Maternal Death Surveillance and Response

Transcription

1 Maternal Death Surveillance and Response A Lessons learned from the MDSR Piloting in Sampang and Central Lombok Districts Evidence Summit Stakeholders Consultation II Jakarta, 18 May 2017

2 Background Persistently high MMR, despite the GoI s concerted efforts in decreasing maternal deaths. MPA was introduced for about 2 decades but implementation is scattered; vary between districts; has not been documented or monitored effectively; not able to expand to other elements of MDSR, the surveillance and let alone the R (response) element Maldives MPDSR meeting (Feb 2016), GoI s ambitious roadmap to 2020, implementing MPDSR covering 20 Provinces and 300 districts UNFPA and WHO are committed to support GoI/ MoH to carry out the roadmap at the country level MDSR piloting in 2 selected districts, conducted by FKMUI, led by MOH, supported by UNFPA

3 Problem Statement High number of preventable maternal deaths Unstandardized MPA process and lack of surveillance for maternal deaths leads to difficulties in Understanding the causes Evidence for interventions/response Determining estimates for measuring level of maternal mortality (at district level)

4 Aims Objectives üto implement the MDSR guidelines at the district level and leverage the maternal death surveillance system üto respond to the findings and prevent other maternal deaths üto provide evidence based initiative for scaling up. TA & FQ 1 üta: Improved local governance system üfq 4A : Does support from the local government affect maternal and neonatal morbidity and mortality? TA & FQ2 üta: Improved utilization of evidence for decision making üfq 5B : How does maternal/mothers related government policy impact maternal & neonatal morbidity and mortality?

5 Theory of change Current Situation: 1. High Maternal Deaths 2. Lack of death surveillance system 3. Unstandardized MPA process 4. Most of maternal deaths are preventable Outputs: 1. All maternal deaths are recorded and reported 2. All maternal deaths are audited 3. Progress to prevent further maternal deaths Outcome: To reduce maternal deaths 1. Improved maternal death surveillance system 2. Improved quality of maternal health care to reduce future preventable maternal deaths 3. More accurate estimate of maternal mortality

6 Design Follow on interview to verify suspected maternal death by FKM UI staff Recapitulation Meeting at PKM with suspect maternal death cases, conduct by PKM staff. Participants Kaur, Bides, Kader. Recapitulation Meeting at PKM with suspect maternal death cases, conduct by PKM staff. Participants Kaur, Bides, Kader. Interview using MAMA-IN form to suspect cases of maternal death by Village Midwife WRA Death Data Collection by Village Informants Jan Feb Mar April Mei Juni Juli Agst Sept Okt Nov Des DPI development Preparation for Finalization Design Meeting Finalization Design Meeting at central level (Prov/Dist) Preparation Meeting with MoH, UN- Agency, FKM UI Kick off Meeting followed by Orientation at District Orientation at Community Conducted by PKM Staff Monitoring Evaluation Monitoring Evaluation Annual Review at District Level Writing Report

7 District Profile, 2015 Indicators Sampang Lombok Tengah Number of Population (Estimate) 936, ,120 Number of Sub-District Number of Village (2017) Number of Public Hospital 1 1 Number of Private Hospital 0 1 Number of Public Health Centre (2017) Number of OBGYN Number of Midwife % Antenatal Visit (1 st Trimester) 101.2% 100.6% % Antenatal Visit (4 th Trimester) 88.9% 91.2% % Delivery with Skilled Attendance 100.7% 89.9% Number of Maternal Death (2015) Number of Maternal Death (2016) Number of Births Number of Live Birth % Facility Delivery % Delivery by health personnel

8 MATERNAL DEATHS BASED ON SUB-DISTRICT, SAMPANG DISTRICT, 2015 U LAUT JAWA BANYUATES 1 KETAPANG SOKOBANAH 1 KAB. BANGKALAN ROBATAL KARANG PENANG 1 TAMBELANGAN KEDUNGDUNG 2 JRENGIK 1 TORJUN OMBEN 2 KAB. PAMEKASAN SRESEH PANGARENGAN SAMPANG 2 CAMPLONG 4 SELAT MADURA

