Maternal MortalityUnderstanding the Biological and Social Contexts
Jeromeo Jose11382333
Biological and Social Foundations of HealthMAHESOS
The great divide of Maternal Mortality
Everyday, 800 women die from pregnancy and
childbirth
Developing countriesDeveloped Countries
99%
• Who are the most susceptible?– Women living in rural
areas and poor communities
– Young adolescents– Women who do not
receive care (pre, during and post)
The Philippine Context
'08 '09 '10 '110
50
100
150
200
250
162
221
Philippines Maternal Mortality
RP MDG
Source: Department of Health
What do we mean by maternal death?
• a maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes (ICD-10)
Medical causes of death and treatment (WHO, 2011)
• Post partum hemorrhage– World’s leading cause of maternal mortality– 127,000 maternal deaths annually– may cause up to 50% percent of all maternal
deaths in developing countries– Medicines • Oxytocin: 10 IU in 1-ml ampoule• Sodium chloride: injectable solution 0.9%
isotonic or Sodium lactate compound solution – injectable (Ringer’s lactate)
Medical causes of death and treatment (WHO, 2011)
• Severe Pre-eclampsia and Eclampsia– Major health problems in developing countries.– Every year, eclampsia is associated with an
estimated 50 000 maternal deaths worldwide.– Medicines
• Calcium gluconate injection (for treatment of magnesium toxicity): 100 mg/ml in a 10-ml ampoule
• Magnesium sulfate: injection 500 mg/ml in a 2-ml ampoule, 500 mg/ml in a 10-ml ampoule
Medical causes of death and treatment (WHO, 2011)
• Maternal sepsis– Infection can follow an abortion or childbirth and is a major
cause of death. – Sepsis not related to unsafe abortion accounts for up to
15% of maternal deaths in developing countries. – Medicines
• Ampicillin: powder for injection 500 mg; 1 g (as a sodium salt) in vial
• Gentamicin: injection 10 mg; 40 mg /ml in a 2-ml vial
• Metronidazole: injection 500 mg in a 100-ml vial• Misoprostol: tablet 200 μg
Medical causes of death and treatment (WHO, 2011)
• Sexually transmitted infections– Nearly a million people acquire a sexually transmitted infection,
including HIV, every day. – The results of infection include acute symptoms, chronic infection, and
serious delayed consequences such as infertility, ectopic pregnancy, cervical cancer, and the untimely deaths of infants and adults.
– Medicines• Uncomplicated genital chlamydial infections: Azithromycin:
capsule 250 mg; 500 mg or oral liquid 200 mg/5 ml• Gonococcal infection – uncomplicated anogenital infection:
Cefixime: capsule 400 mg• Syphilis: Benzathine benzylpenicillin: powder for injection
900 mg benzylpenicillin in a 5-ml vial; 1.44 g benzylpenicillin in a 5-ml vial
Maternal Death Review18 deaths in 82 LGUs (9 audited cases)
Top causes of maternal
deaths
Placenta Previa/PPH Eclampsia Sepsisothers
56%22%11%11%
Gravida Status
Gravida Percentage
Prima Gravida 11%
2 – 4 33%
Multi Gravida 53%
Interventions: Preventive measures:
1. Map catchment areas2. Augment human resources (competency & number) / health
facilities /equipment3. Implement well-coordinated referral and return referral
systems, including transportation to and from home to facility4. Improve access to medicines for obstetric emergencies like anti-
hypertensive meds
1. Pregnancy Tracking System, early detection of high-risk patients
2. Birthing plans for high-risk patients3. Skills Training (BEMONC, Life-saving
Skills) for birth attendants4. FP counselling and access to FP
commodities
Re-ferral Hos-pital44%
RHU/BHS12%
Home
44%
SBA=67% vs Hilot=33%Hilots now referring pregnant
women albeit usually late
Maternal Deaths
Systems Approach to addressing Maternal Mortality
• 6 Building Blocks (Technical) – Governance, Human Resource, Financing,
Medicines, Health Info, Service Delivery. (WHO)• Local leadership is the key to changing systems
and innovating programs that lead to better health outcomes (ZFF, 2012)– Focused on Mayors and MHOs who decide to
change the health system, through meaningful engagements and new arrangements with other stakeholders.
Road Map
• A way to analyze the health situation in municipalities including gaps and challenges
• A road map to weigh options and set priorities• A scorecard to measure accomplishment.
