peru’s postabortion care program: improving quality and accessibility funded by dfid pathfinder...
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Peru’s Postabortion Care Program:Peru’s Postabortion Care Program: Improving Quality and AccessibilityImproving Quality and Accessibility
Funded by DFIDFunded by DFID
PATHFINDER INTERNATIONAL
30th Annual Conference, Global Health Council
Washington, DCMay 29, 2003
Miguel Gutiérrez, MDJhony Juárez, MDElvisa Loayza
SITUATION IN PERUSITUATION IN PERU
Abortion is the fourth leading cause of maternal mortality
Abortion is only considered legal when the mother’s life is at risk
Many women confronted with unwanted pregnancy seek clandestine abortions
SITUATION IN PERUSITUATION IN PERU
It is estimated that there are more than 350,000 induced abortions annually
Of these, 30% usually result in complications, the most frequent being incomplete abortion
Only 50% (60,000) women with these complications ever reach a hospital
PERU’S POSTABORTION CARE PERU’S POSTABORTION CARE PROGRAMPROGRAM
GOAL : To improve the reproductive health status of underprivileged women in Peru and contribute to the reduction of maternal deaths
PURPOSE: To improve the quality and availability of treatment for complications of incomplete abortion and postabortion family planning and counseling services
OBJECTIVESOBJECTIVES
Increase health professionals’ awareness of issues related to abortion and the treatment of emotional and physical consequences
Improve integration between postabortion care and family planning services
Develop appropriate IEC materials for PAC patients
Introduce MVA in MOH hospitals
IT IS A IT IS A WOMAN´S RIGHT WOMAN´S RIGHT
TO RECEIVE TO RECEIVE HUMANE CARE HUMANE CARE
WHEN WHEN SUFFERING FROM SUFFERING FROM
ABORTION ABORTION COMPLICATIONSCOMPLICATIONS
PERU’S PAC PROGRAM´S PHILOSOPHYPERU’S PAC PROGRAM´S PHILOSOPHY
OUTPATIENT CARE FOR COMPLICATIONS ABORTION WHEN IT IS MEDICALLY APPROPRIATE
USE OF MVA FOR THE EVACUATIONOF OVULAR REMAINS
EARLY DIAGNOSIS OF SECONDARY INFERTILITY AND REFERRAL IN ORDER TO RECEIVE TREATMENT.
PROVISION OF INFORMATION AND CONTRACEPTIVE SERVICES IMMEDIATELY AFTER TREATMENT FOR COMPLICATIONS
IDENTIFICATION OF PROBLEMS RELATED TO SEXUAL VIOLENCE WHICH COULD AFFECT WOMEN’S REPRODUCTIVE HEALTH AND THE RESPECTIVE REFERRAL TO RECEIVE TREATMENT.
DIAGNOSIS AND TREATMENT OF SEXUALLY TRANSMITTED DISEASES
IDENTIFICATION OF OTHER PROBLEMS RELATED TO REPRODUCTIVE HEALTH
Pathfinder International, 2003
Hospital assessmentsHospital assessments TrainingTraining Monitoring and follow-upMonitoring and follow-up AdvocacyAdvocacy
PERU’S POSTABORTION CARE PERU’S POSTABORTION CARE PROGRAM COMPONENTS:PROGRAM COMPONENTS:
PERU’S POSTABORTION CARE PERU’S POSTABORTION CARE PROGRAMPROGRAM
What is the postabortion care What is the postabortion care (PAC) model used by Pathfinder (PAC) model used by Pathfinder International in Peru?International in Peru?
