|
Home :
Program Approach :
Clinical Interventions
Clinical Interventions
 Newly-trained auxiliary nurse midwives (ANMs) visit communities, promote birth preparedness/complication readiness (BP/CR), offer care and build partnerships with other local providers The ACCESS Program's clinical interventions are designed to promote and
scale up the use of proven, cost-effective clinical practices suitable for low-resources
settings that enhance maternal and newborn survival. Key interventions are introduced at
each level of the household-to-hospital continuum of care, as the basis for a range of
basic health services for women and newborns that can be provided effectively in the home,
community, peripheral facilities and referral centers.
ACCESS promotes integration of care throughout the continuum so
that services such as identification and treatment of sexually transmitted infections,
prevention of malaria, testing and counseling for HIV and postpartum care for mothers
and newborns are provided in a coordinated, convenient manner for women and their families.
ACCESS works to strengthen and expand the following practices:
- Birth preparation, including counseling
by community workers and skilled providers about practices that mothers and families
can carry out to promote health (such as good nutrition and hygiene), identification
of a skilled provider, preparation for normal birth, knowledge of danger signs and
planning for emergency transport and care
- Antenatal care as a platform
for a range of basic care services based on local context and individual
need. Focused antenatal care targets the specific physical, emotional, and cultural
needs of each woman while providing comprehensive preventive care and promotion of
normal pregnancy; detection and treatment of existing diseases; and early detection
and management of complications within a system that provides for timely referral
when necessary. Specific preventive measures include use of intermittent preventive
therapy (IPT) and insecticide treated bednets (ITNs) in areas of stable malaria
transmission, testing and counseling for HIV, and counseling about immediate
exclusive breastfeeding and optimal birth spacing.
Success Story: Midwives Applying Emergency Obstetric Skills in Ghana
In Ghana, midwives routinely transfer pregnant women in distress to distant tertiary hospitals. Now, with ACCESS training in basic emergency obstetric and newborn care, many skilled birth attendants are confidently performing emergency procedures themselves.
An ACCESS-trained midwife in Birem North District encountered such a situation when she was required to manually remove a placenta on her own. Having now performed this skill successfully, she no longer refers such cases. Rather than risking the lives of mothers and newborns in transport, this midwife has the skills to appropriately care for delivering mothers on-site.
- Safe delivery,
including skilled care at birth using infection prevention practices to protect
the mother and newborn; a partograph to prevent prolonged/obstructed labor that
can lead to obstetric fistula and fetal death; use of practices to support the
normal birth process; active management of third stage of labor to prevent
postpartum hemorrhage; prevention of mother-to-child transmission of HIV/AIDS
through minimizing invasive procedures and use of prophylactic antiretrovirals;
and identification, treatment and appropriate referral of obstetric and newborn
complications.
- Essential newborn care,
including drying and warming through skin-to-skin contact with the mother,
newborn resuscitation using bag and mask to treat asphyxia, eye and cord care,
immediate and exclusive breastfeeding, and recognition of complications and
appropriate referral.
- Postpartum care for mother and newborn,
including a visit with a community worker and/or skilled provider within 24-48 hours
and again within one week of life; counseling about continued exclusive breastfeeding,
maternal nutrition, hygiene, immunizations, and birth spacing; and support for
HIV-positive mothers in making appropriate, sustainable choices about feeding and
referral for ongoing care.
- Treatment of obstetric complications,
including postabortion care, hemorrhage, pre-eclampsia/eclampsia, infection, and
assisted delivery.
- Basic care for sick newborns,
including neonatal resuscitation, kangaroo mother care for low birth weight infants,
and identification and treatment of infections.
Scaling Up
ACCESS promotes and scales up these practices through human resource development, standards-based management and performance quality improvement mechanisms, and collaboration and partnerships. These approaches empower communities to be active users of care and active participants in planning health services.
|
