ASEAN Regional Guideline · reasons underlying these variations and amongst them the main reasons are lack of a consensus definition of SBA by AMS and lack of accreditation system

one vision one identity

one community

ASEAN Regional Guideline

for Minimum Requirementsfor Training and Accreditation

of Skilled Birth Attendants (SBA)

ASEAN REGIONAL GUIDLINE

for Minimum Requirementsfor Training and Accreditation

of Skilled Birth Attendants (SBA)

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TABLE OF CONTENTS

Glossary of Terms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3Foreword. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51. INTRODUCTION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 1.1Definition.......................................................7 1.2PurposeoftheGuideline...........................................82. REQUIREMENT FOR CORE COMPETENCIES OF SBA IN ASEAN. . . . . . . . . . . . . . . . .93. STANDARDS FOR SBA TRAINING PROGRAMMES. . . . . . . . . . . . . . . . . . . . . . . . . . . 20 3.1Typesoftraining ................................................20 3.2Admissionrequirements.......................................... 20 3.3Standardsfortrainingprogrammes..................................204. REQUIREMENTS FOR TRAINING INSTITUTIONS. . . . . . . . . . . . . . . . . .. . . . . . . . . . . 22 4.1.TeachingStaff.................................................. 22 4.2Trainingprogrammeandmaterials.................................. 22 4.3.Requiredinfrastructureandequipment..............................22 4.4.Clinicalpracticesite.................................. ...........235. ASSESSMENT AND ACCREDITATION OF SBA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 5.1CandidatestobeassessedtobeaccreditedasSBA.................... 24 5.2Accreditation...................................................24 5.3InstitutionseligibleforconductingSBAassessment.....................24 5.4.AccreditationofTrainingInstitutions................................256. RE-ACCREDITATION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Annex1:SBAAssessment(ProposedMethodologies)...........................28 Part1:Skillssuitabletobeassessedbycasemanagement.................28 Part2:Skillssuitabletobeassessedbyobservationofpracticeonsimulators..28Annex2:GuidanceforDevelopingCurriculaandCourseContentforShortSBA UpdatingTrainingProgramme.......................................29Annex2.1:MatrixforKnowledge,SkillsandAttitudeforeachASEANSBA Competency................................................... 30Annex3:StandardClassroomandSkillsLabRoom.............................43

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Glossary of Terms

Accreditation Acertificationprocessdonebyathirdpartyandbestoweduponapersonwhohas demonstratedacertaindegreeofproficiencyrequiredofaprofessionorinstitutionthat hascompliedwiththestandardssetaccordingtothetypeofserviceitprovides.topublicly declarethehealthworkerhasdemonstratedtheyhavereachedtherequiredlevelof proficiency.TheobjectiveofAccreditationistopromoteandensurequality,bydeclaring apersonorinstitutionhasdemonstratedtheyhavereachedarequiredstandard.

Accredited Alicensed,certifiedorregisteredhealthprofessional(e.g.midwife,medicalphysician,Health nurseorother)whohasalegalrighttopractisehisorherprofessionaccordingtoProfessional countrycontext.

Accreditation TheorganizationthathasbeengiventheauthorityeitherbylaworbyappointmentbyBody arelevantgovernmentministrytoundertakeevaluationandregulatethepracticeofa professionbasedoncertainstandards

ASEAN ThelevelofcompetencerequiredofprofessionalstobeabletopracticetheirprofessioninCompetency theASEAN(AssociationofSouthEastAsianNations)region.

Competency Asetofknowledge,skills,attitudesandexperiencesrequiredofprofessionalstobeableto practiceproficiently(A+S+K+E=competence).

EmONC EmergencyObstetricandNeonatalCareincludeslifesavingformothersandnewbornsat birth.Hasbeendefinedastheabilitytoperformanagreedsetofsignalfunctions(9signal functionsforcomprehensiveEmONCand7forBasicEmONC)

JICA JapanInternationalCooperationAgency

MDG MillenniumDevelopmentGoals

Postnatal Aperiodoftimefromthecompletedeliveryofplacentaandmembranes,until6weeksafter birth,duringwhichtimethemajorreproductiveorgansreturntotheirpre-pregnantstage andlactationisestablished;isconsideredanimportanttimeperiodforthemother-baby relationshiptobeformed.Postnatalcareisthetermmostfrequentlyconsideredto becareofboththemotherandnewbornasoneunit(mother-babydyad).

Postpartum Theprocessthebodyundergoesfollowingchildbirth,wellalltheorgansreturntopre- pregnantstate.Thepostpartumperiodhasnospecifictimelineanditcouldtakeupto 6monthsforsomeorganssuchasurinarytracttorecoverafterpregnant.Theterm postpartumisgenerallyusedtorefertothewomenafterbirth.

Proficiency Theabilitytoperformtherequiredcorefunctionstotherequiredstandard.Tobeproficient, thehealthprovidermustpossessallthenecessarycompetenciesandhavepractisedthese repeatedlyandregularlyuntilheorsheisabletoperformtheskillcorrectlywithnoneedfor supervision.

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SelfandFamily- Thisisintendedtoinclude:adviceongoodnutritionforpregnancyandhowtoachievethem:Care Adviceonironsupplementationtopreventanemia;working,physicalactivities,hygiene(sexual organs,breast,body);whatfactorscanbeharmfultothepregnantwomanandfoetus-suchas smoking,alcoholabuseandillicitdrug,toxicworkplace,etc.andhowbesttoavoidthem;danger signsandwheretoseekmedicalhelp

SkilledBirth ASkilledBirthAttendant(SBA)isdefinedasanaccreditedhealthprofessional-suchAttendant asmidwife,doctorornurse-whohasbeeneducatedandtrainedtoproficiencyintheskillsneeded tomanagenormal(uncomplicated)pregnancies,childbirthandimmediatepostnatalperiodandin theidentification,referralandmanagementofcomplicationsinwomenandnewborns

UNFPA UnitedNationsPopulationFund

WHO WorldHealthOrganization

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Achievingthepeople-orientedandpeople-centredASEANCommunityby2015signifiesahealthycommunityofASEANpeopleswithquality,accessibleandaffordablehealthcareandservices.InlinewiththeASEANStrategicFrameworkonHealthDevelopment(2010-2015),ensuringahealthyASEANCommunityby2015involvesvariouspartnershipsandengagementswithrelevantstakeholdersfrombothhealthandnon-healthsectors.

Inherent in this aspiration for a healthy community are the sustained thrusts of ASEANMember Statesin improvingmaternal and child health.Seeking to accelerate and sustain the reduction inmaternal andneonatalmortalityandmorbidityinASEAN,theASEANWorkPlanforMaternalandChildHealth(MCH)for2011to2015seekstoenhance,amongothers,thecompetencyofhealthcommunityworkersorpractitionersinbecomingaccreditedskilledbirthattendants(SBAs),addressing,asastrategy,thecapacityneedsofthehealthworkforceinmaternal,newbornandchildhealthcareatthelocalcommunitylevels.

Afteraseriesofconsultations,theASEANHealthMinisters’Meeting(AHMM)andSeniorOfficialsMeetingonHealthDevelopment(SOMHD)throughtheASEANTaskForceonMaternalandChildHealth(ATFMCH),withsupportfromrelevantstakeholders,haveendorsedthefirstASEANRegionalGuidelinesforMinimumRequirementforTrainingandAccreditationofSkilledBirthAttendants.TheguidelinesprovidecriticalinformationontherequiredcorecompetenciesofSBAsinASEAN,thestandardsfortheirtrainingprogrammes,aswellastherelevantrequirementsfortraininginstitutionsandfortheassessmentandaccreditationofSBAs.

ItishopedthatthisbookwillbeutilizedbytheASEANMemberStatesinaddressingtheworkforceneedsofmaternal,newborn,andchildhealthcareintheirrespectivecommunities,ultimately,contributingtobetterhealthoutcomesintheASEANCommunity.

LeLuongMinhSecretary-GeneralofASEAN

FOREWORD

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FOREWORD

At the8thASEANSeniorOfficialsMeetingandsubsequentASEANTaskForceMeetingonMaternalandChildHealthheldinAugust2013,UNFPAandASEANagreedtocollaboratetopromotethematernalhealthofwomenintheASEANMemberStates.

LedbytheMinistryofHealthofMyanmar,andsupportedbyUNFPA,inOctober2013theASEANTaskForceonMaternalandChildHealthorganizedaworkshoptodeveloptheASEANRegionalGuidelineforMinimumRequirementsforTrainingandAccreditationofSkilledBirthAttendants.ThispublicationistheculminationofeffortsmadebyTaskForceMembersduringandafterthatworkshop.

SeveralASEANMemberStateshavebeenhighlysuccessfulinreducingmaternalandneonatalmortalityandmorbiditythroughtheadoptionofforwardlookingstrategiesprovidingmidwivesandotherpractitionerswiththenecessarytraining,skillsandcompetenciestobecomeaccreditedskilledbirthattendants(SBAs).TheRegionalGuidelineincorporatesexpertknowledgeandopinionfromwithintheregionandbeyond,providingguidanceonstrategiesandprocesses that representminimumrequirements forcoreSBAcompetencies,training,assessmentandaccreditation.

UNFPAiscommittedtoensuringthatscientificevidenceisusedtosupportthecriticalroleofSBAsinreducingmaternalmortality,andvaluestheessentialrolethatthesehealthprofessionalsperform.Recognizingthattherewillbeaneedforskilledbirthattendantswellbeyondthe2015deadlineforachievingtheMillenniumDevelopment Goals, UNFPA encourages each ASEAN Member State to use the Regional Guideline tostrengthennationaleffortstoprovidesafedeliveries,andthecareofmothersandtheirnewborninfants.

UNFPAwelcomesthisopportunitytocollaboratewithASEANandlooksforwardtoacontinuedpartnershipbothatregionalandcountrylevels.

NobukoHoribeRegionalDirector

UNFPAAsiaandthePacificRegionalOffice

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1 AnAccreditedHealthProfessionalforthepurposesofthisguidelineis–ahealthprofessionalwhohasalegalrighttopractiseaccordingtocountrycontext

1. INTRODUCTION

Goal5–ImproveMaternalHealthisacriticalgoalamongtheeightMillenniumDevelopmentGoals(MDGs)andwillcontinuetobeprominentinthepost-2015healthagenda,asseveralcountrieswillnotreachtheMDGtargetssetoutattheMillenniumSummit.AkeyindicatorforMillenniumDevelopmentGoal(MDG)5is,“theproportionofdeliveriesassistedbyaskilledhealthprofessional/SkilledBirthAttendant(SBA)”.TheproportionofdeliveriesassistedbySBAsvarieswidelyamongASEANMemberStates(AMS).InfactthereareseveralreasonsunderlyingthesevariationsandamongstthemthemainreasonsarelackofaconsensusdefinitionofSBAbyAMSandlackofaccreditationsystemwithmidwiferycompetenciesinthecurriculumforSBAs.Nationalreportsandneedassessmentsreportthathealthprovidersareassistingavastmajorityofdeliveries.Howevermanyofthesedonothavethecompetencies,asinternationalrecommendation,forallthetaskstheskilledattendantisrequiredtoperformsafedeliveriesandsavethelivesofmothersandnewborns[1,2].

