women, maternal and reproductive health policies and guidelines...
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Date 13 September 2018
Chief Director WMRH: Dr Manala Makua:
RareX CONFERENCE 2018
Canvas
Women, Maternal and Reproductive Health
Policies and Guidelines and Guidelines
INTRODUCTION
Ambition(2030)
SDG
Reality(2015)
MDG
IMPACT OF UNACHIEVED MDG GOALS
Maternal mortality ratio from
155/100,000 (4 pregnant women
die every day) to less than
70/100,000 (less than 2)
Teenage pregnancies from
72,000 per year (197 per day)
to less than 36,000 per year
(less than 100 per day)
Neonatal mortality from
12/1,000 live births (33
neonates die every day) to
8/1,000 (<22 per day)Under 5 mortality rate from
39/1,000 live births (106 children
under 5 die every day) to less than
25/1,000 (to less than 69 per day)
Mother to child HIV transmission from 1,5% to
<1% (from 4,500 new infections to less than 3,000
per year)
Neonatal deaths by weight category and cause
9/28/2018
SUSTAINABLE DEVELOPMENT GOALS:
FOCUS
New -Born
Women
Young Women
Child
AdolescentsPregnant WOMEN
PATHWAYS TO 20302015(119)
2020
2025
2030(70)
9/28/2018
ACCELERATE
SUSTAIN THE ACCELERATION
Service integration with other components of SRH and Genetics
• Service delivery platform that do not allow the missed opportunity
• Clearly defined referral pathways
• Allow skills transfer and shared responsibilities
• Implement patient centered approach as opposed to program centered approach
Multidisciplinary team approach
• Acknowledge the need for extra help from other categories of health care providers
• Assist in defining the roles of different team players in screening, testing, diagnosis, management of patients requiring genetics services
• Allow relevant and appropriate skills transfer
• Develop realistic expectations for the health care workers
health
• Allow technology to complement the service provision
• Invest in improving the knowledge of the service users
• Recognize patient’s effort in taking the responsibility of their health( partnership)
• B-WISE, mom Connect, nurse Connect
Clear policy guidelines
• Cascade the information to the lowest possible level
• Use the evidence based information
• Create opportunity to participate in the process of the development of the policy
• Communicate if identifying the ambiguous statement in policy or clinical guidelines
CHANGE IN APPROACH
9/28/2018
Transparency
FOCUSED
CHANGE APPROACH (2)
OUTCOMES
IMPLEMENT
AND
MONITOR
PLAN
9/28/2018
Causes of Neonatal Deaths by Level of care
9/28/2018
SAVING BABIES REPORT ( 2014-2016)
15
SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS
10- 19 20-24 25-35 >35
InterventionsScreening Management
Teenage pregnancy
UNPLANNED PREGNANCY
HIGH RISK-ADVANCED
MATERNAL AGE
EU
R
G
V o
PROBLEM STATEMENT
16
GAPS/ CHALLENGES IN THE CURRENT APPROACH
17
Background on the Development of the SRH& R Policy
National Integrated Sexual and Reproductive Health and Rights Policy
• Intended to be an overarching policy document, covering a range of cross cuttingissues relating to sexual and reproductive health and rights (SRH&R) principles,programmatic implementation and service provision, with the mission to reducematernal and newborn mortality and morbidity in South Africa.
The need for the National Integrated SRH&R Policy was prompted by new evidence and:
• Changes in service delivery platform.
• The maturity towards NHI implementation and development service benefitspackages.
• The need to ensure integration, linkages and alignment with other related nationaland international policies and frameworks.
• Reaffirming national commitment to reducing service fragmentations
Public Health Impact : Policy and guidelinesSeeks To Achieve the following:
18
Objectives Expected Results
Objective 1: Enable all people to make informed
decisions about the services and ensure that their
rights are respected, protected, and fulfilled.
Informed and autonomous decision-making
Objective 2: Increase the uptake of services, care and
treatment services across all life stages.
Person-centred differentiated care across all life stages
Objective 3: Ensure access to respectful and non-
judgemental services for priority groups.
Rights-based approach
Objective 4: Strengthen the health system to deliver
integrated services at the lowest feasible level in the
healthcare system.
Enabling environment for high quality services delivered by trained providers
Objective 5: Promote multi-sectoral engagement and
shared accountability.
Coordinated implementation for a sustainable response
19
SRH&R policy
( WOMEN)
Contraceptives guidelines
PEP guidelines
HIV and STI prevention guidelines
CToP guidelines
Safe conception and fertility
Breast and Cervical guidelines
Maternal and Neonatal
eMTCT
Intra-partum care
BANC plus
Post natal care
Post partum/post abortion
Neonatal care
Ge
net
ics
GENETICS SERVICES GUIDELINES FRAMEWORK:
20
COMPONENT Focus areas
Pre natal service
package
• Safe conception and fertility planning - prevention of preventable conditions such Neural tube defects and foetal alcohol syndromes
•Early access to screening ( before 24 weeks) and access to options in case of abnormality detected – Down syndromes
•Strengthening the counselling services for high risk obstetric cases
Post natal and
childhood
•Early detection , corrective measures, linkages to care and management of congenital anomalies
•Include both exposure to teratogens and genetics conditions
Adolescents and adults • Long term management approach
Cancer services • Early detection and linkages to care for high risk groups
Surveillance •Improve reporting which will redefine the SA burden of CD and subsequently inform priority setting
21
Milestones and timelinesJun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19
Consultative meeting
Establishment of TWGEstablishment of sub groups for chapters writing
Symposium for consultationDraft 0
Consultative meeting with NaPeMMCoConsultative meeting with NCCEMDConsultative meeting with MCWH think tankDraft 1
Stakeholders consultationDraft 2
Provincial consultationPre final draft
Costing/ cost effective analysis
Submission to NHC techFinal draft
Submission to NHC techEditing and layout
Printing and dissemination
THANK YOU
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