Components of PAC Program Components of PAC Program Necessary for SustainabilityNecessary for Sustainability
Family Planning
Identifica-tion& Treatment of other RH problems
Diagnosis &Treatment ofSTDs
Diagnosis &Treatment ofSecondary Infertility
1.1. Comprehensive Comprehensive PACPAC
2. Continual
Training
3. Organization of services:Standarization (Norms &
protocols)Improvement of infrastructure
5. Logistics:Equipments
and supplies
4. Information Systems
6. Community Involvement
Control
Control of fears,Information procedureCounselingFP*,RH*
Patient’s admissionPatient’s admission
Medical Evaluation : Clinical records Physical Exam Diagnosis
MVA ProcedureVerbal support
for pain control during the procedure
Orientation on RH and FP *
Recovery
Information onpost procedure
care and referral if neccesary
DISCHARGE
Provision of contraceptive method C
oun
seli
ng
* FP = Family Planning RH = Reproductive Health
PATHFINDER´S PAC MODELPATHFINDER´S PAC MODEL
Distribution of Hospitals Where the PathfinderDistribution of Hospitals Where the PathfinderPAC Model Has Been Implemented PAC Model Has Been Implemented 1997- 20021997- 2002
AM
AZ
ON
AS
TUMBES
PIURA
CA
JAM
AR
CA
LAMBAYEQUE
LA
LIBERTAD
SAN
MARTIN
ANCASH HUANUCO
PASCO
UCAYALI
JUNIN
HU
AN
CA
VE
LIC
ACUZCO
APURI-MAC
AY
AC
UC
HO
ICA
PUNO
LIMA
AREQUIPAM
OQ
UE
GU
A
TACNA
L O R E T O
MADRE DE
DIOS
• Hospital Apoyo Sullana
• Hospital Belén• Hospital Reg. De Trujillo• CS Viru
• Hospital La Caleta
• Instituto Materno Perinatal• Hospital Hipólito Unanue• Hospital San Bartolomé• Hospital Dos de Mayo• Hospital Local Vitarte• Hospital Apoyo Puente Piedra• Hospital Sergio Bernales
(Collique)
• C.S. Canto Grande• Hosp. Huaycan• Hosp. Huacho• Hosp. Chancay• Hosp. Cañete
• Hosp. Regional de Pucallpa
• Hospital Amazonico
• Hospital Daniel A. Carrión
• Hospital Antonio Lorena• Hospital Regional de Cusco• CS Acomayp• CS Urubamba
• Hospital Carlos Monge Medrano• Hospital Regional de Puno
• Hospital Goyeneche• C.S. Zamacola
• Hospital Regional de Cajamarca
• Hospital Apoyo de Iquitos• Hosp.Santa Gema
Yurimaguas
• Hospital de Tacna
• Hosp. Pisco
• Hosp. • Chincha• Hosp• .Ica
• Hosp. Hermilio Valdizan
• CentroMaternoTarapoto• H. Rural Tocahe• H. Rural Rioja• H. R. Nueva Cajamarca
• Hospital las Mercedes
PERU’S POSTABORTION CARE PERU’S POSTABORTION CARE PROGRAMPROGRAM
How does offering PAC on an How does offering PAC on an outpatient basis reduce costs outpatient basis reduce costs and increase access?and increase access?
Average Total Cost Per PatientAverage Total Cost Per Patient (US Dollars) (US Dollars)
MVA vs. D&CMVA vs. D&CPathfinder International 1995Pathfinder International 1995
00
2020
4040
6060
8080
100100
MVAMVAMVAMVA D&CD&CD&CD&C D&C/HospD&C/Hosp..D&C/HospD&C/Hosp..
84.1184.1184.1184.11
16.7016.7016.7016.7016.3016.3016.3016.30
PERU’S POSTABORTION CARE PERU’S POSTABORTION CARE PROGRAMPROGRAM
OUTPATIENT BASISOUTPATIENT BASIS
Transferto
floor
5'
12'
Transferto floor
3'
4'Transfer
toO.R.
GynecologicalExamination
30'
Physical preparation for hospitalization
DISCHARGE
209'Hospitalizationpost-procedure
722'
32'
Operating Room
PROCEDURE(D&C )
Operating Room
PROCEDURE(D&C )
ENTRANCE
Hospital’s Emergency
Service
Cashiers
21'
158'
158'
MedicalExamination
Drugstore
35'Hospitalization
pre-procedures
physical preparation
404'
Average Time: 27.25 hours; 1.1 days
EXIT
Emergency
Doctor’s Rounds
Patients Treated for Incomplete Abortion in the Regional Hospital in Trujillo (Peru) Before the ProgramBefore the Program
Transferto
floor
5'
Post-procedurehospitalization
120'
GynecologicalExamination
30'
Physical preparation for hospitalization
4'Transfer
toO.R.
20'
Operating Room
PROCEDURE(MVA)
Operating Room
PROCEDURE(MVA)
ENTRANCE Emergency
Admission 30'
158'
MedicalExamination
Drugstore
15'
Average Time: 4.3 hours
DISCHARGE
10'
EXIT
(5)10'
Cashier
(2) (2) (3)
Hospitalization pre-procedure
Physical preparation
20'
Transferto floor
3'(20)
(6)
Emergency
Patients Treated for Incomplete Abortion in the Regional Hospital in Trujillo (Peru) After the ProgramAfter the Program
How can the lessons learned from Peru´s PAC Program be applied to improve quality and accessibility in PAC programs in other developing countries?
PERU’S POSTABORTION CARE PERU’S POSTABORTION CARE PROGRAMPROGRAM
POSTABORTION CARE PROGRAM
We must convince policy-makers and governments to be sensitive towards women suffering from abortion complications in order to guarantee the implementation and expansion of the Postabortion Care Program.
POSTABORTION CARE PROGRAMPOSTABORTION CARE PROGRAM
It is not always necessary to invest a large amount of financial and human resources in order to implement a PAC Program.
The strength of the PAC Program is that it not only implements a new technology (MVA), but even more important, develops a comprehensive program which encompasses other key issues important for the sustainability of the project.
POSTABORTION CARE PROGRAMPOSTABORTION CARE PROGRAM
The fundamental elements of the project carried out in health facilities must be considered from its initiation.
Baseline data is needed to evaluate the impact at the end of the project.
Follow-up is the foundation for the implementation and sustainability of the project.