amelia_management strategies at different levels of health systems

8/2/2019 Amelia_Management Strategies at Different Levels of Health Systems

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Management strategies at different

levels of health system on

pre-eclampsia /eclampsia (PE/E)

Dwirani Amelia, SpOG

JHPIEGO/Indonesia


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Principles of Management of PE/E

Early identification and diagnosis of Preeclampsia/Eclampsia

Prompt and timely management of Preeclampsia/Eclampsia :

Prevention of seizures

Control of blood pressure

Evaluation of womans and babys

condition

Timely management and delivery


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Province/National General (type

A/ special) Hospital/ Private

District General (type D)

Hospital/ Private

District General (type C)

Hospital/ Private

Province General (type B)

Hospital/ Private

Public Health Centers BEmONC/Non-BEmONC

Private GP/Obgyn Specialist

Midwife PrivateClinic/Practice

Village health post/

satellite commhealth center

Community/Integrated Village Health Post/CadreReferral

Referral Back


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Emergency Training at Different Levels

of Health System

Other training forEmergency and

BEmONC

BEmONC

CEmONC HospitalPublic/Private

Primary Health Center

Satellite

PrimaryHealth Center

VillageMidwife

Village HealthPost

Private Primary HealthCenter

Private midwivespractice


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Early Identification-Stabilization-

Referral

Community:

Trained volunteer community health worker:

Identification of danger signs in pregnancy

Village midwives/ Midwives and General

Practitioners in Private Practice

Identification: routine check on BP, urine protein

Stabilization: Nifedipine/Metyl Dopa to control BP andadministration of MgSO4

Referral


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Prompt and Timely Management

Community level

Prompt and adequate/proper referral

BEmONC and CEmONC facilities

Early-continuing management

Timely and proper delivery

Appropriate monitoring

Appropriate referral


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Challenges

Trained Volunteer Community Health Worker

Limited number

Knowledge, skill and attitude as cadre need tobe improved

Evolving policies regarding the village health

post management Training package and funding available


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Challenges-2

Midwife scope of practice/General Practitioner

Limited authorization in emergencies condition

Giving medication, administering iv drug

Competent-Proficient-Mastered/confident

Front line in provision of health services


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Continuum of Medical Education

InitialTraining

Continuing Education

Case-based

classroom

training,

clerkship/clinical

rotations

In-service or on the job training

Clinical Mentoring


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SMS

TELE CONSULTATION

WEB-BASED

INFORMATION

EXCHANGE

Mentoring

HOTLINE


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Challenges-3

Prompt, adequate and

proper referral

Infrastructure,

transportation Socio-economic-culture


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Challenges- 4

Prompt and timely management and delivery

National standards on management of PE/E

Policy on decentralization of Health System High turnover of health providers

Limited human resources with urban bias

Non-functioning PONED certifiedhealth facilities


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Strategies

Strengthening community engagement

Develop and operationalize standard clinicalguidelines on PE/E

Update health providers knowledge and skills onPE/E

Strengthening the role of midwives and GP

Strengthening Health Care System Commitment Clear Strategy and Action Plan


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Thank You..

amelia_management strategies at different levels of health systems

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