ACCELERATED REDUCTION OF
MATERNAL AND CHILD
MORBIDITY AND MORTALITY
‘CARMMA – CH’
THE ROAD MAP TO 2014
Key priorities for 2012/2013
Things that can be done this year
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Commitment
Change of attitude
Willingness to change
Not dependent on increased budgets
Can be implemented at District Level
Responsibility
– District Manager
– CEO
– District Clinical Specialists
– Hospital Medical Manager
Community Based Interventions
• Health Information and Promotion must be provided
at household level
• Identification, referral and feedback of suspect cases
• Indicator:
– FP uptake; Early booking before 20 weeks; growth
monitoring; breastfeeding
– Community Care Givers trained
– CCG data captured into DHIS
• Target: Early booking 50%
• Responsibility: Deputy District Manager –
Programmes
Antenatal Care
• All ANC sites must initiate ANC at the time
pregnancy is diagnosed
• Indicator:
• ANC attendance < 20 weeks
• Target: 50%
• Responsibility: PHC supervisor and Clinic Ops
manager
Antenatal Care
• All ANC sites must provide Calcium carbonate
supplementation for all pregnant women
from booking
• Indicator:
– Cases of eclampsia delivered
– Hypertensive maternal deaths
– Target for KZN <30 deaths for next year 2008-10:
110 deaths)
• Responsibility: PHC supervisor and Clinic Ops
manager
Antenatal Care
• Integrate HIV care into antenatal care
– HAART theraphy
– PCP and TB prophylaxis
– TB screening
– Management of opportunistic infections
• Indicator: Number of NPRI maternal deaths
(target <140); % percentage eligible antenatal
clients on HAART before delivery (target
>90%)
• PHC supervisor/ Ops Manager
Antenatal Care
• All District Hospitals should have a plan for a
waiting mothers area / maternity waiting
home
• Indicator:
– Number of MWHs
• Target for KZN: functioning MWH at 50% of
District Hospitals (26), at least 1 per District
• Responsibility: CEO and General Manager
Infrastructure
Labour care
• All hospitals / MOUs should encourage and
allow companions for women in labour
Indicator:
• Institutional policy on companions in labour
• Target for KZN: all hospitals / MOUs must
have written policy on companionship in
labour
• Responsibility: Medical manager/ Clinic Ops
Manager
Neonatal care
• All hospitals should have a functional KMC
unit
• Indicator:
• Babies managed by KMC
• Target for KZN: all hospitals must have a
policy that stable low birth weight babies are
managed by KMC
• Responsibility: Medical Manager
Training
• All hospitals should be running ESMOE fire
drills monthly
• Indicator: Number of master trainers
• Target for KZN: every hospital must have at least
one ESMOE Master Trainer
• Indicator: Records of fire drills, numbers of staff
completed full ESMOE course
• Target: Monthly fire drills in 50% of institutions,
100% of interns completed ESMOE course
• Responsibility: Medical Manager
Outreach
• All district hospitals must have designated
specialists for O+G and neonatology for
outreach
• Indicator: cell phone and email contact details of
designated specialists for outreach available at
district hospitals
• Target for KZN: 100% district hospitals must have
contact details available.
• Responsibility: Medical Manager/ General
Manager - IT
Referral criteria
• All clinics, district hospitals and regional
hospitals must have referral criteria for
obstetric and neonatal problems
• Indicator: referral criteria clearly displayed in
maternity and neonatal departments
• Target for KZN: 100% of clinics, hospitals
• Responsibility: Medical Manager
Referral criteria
• Maternity doctor on duty at local (district)
hospital must be directly accessible by phone
from all clinics in catchment area
• Indicator: Contact details of doctors (not just
hospital) displayed at clinics
• Target for KZN: 100% of clinics
• Responsibility: Medical Manager
Referral criteria
• Obstetric specialist on-call at regional referral
centre must be directly accessible by phone
by the medical officers at referring hospitals
and clinics in catchment area
• Indicator: Contact details of specialists on-call
(not just hospital) available at district
hospitals
• Target for KZN: 100% of District hospitals
• Responsibility: Head Clinical Department
Patient transport
• Patient transport must be available within 15
min of request
• All the listed hospitals must have specialised
ambulances on-site
• All MOUs must have non-specialised transport
• Indicator: Response times
• Target: 15 Min
• Responsibility: EMS district manager
Maternal and Perinatal Audit
• All hospitals must have scheduled PNMMs at
least monthly
• Indicator: Yearly schedule of PNMM meetings
• Target for KZN: 100% of hospitals
• Responsibility: Medical Manager
Maternal and Perinatal Audit
• PNMM must be attended monthly by at least
one of top hospital management and must
include setting an action plan and follow-up
of previous action plans
• Indicator: Minutes of PNMM meetings
• Target for KZN: 100% of hospitals
• Responsibility: CEO
Maternal and Perinatal Audit
• All institutional maternal mortalities to be
discussed at the institution within 3 days and
an action plan made to prevent recurrence
• Indicator: Record of maternal death meeting
• Target for KZN: 100% of maternal deaths per
District
• Responsibility: Medical Manager
PPIP
• Each hospital must have a designated PPIP
champion, and functional PPIP programme
• Indicators: PPIP data forwarded to District
quarterly; minutes of 6-monthly hospital PPIP
meetings with action plans, and follow-up of
previous action plans
• Target for KZN: 100% of hospitals
• Responsibility: Medical Manager
Women’s Health
• All women with HGSIL on Pap smear results
must be able to access colposcopy / Lletz
service promptly
• Indicators: new cases of cancer of the cervix,
waiting time for colposcopy appointment
• Target for KZN: waiting time for colposcopy
appointments per District must be < 1 month
• Responsibility: Medical Manager
Women’s Health
• Every hospital must be able to offer TOP or
refer clients for free TOP service to another
service provider
• Indicators: Hospital policy on TOP service
• Target: 100% of hospitals have policy
ensuring access to TOP
• Responsibility: CEO
Family Planning
• Every hospital conducting deliveries must be
able to offer tubal ligation post vaginal
delivery before the mother is discharged if
she requests it
• Indicators: number of post-partum T/Ls
• Target: 100% of hospitals conducting postpartum T/Ls
• Responsibility: Medical Manager
Family Planning
• Every hospital/ clinic must have IUCD available
as a contraceptive option
• Indicator: Number of IUCD inserted
• Target: IUCD insertion trained provider at all
hospitals
• Responsibility: Medical Manager