9 MATERNAL DEATHS BASED ON HEALTH CENTER SUB-DISTRICT, LOMBOK TENGAH DISTRICT, JAN-JULY

10 MARCH APRIL 2017 Lombok Tengah Kick Off: March 13 th (Bappeda, BPMPD, RSUD, DHO, Dispendukcapil, 28 Head of PHC, 6 Head of Sub-District) Orientation at District Level: March th (99 participants: Coordinator Midwife, MCH Midwife, Surveillance Personnel) Head of Sub-District Meeting: March 15 th (9 Head of Sub-District) Orientation at Community Level: 5-19 th April (423 participants: Village Midwives, Cadre, Head/Kaur of Village) Sampang Kick Off: March 20 th (Bappeda, BPMPD, RSUD, DHO, Dispendukcapil, 21 Head of PHC, 14 Head of Sub-District) Orientation at District Level: th March (75 participants: Coordinator Midwife, MCH Midwife, Surveillance Personnel) Orientation at village level: th April (558 participants: Village Midwives, Cadre, Head/Kaur of Village) Cadre Orientation (local budget): April 7 th May 10 th (in batches as part of village activities)

11 FINDINGS FROM THE KICK OFF & ORIENTATION IN LOMBOK TENGAH (1) Lombok Tengah Challenges Potential/Solution/Conditions Budget Sustainability of program due to lack of funding. Villages have potential budget from ADDs (Anggaran Dana Desa) that can be used for funding the village health programs, including to support MDSR activities. MPA 1. The MPA process is done by OBGYN who handle the death case -- introduce bias and causing difficulties in producing recommendation 2. Village Midwives filling the AV (Autopsy Verbal) form for maternal death case introduce bias. 3. Budget is not sufficient to cover all cases for MPA process 1. Involving the professional organization (POGI) for case assessment 2. MPA strengthening includes assessment and cases review 3. MPA refresher training for Province and District (including to emphasize the role of coordinator midwife for AV)

12 FINDINGS FROM THE KICK OFF & ORIENTATION IN LOMBOK TENGAH (2) Lombok Tengah Challenges Potential/Solution/Conditions Death Recording and Reporting 1. Deaths were not recorded based on the domicile -- causing under reporting of death case, especially the trans-domicile death 2. At village level, not all deaths were recorded and reported Death Certificate Only 110 death certificates were issued in This indicates that many deaths were not reported. 1. Socialization of the recording of death should be based on the domicile (according to ID card), regardless of the location of the death or the address of the residence; can be conducted by Dispendukcapil 2. The DHO plan to provide fee for Kadus with requirement of death report submission (source of funding: ADD) There should be a village registration officer to record LAMPID (Born, Dead, Move, Coming); and it is expected to be funded from village funds

13 FINDINGS FROM THE KICK OFF & ORIENTATION IN SAMPANG (1) Budget MPA Sampang Barriers Potentials/Solutions/Conditions There supposed to be no barriers related with the budget 1. There are some puskesmas that have not implemented the revised MPA in accordance with the guideline (they still use the older version of MPA forms) 2. Incomplete OVM, and the OVM is still being filled out by village midwives 3. Budget for the implementation of MPA is still considered insufficient to conduct review of all death cases. There is no need for stimulant because the villages are considered independent in terms of budgeting (ADD fund, village fund). 1. Dissemination and refresher training on the revised MPA are still needed

14 FINDINGS FROM THE KICK OFF & ORIENTATION IN SAMPANG (2) Sampang Barriers Potentials/Solutions/Conditions Recording and reporting od death cases Death certificate 1. Insufficient supply of reporting forms and there is no training on administrative matters for the personnel at village level. 2. Incomplete and untimely reporting. 3. Health personnel are reluctant to record death cases that occurred outside the project area or deaths among women who did not access health care in the project area, into the puskesmasrecording and reporting system. There were only 143 death certificates issued in This indicates that a large number of deaths remain unreported and without death certificate. 1. The recording and reporting have been the responsibility of the cadres/kaur, and incentive have been provided through the Village-APB. 2. Personnel in charge of the recording and reporting of death cases could work optimally by determining the death as one of the success indicators of the village. There is a need to appoint village level registrars who will be responsible for the recording of LAMPID (Birth, Deaths, Migration), which are expected to be funded from the village fund (it is not in place yet).

