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IntroductionA. The Situation of Maternal and Newborn Care in the PhilippinesThe Philippines registered a Maternal Mortality Rate (MMR) of 172 per 100,000 in 1998compared to 180 per 100,000 in 199 (!ational "emographic #ealth $%r&ey, 1998)' "espitethe decrease in MMR, the red%ction of maternal deaths d%e to pregnancy related complicationremains a challenge' The 1998 !"#$ indicated that postpart%m hemorrhage is the leadingca%se of deaths folloed y hypertensi&e complications, sepsis, ostr%cted laor and %nsafeaortion' *n the same s%r&ey, perinatal death as placed at 18 per 1000 li&eirths' +omparedith Malaysia and $ingapore (9'1 per 1000 li&eirths -'1 per 1000 li&eirths, respecti&ely),the *nfant Mortality Rate (*MR) in the co%ntry is ./ per 1000 li&eirths' *n the latest 200.!"#$, the percentage of aies (3200 gms) is high at 1.4, not incl%ding those thatere not eighed' This is a reflection of the intra%terine groth retardation ro%ght y

maternal depri&ation d%ring pregnancy' $tillirths or infant deaths, on the other hand, can ea&oided especially in the critical first ee5 of life if essential care is a&ailale d%ringpregnancy, childirth and the immediate postpart%m period'

6s eplained in the Three "elays Model, maternal deaths occ%r d%e to delays in (1) decidingto see5 care for percei&ed ostetrical complications (2) identifying and reaching theappropriate facility and (.) recei&ing appropriate and ade:%ate care in the facility'

The orld #ealth ;rganior ostetrical

inter&ention to s%r&i&e' *f ?mergency ;stetric +are is a&ailale, and omen can access it intime, omen@s li&es can e sa&ed'

The estalishment or %pgrading of strategic health facilities on asic ?mergency ;stetric+are (?m;+) aims to a&ert death and disaility among pregnant omen and neornaies' ?m;+ refers to the f%nctions that can e pro&ided y a team of eperienced andtrained s5illed irth attendants composed of licensed doctor, n%rse and midife ho act as ateam at the primary le&el in pro&iding asic emergency care to mothers and aies to a&ertmaternal and neorn moridity and mortality' The #; recommends a ratio ofone ?m;+ facility per one h%ndred tenty fi&e tho%sand (112,000) pop%lation'

The folloing are the si (/) asic f%nctions of a ?m;+ facility1' administer parenteral antiiotics ( initial loading dose)2' administer parenteral oytocic dr%gs (for acti&e management of the .rd stage of laor only).' administer parenteral anticon&%lsants for preeclampsia and eclampsia (initial loading dose)-' perform man%al remo&al of placenta' perform remo&al of retained prod%cts/' perform assisted &aginal deli&ery

B. The Safe Motherhood Policy

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The Philippines is committed to p%rs%ing the principles en%nciated in the +airo and ei>ing+onferences on Pop%lation and omen respecti&ely for the promotion of safe motherhoodand omen@s health, and to ens%re healthy neorns' #ence, the enactment of the"epartment of #ealth@s 6dministrati&e ;rder !o' 79s'2000,otherise 5non as the $afe Motherhood Policy on 6%g%st 28, 2000'

*t is restating its commitment to the aspiration of a healthy nation thro%gh a more &irant and&igoro%s $afe Motherhood *nitiati&es' The folloing principles form the asis forprogramming the red%ction of maternal and perinatal mortality and moridity in the co%ntry

Promotion of omen@s rights and gender sensiti&ity

6ccess to :%ality health and n%trition ser&ices

Aoc%sing on health promotion, ed%cation and ad&ocacy

?stalishing lin5ages and de&eloping collaoration to ens%re s%stainaility

Moili%dgmental care that isresponsi&e to

omen@s needs

*n&ol&e the client in decision=ma5ing, and see the client as partners in health care and

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acti&e

participants in protecting their on health and

;ffer economic and social s%pport to health care pro&iders that enale them to do theest

>o they can

?nco%rage partner as ell as family and comm%nity in&ol&ement in pre=natal and post=

natal ser&ices'

2' ?lements of D%ality Maternal and !eorn +are

PrenatalPregnant omen sho%ld ha&e at least fo%r (-) prenatal &isits for

#ealth promotion ad&ice on n%trition (e'g iodi

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+o%nseling and health promotion on ecl%si&e reastfeeding, follo=%p imm%ni

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About the Trainer'sGuide

Bac(!round of the Trainer's GuideThe WHO document -- Pregnancy, Chilbirth, Postpartum and Newborn Care: A uide !or"ssential Practice #PCPNC$as adopted as a reference man%al for health care pro&idersresponsile for the care of omen d%ring pregnancy and childirth, and their neorns' Tofacilitate the cond%ct of training, this training g%ide as de&eloped in collaoration ith&ario%s partner organi

