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)

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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

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GAPS/ CHALLENGES IN THE CURRENT APPROACH

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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:

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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

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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:

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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

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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