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Scaling Up MA within the Context of SA Services in Nepal

Scaling Up MA within the Context of SA Services in Nepal. Indira Basnett, MD, MPH Ipas /Nepal Country Director Expanding Access to Medical Abortion: Building on Two Decades of Experience Lisbon, Portugal March 2-4, 2010. Background in Nepal.

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Scaling Up MA within the Context of SA Services in Nepal

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  1. Scaling Up MA within the Context of SA Services in Nepal Indira Basnett, MD, MPH Ipas/Nepal Country Director Expanding Access to Medical Abortion: Building on Two Decades of Experience Lisbon, Portugal March 2-4, 2010

  2. Background in Nepal • Maternal Mortality Ratio was 539/100,000 live births in 1996 • The abortion was legalized in 2002 • Before legalization, 50% of all maternal deaths were due to abortion related complications • The latest MMR (2008) is 281/100,000 • Nepal’s target is to reduce MMR to 134 by 2015

  3. … Services – public & private Female CH Volunteers - 48,000 Sub Health Posts – 3126 MA Health Posts- 677 Primary Health Center -35/209 Public hospitals- 89, NGOs & private clinics =106 MVA 2nd Tri Specialized hospitals-14 Tertiary level maternity hospital-1 Ce

  4. Advocacy MoHP MoHP Training curriculum development Policy MOHP Professional obs/gyn society Ipas IEC materials development MoHP Service delivery Regional/district health authorities Project management Ipas/TCIC PSI and Ipas All listed CAC service providers Public & private Training Operations Research MoHP Gynuity Product availability Sun Pharma Ipas CREHPA PSI, Concept

  5. An incremental and systematic approach to scaling up MA Integrating MA to all approved centres (public, NGOs and private) Community midwives -SBAs & CEM for EE FCHVs - counselors Clinical trial & Introductory Period 2007-2009 Private sector and pharmacists

  6. FCHVs –counselors FCHVs learning how to use urine tests for early detection of pregnancy Training materials for FCHVs

  7. Client & stakeholder brochures Counseling and IEC materials Counseling materials

  8. Referral Card and Safe Abortion Logo

  9. % of MA v/s MVA Medical abortion scale up strategy approved in November 2009 Source: HMIS/MoHP 2008-2009

  10. Outcomes of medical abortion Source: HMIS/MoHP 2008-2009

  11. Post MA complications & USG Source: SA logbook & client profile record 2008-2009

  12. Lessons learned System related: (MA pilot findings 2008-2009 in six districts) • Government leadership encourages public-private-NGOs partnership • Approved protocol protects providers for any adverse events • Training MLPs (RN and ANMs) ensures women friendly clinic • Female community health volunteers empower women to make timely decision for their RH needs • MA drug availability & distribution is possible through the public-private system • ‘’No blame approaches’’ for auditing AEs inspires team spirit and strengthens the capacity of health facility to handle complicated cases

  13. Lesson learned Client’s perspectives: (client exit interview in 36 MA pilot sites 2008-2009 in six districts) • Consulting FCHVs to confirm their suspected pregnancy • MA service delivery closer to their community • Telephonic conversation for assessing abortion status (complete/incomplete) • Women with Prolapse Uterus prefer (non vaginal route)

  14. Lessons learned Service provider’s (physicians and nurses) perspectives: (interview with 68 trained providers on MA 2008-2009 from six pilot districts) • Feel confident minimum with 20 MA cases • Understanding a difference between ‘’process’’ vs ‘’procedure’’ is critical • Training should be combined with clinical practicum and with real clients • How to handle women seeking TOP with HIV positive and undergoing TB treatment ??

  15. Conclusion The success rate without USG and routine hemoglobin test in a population with high prevalence of anemia is an example of great importance for MA implementation in other low resource countries.

  16. Visit us online atwww.ipas.org/medicalabortionor write tomedicalabortion@ipas.org

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