EssentialObstetric and Newborn Care

CSHGP

COTOPAXI PROVINCE, ECUADOR

Kathleen HillCenter for Human

Services (CHS)

Cotopaxi Province Figures

Population 384,499

Project Target Population

(Women, Children, Infants)

Skilled Birth rate Early post partum

visit

72,437

70-80% < 5%

Poverty Level 90.47%

Rural Population 67%

Indigenous Population

Skilled Birth rate

28%

36%

Maternal Mortality 102 Deaths per 100,000 Live Births

Newborn Mortality 7.8 Deaths per 100,000 Live Births

Cotopaxi, Ecuador

Provincial Hospital (Surgery & Blood 4 hours/day)

5 County Hospitals(Basic EONC 4 hours/day)

Ambulatory Health Centers (Parish Level)

TBAs (Community Level)(3,000 deliveries)

1,500 deliveriesMinistry of

Health (4,000 deliveries)

Social Security

NGOsPrivate providers

Cotopaxi Provincial Health System: Fragmented; No continuum of care; Inequitable access; Poor quality

of care

Targeting Vulnerable Parishes for greater Equity:

21/38 Total Parishes in Province: Pregnant women and newborns in parishes where:

> 50% population extremely poor > 50% population indigenous Indian

Main Project strategies: Mobilize Community and use BCC methods to increase demand for & access

to care and to improve household best practices.

Create a Community level of EONC care, firmly linked to primary and referral levels of care via “Parish MNH micro-network teams”

Improve quality and 24/7 availability of high impact, evidence-based EONC care at all levels, community, primary and referral (including public and private facilities) as part of a “Provincial MNH Network”

Project Overview: Cotopaxi, Ecuador

REFER

RA

L BASIC EONC24 hours/7days

COMMUNITY EONC

COMPLETE EONC

24 hours/7days

TBAs

HEALTH CENTERS

COUNTY HOSPITALS (5)

ESSENTIAL OBSTETRIC AND NEWBORN CARE NETWORK, COTOPAXI PROVINCIAL HOSPITALS (2)

HomesCommunities

Social Organizations

Building a Community EONC level of Care Anchored in a Parish Maternal-Newborn “micronetwork”: linking TBAs to

health centers

MICRONETWORK TEAM IN GUANGAJE PARISH

TBAS & SKILLED PROVIDERS WORKING TOGETHER AS PART OF A PARISH

MATERNAL NEWBORN “MICRONETWORK” TEAM

TBAs AND COMMUNITY LEADERS IDENTIFY PREGNANT WOMEN USING A PARISH MAP

STRATIFYING RISK STATUS OF PREGNANT WOMEN IN COMMUNITY TO PRIORITIZE HOME VISITS BY TBA-SKILLED PROVIDER TEAMS

HOME VISITS BY DOCTOR AND TBAs TO TARGETED PREGNANT WOMEN AND

NEWBORNS

OUR MICRONETWORK TEAM ON THE ROAD TO A HOME VISIT

MOBILIZING THE COMMUNITY TO IDENTIFY PREGNANT WOMEN AND TRANSPORT

EMERGENCIES

A “KARDEX” OF PREGNANT WOMENORGANIZED BY DELIVERY MONTH

STANDARD REFERRAL COUPONS COMPLETED BY A TBA WHEN SHE SENDS A WOMAN TO HEALTH CENTER OR COUNTY HOSPITAL

Cumulative % deliveries in 2011 versus 2010 attended by a parish micro-network team member Pujili County (8 parishes); Denominator=Total MOH deliveries in 2010. (77% skilled provider-members and 23% trained TBA team-members)

0

20

40

60

80

100

120

140

ene-11 feb-11 mar-11 abr-11 may-11 jun-11 jul-11 ago-11 sep-11 oct-11 nov-11 dic-11

Porce

ntaje

% acumulado de Partos esperados que recibieron atención en el Cantón Pujilí. Año 2011

% early post-partum home visits (first 48 hours) in 2011 relative to expected total County Births provided by a micro-network team-member Pujili County (8 parishes); N= 1,300 births per year in Pujili County(71% skilled provider; 19% trained TBA)

0102030405060708090100

ene-11 feb-11 mar-11 abr-11 may-11 jun-11 jul-11 ago-11 sep-11 oct-11 nov-11 dic-11

Porce

ntaje

% acumulado de Recién Nacidos que tuvieron una visita en las primeras 48 horas en el Cantón Pujilí. Año 2011

Linking TBAs and community organizations to the formal health system increases access to quality EONC

TBAs and community organizations are an effective source to identify high risk women/newborns

TBAs are a powerful resource to increase early post-partum home newborn visits

A “micronetwork” of skilled personnel and TBAs, at the base of an EONC system, is a powerful strategy to deliver high impact, evidence-based interventions.

SOME INITIAL CONCLUSIONS

“THANK YOU FOR NOT LEAVING ME ALONE”

Overview of CHS-Ecuador Child Survival Project

Reduce Maternal & Newborn Mortality

Improve household best practices and a continuum of high-quality community- and facility-

maternal newborn services

Increase availability of and access to

MNH care

Improve knowledge & demand for community & facility services; improve household best practices

Improve quality of MNC services provided as part

of parish micronetworks

Improve policy environment

Goal/Impact

Strategic Objective

Results/Outcomes

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