1.1 DefinitionAccordingtoJointstatementofWHO,ICM,FIGOin2004:ASkilledBirthAttendant(SBA)isdefinedas“anaccreditedhealthprofessional1-suchasmidwife,doctorornurse-whohasbeeneducatedandtrainedtoproficiency in theskillsneededtomanagenormal (uncomplicated)pregnancies,childbirthand immediatepostnatalperiodandintheidentification,managementandreferralofcomplicationsinwomenandnewborns”[3].

This applicable and consensus statement, which includes 23 competencies for qualified SBAs, helpsmedicaltrainingorganizationsdesigningtheircurriculatoachievetherequiredcompetenciesofSBA.TheJointstatementisagoodstartingpoint,howeverinitselfnotsufficienttodeveloptheprocessoftraining,certificationandlicensing.Myanmar,VietNamandLaoPDRareassignedasleadingcountriestodevelopaguidelinetohelpprovideacommonframeworkforthetrainingandaccreditationofSBAinASEANcountries.TheworkhasbeencarriedoutwiththeinvolvementandsupportfromUNFPA,WHOandJICA.

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1.2 Purpose of the GuidelineThepurposeoftheGuidelineistoassisttheASEANMemberStates(AMS)to: (i).DefinethecorecompetenciesforSBAoftheASEANcommunityaswellasevaluationand accreditationmethods. (ii).EstablishtrainingstandardsforbirthattendantstomeettheASEAN’sSBAcorecompetencies. (iii).Definethecriteriaandprocessesforcapacityassessmentandaccreditationofatraining institutioncapableofdeliveringSBAtrainingand/oraccreditation,inaccordancewithASEAN agreedcorecompetencies.

Note: This guideline is a reference with common perspectives; each country in ASEAN will need to develop their specific regulations on qualification and accreditation process and training programme to ensure they are in line with their own national context.

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Competencies Core functions Skill and/or ability to do as minimum the following:

Competency 1:

Tobeabletouse all forms of communication3 effectivelyandtoapplytheunderlyingknowledgetobeabletoprovidequality,culturallyrelevantcare.

1.Communicateeffectivelycross-culturallyinordertobeabletoprovideholistic“women-centred” care. 2.Communicateeffectivelywithclientsregardlessofeducationalandeconomicstatus,religiousandethnicbackground.3.Cultivateeffectivecommunicationwithcolleaguesandothermembersofthehealthcareteam.4.Promotearights-basedapproachtohealththatencourageswomentoparticipateindecision-making.

•Engageinhealtheducationdiscussionswith andforwomenandtheirfamilies.•Useappropriatecommunicationandlisteningskillsacrossalldomainsofcompetency4.•Usesimplelanguagetoconveymessagesthatareeasy-to-understand.•Recordandinterpretrelevantfindingsforservicesprovidedacrossalldomainsofcompetency,includingwhatwasdoneandwhatneedsfollow-up.•Takeaccountofthelocalcircumstancessuchasgeographicaldiversity,culture,beliefs,customs,etc.whenprovidingservicesandcommunicating.•Respectandencouragetraditionalpracticeswhicharebeneficalandnotharmfulanddiscouragepracticeswhichareknowntobeharmful.•Takealeadershiproleinthepracticearenabasedonprofessionalbeliefsandvaluespracticeeffectiveinterpersonalcommunicationskills.

Competency 2:

Providehighqualityantenatal

1.Takeadetailedhistorybyaskingrelevantquestions.

•Takeaninitialandongoinghistoryateachantenatalvisit.•Performaphysicalexaminationandexplain findingstothewomanandherfamily.

2. REQUIREMENT FOR CORE COMPETENCIES OF SBA IN ASEANAllskilledattendantsatalllevelsofthehealthsystemmusthaveskillsandabilities2toperformallofthecorefunctionsbelow:

2ForguidanceontheorycontenttoenableSBAtoperformthefollowing,seeAnnex23InthecontextofcorecompetenciesforSBA,“allformsofcommunication”includeinterpersonalcommunications,writingskills,skillsinusingtelephoneorotherformsoftelecommunicationreadilyavailableincountry.4 Domainsofcompetencies:acompetencyismadeupofmanyindividualcomponentssuchasasetofpracticalpsychomotorskills, scientificandbehaviouralknowledge,professionalbehaviours,personalattributes,aswellascriticalthinking,decisionmakingandjudgementskills.

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caretomaximizehealthduringpregnancythatincludesearlydetectionandtreatment5andwhereneededreferralofselectedcomplications.

2.Assessindividualneedsandgiveappropriateadviceandguidance.3.Performaphysicalexaminationtoassess healthstatusandprogress ofpregnancyandidentify problemsandgiveappropriatetreatmentand or refer.4.Performappropriatescreeningtestsasrequired5.Assistpregnantwomentomakeandupdatebirthplans.6.Educatewomen(andtheirfamiliesandotherssupportingpregnantwomen)inself-care,goodnutritionanddangersignsduringpregnancy,childbirthandthepostnatalperiod.7.Identifyobstetricandmedicalconditionsdetrimentaltothehealthofthemotherandfoetusespeciallypre-eclampsia,performfirst-linemanagement(includingperformanceoflife-savingprocedureswhenneeded)andmakearrangementsforeffective referral.

•Takeandassessmaternalvitalsignsincludingtemperature,bloodpressure,pulse.•Assessmaternalnutritionanditsrelationshiptofoetalgrowth;giveappropriateadviceonnutritionalrequirementsofpregnancyandhowtoachievethem.•Performacompleteabdominalassessmentincludingassessmentoffundalheightusingmanualmeasurements,lie,position,andpresentation.•Listentothefoetalheartrateanddeterminefoetalwell–beingandinterpretfindingsandtakeappropriateaction.•Evaluatefoetalgrowth,placentallocationandamnioticfluidvolume,usingultrasoundvisualizationandmeasurement(ifequipmentisavailableforuseandwithinscopeofpractice).• Performapelvicexamination,includingsizingtheuterus,anddeterminingtheadequacyofthebirthcanal.•PerformscreeningtestsforanaemiaHIV,syphilis,proteinuriaoranyothertestsaccordingtonationalprotocol.•Takebloodtodeterminebloodgrouping,andotherhaematologicalinvestigationsasmayberequired.•Administertetanusimmunizationaccordingtonationalprotocols.•Recordandreportallfindingsateachantenatalvisit.•Makedecisionsbasedonclinicalfindingsandtakeappropriateactionincludinggivingfeedbacktothewomanandfamilyandreferraltohigherlevelhealthfacilities.

5 Treatment–itisassumedallSBAsmustbeabletoofferasminimumfirstlinetreatment,toincludeperforminglifesavingmeasures

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6 InformationinBirthPlanshouldincludeasminimum;peoplewhowillbepresentduringlabourandbirth,essentialsuppliesformother andnewborn(willvarybycontext):clothingneededforgingtohealthfacility,nursingbrasandpads,etc.Signsandsymptomsoftheonsetoflabour(includingwomen’sperceptionsandsymptoms);7“Selfandfamily-care”isintendedtoinclude:goodnutritionforpregnancyandhowtoachievethem.Adviseonironsupplementationtopreventanemia;working,physicalactivities,restingduringscheduledappointments;+Hygience(sexualorgans,breast,body);Avoidharmfulfactorsonthepregnantwomanandfoetussuchassmoking,alcoholabuseandillicitdrug,toxicworkplace,etc.


Competency 2 (contd):

•Assistpregnantwomenandtheirfamiliesinmakingandupdatingaplanforbirth6:•Makearrangementsfortimelyeffectivereferral•Discourageharmfulcustomsandpractices•Identifysignsandsymptomsofobstetricandmedicalconditionsdetrimentaltothehealthofthewomanandfoetusandmakeclinicaldecisionsbasedonfindingsandtakeappropriateactionincludinggivingfirstlinemanagementandmakingeffectivereferral.•Providefullcounsellingtothewomantoaccepttreatmentand/orreferralcheck-up,monitoring.•Educatewomen(andtheirfamiliesandotherssupportingpregnantwomenandnewborn)on:-theimportanceofregularcheck-up - Self7andfamilycare-theneedforcreatingasafeandhealthyenvironment•Counsellingon-thebenefitsofearlyandexclusivebreastfeeding. -sexualpracticeduringpregnancyandafterchildbirth-voluntaryfamilyplanningandbirthspacingfollowingchildbirth•Psychologicalsupportformother:normalpsychologicalchangesinpregnancy,information

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aboutreliefofcommondiscomforts, techniquesforincreasingrelaxationandpainreliefmeasuresavailableforlabour.•Explaintothewomanonhowtoidentifytheonsetoflabourandneedforgoingtohealthfacilityearlytoallowforgoodmonitoringandcareduringlabour.•Emergencypreparednessandpreparingforpossiblecommunity-basedreferral:whotocontact,whatsupport,etc.•Performfirst-linemanagement(includingperformanceoflife-savingprocedureswhenneeded.

Competency 3:

Providehighquality,culturallysensitivecareduringlabour,conductacleanandsafebirthandhandleselectedemergencysituationstomaximizethehealthofwomenandtheirnewborns.

1.Identifytheonsetoflabour2.Performvaginalexamination,ensuringthewoman’sprivacyandsafety,andproperconductbySBA.3.Monitormaternalandfetalwell-beingduringlabour.4.Providesupportivecare.5.Recordmaternalandfoetal well-beingonapartograph.6.Identifydelayedprogressinlabourandtakeappropriateaction,includingreferral.7.Manageanormalvaginaldelivery.8.Effectivelymanagethethirdstageoflabour,includingapplicationofAMTSLwhereappropriate andinitiateearlbreastfeeding,includingskin-to-skincontact.

•Provideculturalysensitivecarethroughoutthefullprocessoflabourandbirth;•Assessandrecordthewoman’sgeneralstatusandcondition:vitalsigns,physicalconditions,etc.•Explaintopregnantwomenthestagesof labour,thereasonsforandproceduresforvaginalexaminationduringlabour.•Preparesterilizedequipmentforvaginalexamination.•Perfomlimitedandtimelyvaginalexaminations,toreduceinfectionandrecordfindingsonpartographorsimilarrecord.•Performacompleteandaccuratepelvic examinationvaginallywithprivacyandrespect,toassessfordilatation,effacement,descent,presentingpart,position,statusofmembranes, andadequacyofpelvisforbirthofbabyand recordallfindingonpartographorsimilar record.•Regularlymonitorprogressoflabour:dilatation,effacement,etc.andfoetalheartrateandrecordallfindingsonpartographorsimilar record.

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•Providesupportivecareduringlabour:Instructiononhowtomove/lie,breathduringlabouranddelivery,howtorelievepain,psychologicalsupport,etc.•Provideadequatehydration,nutritionandnon-pharmacologicalcomfortmeasuresduringlabourandbirth.•Providepainreliefduringlabourandbirth•Allowcompanionofchoiceduringlabourandbirth.•Encouragepositionofchoiceduringlabourandbirth.•Manageinaccordancewithnationalguidelines•Identifydelayedprogressinlabour,byusingthepartographandclinicalsigns.•Augmentuterinecontractility,usingpharmacologicagents(inappropriatebirthsettings),accordingtonationalguidelines.•Earlyidentificationofmaternalandfetaldistressandtakeappropriateaction,includingreferralwhererequired.•Keepthewomanandherfamily/supporterregularlyupdatedaboutthestatusoflabourandplannedmanagement.•Explaintofamiliesfortheirsupportersandmobilizecommunity-fortimelyreferral•Assistnormaldeliveryaccordingtobestpractice.•Performanepisiotomytimely,ifindicated.•Conductactivemanagementofthe3rdstageoflabour(AMTSL),includingestimationandrecordingofmaternalbloodloss.•Performfundalmassagetostimulatepostpartumuterinecontraction.