15 FINDINGS FROM THE COMMUNITY-LEVEL ORIENTATION MEETING IN LOMBOK TENGAH (1) Implementation Facilitators from some of the PKM had not understood their roles to deliver training of the recording and reporting during the community-level orientation meeting Facilitators for the orientation in 3 PKM (Bagu, Wajageseng, and Kuta) were surveillance officers. All activities were supervised/mentored by the staff from DHO (Family Health, Surveillance, and Health Service Units) There was no supervision from the province level Most of the village staff were willing to reproduce the forms to be distributed to the cadres There were questions about the salary for cadres.

16 FINDINGS FROM THE COMMUNITY-LEVEL ORIENTATION MEETING IN SAMPANG (1) Implementation: Orientation was conducted at the PKM All activities were supervised/mentored by the staff from DHO (Family Health and Community Health Units) There was no supervision from the province level There were questions about the salary for cadres Orientation for the cadres is scheduled to be conducted in April and May (Kamoning and Camplong).

17 MPA (1) Number of maternal death Number of audited maternal death through MPA Number of MPA forms obtained from preliminary visit Number of MPA per year (budgeted) Maternal Death Cases Discussion in Sampang Lombok Tengah OVM (4) (DRK) Maternal Review (11) Summary of Maternal Review (11) - - OVM 17 RMM On March 29 th, 2017 the MPA process has been done to discuss the maternal death cases On April 11 th, 2017 DRK (Diskusi Refleksi Kasus) has been done to discuss the maternal death cases -

18 MPA (2) 1.Lombok Tengah besides the MPA budget, the DHO also receives the DRK funding (Diskusi Refleksi Kasus) for twice a year, which involved ObGyns, Pediatricians, CEONC Team, and the PKM where the maternal death occured. 2.Sampang MPA is not performed to all death cases: The deceased is not originally from the area 42 days Post-partum with hours discrepancy (considered as 43 days) Deaths that are not caused by direct cause according to the DHO the cases are still reported as death cases, but MPA is not conducted for thoses cases, the cases are only discussed by the managerial team, reviewer team, and the DHO.

19 MPA (3) Recommendation resulted from the MPA Sampang Improve the competency of the health personnel, and compliance with the SOP Case management at RSUD Sampang (shorten the response time at the ER and VK) Consultation via WA with the ObGyn. Visit of the DSOG to the 21 PKM to deliver the materials and perform role-play of complication cases. Lombok Tengah BKD Consensus not to rotate the trained midwives without coordination with the DHO RSUD -- Rolling of experienced and trained midwives in the ER/CEONC à 4 moths review does not show any death cases PDAM Not to restrict the time and amount of clean water supply to the RSUD Midwife-TBA partnership incentive for transportation in the amount of ,- /delivery Babinsa Decision making process for referral

20 FOLLOW-UP PLAN May Oct: Recording and reporting of deaths of women of reproductive age (WRA) by village informants. Visit and interview of the WRA death cases using the MAMA-IN forms by village midwife. Visit for validation of WRA death cases by the field staff as a mean of verification of maternal deaths. Monev: Monev Sampang: 4 7 June2017 Monev Lombok Tengah: June 2017 Activities Agenda: Obtain description of the problems in the implementation of recording and reporting of death cases. Review and documentation of all forms collected for each maternal death, including MPA and its recommendations. All collected forms will be reviewed by experts at the national level to evaluate the quality of MPA (tentative).

21 Thank you