Safe motherhood programme of nepal

1. SAFE MOTHERHOOD
Aakash Jayswal
Batch 2017
NGMC

2. INTRODUCTION
 Safe motherhood is A series of initiatives practices,
protocols & service guidelines designed to ensure that
women receive high quality gynaecological, family
planning, prenatal, delvery and postnatal care in order
to achieve the optimum level of health of mother and
infant.
PILLARS OF SAFE MOTHERHOOD

3. BACKGROUND
 Initiated in 1997
 Safe Motherhood Policy - 1998
 National Safe Motherhood Program (2002-2017)
 Safe Motherhood and Neonatal Health Long Term Plan
(2006-2017)

4. GOALS
 To reduce maternal and neonatal morbidity and
mortality
 To improve the maternal and neonatal health
through preventive and promotive activities as well
as by addressing avoidable factors that cause
death during pregnancy, childbirth and postpartum
period.

5. •5th MDG – To reduce Maternal mortality by 75% and universal
access to reproductive health
•SDG 3 : Good Health and well being
By 2030 , reduce the global Maternal mortality ratio
To less than 70 per 100,000 live births
By 2030, end preventable deaths of newborns and children
under 5 years of age with
countries aiming to reduce NMR to as low as
12 per 1000 LB And U5MR to at least as
low as 25 per 1000 LB

10. 3 DELAYS
 DELAY IN SEEKING CARE
 DELAY IN REACHING CARE
 DELAY IN RECEIVING CARE

11. STRATEGIES
 Promoting birth preparedness and complication
readiness including awareness raising and
improving preparedness for funds, transport and
blood transfusion.
 Expansion of 24 hours birthing facilities alongside
Aama Suraksha Programme promotes continuum
of care from ANC to PNC.
 The expansion of 24-hour emergency obstetric
care services (basic and comprehensive) at
selected health facilities in all districts.

12. MAJOR ACTIVITIES IN 2076/77
Community level maternal and newborn health interventions
 1. Birth Preparedness Package (jeevansuraksha flipchart and
card)
 2. Distribution of Matri SurakshaChakki (misoprostol 600mcg)
to prevent postpartum haemorrhage (PPH) in home
deliveries
 3. Through FCHV, public health system promotes
Birth preparedness and complication readiness
(preparedness of money, SBA /facilities for the delivery, transport
and blood donors).
Promote Key ANC/PNC services (Iron, Td, Albendazole, etc),
self-care (food, rest, no smoking and no drinking alcohol,
including pregnancy and post-partum period),
Promote essential new born care,
Identification and prompt care seeking for danger signs during
pregnancy, delivery, post-partum and newborn period

13. AAMA AND THE NEW BORN PROGRAM
 The Government of Nepal introduced demand side
intervention in maternal health with the aim of encouraging
institutional delivery.
 The Maternity Incentive Scheme, launched in 2005 and
designed to share the cost of transportation to health facility.
 In 2009, in addition to transport incentive user fees were
removed from all types of delivery care, known as the Aama
Programme.
 In 2012, 4 ANC incentives programme (introduced in 2009)
was merged with Aama Programme.
 In FY 2073/74, the free new born care programme
(introduced in FY 2072/73) has been merged to the Aama
programme.

14.  Aama programme and has the following provisions
 For women delivering their babies in health
institutions:
Transport incentive for institutional delivery
NPR 3,000 in mountains districts,
NPR 2,000 in hills districts
NPR 1000 in Tarai districts
Incentive for 4 ANC visits
NPR 800 to women on completion of four ANC visits
Free institutional delivery services:
A payment to health facilities for providing free delivery care.
For a normal delivery NPR 1,000 or 1,500.
For complicated deliveries NPR 3,000
For C- sections (surgery) NPR 7,000.
Anti-D administration for RH -ve mothers NPR 5,000.
Laparotomy NPR 7,000 to both public and private facilities.

15.  Incentives to health service provider:
 For deliveries: A payment of NPR 300 to health workers for attending all
types of deliveries to be arranged from health facility reimbursement
amounts
Newborn Care Programme Provision
 Free sick new born care:
 a. For sick newborns:
 4 different types of package (Package 0, Package A, B, and Package C) for
sick newborns case management.
 reimbursed to health facility.
 The cost of package of care include 0 Cost for Packages 0, and NPR 1000,
NRP 2000 and NRP 5000 for package A, B and C respectively.
 maximum of NPR 8,000 (packages A+B+C), depending on medicines,
diagnostic and treatment services provided.
 b. Incentives to health service provider: A payment of NPR 300 to health
workers for providing all forms of packaged services to be arranged from
health facility reimbursement amounts..