8ActivemanagementoftheThirdstageoflabour(AMTSL)hasanumberofcomponents:giveintramuscularlyanoxytocixdrug,manuallydetectuterinecontraction,encouragethewomantoexpeltheplacenta(sometimesarchivedbyhavingthewomanchangepositionorsit/squatonabed-pan).Thepracticeofcontrolledcordtractionwhilstsimultaneouslyguardingtheuterusisnolongerrecommendedunlessallotherattemptsabovedonotwork.

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•Performurinecatheterizationifindicated.•MakeRapidAssessmentandinstitutemanagementofobstetricalandnewbornemergenciesaccordingtonationalprotocols,including:managementofcordaroundthebaby’sneckatbirth,prolapsedcordandseverematernalandfoetaldistress,eclampsia,etc.•Provideimmediateessentialcareofthenewbornatbirth.•Recognizesignsofasphyxiaatbirthandtakeimmediateaction,includingperforming newbornresuscitationaccordingtobestpractices.•Initiateearlybreastfeedingincludingskin-to- skincontact.•Inspecttheplacentaandmembranesforcompleteness.•Inspectthevaginaandcervixforlacerationsandrepair1stand2nddegreeperinealorvaginallacerations.•Repairanepisiotomy.•Educatewomenandfamiliestodetectearlysignsofhaemorrhageduringthepospartumperiodandwheretoseekassistance.•Performfirstlinemanagementofpostpartumbleedingandhaemorrhage,includingusinguterotonicagentsandfundalmessage.•Recognizeandrespondtoshock,includinginsertionofintravenousline,anddrawingbloodforlaboratorytests.•Performcardio-pulmonaryresuscitation.•Performmanualremovalofplacenta,inaccordancewithnationalguidelines.

5 Bestpracticecallsforallwhoprovidecarefornewbornatthetimeofbirthasminimummustbeabletoaccurateconductarapid assessmentusingAPGARorsimilarscore,clearingofairways,provideventilationbybagandair,maintainbodytemperatureduring procedureandprotectforharmincludingprotectionforinfection.

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•Performinternalbimanualcompressionoftheuterustocontrolsevereuterinebleedingandperformaorticcompressionifindicated.•Arrangeforandundertaketimelyreferralandtransferofwomenwithseriouscomplicationstoahigherlevelhealthfacility,takingappropriatedrugsandequipmentandaccompaniedbyahealthprofessional.

Competency 4.1: Providecomprehensive,highquality,culturallysensitivecareinpostpartumperiod.

1.Identifyhaemorrhageandperformmanagementduringimmediatepostpartumperiod.2.Providepostnatalcaretowomen.3.Identifyillnessesandconditionsdetrimentaltothehealthofwomeninthepostnatalperiod.4.Provideadviceon postpartumfamilyplanning.

•Provideculturallysensitivecareandsupport.•Monitorcontractionoftheuterus,pulse,bloodpressuretoearlydetecthaemorrhageduringthepospartumperiod(atleastonceduringthefirst6hoursafterdelivery,firstdayafterdelivery,andfollowingdaysasneeded).•Assessforuterineinvolutionandhealingoflacerationsand/orrepairs.•Performpostnatalscreeningtestsaccordingtonationalpolicy.•Educatewomanhowtomassagetheuterustokeepitwell-contracted.•Explaintowomanandherfamilyaboutlife-threateningsituationsiftheyarise,andmanagementprocedures.•Provideeducationonself-care,nutrition,personalhygiene,breastfeedingandsexualrelations.•Providesupportforwomenandtheirfamilies whoarebereaved(stillbirth,pregnancyloss,neonataldeath,congenitalabnormalities).•Detectandmanageabnormalconditionsinthepostnatalperiod,includingeclampsia,breastcomplications,sepsis,psychologicaldisorder,urinarytractinfections,etc.• Teachwomenandfamiliesonearlydetectionofabnormalsignsinpostnatalperiod:

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eclampsia, breast complications, sepsis, psychology disorder, urinary tract infections etc. • Administer, life-saving drugs according to national guidelines (e.g. antibiotics, anticonvulsants, anti-malarials, anti- hypertensive, anti-retroviral).• Make arrangements for timely referral and apply management as per national protocols.• Counsel couples on the importance of family planning/birth spacing after delivery, as well as appropriate contraceptives that can be used during breastfeeding period.• Provide family planning services concurrently, as an integral component of postpartum care.

Competency 4.2:Provide high quality, culturally sensitive, post- abortion care.

1. Detect signs of miscarriage and provide emergency management.2. Provide post abortion family planning counselling and services.

• Diagnose miscarriage.• Insert IV line.• Accompany the patient to the health facility.• Perform evacuation of retained products of conception according to national guidelines.• Provide psychological support.• Provide post-abortion family planning counselling and service according to national guidelines.

Competency 5:

Provide high-quality,

comprehensive care

for the

healthy

infant

from birth

to

two months

of

age.

1. Assess the newborn at birth and give immediate care.2. Identify any life threatening conditions in the newborn and give essential life- saving measures,including, where necessary, active resuscitation as a component of the management of birth asphyxia, and referral where appropriate.

• Provide immediate care to the newborn, including: dry the newborn; place in skin-to-skin contact on mother’s abdomen or chest and cover to keep baby warm; suctioning (if needed); cord clamping and cutting when pulsation ceases.• Take steps to prevent infection.• Assess the immediate condition of the newborn (e.g., APGAR scoring or rapid assessment method: breathing, colour of the skin and heart rate).• Promote and maintain normal newborn body temperature through skin-to-skin contact (e.g.,

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3.Assistwomenand theirfamiliesininitiating,establishingandmaintainingexclusivebreastfeeding,includingprovidingeducationonbenefitsofearlyexclusivbreastfeedingandseekingassistanceearlyforbreastfeedingdifficulties.4.Educatewomenandtheirfamiliesonbenefitsofearlyexclusivebreastfeeding.5.Providemonitoringandcarefortheinfantinthefirsttwomonths.

blanket,cap),andenvironmentalcontrol(e.g.warmer).•Provideroutinecareofthenewborn,inaccordancewithnationalguidelinesandprotocols(e.g.,identification,eyecare,screeningtests,administrationofVitaminK,HBV,BCGandneedforbirthregistration.•Performnewbornscreening.•Identifycongenitalabnormalitiesandinitiateappropriateandtimelyintervention.•Identifyrespiratorydistressinthenewbornbyrapidassessmentbybreathing,skincolourand heartrate,andperformin-linemanagement.•Performemergencynewbornresuscitation:-Suction(incaseofairwayobstruction)-Ventilationwithbagandmask/tubeandmask-Chestcompression-Makearrangementsfortimelyandeffective referral•Explaintowomenandtheirfamiliesabouttheimportanceofbreastfeeding.•Initiateandsupportearlybreastfeeding(within thefirsthour).•Teachmothershowtoexpressbreastmilk,and howtohandleandstoreexpressedbreastmilk.•Teachmothershowtobreastfeedandmaintainsuccessfulbreastfeeding.•Giveappropriatecareincluding,kangaroomothercareforthelowbirthweightbaby,andarrangeforreferralifpotentiallyserious complicationsarise,orifverylowbirthweight.•Detectandteachmothersonearlydetectionofabnormalsignsofnewborninpostnatalperiod:eyes,complexion,digestion,umbilical cord,etc.•Recognizecomplicationsintheinfant,stabilize andtransferhigh-riskinfanttoemergencycarefacilityaccompaniedbyhealthprofessionalandmother.•Makearrangementsfortimelyeffectivereferral•Monitorthegrowthanddevelopmentoftheinfant.•Performimmunizationaccordingtonationalimmunizationschedule.

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Competency 6

Provide high quality, culturally sensitive health education and services to all in the community, to promote healthy family life, planned pregnancies and positive parenting.

1. Educate women and their families on how to prevent sexually transmitted infections including HIV.2. Supervise non-skilled attendants, including TBAs where they exist, in order to ensure that the care they provide during pregnancy, childbirth and early postpartum period is of sound quality.3. Collect, analyse and report relevant data of women and their newborns4. Promote an ethos of shared responsibility and partnership with individual women, their family members and the community for the care of women and newborns throughout pregnancy, childbirth and the postnatal period

• Educate and communicate with women and

up/medical examination.• Educate women and their families on risk factors of sexually transmitted infections and how to prevent sexually transmitted infections.• Educate members of the community how to recognize sexually transmitted infections/ reproductive tract infections and seek health care.• Educate families and communities on dangers of early teenage pregnancies.

• Identify birth attendants who are not yet SBAs, including TBAs where they exist (numbers, workplace).• Work in partnership with non-skilled attendants to identify pregnant women and encourage them to seek antenatal care, safe delivery and postnatal care with skilled health professionals.• Educate non-skilled attendants on practices to avoid during pregnancy, delivery and postnatal period.• Collect, report data on a monthly, quarterly and yearly basis, as the national reporting guidelines dictate.• Analyse relevant data on women and their

to promote good health care practice (evidence- based practices).• Promote partnership with colleagues to provide high-quality Maternal and Newborn Health care in health facilities: manage and provide comprehensive health care, provide adequate information on maternal and newborn care.• Promote partnership with the community to provide quality evidence-based home-based care for mothers and newborns.• Make arrangements for referrals including for emergency care, etc.• Health education and promotion to families and communities, including community leaders and

newborn health practices and services.

19

The above Competencies were developed based on:Makingpregnancysafer:thecriticalroleoftheskilledattendant,ajointstatementbyWHO,ICMandFIGO,2004[3];StrengtheningMidwiferyToolkit,WHO2011[4]);Essentialcompetenciesforbasicmidwiferypractice2010,revised2013,ICM2013[6].Memberstatesmayaddtothesecompetenciesandorskillsaccordingtonationalcontext.ForknowledgebasetoperformthesecompetenciesseeAnnex2.TheASEANregionalcompetencylistabovehasbeendevelopedasaguidetominimumrequirementsfortheskillsandcorefunctionofwhatSBAsinASEANcountriesshouldbeabletoprovide.

20

3. STANDARDS FOR SBA TRAINING PROGRAMMES

3.1 Types of training Four types of training are recognized as applicable in the ASEAN region: 1. SBA Accreditation as part of an initial pre-service programme (e.g. for nursing, midwifery or medicine). 2. SBA Accreditation as integral to a recognized Post-basic Nursing programme to obtain an additionalLicense/Certification/Registration(e.g.:asamidwife/nurse-midwife)oraspecialized clinical course for Medical Practitioners. 3. Specialized Post-basic/part of Continuing Professional Development (CPD) for Accreditation for Health Providers who are not SBAs. 4. Professional updating for midwives, nurse-midwives, doctors or others, to meet competencies for SBA in the ASEAN region.

3.2 Admission requirementsType 1 and 2: determined by national regulations depending on the type of programme.Type 3 and 4: to be recognized as SBA for existing health providers, entry requirements should, as a minimum,

include: - Hold a professional accreditation/registration or license as a health provider according to National Human Resources for Health (HRH) system. - Currently working on maternal and newborn care. - Willing to be trained for improvement and for SBA accreditation.Regardless of type of training, on completing of any of above the health providers must be able to demonstrate they have all the required competencies of SBA in the ASEAN region. As such they should be able to demonstrate they have: -TherequisiteknowledgeandskillstobeabletoperformallthecorefunctionsasdefinedinSection2. -The required professional and ethical attitude to practise maternal and newborn care for safe motherhood while respecting human rights, dignity and the cultural values of the mother’s locality.

