MNCHN EINC: The role of the academe

Mariella S. Castillo, MD, MSc

Teresita S. Cadiz, MD, MHPEd, FPOGS
 Outline
Philippine situation of MDG 4 & 5
Philippine government response
Role of academe (ADPCN)
Next steps
 Status of Philippines MDG4 achievement:
<5 year old and Neonatal Mortality
80
# of deaths per 1000 live births

70
60
50
40
30 Under Five MR
20
10 Neonatal MR
0
1990 1993 1998 2003 2008 2011

1988-1998: 40%
1998-2008: 20%
Neonatal mortality hasnt improved
DHS 88, 93, 98, 03, 08
 Status of Philippine MDG5 achievement:
At current rate of decline, the Philippines is unlikely to
reach MDG 5 target for MMR by 2015
250
221
209 203 197 191
200 188 180 172
162
150

100

50 52
0
1990 1991 1992 1993 1994 1995 1998 2006 2010 2015
 Undergraduate health professional education
remains to be hospital-based in orientation with
very little integration of key public health issues

Health Sector Government

Millennium Development
Goals 4 & 5
reduce neonatal and maternal mortality and
improve access to quality health service for
mothers and newborns

Academe Society
 Philippine government
response
Maternal, Newborn, Child Health and Nutrition
(MNCHN) Strategy (Department of Health Administrative
Order 2008-0029)
Adopting Policies and Guidelines on Essential
Newborn Care (DOH Administrative Order 2009-0025)
Universal Healthcare / Kalusugang Pangkalahatan
(DOH Administrative Order 2010-0036 )
Essential Newborn Care Protocol (DOH/WHO/UNICEF
Clinical Pocket Guide)
Clinical Practice Guidelines on Essential Intrapartum
and Immediate Postpartum Care (DOH/WHO/POGS )
 Components to Consider in Curriculum
Integration for MNCHN-related programs
Pre-union
Conception Birth and Under 5
Premarital
Pregnancy Delivery years
counseling

MBFHI

EINC
NBS, EPI, IMCI, IYCF

Essential intrapartum and newborn care

Rooming-in and breastfeeding
Breastfeeding and infant and young child feeding (IYCF)
Breastfeeding during emergencies and disasters
Newborn screening and newborn hearing screening
Postpartum care and postnatal care
Birth spacing, family planning
Health lifestyle
Oral health
Improving quality of care through EINC

WHO component of AusAID funded - Joint Program for Maternal

Neonatal Health (JPMNH) together with UNFPA, UNICEF and DOH
Transition year funding (2010-11) A$ 1.78M
 Hospital
Reform
Agenda
Network of
Centers of
Excellence
Role of Nursing Academe:
EINC to be practiced by
Curriculum
Curriculum
Changes
Changes
Social
Marketing
Campaign
future health workers
CURRICULUM CHANGE
Integration in
medical, nursing & midwifery
curriculum ongoing
Inclusion in board
examinations

Deans of Nursing and Midwifery

Schools July 2011
 Behavioral Change Objective
Health Professionals and health facilities to:
STOP practicing unnecessary
medicalized practices
use the DOH/WHO protocol for low-risk,
evidence-based intrapartum & newborn
care that protects and saves lives
The UY 4&5 Promise:
Safer,
Evidence-based,
Better Quality Care
for Mothers & Newborns
Conceptual Framework: Adopting EINC

Making the Choice:

Policy: DOH, PHIC Awareness of Benefits vs.
and Hospital EINC Weaknesses & Risk of
Customary Methods

Testing the Choice:

EINC Practitioner Adoption of the
& Advocate EINC Does it Live Up to the
Promise & Benefits
 GOALS
CUSTOMARY
BIRTHING
PRACTICES
 GOALS
Maternal & Newborn deaths
Medicalized Birth
Hypothermia
Hypoglycemia
Anemia
Formula Feeding & its Risks
 EINC
GOALS
Maternal & Newborn deaths
Medicalized Birth
Hypothermia
Hypoglycemia
Anemia
Formula Feeding & its Risks
Evidence-based Global Standard for
Birthing & Newborn Care
Mother & Newborn Centered Care
Breastfeeding is Assured
Newborn Safety, Reduced Sepsis
Reduced Costs
DOH/PHIC Compliant
GOALS
Maternal & Newborn deaths
Medicalized Birth
Hypothermia
Hypoglycemia
Anemia
Formula Feeding & its Risks
 At least 4 antenatal visits
Iron and folate supplementation
Antenatal
Tetanus Toxoid Vaccine
Prepare a BIRTH PLAN including UnangYakap

