linkages with other RH services In 1993-The PAC consortium AVSC now Engender health IPPF IPAS Pathfinder International JHPIEGO The Original PAC model 1994 Emergency Treatment-Evacuation of the uterus Post Abortion Family Planning counseling and services Referrals and Linkages with other RH services ICPD 1994 and Land mark para 8.25 “All governments and organizations to strengthen their commitment to women’s health" and “deal with the health impact of unsafe abortion” Expansion of the programmes and access issues Decentralization of: – – – The provider skillThe health facility Involvement of the informal providers and the community Consultants Referral hospitals General Practitioners First level referral hospitals Sub-district hospitals Mid level providers All hospitals Health Centers Dispensaries Informal providers ( TBAs, Health workers, community based health workers) Found in the communities The reviewed PAC concept Community and service provider partnership Counseling Emergency treatment Family Planning and Contraceptive Services Referrals and Linkages to RH and other services Community and service provider partnership 1. Community and service provider partnerships for prevention (of unwanted pregnancies and unsafe abortion), mobilization of resources (to help women receive appropriate and timely care for complications from abortion), and ensuring that health services reflects and meet community expectations and needs Community and service provider partnership Cont’d 2. Counseling to identify and respond to women’s emotional and physical health needs and other concerns. 3. Treatment of incomplete and unsafe abortions and complications that are life threatening. Community and service provider partnership Cont’d 4. Contraceptive and family planning services to help women prevent unwanted pregnancy or practice birth spacing: and 5. Linkages with other reproductive health services that are preferably provided onsite or via referral to other accessible facilities in the providers network. Community and provider partnerships The partnership includes education: 1. To increase FP use, prevention of unwanted pregnancies 2. Risks and consequences of unsafe abortions 3. Promotion of client oriented health rights based on sexual and RH services 4. Signs and symptoms of obstetric emergencies Community and provider partnerships cont.. 5. In what sexual and RH services are provided 6. Mobilization of community resources to ensure that women with obstetric emergencies (including PAC) receive timely and appropriate care 7. Planning and sustaining PAC and other RH services (HIV/AIDS, FGM, gender violence etc) Counseling 1. To find and affirm the women’s feelings 2. Ensure that women receive appropriate answers to their questions or provided with adequate information on their condition and treatment. 3. Help women clarify their thoughts about pregnancy, PAC, return of ovulation and RH future 4. Address other concerns that women may have Treatment Provision of emergency treatment by evacuation of the uterine contents through: 1. Manual Vacuum Aspiration (MVA) or 2. Sharp Curettage (SC) or 3. Electric Vacuum Aspiration (EVA) or 4. Use of chemicals e.g Misoprostol. Contraceptive and FP services Access to a wide range of contraceptive methods to women who desire to delay or avoid pregnancy so as to avoid unwanted pregnancies. What is going on in the recent past and now? Community Based Abortion Care Creation of community partnerships High profile newspaper reported cases regarding unsafe abortion ,Street dumped fetuses What is new in Kenya? The challenges of providing all the PAC components: – – – – – PAFP -counseling and services Continuous decentralization of MVA/PAC services Obs/Gyn,MOs,MLPs,Informal Providers Training,MVA kit new to MVA Plus The Environment is getting more hostile 40th Anniversary of FP On May 13th,2008 will be the 40th anniversary of FP as a recognized Human rights issue “On that day, there will be many couples who will have an unmet need for FP”For many reasons they will not access Family planning methods One reason in Kenya :there has been no major investment in FP the last almost 2 decades On Investment in Health Investment at the community level in creating awareness and seeking to improve health seeking behaviour Investment in the institutional level in getting the infrastructure up and running with the right mix of skills On Investment in Health Investment in health systems development and use of RH abortion included as a fulcrum for change Investment in policy and strategy development for Health and therefore RH and undertake advocacy for stronger legislation and better services integration ANC CPAC Safe Delivery Basic Maternity Care Essential Obstetric Care Family Planning PILLARS OF SAFE MOTHERHOOD PRIMARY HEALTH CARE EQUITY FOR WOMEN MAP OF KENYA & KMET PROJECT AREAS The Map of Kenya and some facts Kenya: Country Background •Population: 33 million •GDP: Kshs. 920 b (US $ 12.5 b) •Per capital income: US$ 380 A map of Kenya showing the PEV hot spots what it will mean in PAC KMET PROGRAMS POST ABORTION CARE SAGAM COMM HOSPITAL INT’L STUDENTS/ VOLUNTEERS CLINICAL SERVICES HOME BASED CARE FOR PLWHA NUTR’N AS A COMPONENT OF HBC KMET PROGRAMS SAFE MOTHERHOOD INITIATIVE MICROFIANANCE YOUTH FRIENDLY SERVICES The allocation of health budget-Kenya Reproductive health services cover a meager 0.6% of the health budget. Households are the greatest source of expenditure on health they spend from their pockets. The households expenditure on RH is minimal Transportation of a patient with impending uterine rupture and choriamnionitis worse for abortion patients.