3.3 Standards for training programmes 1. All training programmes should be competency–based. 2. All courses should provide minimum of 50% clinical practice for type 1 and type 2, but for type 3 and 4 there should be a minimum of 70% (more may be needed depending on need, and decisions on length and content should be based on a detailed Needs Assessment). 3. For the minimum number of cases during the training, see matrix below:

21

Minimum number of case (for content be covered in each case see annex 2)

Type 1

SBA Accreditation -part of initial pre-service programme

Type 2

SBA Accreditation

Post-basic Nursing

programme

Type 3

Specialized Post-basic/

part of CME for Accreditation

for Health Providers

Type 4

Professional updating for midwives,

nurse-midwives, doctors

1. ANC 40 20 20 3

2.Complicated pregnancies*

10 10 10 Asneeded

3. Normal vaginal deliveries 20 10 10 3

4.Abnormal /complicated deliveries (breech/face )

2 2 2 Asneeded

5.Essential care of newborn at birth

20 10 10 3

6. Postnatal care of mother and baby - first 24 hours 40 20 20 6

7.Postnatal care mother and baby after 24 hrs up to 6 weeks

40 20 20 6

8.Complications of postpartum period** 10 10 10 Asneeded

9.Care of women following haemorrhage and/or sepsis in pregnancy

2 2 2 Asneeded

NOTE :Foritem2,3,8and9inmatrixabove:InsomecountriesstudentsundertakingType1and2wouldnotberesponsibleforthecasebutmustassistinthemanagementofcases.*Priorityshouldbegiventomanagingpre-eclampsiaandeclampsia.**Priorityshouldbegiventomanagementofpostpartumhaemorrhage.

22

4. REQUIREMENTS FOR TRAINING INSTITUTIONS

Based on global standards for initial education of professional nurses and midwives[5] (for pre-servicetraining),andstandardsofgoodpracticeformedicaleducation,all traininginstitutionswishingtoprepareSBAsmustmeetminimumrequirementsasdescribedbelow.

4.1. Teaching staffTeaching staff/Trainee ratioForclassroomteachingtheminimumstandardteachertostudentratiois1:20.Forskillslaboratorytheminimumstandardteachertostudentratiois1:5forsimulationpractices.Forclinicalpracticetheminimumstandardteacher/clinicalpreceptorormentortostudentratiois1:4.

Qualifications of Teaching StaffMustholdarecognizedprofessionalqualificationinthesubjecttheyareteaching.MusthaveundertakenapreparationforTrainingofTrainers(TOT).Musthaveundertakenrecent(withinthelast3-5years)professionalupdating.

In addition to small group teaching and clinical training, teaching staff also have the responsibility ofsupervising,coachingandmentoringoftrainees.

4.2 Training programme and materials 1.Thetraininginstitutionmustdevelopaspecifictrainingprogrammeincludingcurriculumand teachingandlearningmaterialsbasedontheminimumcompetenciesasdescribedinsection2 andthestandardfortrainingprogrammeinsection3ofthisguideline. 2.Allteachingandlearningmaterialsmustbesuitableforcompetency-basedtraining–boththeory andpracticum.Thematerialsneedtobeevidence-basedwithup-to-dateinformationonhealth promotion,obstetricsandnewborncare.

4.3. Required infrastructure and equipment 1.StandardsforType1andType2trainingwillbedefinedaccordingtonationalregulations. 2.StandardsforType3and4trainingmusthavethefollowing:

Alargeclassroomwithatleast2M2/participantthatisfullyequippedwithaudiovisualequipment.

Atleastoneskillslabroomequippedwithmodels,teaching/learningaids,posters,etcforensuringqualityoftraining.Theamountofequipmentshouldbesufficientforeachparticipanttobeabletopractisethreetimesforeachskill.(For a detailed description of classroom and skills lab room requirements see Annex 3)

23

4.4. Clinical practice siteAlltraininginstitutionsmusthaveorcooperatewithatleastoneclinicalpracticesiteofferingMCHserviceswhichmeetthefollowingminimumrequirements: 1.Havetheappropriatenumberofteachingstaff,asdescribedinitem4.1. 2.Normallyhave,asminimum,anaverageof60vaginaldeliveriespermonthinthe6monthspriorto studentpractice. 3.Havewrittencommitmenttoensureeachtraineewillhavetheopportunitytoimplementthe minimumnumberofcasesinclinicalpracticerequiredin3.3. 4.Allclinicalsitesmusthaveregularperiodicauditsofclinicalpractice,toensuretheymeetnational guidelines/protocols.

A clinical practice site could be a provincial, district level health facility or district level health facility incombinationwithsub-districtlevelhealthfacilities.

24

5. ASSESSMENT AND ACCREDITATION OF SBA

5.1 Candidates to be assessed to be accredited as SBAThecandidatesinclude: •Healthproviders(doctors,midwivesandnurses)whoareworkinginthefieldofmaternaland newborncare,providingmidwiferycareandhaveaneedtobeaccreditedasSBA; •Newgraduatesofpre-servicemidwiferyormedicalprogrammeswheretheyareexpectedtooperate asSBAimmediatelyaftergraduation(exceptwhereSBAcompetenciesareincludedinfinalexit examination); •AccreditedhealthprofessionalswhohavecompletedaspecialistSBAprogrammeorSBArefresher trainingcourse(Type4programme).

5.2 Accreditation5.2.1 Assessment methods used to accredit SBA

AllcandidatesforSBAaccreditationmustundergoaformalassessmentofcompetencies.Assessmenttoolsandprocessesmayvaryaccordingtocountrycontextbutmustasminimumhavetwocomponentsincluding: -Multiplechoiceandcasemanagement; -OSCE/OSPE(Objectivestructuredclinical/practicalexamination)usingskillchecklistsforscoring (seeAnnex1forproposedmethodsofassessment).

5.2.2 SBA accreditation

ThecandidatewillbeaccreditedasASEANSBAifshe/heobtainsallthefollowing: -Atleast70%forthewrittenexamination; -Atleast80%ofthemaximalscoreforeachassessmentdomain; -PassalltheOSCE/OSPEstations.

5.3 Institutions eligible for conducting SBA assessmentAllinstitutionsconductingSBAassessmentsand/orprovidingtrainingofSBAsmustbeformallyapprovedandaccreditedbyanauthorizedorganization(s)andMinistryofHealth.

TheinstitutionsshouldideallyhavebeeninvolvedindeliveryofSBAtraining,butregardlessofiftheyhavebeeninvolvedindeliveryorSBAtrainingornot,allinstitutionswillneedtomeetthefollowingcriteriatobeeligibleforconductingSBAassessmentandaccreditationofSBA:

5.3.1 Standards for institutions conducting SBA assessment

AllfacilitiestobeaccreditedforconductingSBAassessmentsmusthaveasminimumthefollowing: 1.Atheory-basedexaminationarea(room)foratleast20examineespersession(paper-basedor computer-basedtest),adequately-equipped(furniture/computers).

25

2.AnOSCE/OSPEexaminationarea,includinganadequatenumberofseparatedroomswithone- wayflowtolimitcommunicationbetweencandidatesgoinginandout: -Waitingroom:adequatechairsforcandidates,atleast20chairs; -Examinationroom/roomswithadequatespaceforOSCE/OSPE; -Post-examinationroom:adequatechairsforcandidateswhofinishedtheirexamination.

3.AdequatecommodityandequipmentforOSCE/OSPE,including: -Models,simulators,tools,commoditiescorrespondingtoeveryskillbeingassessed; -OthercommoditiesforOSPE:timer(tomeasureminutes);bells,etc.Ifaffordable,acamera systemwithlargedisplaytobeprovidedformonitoringpurpose.

5.3.2. Minimum standards for examiners

Theremustbeadequateexaminers(atleast2examinersperstation).Allexaminersmustmeetallthefollowingcriteria: •Beacertified/licensed/accreditedSBA,orhavepost-graduateorequivalentdegreeinobstetrics- gynaecologyormidwfery; •Haveover10yearsexperienceofpractisingasSBA; •BeaSBAtrainerormaternal/newbornhealthtrainer; •BetrainedinconductingOSCE/OSPE; •HaveattendedSBAPreparationofExaminersworkshop,tobefamiliarintoolsandprocessesfor theassessment.

5.3.3 Other human resources required

Inadditiontoexaminers,theremustbesufficentassistants,tohelpwithtimekeeping,ensureOSCE/OSPEstationsarewellmaintainedandescortcandidatestostations.

There shouldbeat least twocoordinatorsper assessment session formanaging recordsandorganizingassessment,ormanagingunforseenincidents/potentialdisruptions.

5.4. Accreditation of training institutionsAccreditation reflects thesystematicassessmentof infrastructure (which includesmanpower, equipment,etc.) requiredforconductingSBAtraining. It refers toavoluntaryprocesswherein therequirementof thetrainingfacilityisassessedagainstsetstandards.

5.4.1 Committee for Accreditation

TheCommittee forAccreditation ofSBA training siteswill be set upbyMinistry ofHealth or authorizedorganization(oranagencyassignedbyMinistryofHealth)ofASEANMemberStates.

TheCommitteeshallbecomposedoffollowing:OBGYN(1),MidwiferyTeacher(1),MidwifewhoisanaccreditedSBA(1),Paediatrician(1),Medicaleducator(1),andMCHServiceManager(1).

26

5.4.2 Accreditation procedure

AllinstitutionsprovidingtrainingofSBAsmustbeapprovedandaccreditedbyanauthorizedorganization.

5.4.3 Application for accreditation as a training institution

Training institutionsapplying for sitesneedaccreditation forSBA trainingshouldprepare theappropriateapplicationdocuments,including: •ApplicationformtotheCommittee; •Reportofthetrainingsite,includingself-assessment; •ListandCVofallteachingstaffinvolvedintrainingandaccreditationofSBAs; •Up-to-datelistandstatusofinfrastructure,equipment; •Trainingprogrammeandmaterialstobeused; •ReportonSkillslabstatus.

5.4.4 Site assessment of institutions

TheSBAAccreditationCommitteewill: -ReviewapplicationdocumentsbasedonrequirementsdescribedinPart4ofthisdocument; -Conductasitevisitandassesstheinstitutionfortheactualassessment.

5.4.5 Post site visit and awarding accreditation

If thetraininginstitutionssitemeetsall therequirementsdescribedinPart4,theCommitteewill reporttotheMinistryofHealthorauthorizedorganization(oranagencyassignedbyMinistryofHealth)oftheASEANMemberStatethatanaccreditationcertificationrecommendationshouldbeawarded.

Ifthetraininginstitutionssitevisitshowssomedeficiencies,thenareportoutliningthesedeficiencieswillbesenttotheinstitution,withacopytotheMinistryofHealthorauthorizedaccreditationbody(oranagencyassignedbyMinistryofHealth)witha recommendationon the timewhen thesecondvisitwillbemade.Accreditationcertificationshouldbepostponeduntilallcriteriaaremet.

