MOVING TO ACTION:Identifying Responses

Learning objectivesBy the end of this session, participants will be able to:

• Identify actions appropriate to data presented • Use the action tool and support its

implementation • List ‘evidence based actions’• Prioritise actions in a systematic way

Taking action to reduce avoidable maternal deaths is the reason for conducting

MDSR

What are appropriate actions?

Scenario • A 21-year old had her 3rd baby at home. • Her first baby died after a difficult delivery. Her second baby

was premature and survived.• During this pregnancy, she attended antenatal care at the

local health centre. • She started bleeding 1 hour after delivery of a healthy baby.

The local skilled birth attendant (SBA) came within 1 hour. • She found the woman very pale and collapsed and gave her

oxytocin and then misoprostil. • The SBA suggested moving the woman to the local

hospital , an hour away, as the bleeding continued. The husband did not agree and the woman died

Practical exercise

• Work on your own• Consider the 9 possible actions

listed on pg. 22 in the workbook• List the 3 actions you think would

be most effective in this case

?

What are evidence based actions?Actions for which there is over whelming evidence that

maternal mortality and morbidity will be prevented if they are followed.

• Usually refer to clinical actions, based on trials• Individual cases should be assessed to see if “best

practices” were carried out or not• If not, appropriate action should be taken to ensure

these are implemented to prevent further deaths• Ethiopian Guidelines (FMOH) for A/N and

intrapartum care provide details

General

• Family planning• Iron• HIV• Malaria• SBA and Birth

preparedness• Health

education & promotion

Eclampsia

• Diagnosis and treatment of high blood pressure

• Magnesium Sulphate

• Timely delivery

Haemorrhage

• Active management of third stage of labour

• Misoprostil• Blood transfusion

(dependent on environment)

Sepsis

• Clean delivery• Antibiotics for

prolonged ruptured membranes at term

• Antibiotics for C/S • Avoid prolonged

delivery

Abortion

• Availability of safe abortion

• Availability of post abortion care including safe MVA or D&C and i/v antibiotics

Obstructed labour

• Facility delivery after 12 hours of labour

• Use of partograph• Availability of C/S

Non clinical actions

• Not all problems identified during the review and analysis have clinical solutions

• Actions in the community e.g. Changing health-seeking behaviour, addressing transportation, reducing costs of accessing care, also play a role.

• Innovative solutions come about through community participation in identifying and carrying out actions likely to be successful.

Prioritising!

Which actions?

• Not all problems can be tackled simultaneously• Prevalence – how common is the problem?• Feasibility of carrying out the action – are there

extra staff available? Is it technologically and financially possible?

• What is the potential impact of the action? – If successfully implemented how many

women would be reached and how many lives saved?

Prioritisation Exercise

Prioritisation Action Prevalance Feasibility Potential impact

Iron is available- anaemia is eliminated

Commend and empower SBA

Family planning to prevent unwanted pregnancy

Guidelines re ANC available

EMONC training re AMTSL + PPH

SBA attendance at delivery- community education

(Facilitated Discussion)• Which action(s) address the most prevalent

problems• Which action(s) are most feasible? (Why or

why not?)• Which action(s) will deliver the most impact?

• Reminder that prioritisation is subjective and best done in a multi disciplinary team including community members ( especially non clinical)

Group exercise using action tool6 groups of 5-6 eachDetails and scenario in WorkbookExercise simulates facility

committeeAction tool completed for the

scenario described