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Training and Monitoring of Midwives for their Expanded Role in Maternal and Child Health Alejandro R. San Pedro Board of Midwifery Professional Regulation Commission Department of Obstetrics and Gynecology Bulacan Medical Center The Women Deliver - Philippines Conference September 17, 2010 The Crowne Plaza Hotel, City of Mandaluyong Presentation content • Midwifery in the Philippines • Scope of midwives’ expanded functions • Undergraduate & In-Service training • Monitoring facilities & practitioners • Challenges in training & monitoring Midwifery in the Philippines • Direct entry course • 248 Midwifery Schools* • Training on expanded role begins in Midwifery school (new curriculum) • Entry into practice requires passing the MLEx (PRC)* • Ladderized curriculum in selected schools • BSc in Midwifery * CHED data ** Professional Regulation Commission Expanded role added skills (Midwifery Act of 1992) Internal examination Suturing perineal lacerations Intravenous fluid insertion Dispensing oxytocics Vitamin K for newborn Midwives in the Philippines 157,501 RMs up to Jan. 8, 2010 17,000 RMs work in the public sector Midwifery Act of 1992 (R.A.7392) primary health care services in community, including nutrition and family planning • to giving motivation and counseling to married couples who wish to avail of family planning services. • midwives who have undergone a special training given a certificate by the Certifying Board jointly undertaken by the DOH and the Board of Midwifery will be allowed to provide FP interventions that are medical or surgical in nature, i.e. pills and intrauterine devices. 82,000 Filipino children die annually, most could have been prevented Source: CHERG estimates of under-five deaths, 2000-03 The Philippines is one of the 42 countries that account for 90% of global under-five mortality Source: H. Sobel Unang Yakap – Essential Newborn Care Presentation Training for midwives’ on expanded role (mainly In-Service) 1. Life Savings Skills and MDG Countdown (POGS) 2. Basic and Comprehensive Family Planning (DOH, IMCH) 3. BeMONC (Fabella Hosp) 4. EPI/IMCI (DOH) 5. Newborn Screening 6. Essential Newborn Care (PSNbM) * DrJFMH began training in 1994 on expanded midwifery functions CPE Council for Midwifery Composition: • Accreditation & monitoring CPE • Board of Midwifery Providers and • APO (accredited Programs professional organization) (Competency-based training, interactive learning, workshop, • APSOM (academe) standards of care and best practices, unlearning harmful practices, clinical case conference, maternal death review). Monitoring • Licensing & Regulating of Birthing Homes (BH) • PhilHealth monitoring of Accredited BH • Board of Midwifery (BOMid) monitoring of BH or solo practice • Joint BOMid-CHED assessment of poorly performing schools Achieving & maintaining competence of Midwives • Caseload (e.g. childbirth attended) is needed to gain and maintain competence? • Tools for assessing different competence • Standardization (harmonize) of modules * 15462 currently enrolled AY 2009-2010 7053 Midwifery graduates AY 2008-2009 Some observations on monitoring Some observations on monitoring (Birthing Clinic Chart) Some observations on monitoring (Birthing Clinic Chart) Some challenges 1. Compliance with required competencies (caseload) 2. Getting support of LGU leaders 3. No appropriate items in hospital for midwives (Nursing Attendant) 4. Proliferation of “unregulated” birthing homes 5. Overmedicalization of childbirth 6. Health system not fully functioning Attendance during childbirth (Bulacan Province 2009) • Doctors (33.24%) • Midwives (60.46%) • Nurses (0.26%) • Hilots (6.04%) 59.94% are Homebirths 65,189 births in 2009 Source: Bulacan 2009 Annual Report on Natality by Attendance Reminder • Graduate midwives of the old curriculum (before 1996) are required to attend a Professional Regulation Rule 10. No. 4. Commission (BoMid) Only registered midwives with the proper training on accredited training intravenous insertion and suturing perineal laceration will program to acquire be allowed to perform such procedures….. and by the year competence on the 1996 no midwife will be allowed to renew her/his license without the needed training. added skills. Source: Resolution 100 R.A.7392. Key Message Competent, committed, compassionate and connected midwives supported by an enabling environment can help achieve MDGs’ 4 & 5 and protect public safety!
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