MOVING TO ACTION:
Identifying Responses
Learning objectives
By the end of this session, participants will be able to:
• Identify actions appropriate to data
presented
• Use the action tool and support its
implementation
• List ‘evidence based actions’
• Prioritise actions in a systematic way
Taking action to reduce
avoidable maternal deaths
is the reason for conducting
MDSR
What are appropriate actions?
Scenario
• A 21-year old had her 3rd baby at home.
• Her first baby died after a difficult delivery. Her
second baby was premature and survived.
• During this pregnancy, she attended antenatal care
at the local health centre.
• She started bleeding 1 hour after delivery of a
healthy baby. The local skilled birth attendant (SBA)
came within 1 hour.
• She found the woman very pale and collapsed and
gave her oxytocin and then misoprostil.
• The SBA suggested moving the woman to the local
hospital , an hour away, as the bleeding continued.
The husband did not agree and the woman died
Practical exercise
• Work on your own
• Consider the 9 possible actions
listed on pg. 22 in the workbook
• List the 3 actions you think would
be most effective in this case
?
What are evidence based actions?
Actions for which there is over whelming evidence that
maternal mortality and morbidity will be prevented
if they are followed.
•
•
•
•
Usually refer to clinical actions, based on trials
Individual cases should be assessed to see if
“best practices” were carried out or not
If not, appropriate action should be taken to
ensure these are implemented to prevent further
deaths
Ethiopian Guidelines (FMOH) for A/N and
intrapartum care provide details
General
• Family
planning
• Iron
• HIV
• Malaria
• SBA and Birth
preparedness
• Health
education &
promotion
Eclampsia
• Diagnosis and
treatment of high
blood pressure
• Magnesium
Sulphate
• Timely delivery
Haemorrhage
• Active management
of third stage of
labour
• Misoprostil
• Blood transfusion
(dependent on
environment)
Sepsis
• Clean delivery
• Antibiotics for
prolonged ruptured
membranes at term
• Antibiotics for C/S
• Avoid prolonged
delivery
Abortion
• Availability of safe
abortion
• Availability of post
abortion care
including safe MVA
or D&C and i/v
antibiotics
Obstructed labour
• Facility delivery
after 12 hours of
labour
• Use of partograph
• Availability of C/S
Non clinical actions
• Not all problems identified during the review
and analysis have clinical solutions
• Actions in the community e.g. Changing healthseeking behaviour, addressing transportation,
reducing costs of accessing care, also play a
role.
• Innovative solutions come about through
community participation in identifying and
carrying out actions likely to be successful.
Prioritising!
Which actions?
• Not all problems can be tackled simultaneously
• Prevalence – how common is the problem?
• Feasibility of carrying out the action – are there
extra staff available? Is it technologically and
financially possible?
• What is the potential impact of the action?
– If successfully implemented how many
women would be reached and how many
lives saved?
Prioritisation Exercise
Prioritisation
Action
Iron is availableanaemia is
eliminated
Commend and
empower SBA
Family planning to
prevent unwanted
pregnancy
Guidelines re ANC
available
EMONC training re
AMTSL + PPH
SBA attendance at
delivery- community
education
Prevalance
Feasibility
Potential impact
(Facilitated Discussion)
• Which action(s) address the most prevalent
problems
• Which action(s) are most feasible? (Why or
why not?)
• Which action(s) will deliver the most impact?
• Reminder that prioritisation is subjective and
best done in a multi disciplinary team including
community members ( especially non clinical)
Group exercise using action tool
 6 groups of 5-6 each
 Details and scenario in
Workbook
 Exercise simulates facility
committee
 Action tool completed for the
scenario described