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application of D%ic5 +hec5 and R6M

disc%ss the impact of doing an immediate general assessment of the oman %poncons%ltation at the health facility

perform an assessment and management of a oman d%ring laor, after deli&ery anddischarge from the health facility

recogniecti&es, topics, d%ration,methodology and materials needed' This part also pro&ides practical tips on ho to monitorand e&al%ate efore, d%ring and after the co%rse, incl%ding the preparation of an action plan'

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Part / pro&ides an o&er&ie of post=training acti&ities hich the trainers and participants can%nderta5e collaorati&ely' This part incl%des disc%ssion of o%tcome indicators for thetraining, the need for contin%ing comm%nication, ho to monitor and e&al%ate trainingo%tcomes and the importance of doc%menting eperiences' The introd%ctory part al5s thetrainer or reader into the contet of the g%ide hich incl%des the sit%ation of maternal andneorn care in the Philippines, the $afe Motherhood Policy and the contet of the P+P!+hich ser&es as the main reference oo5 of the Trainer@s E%ide'

To facilitate the %se of this oo5, especially finding information, the three ma>or parts and the6nne hich incl%des the Trainer@s !otes are colorcoded

Part 1 Pre=Training 6cti&ities JelloPart 2 +ond%ct of the Training +o%rse

6' "idactic Phase l%e' Practic%m Phase Pin5+' Monitoring, ?&al%ation and ;range 6ction Plan

Part . Post=Training 6cti&ities Ereen6nne Fiolet

6 Glossaryis also incl%ded in page 87 to aid the trainers and readers in %nderstanding themeanings of ordsCterms %sed in the g%ide'

TheAnne0 Portionincl%des the trainer@s notes, g%ide to the poerpoint presentation, andsample training sched%le for the didactic phase' The trainer@s notes contain the &ario%sreference and presentation materials' $ample forms and tools arealso incl%ded in this section'

Together ith this Trainer@s E%ide are the instr%ctional materials s%ch as the +ompact "is5 ofPoerPoint Presentations, a set of transparencies of selected presentation materials and theP+P!+ Man%al as main reso%rce oo5'

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PreTrainin!Preparation

Prior to cond%cting the s5ills training on ?m;+, certain preparations need to e done toens%re its smooth implementation'

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Technical Preparation1r!ani+ation of the Trainin! Tea$6 Training Team needs to e organiecti&es, gro%p acti&ities, epected o%tp%ts and materialsCreso%rces needed'

Practicu$ Phase

o>ecti&es

hospital departmentsCareas that ill e in&ol&ed

hospital personnelCstaffCarea facilitators ho ill e in&ol&ed

re:%irements of the practic%m and the epected technical assistance from the areafacilitators

determine sched%le of rotation to approimate completion of re:%irements (may %se as

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asis res%lts of Training !eeds 6ssessment (T!6) to address the gapsCs5ills re:%iredy the participants on ?m;+)

formsCchec5lists to e filled=%p y the participants

formsCmonitoring tools to e accomplished y the area facilitators to aid in facilitatingapplication of s5ills

cond%ct of mid=practic%m assessment

ho to effecti&ely pro&ide technical assistance and monitoring of the participantsincl%ding proper feedac5ing of oser&ations

proper cond%ct and decor%m d%ring practic%m

Monitoring and ?&al%ation of the Training (d%ring and after)+riteria for the $election of Reso%rce Persons

?perienceCepertise in the area of maternal and neorn care

;rientation on P+P!+

?pos%re to cond%ct of training acti&ities

illingness to e part of the team

Identification of Partner Institutions and 3acilities*nstit%tions and facilities that ill e in&ol&ed in the deli&ery of the training co%rse sho%ld eidentified early on' The identification process sho%ld consider the folloing criteria

Training *nstit%tion for Practic%m

6ccredited y Philippine ;stetrical and Eynecological $ociety (P;E$) or "epartmentof #ealth for teachingCtraining

+an e go&ernment (as co&ered y ";# 6dministrati&e ;rder) or pri&ate instit%tions

that ill meet the criteria (co&ered y M;6 ith ocal Eo&ernment Bnit)

#ealth Aacilities for Practic%m

ith %siness Plan (according to Phil#ealth 6ccreditation scheme)

6ccessiility of the facility

+apaility of the personnel to model correct ser&ice pro&ision and assist participantsd%ring practice

ith ade:%ate caseload for clinical proced%re (?m;+)

6&ailaility of essential s%pplies and e:%ipment

Training Fen%e for the "idactic

6de:%ate space for the n%mer of participants and acti&ities that ill e cond%cted,incl%ding rea5=o%t gro%ps

6&ailaility of e:%ipment and s%pplies

6&ailaility of facilities for comm%nication +omfortaleCell=appointed accommodation

