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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
1 2 3 4
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