Intervention on Health Systems Transformation: Municipal Basic Health System’s Technical Roadmap
Leadership & Governance Health Financing Health Human
ResourceAccess to
Medicine & Technology
Health information
SystemHealth Service Delivery
Municipal Health Governance
Municipal Health Action
PlanHealth Resource
Generation and Management
LGU Budget for Health
(15% IRA)
RHU
and BHS Resource management
Health Human Resource Adequacy at
the RHU(MD 1:20,000)
(Nurse 1:20,000)
Drug
Management System
Presence of Essential
Medicine at the RHU
(Stock Basis)
Data Collection,
Utilization and
Information Disse
mination
Accomplished Baseline Data
Collection
Baranga
y Heal
th Infrastructu
re
Presence of Barangay Health Stations(1 BHS:1 Braangay or 1 BHS per
Catchment)
Maintenance and Operations
Utilization
Actual budget Utilization
(95% Utilization)
RHU HHR Competency Available Transportation for Emergency
Regular Data Gathering and
Recording
Materna
l and Chil
d Care
Sustainable Maternal
Health Care
Initiatives
Pre-Natal Services(at least 80%)
Full Implementation of Magna Carta for
Public Health WorkersExpanded and Functional
Local Health Board
Facility-Based Devleiries(85%)
BLGU Health Budget
(5% of Barangay IRA)
Skilled Birth Attendants(85%)
Installed Performance Management System Sustainable
Breastfeeding
Initiatives
Exclusive Breastfeeding for Infants (70%)
RHU Medicine Tracking and
Inventory System
Maternal/Infant Death Review
Newborns Initiated Breastfeeding (85%)
Barangay Health Governance
Functional Barangay
Health Governance
Body(with functional
CHT) Local
Philhealth Administratio
n
4-in-1 Accreditation Sustainable Essential
Intrapartum and Newborn Care InitiativesHealth Human
Resource Adequacy in BHS
(1 Midwife: 1 Brgy; with consideration to
GIDA)(BHW to HH 1:20HH)
Sustainable Infant and Child Care Initiatives
Fully Immunized Child (95%)
Regular IEC for Enrolled Indigent(for Q1 and Q2)
Monthly Updated Health Data
BoardUnder-5 Malnutrition
Prevalence Rate(Below 17.3%)
BHS HHR Competency(Basic BHW Training
Course and CHT Training)
Accomplishment, Utilization and
Dissemination of the DILG, DOH LGU Scorecards
Reproductive
Health
Sustainable Adolescent Reproductive Health Initiatives
Reimbursement Filing
(PCB, MCP, TB-DOTS) Sustainable
Family Planning Initiatives
Provision of FP Commodities and Services
(RHU)
Implemented and Integrated
Barangay Health Plan
Contraceptive Prevalence Rate (63%)
System for BHW Recruitment and
Retention Mechanisms Creation of
Citizen’s ChraterOrdinance and
System for Claims Disposition and
Utilization Monitoring
Ratio of Community-
Based Pharmaccy(1 BNB/CBP
catchment or 1 BNB per
barangay)
Unmet Needs (50% under NHTS)
WaSH
Sanitary Toilets(86%)
Ordnance and Timely Provision of BHW
HonorariumAccess to Safe Water
(87% of HH)
Progress of LGUs vis-a-vis building blocks
Leadership & Governance
Majority have reactivated and expanded membership of their local health boards
Activating barangay health boards a work in progress in most LGUs
Human ResourcesMost have hired additional personnel but ideal ratios have yet to be met
Financing
33 of 82 (40%) LGUs have 4-in-1 Philhealth accreditation
Non-ARMM LGUs have increased health budgets to 10% or above
Still working on having barangays raise their health budgets to 5%
Continuous & close coordination with DOH-ARMM & Philhealth led to release of much-needed reimbursements to LGUs in the region
Medicines
Procurement and inventory systems have been fixed at the RHU but availability of medicines in barangay health stations needs to improve in cohorts that have ended the 2-year partnership
Accessibility, procurement & inventory systems are being improved in other LGUs
Service Delivery LGUs have created their own innovative programs to address issues
Information systems
Systems of reporting & recording have improved
Need to improve ability to analyze data
Need to strengthen mortality audit system
Progress of LGUs vis-a-vis building blocks
Health Outcomes (SLAM, Cohort 3)
'08 '09 '10 '11 '12 '130
50
100
150
200
250
207
73
153
106
70
212
SLAM and Cohort 3 MMR
Cohort 3 SLAM
141
68
41
0
Cohort 3
Sources: FHSIS for ZFF ARMM municipalities
Working on Health Seeking Behavior
'08 '09 '10 '11 '120
5
10
15
20
25
30
35
40
2.475.30 5.94 16.96 22.12
16.52 14.91 33.622.47
5.30
12.9915.59
29.44
Facility Based Deliveries Trend (ARMM)
Cohort 1 Cohort 3ARMM Cohort
'08 '09 '10 '11 '120
10
20
30
40
50
60
70
80
51.44 49.12 39.74 41.88 34.21
73.41 69.53 72.41
51.44 49.12
62.18 60.31 59.68
Deliveries Attended by Skilled Birth Attendants (ARMM)
Cohort 1 Cohort 3ARMM Cohort
Sources: FHSIS for ZFF ARMM municipalities
Conclusions
• Medical and social factors are important to be understood.
• There is a technical solution that can be implemented – medical response, strengthening the health system (6BB)
• Leadership will ensure that more stakeholders gain ownership of the issue.
No mother should die giving life...
Top Related