16. . NYANO JHOLA PROGRAMME
• Launched in 2069
• To protect newborns from hypothermia and
infections
• 2 set of clothes (Bhoto, daura napkin & cap)
• 1 set wrapper , mat for baby
• 1 gown for mother

17. RURAL ULTRASOUND PROGRAMME
 The Rural Ultrasound Programme aims for the
timely identification of pregnant women with risks of
obstetric complication to refer to comprehensive
emergency obstetric and neonatal care (CEONC)
centres.
 Trained nurses (SBA) scan clients at rural PHCCs
and health posts using portable ultrasound. Women
with detected abnormalities such as abnormal lies
and presentation of the foetus and placenta previa
are referred to a CEONC site for the needed
services.
 This programme is being implemented in the
remote district

18. SAFE ABORTION SERVICES
 To make safe abortion services available, accessible
and affordable to all women with unwanted pregnancies.
 4 key components of comprehensive abortion care as:
Pre and post counselling on safe abortion methods
and post-abortion contraceptive methods;
Termination of pregnancies as per the national protocol;
Diagnosis & treatment of existing reproductive tract
infections;
Provide contraceptive methods as per informed choice
and follow-up for post-abortion complication
management

19. . Emergency Referral Fund
 It is estimated that 15 percent of pregnant women
will develop serious complications during their
pregnancies and deliveries, and 5 to 10 percent of
them will need caesarean section deliveries (WHO,
2015)
 A total of 7,500,000 Rupees was allocated to six
Provinces to support women when needed.
Additional 12,000,000 Rupees was allocated for the
hospitals in the districts through 7 provinces to
support transport fares women who could not afford
referral to high facility (nearby CEONC facilities)

20. REPRODUCTIVE HEALTH MORBIDITY PREVENTION
AND MANAGEMENT PROGRAM
 Management of Pelvic Organ Prolapse
 Cervical cancer screening and prevention
training
 Obstetric Fistula management

21. HUMAN RESOURCES
 NHTC provides training on SBA, ASBA, Anaesthesia
assistant, operating theatre management, family
planning (including implants and IUCD), CAC and
antenatal ultrasonography.
 In 2075/76, 668 SBA, 26 ASBA were trained by NHTC
and NAMS. By the end of 2076/77 a total of 10,388
SBAs and 234 ASBAs have been trained
 FWD continues to monitor the deployment of doctors
(MDGP, OBGYN, ASBA) and AAs, and inform DOHS
and MOH as necessary for appropriate transfer. This
has resulted in improved functionality of CEONC
services.

22. EXPANSION AND QUALITY IMPROVEMENT OF SERVICE
DELIVERY SITES
 24/7 service delivery sites like birthing centres,
BEONC and CEONC sites at PHCCs, health posts
and hospitals.
 By the end of 2076/77 CEONC services were
established in 72 districts
Onsite clinical coaching and mentoring
By 2076, 528 Municipals of 51 districts implemented on-site clinical
coaching /mentoring programme to enhance knowledge and skill of
SBA and non-SBA nursing staffs providing delivery services at
BC/BEONC and CEONC service sites.

23. PNC HOME VISIT (MICRO PLANNING FOR PNC)
 . Till FY 2076/77, It has been expanded in to 229
Municipals from 40 districts
 to strengthen PNC services by mobilizing MNH
service providers from health facilities to provide
PNC at women’s home.

24.  Eligibility Criteria:
 The incentives and services are available to the
Nepali citizen especially the pregnant mother and
newborn
 Required Documents:
 Only the Nepali nationals are eligible for this service
hence, a copy of the Nepali citizenship need to be
presented to claim incentives and services under
this programme.
 Service Availability:
 Available in all public health facilities with birthing
facility
 Newborn are eligible to receive the free sick
newborn care in the programme implemented major
hospitals. The plan is to roll out throughout the
country

25. REFERENCES
 www.fhd.gov.np
 www.dohs.gov.np
Annual-Report-FY-2076-77
 who.int/safemotherhood
 NDHS 2016