Exceptionally, where only minor deficiencies are observed during the site visit, the Committee may decide that a return visit is not necessary, as long as evidence is sent to the Committee that remedial action has been instituted. In such cases a defined period of time for such action should be stated. The Chairperson appointed to the Committee should ensure that all action is followed up and evidence is received and adequate. The report can be sent to the Ministry of Health or authorized accreditation body (or an agency assigned by Ministry of Health) whilst waiting for the evidence that remedial action has been instituted. Such evidence when received by the Committee should be forwarded to the authorized accreditation body.

27

6. RE-ACCREDITATION

Re-accreditation of institutions

6.1AnaccreditedSBAtraininginstitutionshallseekre-accreditationafterfiveyears;howevertheprocessforapplicationmustbegininthefourthyear.Supportivemonitoringcanbeconductedeverytwoyears,orasoftenasdeemednecessarybytheapprovedaccreditationauthority.

Re-accreditation of SBA

6.2.TheaccreditedSBAindividualshallapplyforre-certificationthroughher/hisimmediatesupervisor,orbyparticipationincontinuedprofessionaleducationprogramme(CPE).TheCPEcouldincludecertificationafterfollowingon-lineorothercourses.

6.3.Re-accreditationwillbedependentuponmeetingcertaincriteriaasdefinedbyeachASEANMemberState,butshouldinclude,asminimum,evidencethattheyhaveconductedatleast24deliveriesperyear,proofofsatisfactorypracticeandprooftheyhavepractisedallofthecompetenciesasoutlinedinPart2ofthisguideline.

REFERENCES1.Campbell,O.M.,W.J.Graham,andLancetMaternalSurvivalSeriessteeringgroup,Strategiesforreducingmaternalmortality:gettingonwithwhatworks.Lancet,2006.368(9543):p.1284-99.2.Maclean,G.D.,AnhistoricaloverviewofthefirsttwodecadesofstrivingtowardsSafeMotherhood.SexReprodHealthc,2010.1(1):p.7-14.3.WorldHealthOrganization,Makingpregnancysafer:thecriticalroleoftheskilledattendant:ajointstatementbyWHO,ICMandFIGO.2004.4.WHO,Strengtheningmidwiferytoolkit,2011.5.WHOandNursing&MidwiferyHumanResourceforHealth,Globalstandardsforinitialeducationofprofessionalnursesandmidwives,2009.6.ICM,Essentialcompetenciesforbasicmidwiferypractice2010,revised2013,2013.

28

Annex 1: SBA Assessment (Proposed Methodologies)Part 1: Skills suitable to be assessed by case management: -Assistpregnantwomenandtheirfamiliesinmakingbirthplans -Identifyandmanagepre-eclampsiaandeclampsia -Identifytheonsetoflabour -Identifyandmanageobstructedlabour -Providepostnatalcaretowomenandtheirnewborninfantsandpost-abortioncare -Identifyobstetricandmedicalconditionsdetrimentaltothehealthofwomenand/ortheir newbornsinthepostnatalperiod -Supportnon-skilledattendants,includingTBAswheretheyexist,inordertoensurethatthe supporttheyprovideduringpregnancy,childbirthandearlypostpartumperiodisofsoundquality -Collectandreportrelevantdataandcollaborateindataanalysisandcaseaudits

Part 2: Skills suitable to be assessed by observation of practice on simulators: -Communicateeffectivelycross-culturallyinordertobeabletoprovideholistic“women-centred” care. -Educatewomen(andtheirfamiliesandotherssupportingpregnantwomen)inself-careduring pregnancy,childbirthandthepostnatalperiod -Examinationofapregnantwoman -Recordmaternalandfoetalwell-beingonapartograph,identifymaternalandfoetaldistressand takeappropriateaction,includingreferralwhererequired -Manageanormalvaginaldelivery -Conductactivemanagementofthethirdstageoflabour -Identifyhaemorrhageinlabour,providefirst-linemanagement -Assistwomenandtheirnewbornsininitiatingandestablishingexclusivebreastfeeding -Provideadviceonpostpartumfamilyplanningandbirthspacing -Assessthenewbornatbirthandgiveimmediatecare -Activeresuscitation,wherenecessary -Educatewomen(andtheirfamilies)onhowtopreventsexuallytransmittedinfectionsincluding HIV

29

Annex 2 : Guidance for Developing Curricula andCourse Content for Short SBA Updating TrainingProgramme -MemberStateswishingtodevelopatailor-madeshortcoursetoaccreditthosehealthworkers whoareprovidingmidwiferycareandhavebeenfoundtobelackinginsomecompetencies, orspecificknowledgeorskillstofulfillthecompetencies,shouldfirstensurethataNeeds AssessmentisconductedbasedontheASEANcompetenciesforSBA(seeSection2). -Allcoursesshouldbecompetency-basedandapplyadultlearningtechniques. -Thelengthofcourseshouldalwaysensuresufficienttimeisallocatedtohands-on-practiceunder supervisionofacompetentpractitionerintheclinicalareatoreachproficiencylevel. -Attentionshouldbegiventotheneedforevidencethatshowsthelearnerhasattainedproficiency level. -Proficiencyisdefinedas:theabilitytoregularlyperformcorrectlyinallsituationsandrequires regularrepeatedpractice. -Coursecontentshouldincludealltheelementsthatmakeupacompetency,e.g,knowledge, skills,attitudeandexperience. -ThematrixbelowhasbeendevelopedasaguideforASEANMemberStatestodefinetheminimal knowledge,skillsandattitudesrequiredtofulfillthedefinedcorefunctionsproficiently.However anindividualcountrymayneedtoincludeadditionalitems,dependingoncountrycontext/needs.

30

Com

pete

ncy

1: T

o be

abl

e to

use

all

form

s of

com

mun

icat

ion

effec

tivel

y an

d to

app

ly th

e un

derly

ing

know

ledg

e to

be

able

to

prov

ide

qual

ity, c

ultu

rally

rele

vant

car

e.

Anne

x 2.

1: M

atrix

for K

now

ledg

e, S

kills

and

Atti

tude

for e

ach

ASEA

N S

BA C

ompe

tenc

y(LinkToSection2)

Cor

e fu

nctio

nsAttitud

e,skilland/orabilitytoperform

to

proficiencyth

ecorefu

nctions:

Know

ledg

e re

quire

men

t to

perfo

rm s

kills

pr

ofici

ently

1.Com

municateeff

ectivelycross-

culturallyinorderto

beab

leto

provide

holistic“w

omen-centre

d”care.

2.Com

municateeff

ectivelywithclients

re

gardlessofedu

cationaland

econo

micstatus,re

ligiousand

ethnic

backgroun

d3.Cultivateeff

ectivecommunication

withcolleaguesandotherm

embe

rsof

th

ehealthcare,te

am.

4.Promotearig

hts-ba

sedap

proach

to

healthth

atencou

rageswom

ento

participateindecision-making.

•En

gageinhealthedu

cationdiscussion

swithand

forw

omenand

theirfam

ilies

•Useapp

ropriatecom

municationandlistening

sk

illsacrossalldom

ainsofcom

petency.

•Usesimplelang

uageto

con

veymessagesthatare

easy-to

-und

erstand.

•Re

cordand

interpretrelevantfind

ingsfo

rservices

providedacrossa

lldom

ainso

fcom

petency,including

whatw

asdon

eandwhatn

eedsfo

llow-up.

•Takeaccou

ntofthelocalcircum

stancessuchas

geog

raph

icaldiversity,culture,b

eliefs,customs,

etc.,w

henprovidingservicesand

com

municating.

•Re

specta

ndencou

ragetrad

ition

alpracticeswhich

arebe

neficaland

notharmfuland

discourage

practiceswhicharekno

wntobeharm

ful.

-Toprovide

skilledcareatte

ndantswillneed

tocultivate

eff

ectiveinterpersonalcom

municationskills

and

an

attitud

eofre

spectforth

ewom

an’srig

htto

beafull

pa

rtnerinth

emanagem

ento

fherpregn

ancy,childbirth

andthepo

stnatalperiod.Suchskillsrequireknowledg

e of:

-Verbaland

non

verba

lsystems

-Eff

ectivelistening

and

questioning

techniqu

es-Cou

nsellingtechniqu

es-Hum

anrigh

ts-Useand

abu

seofp

ower

-Wom

en’sem

powermentstra

tegies

-Gende

r,diffe

rencebe

tweengend

erand

sex,g

ende

rstereotype

s,im

pactofg

ende

ronhealthofw

omenand

girls

-Com

municationstrategiesfo

rspe

cialgroup

s(hearingdifficulties,b

lindn

ess,learning

difficulties)

31

•Takealead

ershipro

leinth

epracticearenaba

sed

on

professionalbe

liefsand

values.

•Practiseeff

ectiveinterpersonalcom

munication

skills

.

-Healthedu

cationstrategiesand

techniqu

es-Re

portwriting

-Bo

dies,respo

nsetostress(psychologicalandphysic

al)

-Griefand

theoriesofgriefrespo

nse

-Im

pactofd

ifferentreligiousand

spiritualbeliefson

pregnancy,childbirth

and

postnatalada

ptations.

Com

pete

ncy

2: P

rovi

de h

igh

qual

ity a

nten

atal

car

e, t

o m

axim

ize

hea

lth d

urin

g pr

egna

ncy

and

that

incl

udes

ear

ly d

etec

tion

and

treat

men

t or r

efer

ral o

f sel

ecte

d co

mpl

icat

ions

and

edu

catio

n, c

ouns

elin

g fo

r hea

lth d

urin

g pr

egna

ncy

and

prep

arat

ion

for b

irth

and

afte

r birt

h. Cor

e fu

nctio

nsAt

titud

e, s

kill

and/

or a

bilit

y to

per

form

to

profi

cien

cy th

e co

re fu

nctio

ns:

Know

ledg

e re

quire

men

t to

perfo

rm S

kills

pr

ofici

ently

1.Takeade

tailedhistorybyaskingrelevant

questions.

2.Assessindividu

alneedsand

giveap

prop

riate

adviceandgu

idance.

3.Pe

rform

aphysicalexaminationtoassess

healthstatusandprog

ressofp

regn

ancy

andidentifyprob

lemsandgiveapp

ropriate

tre

atmenta

nd/orrefer.

4.Perform

app

ropriatescreening

testsas

re

quired.

5.Assistp

regn

antw

omento

makeandup

date

birthplans.

6.Edu

catewom

en(and

theirfam

iliesand

otherssupp

ortingpregnantwom

en)inself

care,goo

dnutritionandda

ngersignsduring

pregn

ancy,childbirth

and

thepo

stnatal

period.

-Takeaninitialand

ong

oing

historyate

ach

antenatalvisit.

-Pe

rform

aphysicalexaminationandexplain

finding

stoth

ewom

anand

herfamily.

-Takeand

assessmaternalvitalsignsinclud

ing

tempe

rature,b

lood

pressure,pulse.

-As

sessm

aternalnutritionanditsre

lationshipto

foetalgrowth;giveapp

ropriateadviceon

nutritionalreq

uirementsofp

regn

ancyand

how

toachievethem

.-Pe

rform

acom

pleteab

dominalassessm

ent

includ

ingassessmento

ffunda

lheigh

tusing

manualm

easurements,lie,p

osition

,and

presentation.

-Listento

thefoetalheartrateand

determine

foetalbeing

-welland

interpretfind

ingsand

take

ap

prop

riateaction.

-AimsandObjectivesofA

ntenatalcare.

