“Determining Response Capacity in Obstetric and Neonatal Emergencies ” Alfonso Villacorta MD, Miguel Gutierrez MD, Jhony Juarez MD, Enrique Guevara MD 30th Annual Conference, Global Health Council Washington, DC May 29, 2003 PATHFINDER INTERN ATIONAL & CATALYST CONSORTIUM

SITUATION IN PERU Maternal mortality in Peru is very high with a rate of 185 deaths per 100,000 live births.  The main causes of maternal mortality are: –Pregnancy-induced hypertension (13%) –Hemorrhages (48%) –Infections (10%) –Unsafe Abortions (7%)

SITUATION IN PERU  58% of labors are attended in health facilities. In rural areas, only 24% are attended in a health facility.  Nearly 50% of maternal deaths take place in health facilities.  The response capacity of health facilities to control maternal mortality and neonatal emergencies is unknown.

Improving Quality of Services for Obstetric and Neonatal Emergencies in Public Health Facilities in five Regions of Peru Purpose: To contribute to the reduction of maternal and perinatal mortality by improving reproductive health care services for obstetric and neonatal emergencies in 24 health facilities of 5 departments of the Peruvian jungle.

 Assessments  Sensitization  Training courses  Improved quality of the workplan  Supervision and monitoring Principal Activities

Assessment Objectives  Identify the response capacity of health facilities based on obstetric and neonatal functions.  Identify the prevalence of obstetric and neonatal emergencies in the health facilities selected.  Identify the protocols used for obstetric and neonatal emergencies.

 Identify activities performed in the health facilities related to the client’s satisfaction and reproductive rights.  Identify the use of perinatal information systems. Assessment Objectives

What is the importance of assessing the response capacity of health facilities in the case of obstetric and neonatal emergencies? 1. To contribute to the improvement of the service network organization for a timely referral. 2. To determine the lack of resources needed to provide health care in appropriate conditions.

3. To identify critical aspects of clinical procedure management and training requirements with the use of indicators. 4. To gather information on available resources and results indicators.

WHAT IS THE METHODOLOGY DEVELOPED IN PERU TO CONDUCT RESPONSE CAPACITY ASSESSMENTS?  Methodology is quantitative, based on a descriptive analysis of the data.  Data recollection formats were applied to determine the existing resources. Formats were different according to facility type and obstetric and neonatal functions that the facility is able to perform.

 What resources does the health facility have in order to accomplish specific obstetric and neonatal functions?  Considering the existing resources, how are the procedures being done? The response capacity was measured by answering 2 questions:

1.What resources does the health facility have? Two variables are considered: 1.1 Resources: Human Resources, equipment, instruments, disposable material, pharmacy, laboratory, transport, communication, etc 1.2 Obstetric and Neonatal Functiones (ONF) Primary Functions (health posts) Basic Functions (health center) Essential Functions (hospitals) Intensive Functions (hospitals with Intensive Care Units)

INSTRUMENTS:  Checklist for obstetric and neonatal functions by each facility type.  Software for obstetric and neonatal functions

Software for obstetric and neonatal function INSTRUMENTS: Software for obstetric and neonatal function

FUNCION OBSTETRICA Y NEONATAL ESENCIAL RECURSO TOTAL DISPONIBLE ACTIVIDADES N° % Consulta prenatal esencial % Atención del parto distócico o complicado y RN con complicaciones % Extracción manual de placenta complicada % Atención del aborto incompleto % Atención de la hipertensión inducida por el embarazo moderada- severa y eclampsia % Atención de la hemorragia severa y shock hipovolémico %

Software for obstetric and neonatal function INSTRUMENTS: Software for obstetric and neonatal function

2.Considering the existing resources, how are the procedures being done? Process and output indicators are being considered for each of the obstetric and neonatal activities. Initially, only hospitals having ostetric and neonatal functions were considered.

INSTRUMENTS: 1.Computerized clinical history and database 2.Software for indicators obstetric and neonatal function Essencial (EONF)

Software for indicators obstetric and neonatal function Essencial INSTRUMENTS: Software for indicators obstetric and neonatal function Essencial

How can the methodology be applied in other resource-poor settings to determine the response capacity of various level health facilities?

1.Identify the health facility for patient referrals. Steps: 2.Define the obstetric and neonatal functions that each facility should provide, and utilize the existing format for collecting data. 3. Adapt the software to any country.

RESULTS Response capacity of 31 health facilities. HospitalsHealth Centers Health Posts 74 %61 %59 %

RESULTS The response capacity assessment was conducted 226 health facilities in Huanuco. The average response capacity was 44.5%.