Identify mothers in PRETERM LABOR at point of entry

Upon Administer 1st dose of Antenatal Steroid
arrival at
Facility History, Physical Exam and Vital Signs
Obtain Birth Plan, Determine Companion of choice

Allow Position of Choice Use Partograph to monitor labor

During
Labor Allow mother to have oral fluids IV fluid and NPO only when
and light snacks indicated

Check room temperature Arrange all instruments in

Prior to and air drafts a linear fashion
Delivery
Discuss care in the 1st hours Check resuscitation equipment

Perineal Perform Proper Handwashing and Put on 2 pairs of sterile gloves

Bulging NO routine episotomy, fundal pressure
 Time Mother Baby
Support the perineum with Call out time of birth and sex
Delivery controlled delivery of the head

Dry, check breathing

First 30 secs
Put in skin-to-skin contact
Give Oxytocin IM Feel for cord pulsation ,
After excluding a 2nd baby Clamp, cut cord
1 minute to
3 minutes Do controlled traction of cord Return baby to prone position
with counter-traction
Massage the uterus gently

Examine the placenta

Support FIRST FULL BREASTFEED. Monitor as a DYAD q15 minutes

15-90 Continue uterine massage; Do PE, weigh, measure, eye

minutes Monitor every 15 minutes care, inject Vit K, Hep B, BCG

Transport to room TOGETHER

> 6 hours BREASTFEEDING SUPPORT Optional: Bathing

 Role of Nursing Academe
Nurses as health facility managers can create an
enabling policy and physical environment

Decrease in routine IVF, JRMMC Increase in dexamethasone use, GSCH

 Role of Nursing Academe
Create and maintain culture of
quality of care
1. Handwashing, infection control
2. Humane, rights-based care
3. Culture of continuous quality
improvement
4. Culture of continuous learning
 Role of the Nursing Academe
Bring EINC to the community
 Role of the Nursing Academe
Create career paths for nurses
 Role of the Nursing Academe
Create career paths for nurses
As Nurse Advocates
 Role of the Nursing Academe
Create career paths for nurses
As Nurse Teachers and Trainors, Researchers
 Role of the Nursing Academe
Integrate EINC into a competency-based
curriculum
Identify the professional competencies needed
to practice EINC in diverse settings and
situations
Translate professional competencies to student
competencies
Apply the tried and tested 1-day training
formula with demo-return demo of Team EINC
Use of training materials available on the
net, SIM, hand outs, bulletins
 Next steps
Integrate curriculum updates
Latest Policies
According to latest evidence base
Institutionalize reforms through CHED Technical
Committee on Nursing Education
Harmonize PRC licensure examination with
updates
Roll out and evaluate (formative evaluation and
formal curriculum evaluations)
Document process, share success stories
Engagement of PRC Boards of Medicine, Nursing and
Midwifery to update board questions and remove
outdated questions started in Dec 2010
Training of Nurses from Taguig-Pateros
TOT in Northern Mindanao Nursing
Colleges, MSU, Iligan City (2012)
Demo- Return Demo
Training from Makati to Mindanao
 The vision: all health workers to
provide the highest quality of care

Update curricula and

Implementation of the
professional licensure
Maternal, Newborn, Child Updates of the post-
examinations in
Health and Nutrition graduate training curricula
medicine, nursing, and
Strategy including EINC
midwifery

HEALTH
SYSTEM-WIDE
REFORMS
 Summary
Philippine situation MDG 4 and 5- improving but still a
long way off
Philippine government response- MNCHN and EINC as
a direct measure to improve maternal and newborn
health
Role of the academe (ADPCN)
Enabling the environment through policy
Creating career paths for nurses
Translating student competence to professional
competence through integration of EINC in curriculum
Next steps- continuous upgrading and evaluation using
the latest evidence