AMTSL and the newborn AMTSL and the newborn DRCongo AXxe's DRCongo AXxe's experienceexperienceRDCRDC

Michel MPUNGA MD MPHMichel MPUNGA MD MPH

Newborn health program officer AxxesNewborn health program officer Axxes

POPPHI’s MeetingPOPPHI’s Meeting

Washington 20 novembre 09Washington 20 novembre 09

Project AXxesProject AXxes

I. I. Le projet AXxes Le projet AXxes

Global Assitance package to health zonesGlobal Assitance package to health zones

57 health zones 57 health zones

Covers over 8 million personsCovers over 8 million persons

   Reproductive health is given a prominent Reproductive health is given a prominent

placeplace

Alarming situation of Alarming situation of mother and newborn in the mother and newborn in the

DRCDRCAccording to the national health survey (EDS According to the national health survey (EDS 2007:2007:

Maternal Mortality: Maternal Mortality: 549549 for 100 000 live births for 100 000 live births

Neonatal MortalityNeonatal Mortality: : 4242 for 1000 live births for 1000 live births

Reproductive Health Package Reproductive Health Package (AXxes)(AXxes)1.1. Antenatal CareAntenatal Care

2.2. Assisted BirthAssisted Birth

3.3. Care of the newbornCare of the newborn

4.4. Post natal carePost natal care

5.5. Family planningFamily planning

6.6. Management of STIsManagement of STIs

7.7. RRepair of vaginal fistulasepair of vaginal fistulas

8.8. GBVGBV

Essential Components of Essential Components of Maternal and NewBorn CareMaternal and NewBorn Care

1.1. Care of the mother during pregnancy, delivery, and Care of the mother during pregnancy, delivery, and postpartum at the service delivery point with focus on postpartum at the service delivery point with focus on avoidance/management of post partum hemorrhage avoidance/management of post partum hemorrhage (AMTSL)(AMTSL)

2.2. Essential care of the newborn at the level of the service Essential care of the newborn at the level of the service deliver point including newborn resuscitation, treatment deliver point including newborn resuscitation, treatment of infections, and administration of the first doses of of infections, and administration of the first doses of antibiotics before transfer. antibiotics before transfer.

3.3. Promotion of essential care of mother and newborn at Promotion of essential care of mother and newborn at the community level including the early recognition of the community level including the early recognition of signs of danger and care seeking behaviorsigns of danger and care seeking behavior

Integrated care of mother Integrated care of mother and newbornand newborn

► Start of a national workshops to evaluate issue Start of a national workshops to evaluate issue mai-juin mai-juin 0707

► Consensus of the strategies to undertake for integrated Consensus of the strategies to undertake for integrated maternal-newborn care maternal-newborn care october 07 october 07 ::

MOHMOH USAIDUSAID AXxesAXxes BASICSBASICS POPPHIPOPPHI UNICEFUNICEF OMSOMS UNFPA….UNFPA….

Procurement of equipment Procurement of equipment for training, newborn kit for training, newborn kit

and oxytocineand oxytocine

Mannequin for AMSTL ,ENC and Mannequin for AMSTL ,ENC and equipment for baby resuscitation and equipment for baby resuscitation and

newborn kitnewborn kit

ELABORATION, PRODUCTION and ELABORATION, PRODUCTION and DIFFUSION of WORK MATERIAL FOR DIFFUSION of WORK MATERIAL FOR PROMOTING MATERNAL-NEWBORN HEALTH PROMOTING MATERNAL-NEWBORN HEALTH AND Training Kits AND Training Kits

-Reference Manuals -Reference Manuals -Guide for the facilitator-Guide for the facilitator-Notebook for the participant -Notebook for the participant -Register for clinical experiences-Register for clinical experiences-Guide for trainers for rural health -Guide for trainers for rural health promoters on disseminating messages promoters on disseminating messages related to care of mother and newbornrelated to care of mother and newborn

TRAINING OF 27 NATIONAL TRAINERS , 97 TRAINING OF 27 NATIONAL TRAINERS , 97 PROVINCIAL TRAINERS , PROVINCIAL TRAINERS , 370370 PRESTATAIRES PRESTATAIRES