-De

cision

-makingskills

-Sa

feM

otherhoo

dprog

ramme(globa

land

national):

includ

ingfactorsthatputchildbe

aringwom

enatrisk

suchastoo-early,too

-freq

uentpregn

anciesand

too-

shortintervalsbetweenpregnancies.

-Ph

ysiologyofm

enstruation,con

ceptionandfoetal

de

velopm

ent.

-An

atom

yofpelvis.

-Nutritionalneedsduringpregnancy.

-Ph

ysiologyand

managem

ento

fpregn

ancy,including

sign

sandsymptom

sofpregn

ancyand

normal

psycho

logicalchang

esth

roug

houtpregn

ancy.

-Re

ason

sfortreatments,including

self-c

areform

inor

disordersofpregn

ancy.

-Causes,signssym

ptom

sandmanagem

ento

fbleed

ing

inpregn

ancy(earlyand

late).

32

7.Id

entifyob

stetricand

med

icalcon

ditions

detrim

entaltothehealthofthem

othera

nd

fo

etusespeciallypre-eclam

psia,p

erform

first-linemanagem

ent(includ

ingperfo

rmance

oflife-savingproced

ureswhenneed

ed)and

m

akearrang

ementsfo

reffe

ctivereferra

l.

-Evaluatefo

etalgrowth,p

lacentallocationand

am

nioticfluidvolume,usin

gultra

soundvis

ualization.

andmeasurement(ifeq

uipm

entisavailableforu

seandwithinscope

ofp

ractice).

-Pe

rform

apelvicexam

ination,includ

ingsizin

gthe

uterus,and

determiningthead

equacyofthebirth

canal.

-Pe

rform

screening

testsfora

nemiaHIV,syphilis,

proteinuriaora

nyotherte

stsaccordingtonational

protocols.

-Takeblood

todeterminebloo

dgrouping,and

other

haematolog

icalinvestigationsasmayberequ

ired

-Ad

ministertetanusim

muniza

tionaccordingto

nationalprotocols.

-Re

cordand

repo

rtallfind

ingsate

achantenatal

visit.

-Makede

cision

sba

sedon

clinicalfind

ingsand

takeapp

ropriateactioninclud

inggiving

feed

back

toth

ewom

anand

familyand

referra

ltohigh

erlevelhealthfacilities.

-As

sistp

regnantw

omenand

theirfam

iliesinmaking

andup

datingaplanfo

rbirth.

-Makearrang

ementsfo

rtimelyeff

ectivereferra

l.-Discou

rageharmfulcustomsandpractices.

-Identifysign

sandsymptom

sofobstetricand

med

icalcon

ditionsdetrim

entaltothewom

anand

fetusandmakeclinicaldecision

sba

sedon

find

ings

andtakeapp

ropriateactioninclud

inggiving

first

linemanagem

enta

ndm

akingeff

ectivereferra

l.

-Sign

s,m

anagem

enta

ndpotentialcon

sequ

encesof

pre-eclampsiaand

eclam

psia.

-Ph

ysiologyofformationofre

dbloo

dcellsand

haem

oglobin.

-Bloo

dgrou

ping

,Rhfactor,p

hysiolog

icalim

pactof

pregnancyon

cardiovascularsystem.

-Bloo

dgrou

pincompa

tibility.

-Causes,signsand

sym

ptom

s,con

sequ

encesand

managem

ento

fanemiainpregn

ancy.

-Causes,signs,sym

ptom

s,con

sequ

encesand

managem

ento

furinarytra

ctinfectioninpregn

ancy.

-Infectionpreventionprotocols.

-Mechanism

ofactionofvaccinesandnational

immuniza

tionprog

ramme.

-Sign

s,sym

ptom

sandtre

atmentforte

tanus.

-Cause,signsand

sym

ptom

s,includ

ingho

me-ba

sed

carefo

rminordisorde

rsofp

regn

ancy.

-Causes,signs,sym

ptom

s,con

sequ

encesand

managem

ento

fSexuallyTransmitted

Infections,

includ

ingHIV/AIDS.

-Im

pactofp

overtyand

poo

rnutritionon

pregn

ancyand

foetaldevelop

ment.

-Drug

sandpregnancy,includ

ingda

ngersofnon

-prescribed

and

trad

ition

aldrugsinpregn

ancy.

-Ap

plying

healthedu

cationap

proachesinpregn

ancy,

includ

ingbe

haviou

rchang

estrategiesand

impa

ctof

tra

ditionalbeliefsonhealthofm

othera

ndchild.

33

-Providefullcounsellin

gtoth

ewom

anto

accep

ttre

atmenta

nd/orreferralcheck-up,m

onitoring.

-Ed

ucatewom

en(and

theirfam

iliesandothers

supp

ortingpregnantwom

enand

new

born)on:

-th

eimpo

rtanceofre

gularc

heck-up;

-Selfand

familycare;

-

theneedfo

rcreatingasafeand

healthy

environm

ent.

-Cou

nsellingon

:-thebe

nefitsofearlyand

exclusivebreastfe

eding.

-sexualpracticedu

ringpregnancyandafter

childbirth

;-voluntaryfamilyplanningandbirth

spa

cing

followingchildbirth

.•Ps

ycho

logicalsup

portform

other:no

rmal

psycho

logicalchang

esinpregn

ancy,information

ab

outreliefo

fcom

mon

discomforts

,techniques

forincreasingrelaxationandpa

inre

liefm

easures

availableforlab

our.

•Ex

plaintoth

ewom

anonho

wto

identifytheon

set

oflabo

urand

needforg

oing

tohealthfacilityearly

toallowfo

rgoo

dmon

itoringandcareduring

labo

ur.

•Em

ergencyprep

ared

nessand

prepa

refo

rpossible

community-based

referra

l:who

tocon

tact,w

hat

supp

ort,etc.

•Pe

rform

first-linemanagem

ent(includ

ing

pe

rform

anceoflife-savingproced

ureswhen

need

ed.

-Ph

ysiologyoflactation,benefitsofearlyexclusive

breastfe

edingandprep

aringwom

ento

breastfe

ed.

-Se

xuality,and

sexinpregn

ancy.

-Sign

sandsymptom

sofonsetoflab

our.

-Prep

arationforp

regn

ancy.

-Birth

and

emergencyplanning

processes.

34

Com

pete

ncy

3 : P

rovi

de h

igh

qual

ity, c

ultu

rally

sen

sitiv

e ca

re d

urin

g la

bour

, con

duct

a c

lean

and

saf

e b

irth

and

han

dle

se

lect

ed e

mer

genc

y s

ituat

ions

to m

axim

ize

the

heal

th o

f wom

en a

nd th

eir n

ewbo

rns.

Cor

e fu

nctio

nsAt

titud

e, s

kill

and/

or a

bilit

y to

per

form

to

profi

cien

cy th

e co

re fu

nctio

ns:

Know

ledg

e re

quire

men

t to

perfo

rm s

kills

pr

ofici

ently

1.Id

entifytheon

seto

flab

our

2.Perform

vaginalexamination,ensuring

th

ewom

an’sprivacyandsafety,and

prope

rcon

ductbySB

A.3.M

onitorm

aternaland

fetalw

ell-b

eing

during

labo

ur.

4.Provide

sup

portivecare.

5.Recordmaternaland

foetalwell-b

eing

ona

partograp

h.6.Id

entifyde

layedprog

ressinlabo

urand

take

app

ropriateaction,includ

ingreferra

l.7.M

anageano

rmalvaginaldelivery.

8.Effe

ctivelymanagethethird

stageof

labo

ur,including

app

licationofAMTS

Lwhereapp

ropriateand

initiateearly

breastfe

eding,includ

ingskin-to

-skincontact.

•Provideculturallysensitivecareth

roug

houtth

efull

processoflabo

urand

birth;

•As

sessand

recordth

ewom

an’sgeneralstatus.

andcond

ition

:vitalsigns,p

hysicalcon

ditions,etc.

•Ex

plaintopregn

antw

omenth

estagesoflab

our,

thereason

sfora

ndprocedu

resforvaginal

exam

inationduringlabo

ur.

•Preparesterilizedequ

ipmentforvaginalexamination.

•Pe

rfomlimitedandtim

elyvaginalexaminations,

i.e,toredu

ceinfectionandrecordfind

ingson

pa

rtograp

horsimilarrecord.

•Pe

rform

acom

pleteandaccuratepelvic

exam

inationvaginallywithprivacyandrespect,

toassessford

ilatation,effa

cement,de

scent,

presentingpa

rt,position

,statusofm

embranes,

andad

equacyofp

elvisforb

irthofbab

yand

recordallfinding

onpa

rtograp

horsimilarrecord.

•Re

gulalrym

onitorp

rogressoflabo

ur:d

ilatation,

eff

acem

ent,etc.and

foetalheartrateand

record

allfind

ingsonpa

rtograp

horsimilarrecord.

•Providesupp

ortivecareduringlabo

ur:Instru

ction

on

how

tom

ove/lie,b

reathdu

ringlabo

urand

de

livery,ho

wto

relievepain,psycholog

ical

supp

ort,etc.

-Aimsandob

jectivesofcaredu

ringlabo

ur-An

atom

yofbirthcanal,includ

ingcervix,vaginaand

pe

lvicfloo

r.-Th

epe

lvis,landm

arksnoted

onpe

lvicexaminationand

po

ssiblecon

sequ

enceson

labo

uroutcomesfo

rdiffer

type

sandsizesofpelvis.

-Ph

ysiologyoflab

our(all3stages).

-Identificationandconseq

uencesofd

ifferentfoetal

po

sitionsinlabo

ur.

-Ph

ysiologicaland

psycholog

icalneedsofthewom

andu

ringlabo

urand

childbirth

,including

nutritionalneeds

andneed

forg

oodhydration.

-Managem

ento

flab

our(4stages).

-Be

nefitsanduseofpartograp

h.-Pa

inre

liefinlabo

ur.

-Im

pactonmaternaland

feoetalw

ellbeing

and

birthing

processofposture.

-Causes,signs,sym

ptom

sandmanagem

ento

fmaternaldistre

ssinlabo

ur.

-Causes,signs,sym

ptom

sandmanagem

ento

ffoetal

distre

ssinlabo

ur.

-Causes,signs,sym

ptom

sandmanagem

ento

fprolong

edlabo

ur.

35

•Providead

equatehydration,nutritionandno

n-ph

armacolog

icalcom

fortmeasuresdu

ringlabo

urandbirth

.•Providepa

inre

liefd

uringlabo

urand

birth.

•Allowcom

panion

ofcho

icedu

ringlabo

urand

birth.

•En

couragepo

sitionofcho

icedu

ringlabo

urand

birth

.•Manageinaccorda

ncewithnationalguide

lines

•Identifyde

layedprog

ressinlabo

ur,b

yusingthe

pa

rtograp

handclinicalsigns.

•Au

gmentu

terinecontractility,usingph

armacolog

icagents(inap

prop

riateb

irthsetting

s),according

tonationalguide

lines

•Ea

rlyidentificationofm

aternaland

foetaldistre

ssandtakeapp

ropriateaction,includ

ingreferra

lwherere

quired.

•Ke

epth

ewom

anand

herfamily/sup

porte

rregu

larlyupd

ated

abo

utth

estatusoflab

oura

ndplannedmanagem

ent.

•Ex

plaintofamilie

sfortheirsupp

ortersand

mob

ilizecommunity-fortimelyreferra

l.•As

sistnormaldeliveryaccordingtobestp

ractice

•Pe

rform

anep

isiotomytim

ely,ifindicated.

