ARAB REPUBLIC OF EGYPT MINISTRY OF HEALTH AND POPULATION PROGRAM GUIDE FOR PAC S ERVICES IN EGYPT Draft November 2005 The CATALYST Consortium is a global reproductive health activity initiated in September 2000 by the Office of Population and Reproductive Health, Bureau for Global Health, U.S. Agency for International Development (USAID). The Consortium is a partnership of five organizations: the Academy for Educational Development (AED), Centre for Development and Population Activities (CEDPA), Meridian Group International, Inc., Pathfinder International and PROFAMILIA/Colombia. This publication was made possible through support provided by the Office of Population and Health, United States Agency for International Development, under the terms of contract No. HRN-A-00-00- 00003-00. The opinions expressed herein are those of the author(s) and do not necessarily reflect the views of the United States Agency for International Development. Program Guide for PAC Services in Egypt Table of Contents STRENGTHENING PAC SERVICES IN EGYPT .............................................................. 1 INTRODUCTION ....................................................................................................................... 1 HEALTH CONSEQUENCES ........................................................................................................ 1 UNSAFE INDUCED ABORTION ................................................................................................. 2 PAC S TRATEGY FOR EGYPT ................................................................................................... 2 IMPLEMENTATION ACTIVITIES ................................................................................................ 6 ATTACHMENTS................................................................................................................... 11 ATTACHMENT A................................................................................................................. 12 SAMPLE AGENDA – I NITIAL MEETING WITH THE SAFE MOTHERHOOD COMMITTEE ............. 12 SAMPLE SCHEDULE FOR INITIAL SMC M EETING .................................................................. 13 ATTACHMENT B ................................................................................................................. 14 SAMPLE AGENDA – C OMMUNITY NEEDS ASSESSMENT WORKSHOP ..................................... 14 SAMPLE SCHEDULE FOR COMMUNITY NEEDS ASSESSMENT WORKSHOP .............................. 15 ATTACHMENT C................................................................................................................. 16 SAMPLE AGENDA – C OMMUNITY FOLLOW UP WORKSHOP ................................................... 16 SAMPLE SCHEDULE FOR COMMUNITY FOLLOW UP WORKSHOP ........................................... 16 ATTACHMENT D................................................................................................................. 17 SAMPLE AGENDA - C OMMUNITY FOLLOW UP WORKSHOP FOR BCC M ATERIALS TRAINING 17 SAMPLE SCHEDULE FOR COMMUNITY FOLLOW UP WORKSHOP FOR BCC M ATERIALS TRAINING ............................................................................................................................. 17 ATTACHMENT E ................................................................................................................. 18 HOW TO CONDUCT AN ACTION PLAN MEETING ................................................................... 18 ATTACHMENT F ................................................................................................................. 21 SAMPLE ACTION PLAN FROM COMMUNITY NEEDS ASSESSMENT WORKSHOP ...................... 21 ATTACHMENT G................................................................................................................. 22 HOW TO DO CLINICAL COACHING ........................................................................................ 22 ATTACHMENT H................................................................................................................. 24 HOW TO DO CAUSE FINDING ................................................................................................ 24 ATTACHMENT I .................................................................................................................. 27 HOW TO PROVIDE CONSTRUCTIVE FEEDBACK ...................................................................... 27 i Program Guide for PAC Services in Egypt ATTACHMENT J.................................................................................................................. 29 FOCUS GROUP DISCUSSION GUIDE FOR WOMEN WHO HAVE RECEIVED PAC S ERVICES ..... 29 ATTACHMENT K................................................................................................................. 31 FACILITATOR ’S GUIDE – S CENARIO OF LOSING A PREGNANCY ............................................ 31 ATTACHMENT L ................................................................................................................. 33 POSTABORTION CARE TRAINING SCHEDULE FOR HOSPITAL -BASED PROVIDERS (6 D AYS ) .. 33 ATTACHMENT M................................................................................................................ 35 TRAINING REPORT ................................................................................................................ 35 ATTACHMENT N................................................................................................................. 36 INDIVIDUAL TRAINEE FOLLOW UP REPORT .......................................................................... 36 ATTACHMENT O................................................................................................................. 39 MONTHLY FOLLOW UP REPORT FOR PAC P ROGRAM .......................................................... 39 ATTACHMENT P ................................................................................................................. 45 MEDICAL RECORD FORM ...................................................................................................... 45 ATTACHMENT Q................................................................................................................. 46 INITIAL HOSPITAL ASSESSMENT FOR PAC S ERVICES ........................................................... 46 ATTACHMENT R................................................................................................................. 61 CLIENT PAC B ROCHURE AND ENGLISH TRANSLATION OF TEXT .......................................... 61 ii Program Guide for PAC Services in Egypt Strengthening PAC Services in Egypt Introduction Beginning in 1992 the Egypt Ministry of Health and Population, in collaboration with USAID-funded partners, undertook a focused effort to improve the quality of maternal health care. These activities have resulted in a dramatic reduction in maternal mortality, from 174 maternal deaths per 100,000 live births in 1992 to 84 maternal deaths per 100,000 live births in 2000. 1 Among the improvements in maternal care contributing to this reduction are increased use of antenatal care, a gradual shift from home to institutional births, and an increase in skilled attendance at birth. In addition, between 1998 and 2003, contraceptive use among married women has increased from 38 percent to 60 percent, and fertility declined from 4.4 births to 3.2 births per woman. 2 Despite these gains in maternal health care, the problem of undesired pregnancies remains a significant issue. A 1997 study of 89 public hospitals found that complications related to spontaneous or induced abortion accounted for 19 percent of all admissions (Figure 1). 3 The study reports that approximately 340,000 women present for postabortion care (PAC) annually and 85 percent are less than 12 weeks pregnant. Eighty nine percent of PAC admissions were treated by D&C under general anesthesia, while only 3 percent were treated with manual vacuum aspiration (MVA) under local anesthesia. Only 47 percent of the women presenting for PAC have ever used contraception, and only 20 percent were provided a contraceptive method as part of PAC services. Figure 1. OB/GYN Department Admissions During 30-Day Period in Egyptian Public-Sector Hospitals The National Population Council/Research Management Unit and Suez Canal University 1993 study found that 26 percent of all women aged 35-60 in Egypt have had one or more abortions. 4 Health Consequences The health consequences related to complications of spontaneous or unsafe induced abortion are devastating for women and their families. Death may be a direct result of complications 1 Program Guide for PAC Services in Egypt such as sepsis, hemorrhage, genital and abdominal trauma, and perforated uterus or it may result from secondary complications. Long-term disability may occur, related to reproductive tract infections, chronic pelvic pain, pelvic inflammatory disease, and infertility. The majority of women seeking abortion are married and the number of adolescents seeking abortion is increasing. 1 Thus, infertility is a significant consequence of abortion complications. The Egypt National Maternal Mortality Study of 2000 reported that abortion was associated with 20 deaths, contributing to four percent of all maternal deaths. Of these, 11 cases (55 percent) were judged to be spontaneous abortion and nine (45 percent) were thought to be induced abortion. The study notes that “identifying deaths due to abortion […] is extremely difficult” because “deaths in early