Training and Monitoring of Midwives for their Expanded Role in Maternal

and Child Health Alejandro R. San Pedro

Board of Midwifery Professional Regulation Commission

Department of Obstetrics and GynecologyBulacan Medical Center

The Women Deliver - Philippines Conference September 17, 2010 The Crowne Plaza Hotel, City of

Mandaluyong

Presentation content

• Midwifery in the Philippines • Scope of midwives’ expanded

functions• Undergraduate & In-Service training• Monitoring facilities & practitioners• Challenges in training & monitoring

Midwifery in the Philippines

• Direct entry course

• 248 Midwifery Schools*

• Training on expanded role begins in Midwifery school (new curriculum)

• Entry into practice requires passing the MLEx (PRC)*

• Ladderized curriculum in selected schools

• BSc in Midwifery * CHED data ** Professional Regulation Commission

Expanded role added skills(Midwifery Act of 1992)

Internal examination

Suturing perineal lacerations

Intravenous fluid insertion

Dispensing oxytocics

Vitamin K for newborn

Midwives in the Philippines

157,501 RMs up to Jan. 8, 2010

17,000 RMs work in the public sector

Midwifery Act of 1992 (R.A.7392)

primary health care services in community, including nutrition and family planning

• to giving motivation and counseling to

married couples who wish to avail of family planning services.

• midwives who have undergone a special training given a certificate by the Certifying Board jointly undertaken by the DOH and the Board of Midwifery will be allowed to provide FP interventions that are medical or surgical in nature, i.e. pills and intrauterine devices.

Source: H. Sobel Unang Yakap – Essential Newborn Care Presentation

82,000 Filipino children die annually, most could have been prevented

Source: CHERG estimates of under-five deaths, 2000-03

The Philippines is one of the 42 countries that account for 90% of global under-five mortality

Training for midwives’ on expanded role (mainly In-

Service)1. Life Savings Skills and

MDG Countdown (POGS)

2. Basic and Comprehensive Family Planning (DOH, IMCH)

3. BeMONC (Fabella Hosp)

4. EPI/IMCI (DOH)

5. Newborn Screening6. Essential Newborn Care

(PSNbM) * DrJFMH began training in 1994 on

expanded midwifery functions

CPE Council for Midwifery

Composition:

• Board of Midwifery

• APO (accredited professional organization)

• APSOM (academe)

• Accreditation & monitoring CPE Providers and Programs

(Competency-based training, interactive learning, workshop, standards of care and best practices, unlearning harmful practices, clinical case conference, maternal death review).

Monitoring

• Licensing & Regulating of Birthing Homes (BH)

• PhilHealth monitoring of Accredited BH

• Board of Midwifery (BOMid) monitoring of BH or solo practice

• Joint BOMid-CHED assessment of poorly performing schools

Achieving & maintaining competence of Midwives

• Caseload (e.g. childbirth attended) is needed to gain and maintain competence?

• Tools for assessing different competence

• Standardization (harmonize) of modules

* 15462 currently enrolled AY 2009-2010 7053 Midwifery graduates AY 2008-

2009

Some observations on monitoring

Some observations on monitoring

(Birthing Clinic Chart)

Some observations on monitoring

(Birthing Clinic Chart)

Some challenges

1. Compliance with required competencies (caseload)

2. Getting support of LGU leaders3. No appropriate items in hospital for

midwives (Nursing Attendant)4. Proliferation of “unregulated”

birthing homes 5. Overmedicalization of childbirth6. Health system not fully functioning

Attendance during childbirth(Bulacan Province 2009)

• Doctors (33.24%)• Midwives (60.46%)• Nurses (0.26%)• Hilots (6.04%)

59.94% are Homebirths

65,189 births in 2009 Source: Bulacan 2009 Annual Report

on Natality by Attendance

Reminder

• Graduate midwives of the old curriculum (before 1996) are required to attend a Professional Regulation Commission (BoMid) accredited training program to acquire competence on the added skills.

Rule 10. No. 4. Only registered midwives with

the proper training on intravenous insertion and suturing perineal laceration will be allowed to perform such procedures….. and by the year 1996 no midwife will be allowed to renew her/his license without the needed training.

Source: Resolution 100 R.A.7392.

Key Message

Competent, committed, compassionate and connected midwives supported by an enabling environment can help achieve MDGs’ 4 & 5 and protect public safety!