1. MOVING TO ACTION:
Identifying Responses

2. Learning objectives By the end of this session, participants will be able to:
Identify actions appropriate to data presented
Use the action tool and support its implementation
List ‘evidence based actions’
Prioritise actions in a systematic way

3. Taking action to reduce avoidable maternal deaths is the reason for conducting MDSR

4. What are appropriate actions?

5. Scenario A 21-year old had her 3rd baby at home.
Her first baby died after a difficult delivery. Her second baby was premature and survived.
During this pregnancy, she attended antenatal care at the local health centre.
She started bleeding 1 hour after delivery of a healthy baby. The local skilled birth attendant (SBA) came within 1 hour.
She found the woman very pale and collapsed and gave her oxytocin and then misoprostil.
The SBA suggested moving the woman to the local hospital , an hour away, as the bleeding continued. The husband did not agree and the woman died

6. Practical exercise Work on your own
Consider the 9 possible actions listed on pg. 22 in the workbook
List the 3 actions you think would be most effective in this case

7. ?

8. What are evidence based actions?
Actions for which there is over whelming evidence that maternal mortality and morbidity will be prevented if they are followed.
Usually refer to clinical actions, based on trials
Individual cases should be assessed to see if “best practices” were carried out or not
If not, appropriate action should be taken to ensure these are implemented to prevent further deaths
Ethiopian Guidelines (FMOH) for A/N and intrapartum care provide details

9. General Family planning Iron HIV Malaria SBA and Birth preparedness
Health education & promotion

10. Eclampsia Diagnosis and treatment of high blood pressure
Magnesium Sulphate
Timely delivery

11. Haemorrhage Active management of third stage of labour Misoprostil
Blood transfusion (dependent on environment)

12. Sepsis
Clean delivery
Antibiotics for prolonged ruptured membranes at term
Antibiotics for C/S
Avoid prolonged delivery

13. Abortion Availability of safe abortion
Availability of post abortion care including safe MVA or D&C and i/v antibiotics

14. Obstructed labour Facility delivery after 12 hours of labour
Use of partograph
Availability of C/S

15. Non clinical actions
Not all problems identified during the review and analysis have clinical solutions
Actions in the community e.g. Changing health-seeking behaviour, addressing transportation, reducing costs of accessing care, also play a role.
Innovative solutions come about through community participation in identifying and carrying out actions likely to be successful.

16. Prioritising!

17. Which actions? Not all problems can be tackled simultaneously
Prevalence – how common is the problem?
Feasibility of carrying out the action – are there extra staff available? Is it technologically and financially possible?
What is the potential impact of the action?
If successfully implemented how many women would be reached and how many lives saved?

18. Prioritisation Exercise

19. Prioritisation Action Prevalance Feasibility Potential impact
Iron is available- anaemia is eliminated
Commend and empower SBA
Family planning to prevent unwanted pregnancy
Guidelines re ANC available
EMONC training re AMTSL + PPH
SBA attendance at delivery- community education

20. (Facilitated Discussion)
Which action(s) address the most prevalent problems
Which action(s) are most feasible? (Why or why not?)
Which action(s) will deliver the most impact?
Reminder that prioritisation is subjective and best done in a multi disciplinary team including community members ( especially non clinical)

21. Group exercise using action tool
6 groups of 5-6 each
Details and scenario in Workbook
Exercise simulates facility committee
Action tool completed for the scenario described