•Con

ductActiveManagem

ento

fthe3rdStageof

labo

ur(A

MTS

L),including

estimationand

recordingofm

aternalblood

loss.

•Pe

rform

fund

alm

assageto

stim

ulatepo

stpa

rtum

uterinecontraction.

•Pe

rform

urinecatheteriza

tionifindicated.

-Nationalprotocols,including

protocolsfo

rdealingwith

em

ergencysituations.

-Be

nefitsofusing

AMTS

L.-Clinicalindicationsfo

ruseofepisiotom

y.-Pe

rform

inganepisiotom

y.-Techniqu

esfo

rrep

airingpe

lviclacerationsand

ep

isiotomies.

-Causes,signs,sym

ptom

sandmanagem

ento

fimmed

iate/prim

arypo

st-partumhaemorrhage(PPP

H).

-Re

cogn

ition

and

managem

ento

fsho

ck,p

articularly

first-linelifesavingmeasures.

-Im

pactoflab

oura

ndbirthon

foetus.

-Ad

aptationofth

efoetusto

extra-uterinelife:includ

ing

causesand

signsofb

irthasph

yxiaand

hypotherm

ia.

-Managem

ento

femergencysituationsinth

enewbo

rnatbirth.

-Ex

aminationofth

eplacenta,cordandmem

branes

-Causes,signsand

managem

ento

fretainedplacenta

and/orm

embranes.

36

•MakeRa

pidAs

sessmenta

ndinstitute

managem

ento

fobstetricaland

new

born

em

ergenciesaccordingtonationalprotocols,

includ

ing:m

anagem

ento

fcordarou

ndth

eba

by’s

neckatb

irth,prolapsed

cordandseverem

aternal

andfoetaldistre

ss,eclam

psiaetc.

•Provideimmed

iateessentialcareofth

enewbo

rnatbirth

•Re

cogn

izesignsofasphyxiaatbirthandtake

immed

iateaction,includ

ingpe

rform

ingnewbo

rnresuscitationaccordingtobestp

ractices

10

•Initiateearlybreastfe

edinginclud

ingskin-to

-skin

contact

•Inspecttheplacentaandmem

branesfo

rcompleteness

•Inspectthevaginaandcervixfo

rlacerationsand

repa

ir1sta

nd2nd

degreepe

rinealorvaginal

lacerations

•Re

pairanepisiotom

y•Ed

ucatewom

anand

familie

stodetecte

arlysigns

ofhaemorrhagedu

ringthepo

spartumperiodand

whereto

seekassistance

•Pe

rform

firstlinemanagem

ento

fpostpartum

bleeding

and

haemorrhage,includ

ingusing

uteroton

icagentsandfund

alm

essage

•Re

cogn

izeand

respon

dtosho

ck,including

insertion

ofintraveno

usline,d

rawingbloo

dfor

labo

ratoryte

sts

•Pe

rform

cardio-pu

lmon

aryresuscitation

10Bestp

racticecallsfo

rallwho

provide

careforn

ewbo

rnatthetimeofbirthasm

inimum

mustb

eab

leto

accuratecond

ucta

rapidassessmentu

sing

APG

ARorsimilarscore,clearingofairw

ays,provide

ventilationbybagand

air,m

aintainbo

dyte

mpe

ratureduringproced

ureandprotectforharminclud

ingprotectionforinfection.

37

•Pe

rform

manualrem

ovalofp

lacenta,in

accordancewithnationalguide

lines.

•Pe

rform

internalbimanualcom

pression

ofthe

uterusto

con

trolsevereuterinebleeding

and

pe

rform

aorticcom

pression

ifindicated.

•Arrang

efora

ndund

ertaketimelyreferra

land

tra

nsfero

fwom

enwithseriouscom

plications

toahigherlevelhealthfacility,taking

app

ropriate

drug

sandeq

uipm

enta

ndaccom

panied

bya

healthprofessional.

Com

pete

ncy

4: P

rovi

de c

ompr

ehen

sive

, hig

h qu

ality

, cul

tura

lly s

ensi

tive

care

in p

ostp

artu

m p

erio

d

P

rovi

de h

igh

qual

ity, c

ultu

rally

sen

sitiv

e, p

ost a

borti

on c

are

Cor

e fu

nctio

nsAt

titud

e, s

kill

and/

or a

bilit

y to

per

form

to

profi

cien

cy th

e co

re fu

nctio

ns:

Know

ledg

e re

quire

men

t to

perfo

rm s

kills

pr

ofici

ently

4.1

Post

partu

m c

are

1.Id

entifyhaem

orrhageandpe

rform

m

anagem

entd

uringimmed

iatepostpartum

period.

2.Provide

postnatalcaretowom

en.

3.Id

entifyilln

essesandcond

ition

sde

trimental

to

thehealthofw

omeninth

epo

stnatal

period.

4.Provid

eadvic

eonpostpartumfamily

planning.

-Provide

culturallysensitivecareand

sup

port.

-Mon

itorc

ontra

ctionofth

euterus,p

ulse,b

lood

pressuretoearlydetecth

aemorrhagedu

ringthe

po

spartumperiod(atleastoncedu

ringfirst6

ho

ursafterd

elivery,firstdayafte

rdelivery,and

followingda

ysasneed

ed).

-As

sessfo

ruterineinvolutionandhealingof

lacerationsand

/orrep

airs.

-Pe

rform

postnatalscreening

testsaccordingto

nationalpolicy.

-Ed

ucatewom

anhow

tom

assageth

euterusto

keep

itwell-c

ontra

cted

.-Ex

plaintowom

anand

herfamilyabo

utlife-

threateningsituationsifth

eyarise,and

managem

entp

rocedu

res.

-Aimsandob

jectivesofp

ostnatalcare.

-Ph

ysiologicalchang

esinth

ebo

dyim

med

iatelyafte

rbirth

.-Ph

ysiologicalchang

esinpostpartumperiod:includ

ing

processofinvolutionandrecommencemento

fmenses.

-Managem

ento

fpostpartumperiod,includ

enational

protocolsforp

ostnatalcare.

-Riskfactorsinpostpartumperiod.

-Re

cogn

ition

and

managem

ento

fminordisorde

rsafte

rbirth

,including

breaste

ngorgement.

-Re

cogn

ition

and

managem

ento

fmajorcom

plications

afterb

irth,includ

inghaem

orrhage,sep

sis,deepvein

thrombo

sisandUTI.

-Useoflife-savingmed

icinesinth

epo

stnatalperiod.

38

-Provideed

ucationon

self-c

are,nutrition,personal

hygiene,breastfe

edingandsexualre

lations.

-Providessup

portforw

omenand

theirfam

ilies

who

arebereaved(stillbirth,pregn

ancyloss,

neon

ataldeath,con

genitalabn

ormalities).

-De

tectand

manageab

norm

alcon

ditionsin

thepo

stnatalperiod,includ

ingeclampsia,b

reast

complications,sep

sis,psycholog

icaldisorde

r,urinarytra

ctinfections,etc.

-Teachwom

enand

familie

son

earlydetectionof

ab

norm

alsignsofthewom

aninpostnatalperiod:

eclampsia,b

reastc

omplications,sep

sis,

psycho

logydisorde

r,urinarytra

ctinfectionsetc.

-Ad

minister,life-saving

med

icinesaccording

tonationalguide

lines(e.g.antibiotics,

anticon

vulsants,anti-m

alarials,anti-h

ypertensive,

anti-retro

viral).

-Makearrang

ementsfo

rtimelyreferra

land

app

lyfirst-linem

anagem

enta

spe

rnationalprotocols.

-Cou

nselcou

plesontheimpo

rtanceoffamily

planning

/birthspacingafterd

elivery,aswellas

ap

prop

riatecon

traceptivesth

atcanbeused

du

ringbreastfeed

ingpe

riod.

-Providefamilyplanningservicescon

curre

ntly,as

anintegralcom

ponentofp

ostpartumcare.

-Sign

s,sym

ptom

sandmanagem

ento

fphysiolog

ical

disordersafterb

irth,includ

ing“bab

y-blues”,p

ostnatal

de

pression

and

postnatalpsychosis.

-Establishm

enta

ndm

aintenanceoflactation.

-FamilyPlanningMetho

dsand

services,includ

ing

naturalm

etho

ds,L

actationalA

menorrhoeaMetho

d(LAM

).-Healthedu

cationforp

ostnatalwom

en.

39

4.2

Post

-abo

rtion

car

e1.Detectsignsofm

iscarriageandprovide

emergencymanagem

ent.

2.Provide

posta

bortion

familyplanning

cou

nsellingandservices.

-Diagno

sem

iscarriage.

-InsertIVline.

-Ac

compa

nyth

epa

tientto

thehealthfacility.

-Pe

rform

evacuationofre

tained

produ

ctsof

concep

tionaccordingtonationalguide

lines.

-Providepsycho

logicalsup

port.

-Providepo

st-abo

rtion

familyplanningcounseling

andserviceaccordingtonationalguide

lines.

-Aimsandob

jectivesofp

ost-a

bortion

care.

-Bleeding

inearlypregn

ancy,including

molar

pregnancy.

-Causesofearlypregn

ancyloss,including

hab

itual

ab

ortion.

-Re

cogn

ition

ofsignsofm

iscarriage(com

pleteand

incomplete)and

immed

iatelife-savingmeasures.

-Ec

topicpregnancy,includ

ingrecogn

ition

and

managem

ent.

-Ph

ysicaland

psycholog

icalim

pactofearlypregn

ancy

lo

ss.

-Managem

entp

rotocolsfo

rpost-a

bortion

care(PAC

).-Po

st-abo

rtion

cou

nselling.

-Po

st-abo

rtion

familyplanning.

-Pregnancyfollowingmiscarriage/earlypregn

ancyloss.

Com

pete

ncy

5 : P

rovi

de h

igh

qual

ity, c

ompr

ehen

sive

car

e fo

r the

hea

lthy

infa

nt fr

om b

irth

to tw

o m

onth

s of

age

Cor

e fu

nctio

nsAt

titud

e, s

kill

and/

or a

bilit

y to

per

form

to

profi

cien

cy th

e co

re fu

nctio

ns:

Know

ledg

e re

quire

men

t to

perfo

rm s

kills

pr

ofici

ently

1.Assessthenewbo

rnatb

irthandgive

im

mediatecare.

2.Identifyanylife

-threateningcond

itionsin

th

enewbo

rnand

give

essentiallife-saving

m

easures,includ

ing,wherenecessary,

active

resuscitationasacom

ponentofthe

m

anagem

ento

fbirthasph

yxia,and

referra

lw

hereapp

ropriate.

-Provideimmed

iatecaretoth

enewbo

rn,including

:drythenewbo

rn;p

laceinskin-to-skincontacto

nmother’sabd

omenorc

hestand

coverto

keep

bab

ywarm;suctioning

(ifn

eede

d);cordclam

ping

and

cuttingwhenpu

lsationceases.

-Takestepsto

preventinfection.

-As

sessth

eimmed

iatecon

ditionofth

enewbo

rn(e.g.,AP

GAR

scoringorra

pidassessment

metho

d:breathing

,colou

roftheskinandheartrate)

-Prom

oteandmaintainno

rmalnew

bornbod

y.

-Aimsandob

jectivesofn

ewbo

rncare.

-Ph

ysiologicalneedsofthenew

bornatb

irth.

-Be

nefitsofskin-to-skincontact.

