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Management strategies at different
levels of health system on
pre-eclampsia /eclampsia (PE/E)
Dwirani Amelia, SpOG
JHPIEGO/Indonesia
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Principles of Management of PE/E
Early identification and diagnosis of Preeclampsia/Eclampsia
Prompt and timely management of Preeclampsia/Eclampsia :
Prevention of seizures
Control of blood pressure
Evaluation of womans and babys
condition
Timely management and delivery
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Province/National General (type
A/ special) Hospital/ Private
District General (type D)
Hospital/ Private
District General (type C)
Hospital/ Private
Province General (type B)
Hospital/ Private
Public Health Centers BEmONC/Non-BEmONC
Private GP/Obgyn Specialist
Midwife PrivateClinic/Practice
Village health post/
satellite commhealth center
Community/Integrated Village Health Post/CadreReferral
Referral Back
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Emergency Training at Different Levels
of Health System
Other training forEmergency and
BEmONC
BEmONC
CEmONC HospitalPublic/Private
Primary Health Center
Satellite
PrimaryHealth Center
VillageMidwife
Village HealthPost
Private Primary HealthCenter
Private midwivespractice
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Early Identification-Stabilization-
Referral
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 andadministration of MgSO4
Referral
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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
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Challenges
Trained Volunteer Community Health Worker
Limited number
Knowledge, skill and attitude as cadre need tobe improved
Evolving policies regarding the village health
post management Training package and funding available
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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
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Continuum of Medical Education
InitialTraining
Continuing Education
Case-based
classroom
training,
clerkship/clinical
rotations
In-service or on the job training
Clinical Mentoring
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SMS
TELE CONSULTATION
WEB-BASED
INFORMATION
EXCHANGE
Mentoring
HOTLINE
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Challenges-3
Prompt, adequate and
proper referral
Infrastructure,
transportation Socio-economic-culture
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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 certifiedhealth facilities
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Strategies
Strengthening community engagement
Develop and operationalize standard clinicalguidelines on PE/E
Update health providers knowledge and skills onPE/E
Strengthening the role of midwives and GP
Strengthening Health Care System Commitment Clear Strategy and Action Plan
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Thank You..