*n identifying partner instit%tion and facilities, ear in mind that Gthe training scenario sho%lde as close as possile to the or5 en&ironment of the participantsH (#;, 1997-0)' *n thisay, there is greater chance of p%tting into practice the ne s5ills learned in their on or5sites (Mclnerney et al', 2001 I#P*?E;, 2001)'

Selection of Participants and Trainin! Needs Assess$ent

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The s%ccess of the ?m;+ s5ills training co%rse ill also depend on a caref%l selection ofparticipants' +riteria for selecting participants may incl%de

EB Participant

EBsCpro&inces ith high Maternal Mortality

Rate (MMR), neonatal death and lo +ontracepti&e Pre&alence Rate (+PR)

6&ailale ?m;+ facilities of EB

6de:%ate s%pport of EB in terms of %pgrading facilities, a&ailaility of s%pplies andallocation of %dget

EB ith *n&estment Plan and reso%rce management capaility

6&ailale h%man reso%rces for team composition

Pri&ate instit%tions illing to e trained

e&el of competencies of participants

*ndi&id%al Participant

Team of doctors, n%rses and midi&es ho ser&e as s5illed irth attendants at theirthing

facilities that are capale of pro&iding ?m;+

6t least ith eperience in handling irth deli&eries

ac5gro%nd in asic ;=EJ! and Pediatrics

;nce the participants ha&e een selected, a T!6 designed to determine the s5ills hich theparticipants o%ld li5e to learn or impro&e d%ring the training, as ell as their le&el of5noledge and attit%des regarding ?m;+' The participants ill e as5ed to complete a T!6form hich ill e %sed y the Training Team in impro&ing the deli&ery of the co%rse'

Settin! of ScheduleThe sched%les for T;+T among the reso%rce persons, dry=r%n for the co%rse and act%altraining sho%ld e disc%ssed and agreed %pon early eno%gh to prepare them accordingly'*nform them immediately as soon as the sched%les are finaliecti&es,methodology, time allotted to each acti&ity and the reso%rcesC materials needed' *t is oth aplanning tool and a g%ide for the trainers' The co%rse sched%le aims to ens%re that the flo oftraining is logical, the participants are ale to effecti&ely ac:%ire and apply ne 5noledge

and s5ills and stay foc%sed and interested'

Together ith the co%rse sched%le, training materials s%ch as hando%ts, comp%ter=generatedpresentations (PoerPoint) %sing comp%ter and +" or o&erhead pro>ectors, flipchart paper,photographs and models (e'g' dolls, chic5en reast, etc') ha&e to e prepared'

4ist of Trainin! Materials"2esources

Metacards

Pentel pens

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Mas5ing tape

oard

+" and comp%ter

;&erhead pro>ector

P+P!+ Man%al

#ando%ts on ?m;+

Manila paper Transparencies of presentation materials

+" of PoerPoint presentations

+hal5

Pri

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Conduct ofthe Trainin!

CourseThis section consists the didactic phase, practic%m phase and monitoring and e&al%ation ofthe act%al s5ills training on ?m;+' The o>ecti&es and topics of the three main parts,mod%les and specific sessions are laid o%t to g%ide the trainers and participants d%ring thecond%ct of the training co%rse' 6n appropriate mi of training methods that ere %sed in pre=testing this trainers@ g%ide as adopted to ens%re that participants realiecti&es'

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#idactic1b5ectiesy the end of the didactic phase, participants ill e ale to

apply the principles of good care

enhance clinical >%dgment y identifying and prioriti

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Module -1eriew of B6$1C and the

PCPNC Manual

1b5ectieTo enale participants to %nderstand em;+ and the %se of the P+P!+ Man%al'

Topics ;&er&ie of em;+

Bse of the P+P!+ Man%al

#uration1 ho%r and .0 min%tes

Session -?m;+ and the Bse of P+P!+ Man%al

Specific ob5ectie6t the end of the session, the participants ill e ale to %nderstand ?m;+ and theimportance of P+P!+ Man%al and its %se'

Methodolo!yarm=%p eercise 10 minect%re=disc%ssion .0 minReinforcement 10 min

"rill -0 min

Materials neededMetacards, pentel pens, mas5ing tape, oard, +"C;#P, presentation materials andhando%ts on ?m;+ and P+P!+ Man%al'

Procedure

?plain the o>ecti&es and mechanics of the session to the participants

Pro&ide each participant ith 2 metacards, and as5 all of them to rite their ideasao%t ?m;+ and post their cards in the oard

$%mmari

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Module Principles of Good Care

1b5ectie

To pro&ide participants ith the opport%nity to apply the principles of good care to allcontacts eteen the s5illed attendant and all omen and their aies'

Topics +omm%nication

or5place and administrati&e proced%res

Bni&ersal preca%tions and cleanliness

;rgani