Demonstration: Resuscitation Demonstration: AMTSL

43 ZS & 218 MATERNITES43 ZS & 218 MATERNITES

TRAINING OF 591 VILLAGE HEALTH PROMOTERS FROM TRAINING OF 591 VILLAGE HEALTH PROMOTERS FROM 17 HEALTH ZONES IN SOUTH KIVU & KATANGA17 HEALTH ZONES IN SOUTH KIVU & KATANGA

ASSISTED BIRTH GENERAL ASSISTED BIRTH GENERAL TENDANCE OF RATES & by project TENDANCE OF RATES & by project

yearyear

TRIMESTRE

Q2Q3Q4Q5Q6Q7Q8Q9Q10Q11Q12

0

10,000

20,000

30,000

40,000

50,000

60,000

BIRTH BY SKILLED PERSONS

62,58563,497

56,190

ANNEE PROJET

YEAR 1 YEAR 2 YEAR 3

0

50,000

100,000

150,000

200,000

250,000

BIRTH BY SKILLED PERSONS

233,352

AMTSL AMTSL

AMSTL NUMBER TRIMESTRE

Q2Q3Q4Q5Q6Q7Q8Q9Q10Q11Q12

0K

10K

20K

30K

40K

50K

60K

Sum of NB AMSTL N

62,020

58,450

48,162

AMSTL COVERAGE

TRIMESTRE

Q5 Q6 Q7 Q8 Q9 Q10 Q11

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1.0

AMSTL %

STRIKE

AMSTL TARGET GRAPH

LESSONS LEARNEDLESSONS LEARNED

AvantagesAvantages:: Consistent with the integrated care vision of Consistent with the integrated care vision of

the MOH for SMNE covering two essential the MOH for SMNE covering two essential problems and two significant causes of problems and two significant causes of mortality in the DRCmortality in the DRC

Funds can be shared between two domains.Funds can be shared between two domains. Training, Supervision et Monitoring integrated Training, Supervision et Monitoring integrated

(efficient use of time and resources) (efficient use of time and resources)

Avantages: Avantages: Training of clinical workers in essential Training of clinical workers in essential

maternal care and ensuring the availability of maternal care and ensuring the availability of oxytocin plays a key role in the application of oxytocin plays a key role in the application of AMSTLAMSTL

Sensitizing households by community Sensitizing households by community workers trained in newborn and maternal workers trained in newborn and maternal care and accompanying midwives during care and accompanying midwives during labor in health facilities promotes both labor in health facilities promotes both assisted and safe delivery.assisted and safe delivery.

LECONS APPRISESLECONS APPRISES

LECONS APPRISESLECONS APPRISES

Difficultés:Difficultés: Laborious process for obtaining Laborious process for obtaining

consensus during the intervention. consensus during the intervention. Long delays for obtaining training materialLong delays for obtaining training material Consensus around the adaptation and Consensus around the adaptation and

adoption of training materialadoption of training material Putting program in action takes more time Putting program in action takes more time

and resources than planned.and resources than planned.

LECONS APPRISESLECONS APPRISESDifficultés:Difficultés: Documents are voluminousDocuments are voluminous Several messages taughtSeveral messages taught If there is a shortage of trained personnel this If there is a shortage of trained personnel this

could limit the application of these new could limit the application of these new concepts in maternal and newborn care. concepts in maternal and newborn care.

Challenges :Challenges : Consensus for the integration of information on Consensus for the integration of information on

SENN and GATPA in the Registers of Routine SENN and GATPA in the Registers of Routine CareCare

Long distances, inaccessibility of certain health Long distances, inaccessibility of certain health zones, and necessity of traveling by airplane zones, and necessity of traveling by airplane make supervision visits by national structures make supervision visits by national structures less frequent. less frequent.

The adoption of strategies by provincial health The adoption of strategies by provincial health authorities and those in the health zones authorities and those in the health zones constitute a gauge for the continuity of these constitute a gauge for the continuity of these interventions.interventions.

Thank you for your kind Thank you for your kind attentionattention