Human Resources Development in EOC ---------- Condition of High Maternal Mortality Maternal Death Women's Right → Malnutrition ← Economic Socio-cultural → Anemia ← Infrastructure Education → Infection ← Literacy Malaria ---------- Maternal deaths in Bangladesh Eclampsia: 42% Hemorrahge: 15% Ruptured uterus: 11% Obstrucetd labor: 8% Sepsis: 4% Others: 20% ---------- Place of deliveries at home: 91% Government: 6% NGO/private: 3% others: 0% ---------- Birth attendants (BA) Untrained BA: 64% Relatives: 11% Trained BA: 12% Doctor: 6% NS/MW/FWV: 5% No one: 1% Others: 1% ---------- Antenatal care visits None: 53% 1 visit: 14% 2 visits: 12% 3 visits: 9% more than 4: 12% ---------- Health & Population Sector Program (HPSP) ・Sector wide approach program (SWAP) ・Integration of family planning and health services ・Essential Service Package (ESP) ---------- Ministry of Health & Family Welfare DGHS DGFP Upazilla Health Complex Clinical services, Support services, Field services Union Health & Family Welfare Center ---------- Essential service package Reproductive Health Child health Communicable Disease control Limited curative care Behavior change communication ---------- Integration of DGHS & DGFP on Reproductive health DGFP 1. Family planning 2. Maternal nutrition 3. Normal delivery 4. Ante-natal care 5. Post-natal care DGHS 1. Obstetric care (Abnormal delivery) 2. RTI, STD & AIDS 3. Neonatal care National Strategy for Maternal Health ---------- Reproductive health ・Safe motherhood ・Family planning ・Prevention & control of RTI/STD/AIDS ・Maternal nutrition ・Unsafe abortion ・Adolescent care ・Infertility ・Neonatal care ---------- Safe Motherhood Ante-Natal Care C-EOC B-EOC Referral Risk detection Normal delivery Post-Natal Care ---------- Level & activity for EOC ●Community ANC Vaccination Education Normal deliv. Risk detection Community mobilization Referral ●Union Obstetric First aid (Injection of oxytocic drugs, antibiotics and anticonvulsant) Normal delivery Referral ●Upazilla First aid B-EOC (Assisted vaginal delivery) Manual Removal of Placenta ●District & Upazilla First aid B-EOC C-EOC (Cesarean section, Blood trans.) ---------- Community midwife training Training is only a part of whole process to secure the home deliveries. ---------- Human Resources Development in EOC To reduce maternal mortality rate The right people → Who will be trained and where ? With right skills → Standardization of curricula In the right place, At the right time → Referral system GO & NGO collaboration Monitoring and evaluation ---------- Skilled birth attendants to reduce maternal mortality Target One skilled birth attendant per 5,000 population Total needs： 26,000 in Bangladesh Who will be trained ? ●Community Family Welfare Assistant (FWA) NGOs ●Union Family Welfare Visitor (FWV) ●Upazilla/Districts Registered NS Registered MW ---------- Where they will be trained ? ・Training institutes should have; - Adequate number of qualified trainers - Training facilities/ materials - Adequate number of delivery cases Medical Colleges -Dhaka:10,000 -Others:2,000 x 12 MCHTI: 6,000 ICMH: 1,700 District hp (59) 0-2,000 (Av:500) MCWC (61) 300 per each ---------- Human Resources Development in Reproductive Health (HRDRH) 1. To improve the clinical activities in MCHTI 2. To improve the training activities in MCHTI 3. To strengthen the collaboration network between MCHTI & other training institutes 4. To establish monitoring and evaluation system through capacity development of Technical Training Unit (TTU) in MOHFW ---------- To improve the clinical activities ・Hospital management ・Women friendly hospital initiative ・Behavior change communication ---------- To improve the training activities MCHTI ・Establishment of Training unit & Training committee ・Capacity building of sister tutors ↓ - EOC Training for FWV - Community Midwife Training for FWV - Continuous Medical Education for FWV - Training for NGO workers ----------- To strengthen the collaboration network among the training institutes Line- Director In-service training Technical Training Unit MCHTI ICMH NIPORT MFSTC DMCH ---------- To establish monitoring & evaluation system Make linkage based on human relationship in order to empower FWVs! ・Follow-up system by trainers at working site of trainees ・Communication between trainers & trainees ---------- Community midwife training ・Trainees: Family welfare visitor (FWV) ・Working places: Union Health & Family Welfare Center (UHFWC) ・Training courses - Duration: 6 months - Training places: MCHTI, ICMH, District hospitals - Contents: Normal delivery care (with episiotomy), Risk detection and management, ANC, PNC and neonatal care ----------- Post training follow-up ・Follow-up team Training planner, coordinator, trainers ・Results of follow-up - FWV obtained and kept knowledge and skill after the training course - FWV can not conduct home delivery due to several difficulties. ---------- Lesson learnt ・Follow-up system by trainers at working site of trainees should be established. ・Commitment of the Government is important to establish the back-up system to support home delivery by community midwife. ・Community midwife should be selected from the community and stay in the community.