sa home facility nepal by chO6OliW


									 Skilled birth attendant at home,
           SHP, & HP
• Level of competency: A) MCHWs- monitors
  labour using modified partograph, provides active
  management of third stage (I/M oxytocin, CCT, &
  uterine massage, recognise complications, stabilise
  condition by I/V infusion, I/M-mag sulphate,
  Oxytocin, & oral antibiotics and makes referral to
  the appropriate level of facility depending on
  woman’s condition
• B) ANM’s - all above plus I/V mag sulphate,
1. MCHWs not associated with any professional
   council, but a permanent employee of MOH
   with JD (needs revision)
2. Training: A) MCHWs-3.5 month basic course,
   and 6 weeks competency based MRT
   B) ANMs- 18 months basic course, and 30 days
   competency based MRT
3. 500 MCHWs being upgraded to ANMs
   currently and will be continued
4. 250 SHPs will be upgraded with the provision of
   labour room
        Enabling environment
• EOC kit with essential drugs & equipment
• Developed guidelines on refill of EOC kit box, &
  supportive supervision
• Pairing with TBAs and FCHVs
• Formation of community level safe motherhood
• Provision of award system based on performance
• Health management committee in place
• Supportive supervision/mentoring
4. Referral: facilitate the utilisation of emergency
   fund, manage emergency transport, if possible
   accompany the woman to the facility, use referral
   slip, and maintains good relationship with the
   referred health facilities
5. Advocacy to promote new role of trained MCHWs
6. BPP ( as a BCC tool) to address the first, and
   second delay
7. M & E: a self assessment monitoring system on
   quality of care and utilisation has been introduced
   at the facility level, and district level.
SA at the facility level(PHC, district
           level hospital)
Staffed with 1-MO, 1-SN, and 3-ANMs
Level of competency: expanded role of nurses in
    providing a full range of BEOC services and fits
    with the definition of SA.
1. Regulations: amendment of the council act for
    the provision of BEOC
2. Existing curricula of all levels of Nursing and
    ANMs should be revised.
3. In addition in service competency based BEOC
    training should be given (on going)
4. JD should be revised accordingly
       5.Enabling environment
• Inclusion of essential drugs for EOC in the
  essential drug list for PHC
• Ensure regular annual supply of essential drugs
  and logistics
• Effective CDP
• Functional health management committee
• Provision of fund to purchase essential
  drugs/equipment/supplies locally
• Good referral mechanism and feed back for follow
  up and preparedness for receiving referred cases
• Provision of exemption/subsidy for poor
SA at upgraded district hospital and
Level of competency: Nurses provide a full range of
   BEOC services, MDGP/Obs provide a full
   range of B/CEOC services.
1. Regulations: NMA
2. EE: Effective hospital management committee,
   provision of adequate physical facilities and
   supplies for CEOC with blood transfusion
3. M&E: HMIS, EOC utilisation rate, auditing
   QoC ( revision of HMIS tools for SM in

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