Assessment of Skilled Birth Attendance in Lao PDR Ministry of Health - UNFPA March 2008 Map of Lao PDR with the 4 provinces described in this assessment 2 Assessment of Skilled Birth Attendance in Lao PDR, 2008 TABLE OF CONTENTS List of tables.................................................................................................................................5 List of graphs...............................................................................................................................6 Members of the Team for the Assessment for Skilled Birth Attendance……………...……7 Glossary of terms…………………………………………………………………….…..…....11 Executive summary…………………………………………………………………………...12 1. Introduction…………………………………………………………..……… 2. Purpose…………………………………………………………….………… 3. Methodology………………………………………………………………… 4. Results………………………………………………………………….…… 5. Addressing the gaps: The Way Forward: Recommendations and Options…………………………………………… Chapter 1 Maternal and Child Health Care in Lao PDR……………………..……..26-28 Chapter 2 Purpose: To assess the current capacity to provide skilled birth attendance in Lao PDR…………………………………………………………………..…29-31 Chapter 3 Methodology for conducting review…………………………………….…32-38 3.1. Preparation…………………………………………………............... 3.2. Sample……………………………………………………….………. 3.3. Tools…………………………………………………………………. 3.4. Data collection……………………………………………………….. 3.5. Data analysis………………………………………………………… 3.6. Limitations…………………………………………………………... Chapter 4 Results: Policy……………………………………………………………....39-43 4.1. Enabling policy statements………………………………………….. 4.2. Policy and other statements pertaining to human resources………… 4.3. What is needed to strengthen existing policies……………………… 4.4. International policy/standards for skilled birth attendance………….. Chapter 5 Results: Human Resources (Providers)……………………………….…..44-58 5.1. Workforce…………………………………………………..………... 5.2. By different province………………………………………………... 5.3. By different cadre of provider……………………………………….. 5.4. By different facility………………………………………….………. 5.5. Biographical data…………………………………………………….. Chapter 6 Results: Facilities…………………………………………………………....59-70 6.1. Availability of basic medication……………………………………. 6.2. The utilities in the facilities…………………………………………………. 6.3. Equipment and laboratory tests……………………………………… Maternity Waiting Homes…………………………………………………… Chapter 7 Results: Education and Training………………………………………….71-88 7.1. Pre-service education relative to MCH care………………………….............. 7.1.1. Nursing and Midwifery education…………………………..… 7.1.2. Other health care staff providing MCH care……………..…… 7.1.3. Educational facilities, teachers and students……………..…… 7.2. In-service training relative to MCH care……………………….….... 7.2.1. Overview……………………………………………………… Training facilities and modules………………………………............ 3 Assessment of Skilled Birth Attendance in Lao PDR, 2008 Chapter 8 Results: Coverage……………………………………………………….89-108 8.1 Human Resources…………………………………………………….. 8.1.1. Shortages/gaps………………………………………………… 8.1.2. Staffing standards for skilled birth attendance…………............ 8.1.3. Field notes……………………………………………….…….. 8.2. Access………………………………………………………….…….. 8.2.1. National mapping…………………………………………...…. 8.2.2. Facility locations relative to population distribution………...… 8.3. Referral ……………………………………………………………… 8.3.1. Referral procedure…………………………………………….. 8.3.2. Mode of transport……………………………………………... 8.3.3 Referral costs…………………………………………………... 8.3.4. Recipient hospitals……………………………………….……. 8.4. Community…………………………………………………………... 8.4.1. Overview………………………………………………….…… 84.2. Results……………………………………………………….…. Chapter 9 Conclusions……………………………………………………………..109-112 Chapter 10 The Way Forward: Recommendations & Options………………......113-121 10.1. Long term solutions……………………………………………….................................. 10.2. Short term solutions………………………………......………………… 10.3 Other recommendations Bibliography…………………………………………………………………………..122-123 List of Annexes.....................................................................................................................124 Annexes……………………………………………………………………………......125-146 1. Skilled Attendance: the required skills and abilities 2. Facilities and number of providers visited in January 2008 3. Number of births and cost by province 4. EmONC facilities per province 5. Nationwide SBA needed numbers 6. Health care workforce in numbers 7. Health facilities all levels 8. Number of students in education programs 2004-2010 9. Number of EmONC trained human resources by province 10. Minimum clinical experiences for midwifery students 11. Meetings with Key Informants 4 Assessment of Skilled Birth Attendance in Lao PDR, 2008 LIST OF TABLES Chapter 3: Providers Table 3.1. Assistance at delivery for four provinces in the assessment................................... Table 3.2. Place of delivery for four provinces in the assessment........................................... Chapter 4: Providers Table 4.1. Lao PDR National documents relating to maternal and new born health............... Table 4.2. List of Essential Medicines of Lao PDR, 2008....................................................... Chapter 5: Providers Table 5.1. Number of different cadres in workforce................................................................ Table 5.2. Profile of providers assessed................................................................................... Table 5.3. Number of providers assessed by province............................................................. Table 5.4. Providers who feel confident in 3 skills.................................................................. Table 5.5. Provider skills test proficiency................................................................................ Table 5.6. Provider confidence per self-assessment................................................................. Table 5.7. Correlation between skills and training................................................................... Table 5.8. Provider per different facility type........................................................................... Chapter 6: Facilities Table 6.1. All facilities assessed in January 2008..................................................................... Table 6.2. Health centers with birthing room and number of births in 2007............................ Table 6.3.Number of births and caesarean in 2007 in the assessed district hospitals............... Table 6.4. Number of births and caesarean in 2007 in the assessed provincial hospitals......... Chapter 7: Education and training Table 7.1.All health education programs in Lao PDR 1960- 2008........................................... Table 7.2. Number of teachers/students assessed in Luang Prabang and Champassak............. Table 7.3. Number of teachers/students in Luang Prabang and Champassak in 2008…........... Table 7.4. Number of teachers by cadre in Luang Prabang in 2008.......................................... Table 7.5. Number of teachers by subject in Luang Prabang in 2008........................................ Table 7.6. Performance of skills in % for teachers/students....................................................... Table 7.7. MCH services in Luang Prabang and Champasak provincial hospitals..................... Table 7.8. MCHC In-service training manuals........................................................................... Table 7.9. Data of MCHC EmONC trained human resources.................................................... Table 7.10. Number of births and caesarean in 2007 in 3 main hospitals.................................. Table 7.11. Profile of trainees in 3 main hospitals...................................................................... Table 7.12. Equipment/environment in 3 main hospitals........................................................... Chapter 8: Coverage Table 8.1. The 6 Process Indicators of EmOC............................................................................. Table 8.2. National Mapping of EmONC.................................................................................... Table 8.3. Ratio of comprehensive EmONC facilities per population per province.................... Table 8.4. Caesarean section as a proportion of all deliveries...................................................... Table 8.5 Participant‟s profiles.................................................................................................... Table 8.6. Samples of costs of ANC and normal delivery........................................................... 5 Assessment of Skilled Birth Attendance in Lao PDR, 2008 LIST OF GRAPHS Chapter 5: Providers Graph 5.1. Assistance at delivery by province....................................................................................... Graph 5.2. Problem solving scenarios by province................................................................................ Graph 5.3. 4 Key skills by province....................................................................................................... Graph 5.4. Providers who can use Ambu bag......................................................................................... Graph 5.5. Active management of third stage labor by cadre................................................................. Graph 5.6. Use of the Partograph in labor............................................................................................... Graph 5.7. Magnesium sulphate for management pre-eclampsia/eclampsia by cadre............................ Graph 5.8.