Académique Documents
Professionnel Documents
Culture Documents
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Outline
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World Workforce & Health Status:
The Global Picture
2 physicians/10,000
11 nurses and
mid wives/10,000
EURO
27
EMR
AMR O SEARO
O 420 450
99 AFRO
900
WPR
The average global Maternal Mortality Ratio of 400 maternal death
per 100,00 live births in 2005 has barely changed since 1990. O
82
Source: for Regional Averages : WHO: World Health Statistics 2009
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Source: WHO (2005). The World Health Report 2005 – Make Every Mother and Child Count. Geneva, World Health Organization
Source: for Regional Averages : WHO: World Health Statistics 2009
Global Causes of Maternal Mortality and
the Need for Skilled Workforce
**Good quality maternal health services
** > 35% receive no
are not universally available
Antenatal Care
and accessible
In d ire c t C a u s e s
He m o rrh a g e
20%
25%
O th e r D ire c t C a u s e s
8%
In fe c tio n
Un s a fe Ab o rtio n 15%
13%
** ~ 50% of deliveries unattended O b s tru c te d L a b o r ** ~ 70% receive no postpartum care
E c la m p s ia
by skilled provider 7 % during 1st 6 weeks following delivery
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Source: World health Report, 2005
1 2 %
Health Workers Save Lives
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Too Many Preventable Deaths!!...
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Source: WHO (2005). The World Health Report 2005 – Make Every Mother and Child Count. Geneva, World Health Organization
Source: for annual numbers : WHO: World Health Statistics 2009
Task Shifting Types
Task shifting II
Task shifting IV
Expert Patients
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Expanded Service Roles (ESR)
(Example TS I)
Delegation or
Supervision
Regulatory Framework
Pre-service training
coupled
with additional in-
service
training
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Expanded Services Role (ESR)
TS0 and TS I
ESR from specialists to GPs
- C/S, management of complicated cases
ESR and NPCs
- C/S, management of complicated cases
Matching tasks needed with competency
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Expanded Services Role (ESR)
TS III—TBA, CHWs
Traditional Birth Attendants---Community based, community women comfortable with them
Limited technical skills
Tasks--ESR
Antenatal care
- Risk screening…..train to identify risk cases earlier on and refer to higher care site
- Motivate/empower not to keep women away from life-saving interventions due to
false reassurance
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Regulating HCWs and Who is Involved?
Professional Council, MOH,
MOF, Local Government, Other Health Care Providers
MOH, IMF, WB
5 Standard 3
In-Service Training & Standard Pre-Service
4 Licensing &
Certificate Education & Training
Registration &
Certification
MOE, MOH
MOH. MOE, Training Institutions,
Training Institutions, Professional Councils,
Professional Councils Professional Associations
Professional Councils, MOH
Professional Associations
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Types of Regulation
Regulations
Guidelines
Program guidance
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Why Develop A Regulatory Framework?
To ensure quality and safety in the delivery treatment, care and prevention
while task-shifting occurs
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Lessons from the "WHO Task-shifting
Recommendation and Guidelines”?
Adaptability of the TS R&G to other issues
Outlining/identifying task
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Policies need to address interventions at needed levels
District Hospitals
also called
Second-Level Health Care Facilities
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or
E
ES
First-Referral Level Facilities
TH
N
O
Health Centers (Type A and B)
E
also called
AT
Primary (First)-Level Health Care Facilities
TR
or
EN
Health Clinics
NC
CO
Health Posts
Also called
Health Houses
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SOURCE: WHO (2005): WHO Recommendations for Clinical Mentoring to Support Scale-up Of HIV Care, Antiretroviral Therapy
and Prevention in Resource-Constrained Settings.
Pregnancy is NOT a Disease
The Question is
Whom to train?
Where will they be trained?
How will they be trained?
What will they be trained for?
To work where will they be trained?
How will quality & safety of service be ensured?
How will they be retained in needed areas?
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Pregnancy is NOT a Disease
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