-Th

ermoregulationprocessinnew

born.

-Ex

aminationofth

enewbo

rnatb

irth,includ

inguseof

AP

GAR

oro

therscoringsystem

.-Causes,re

cogn

ition

and

managem

ento

fasphyxiaat

birth

.-New

bornre

suscitationmetho

ds.

-Causes,re

cogn

ition

and

managem

enta

nd

40

3.Assistw

omenand

theirfam

iliesininitiating,

establishing

and

maintaining

exclusive

breastfe

eding,includ

ing,includ

ingproviding

ed

ucationon

benefitsofearlyexclusive

breastfe

edingandseekingassistanceearly

fo

rbreastfeeding

difficulties.

4.Edu

catewom

enand

theirfam

ilieson

benefitsofearlyexclusivebreastfe

eding.

5.Provide

mon

itoringandcarefo

rtheinfantin

th

efirsttw

omon

ths.

tempe

ratureth

roug

hskin-to

-skincontact(e.g.,

blanket,cap),and

environm

entalcon

trol(e.g.

warmer)

-Provideroutinecareofthenew

born,inaccordance

withnationalguide

linesand

protocols(e.g.,

identification,eyecare,screening

tests,

ad

ministra

tionofVitaminK,H

BV,B

CGand

need

forb

irthregistration.

-Pe

rform

new

bornscreening

.-Identifycong

enitalabn

ormalitiesand

initiate

ap

prop

riateand

timelyintervention.

-Identifyrespiratorydistre

ssinth

enewbo

rnby

rapidassessmentb

ybreathing,skincolora

ndheartrate,and

perform

inlinem

anagem

ent.

-Pe

rform

emergencynewbo

rnre

suscitation:

-S

uction(incaseofairw

ayobstru

ction)

-V

entilationwithbagand

mask/tube

and

mask

-Chestcom

pression

-M

akearrang

ementsfo

rtimelyeff

ectivereferra

l-Ex

plaintowom

enand

theirfam

iliesab

outthe

impo

rtanceofbreastfe

eding.

-Initiateandsupp

orte

arlybreastfe

eding(withinth

efirsthou

r).-Teachmothershow

toexpressbreastm

ilk,and

ho

wto

handleandstoreexpressedbreastm

ilk.

-Teachmothershow

tobreastfe

edand

maintainsuccessfulbreastfe

eding.

-Giveap

prop

riatecareinclud

ing,kangaroomother

carefo

rthelowb

irthweigh

tba

by,andarrang

eforreferralifp

otentiallyseriouscom

plications

arise,orifverylowbirthweigh

t.

preventionofhypotherm

ia,including

different

techniqu

esfo

rwarmingnewbo

rnwithlowtemperature.

-Ka

ngaroo

metho

dofnursing

new

born.

-Re

cogn

ition

and

immed

iatem

anagem

ento

fobvious

cong

enitalabn

ormalities,including

institutinglife-

saving

measures.

-Causes,re

cogn

ition

and

managem

ento

flow

birth

weigh

tand

preterm

new

born.

-Nationalpoliciesandprotocolsforn

ewbo

rncare,

includ

ingnationalvaccinationprog

ramme.

-Sc

reeningtestsinfirsttwomon

thsoflife.

-Normaldevelop

mentinfirsttw

omon

thsoflife.

-Causes,re

cogn

ition

and

managem

ent,includ

ingsafe

ho

me-carere

med

ieswherepossible,fo

rcom

plications

thatcanoccurinfirsttwomon

thsoflife.

-Re

cogn

ition

ofh

ighriskneon

ate.

-Protocolfo

reffe

ctivereferra

lfromhom

e/communityto

facilityandinfacilityforh

igherlevelcare.

-Ba

rrierstosuccessfulbreastfe

eding.

-Feed

ingcomplicationsand

how

toovercom

ethem

.

41

-De

tectand

teachmothero

nearlydetectionof

ab

norm

alsignsofn

ewbo

rninpostnatalperiod:

eyes,com

plexions,d

igestion,umbilicalcord,etc.

-Re

cogn

izecom

plicationsinth

einfant,stabilize

andtra

nsferh

ighriskinfantto

emergencycare

facilityaccompa

nied

byhealthprofessionaland

mother.

-Makearrang

ementsfo

rtimelyeff

ectivereferra

l-Mon

itorthegrowthand

develop

mento

ftheinfant.

-Pe

rform

immuniza

tionaccordingtonational

immuniza

tionschedu

le.

Com

pete

ncy

6 : P

rovi

de h

igh

qual

ity, c

ultu

rally

sen

sitiv

e he

alth

edu

catio

n an

d se

rvic

es to

all

in th

e co

mm

unity

, in

orde

r to

prom

ote

heal

thy

fam

ily li

fe, p

lann

ed p

regn

anci

es a

nd p

ositi

ve p

aren

ting.

Cor

e fu

nctio

nsAt

titud

e, s

kill

and/

or a

bilit

y to

per

form

to

profi

cien

cy th

e co

re fu

nctio

ns:

Know

ledg

e re

quire

men

t to

perfo

rm s

kills

pr

ofici

ently

1.Edu

catewom

enand

theirfam

iliesonhow

topreventsexuallytransm

ittedinfections

includ

ingHIV.

2.Sup

ervis

enon-skille

dattend

ants,including

TBA

swhereth

eyexist,inordertoensure

thatth

ecareth

eyprovid

edu

ringpregnancy,

childbirth

and

earlypo

stpartu

mperiodisof

sound

quality.

3.Collect,analys

eandrepo

rtrelevantdataof

wom

enand

theirn

ewbo

rns

4.Promoteanethosofsharedrespon

sibility

and

partnershipwithindividu

alwom

en,

th

eirfam

ilym

embe

rsand

thecommunityfo

rth

ecareofw

omenand

new

bornsthroug

hout

pregn

ancy,childbirth

-Ed

ucateandcommunicatewithwom

enand

their

familie

son

thebe

nefitofregularcheck-up/

med

icalexamination.

-Ed

ucatewom

enand

theirfam

ilieson

riskfactors

ofsexuallytransm

itted

infectionsand

how

topreventsexuallytransm

itted

infections.

-Ed

ucatemem

bersofthecom

munityhow

to

recogn

izesexuallytransm

itted

infections/

reprod

uctivetra

ctinfectionsand

seekhealthcare.

-Ed

ucatefamilie

sandcommunitiesonda

ngersof

earlyte

enagepregnancies.

-Prom

otebe

nefitsofplanned

pregn

ancies.

-Identifybirth

atte

ndantswho

arenotyetSBA

s,includ

ingTB

Aswhereth

eyexist(num

bers,

workplace).

-Healthpromotiontechniqu

es.

-De

veloping

acom

munityprofile,includ

ing

identificationofsou

rcesofinformationandsupp

ortto

wom

enofrep

rodu

ctiveage.

-Makingcommunityplansfo

remergencyevacuationof

wom

enand

new

bornstoEmONCfacility.

-Vitalstatistics.

-Be

nefitsofbirthandde

athregistration.

-Protocolfo

rnotificationofm

aternalorn

eonataldeath

orstillbirth.

-Aff

ectingchange.

-Sk

illstraining

metho

dologies.

-De

veloping

training

plans.

-Workplanning

.-Re

cordkeeping

.

42

andthepo

stnatalperiod

-Workinpartnershipwithnon

-skilledattend

antsto

identifypregnantwom

enand

encou

rageth

emto

seekantenatalcare,safede

liveryandpo

stnatal

carewithskilledhealthprofessionals.

-Ed

ucateno

n-skille

dattend

antsonpracticesto

avoiddu

ringpregnancy,de

liveryandpo

stnatal

pe

riod.

-Collect,rep

ortd

ataon

am

onthly,quarte

rlyand

yearlybasis,asthenationalrep

ortinggu

idelines

dictate.

-An

alyzerelevantdataofwom

enand

their

newbo

rnsandsharefinding

swithcom

munities,to

prom

otego

odhealthcarepractice(evide

nce-

ba

sedpractices).

-Prom

otepa

rtnershipwithcolleaguestoprovide

high

qualitymaternaland

new

bornhealthcarein

healthfacilities:m

anageandprovide

comprehensivehealthcare,provide

ade

quate

inform

ationon

maternaland

new

borncare.

-Prom

otepa

rtnershipwithth

ecommunityto

providequ

alityevide

nce-ba

sedho

me-ba

sedcare

form

othersand

new

borns.

-Makearrang

ementsfo

rreferralsinclud

ingfor

em

ergencycare,etc.

-Healthedu

cationandprom

otiontofamilie

sand

communities,including

com

munitylead

ersand

influencersto

promotego

odm

aternaland

newbo

rnhealthpracticesand

services.

-Ad

vocacym

odels.

-Team

work.

-Creatinganhealthyworkenvironm

ent,includ

ing

healthand

safetyatwork.

43

Annex 3: Standard Classroom and Skills Lab RoomI. Classroom (for 15 - 20 trainees)1. General requirement: Area at least 2M2/participant2. Tools and equipment:

Item Unit Quantity

1 Table piece 252 Chair piece 303 Flipchartstand piece 24 Largewhiteboard piece 15 Television piece 16 VCD/DVDplayer piece 17 Multi-projector piece 18 Slideprojector piece 19 Projectorscreen piece 210 Videotapes,CD-Roms,DVDsforskillsdemonstration piece 1011 Desktopcomputerwithinternet piece 212 Laptopcomputer piece 213 Photocopier piece 114 FlipchartsizeAO piece 5015 Boardmarkers(3coloursofblue,red,black) piece 3016 Pens(various) piece 2017 Glassmarkers piece 1018 Whiteboardwiper piece 519 Transparencies box 220 Bookshelf/library piece 321 StandardguidelinesonRHservices22 Clinicalpracticeguideline23 Poster,flipchart set 524 Skillchecklist(sizeAO) piece 525 ReferencebooksonRH26 Scientificjournals,publications27 Airconditioner set 1

44

II. Skills lab room (assuming 15-20 trainees)1. General requirements:Areaatleast2.5M2/participantWall, floor, water supply, electricity and lighting installation, washing basins, firefighting equipment, etc.shouldberational,safe,cleanandsuitableforoperationprocess.

2. List of tools and equipment:

Item Unit Quantity

1 Patientbed,bedsideshelfwithmattress,bedsheets,blankets,pillows

set 1

2 Stainlesssteel2-layerinstrumentcart piece 13 Newbornscale piece 14 Syringes10mland5ml,20pieceseach set 15 Deliverytable(withspotlight) set 16 VCD/DVDplayer set 107 Newbornmodel(doll) set 108 Newborncareandresuscitationsimulators set 39 Femalereproductivetractmodels set 410 Obstetricsimulators set 311 Episiotomy-repairmodel set 412 Placentamodels set 413 Pregnancyexaminationinstruments set 214 Deliveryinstruments set 215 Newbornresuscitationinstruments set 116 Episiotomy/repairinstruments set 217 Newbornbathing,cordcareconsumables set 218 Towelfordryingandwarmingnewborn piece 1019 Kangarooaprons Piece 1020 Infectionpreventioninstruments/consumables piece 121 Femalepelviccharts set 222 Flipchart,leafletaboutRH set 1023 Skillchecklist(sizeAO) set 2024 Airconditioner set 1

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ASEAN Regional Guideline · reasons underlying these variations and amongst them the main reasons are lack of a consensus definition of SBA by AMS and lack of accreditation system