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Management strategies at different levels of health system on pre-eclampsia /eclampsia (PE/E)

Dwirani Amelia, SpOG JHPIEGO/Indonesia

Principles of Management of PE/E


Early identification and diagnosis of Pre eclampsia/Eclampsia Prompt and timely management of Pre eclampsia/Eclampsia :
Prevention of seizures Control of blood pressure Evaluation of womans and babys condition Timely management and delivery

Province/National General (type A/ special) Hospital/ Private Province General (type B) Hospital/ Private District General (type C) Hospital/ Private District General (type D) Hospital/ Private Public Health Centers BEmONC/Non-BEmONC Private GP/Obgyn Specialist Village health post/ satellite comm health center Referral Referral Back Midwife Private Clinic/Practice

Community/Integrated Village Health Post/Cadre

Emergency Training at Different Levels of Health System


CEmONC BEmONC
Other training for Emergency and
Primary Health Center

Hospital Public/Private

Private Primary Health Center

BEmONC

Satellite Primary Health Center

Village Midwife

Village Health Post

Private midwives practice

Early Identification-StabilizationReferral
Community:
Trained volunteer community health worker:
Identification of danger signs in pregnancy

Village midwives/ Midwives and General Practitioners in Private Practice


Identification: routine check on BP, urine protein Stabilization: Nifedipine/Metyl Dopa to control BP and administration of MgSO4 Referral

Prompt and Timely Management


Community level
Prompt and adequate/proper referral

BEmONC and CEmONC facilities


Early-continuing management Timely and proper delivery Appropriate monitoring Appropriate referral

Challenges
Trained Volunteer Community Health Worker Limited number Knowledge, skill and attitude as cadre need to be improved Evolving policies regarding the village health post management Training package and funding available

Challenges-2
Midwife scope of practice/General Practitioner Limited authorization in emergencies condition
Giving medication, administering iv drug

Competent-Proficient-Mastered/confident
Front line in provision of health services

Continuum of Medical Education


Initial Training
Case-based classroom training, clerkship/clinical rotations

Continuing Education
In-service or on the job training Clinical Mentoring

Mentoring
WEB-BASED

TELE CONSULTATION

SMS

HOTLINE

INFORMATION EXCHANGE

Challenges-3
Prompt, adequate and proper referral Infrastructure, transportation Socio-economic-culture

Challenges- 4
Prompt and timely management and delivery National standards on management of PE/E Policy on decentralization of Health System High turnover of health providers Limited human resources with urban bias Non-functioning PONED certified health facilities

Strategies
Strengthening community engagement Develop and operationalize standard clinical guidelines on PE/E Update health providers knowledge and skills on PE/E Strengthening the role of midwives and GP Strengthening Health Care System
Commitment Clear Strategy and Action Plan

Thank You..

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