1. CARMMA Working groups - Hospital 16 July 2012

2. Key areas of focus to address gaps and challenges HR and Training appropriate pre-service and in-service training and mentoring Midwives: identifying core competencies that are needed by a registered nurse (midwifery 3 rd year); provide supplemental training and mentoring to new nurses entering obstetric services; Obstetric anaesthesia and C/S training ESMOE in pre-grad training; with competency evaluation; IMCI Increase number of midwives Limit rotation of staff Retention of skilled staff Interpersonal relationships

3. Key areas of focus to address gaps and challenges Leadership and Clinical Governance 1.Accountability: Clinicians and Hospital Managers – Performance agreements must be outcomes based – Hospital Management addressing bad practices in their staff 2. Meet National Core Standards 3. Role of Office of Standards Compliance

4. Key areas of focus to address gaps and challenges Transport : improving transport through dedicated Obstetric ambulances Patient knowledge: obstetric emergencies and how to recognize them and access help

5. Good practices - support CARMMA strategy 1.Information for planning, M&E 2.Morbidity and mortality meetings: evidence of minutes; follow-up actions with persons responsible and timeframes; presence of management 3.Training midwives and doctors 4.Incorporate maternal and child health forum into district quarterly review meetings 5.Family centered approach 6.Labour companion/Doula 7.Strengthening Baby friendly health initiatives 8.Emphasis on good clinical governance

6. Quick wins to address gaps and challenges 1.ESMOE training 2.Maternal waiting area 3.Family planning to be determined at each interaction with a health care worker

7. Priorities for next 3 years to strengthen MCH 1.Effective functioning of DCSTs 2.Emphasis on good clinical governance 3.Training 4.Mentoring 5.Maternal waiting areas/homes 6.Strengthening Baby friendly health initiative

8. Strategies for sharing good practices/lessons learned 1.Quarterly reviews district level, especially with MEC 2.Using data for management 3.Regional and Tertiary Hospitals to take responsibility for outreach 4.Document and share experiences of DCSTs