Assumptions underlying the Guide ASSUMPTIONS UNDERLYING THE GUIDE 5 Recommendations in the Guide are generic, to the woman's home,if necessary.However services and the community are involved in Adaptation of the Guide made on many assumptions about the health there may be other health workers who receive maternal and newborn health issues. characteristics of the population and the the woman or support the skilled attendant Other programme activities,such as It is essential that this generic Guide is adapted to national and local situations,not only within health care system (the setting,capacity and when emergency complications occur. management of malaria,tuberculosis and the context of existing health priorities and organization of services,resources and staffing). Human resources,infrastructure,equipment, other lung diseases,treatment for HIV,and resources,but also within the context of respect supplies and drugs are limited.However, infant feeding counselling.that require MOH and sensitivity to the needs of women,newboms Population and essential drugs,IV fluids,supplies,gloves and specific training,are delivered by a different and the communities to which they belong. essential equipment are available. provider,at the same facility or at the referral endemic conditions If a health worker with higher levels of skill (at hospital.Detection,initial treatment and High matemal and perinatal mortality the facility or a referral hospital)is providing referral are done by the skilled attendant. An adaptation guide is available to assist national experts in modifying the Guide Many adolescent pregnancies pregnancy,childbirth and postpartum care to All pregnant woman are routinely offered HIV High prevalence of endemic conditions: women other than those referred,she follows testing and counselling at the first contact according to national needs,for different Anaemia the recommendations described in this Guide. with the health worker,which could be during demographic and epidemiological conditions, Stable transmission of falciparum malaria Routine visits and follow-up visits are the antenatal visits,in early labour or in the resources and settings.The adaptation guide Hookworms (Necator americanus and "scheduled"during office hours. offers some alternatives.It includes guidance on postpartum period. developing information and counselling tools so Ancylostoma duodenale) Emergency services("unscheduled"visits)for Women who are first seen by the health worker that each programme manager can develop a Sexually transmitted infections,including labour and delivery,complications,or severe in late labour are offered the test after the HIV/AIDS illness or deteroration are provided 24/24 childbirth. format which is most comfortable for her/him. Vitamin A and iron/folate deficiencies. hours,7 days a week. Health workers are trained to provide Hiv Women and babies with complications or testing and counselling. Health care system expected complications are referred for further HIV testing kits and ARV medicines are care to the secondary level of care,a referral available at the Primary health-care The Guide assumes that: hospital. Routine and emergency pregnancy,delivery and Referral and transportation are appropriate for postpartum care are provided at the primary Knowledge and the distance and other circumstances.They level of the health care,e.g.at the facility near must be safe for the mother and the baby. skills of care providers where the woman lives.This facility could be a Some deliveries are conducted at home, This Guide assumes that professionals using health post.health centre or matemity clinic. attended by traditional birth attendants (TBAs) it have the knowledge and skills in providing It could also be a hospital with a delivery ward or relatives,or the woman delivers alone(but the care it describes.Other training materials and outpatient clinic providing routine care to home delivery without a skilled attendant is must be used to bring the skills up to the level women from the neighbourhood. not recommended). assumed by the Guide. A single skilled attendant is providing care. Links with the community and traditional She may work at the health care centre,a providers are established.Primary health care matemity unit of a hospital or she may goAssumptions underlying the Guide HOW TO READ THE GUIDE Recommendations in the Guide are generic, made on many assumptions about the health characteristics of the population and the health care system (the setting, capacity and organization of services, resources and staffing). Population and endemic conditions N High maternal and perinatal mortality N Many adolescent pregnancies N High prevalence of endemic conditions: ￾ ¡ Anaemia ￾ ¡ Stable transmission of falciparum malaria ￾ ¡ Hookworms (Necator americanus and Ancylostoma duodenale) ￾ ¡ Sexually transmitted infections, including HIV/AIDS ￾ ¡ Vitamin A and iron/folate deficiencies. Health care system The Guide assumes that: N Routine and emergency pregnancy, delivery and postpartum care are provided at the primary level of the health care, e.g. at the facility near where the woman lives. This facility could be a health post, health centre or maternity clinic. It could also be a hospital with a delivery ward and outpatient clinic providing routine care to women from the neighbourhood. N A single skilled attendant is providing care. She may work at the health care centre, a maternity unit of a hospital or she may go to the woman's home, if necessary. However there may be other health workers who receive the woman or support the skilled attendant when emergency complications occur. N Human resources, infrastructure, equipment, supplies and drugs are limited. However, essential drugs, IV fluids, supplies, gloves and essential equipment are available. N If a health worker with higher levels of skill (at the facility or a referral hospital) is providing pregnancy, childbirth and postpartum care to women other than those referred, she follows the recommendations described in this Guide. N Routine visits and follow-up visits are “scheduled” during office hours. N Emergency services (“unscheduled” visits) for labour and delivery, complications, or severe illness or deterioration are provided 24/24 hours, 7 days a week. N Women and babies with complications or expected complications are referred for further care to the secondary level of care, a referral hospital. N Referral and transportation are appropriate for the distance and other circumstances. They must be safe for the mother and the baby. N Some deliveries are conducted at home, attended by traditional birth attendants (TBAs) or relatives, or the woman delivers alone (but home delivery without a skilled attendant is not recommended). N Links with the community and traditional providers are established. Primary health care services and the community are involved in maternal and newborn health issues. N Other programme activities, such as management of malaria, tuberculosis and other lung diseases, treatment for HIV, and infant feeding counselling, that require specific training, are delivered by a different provider, at the same facility or at the referral hospital. Detection, initial treatment and referral are done by the skilled attendant. N All pregnant woman are routinely offered HIV testing and counselling at the first contact with the health worker, which could be during the antenatal visits, in early labour or in the postpartum period. Women who are first seen by the health worker in late labour are offered the test after the childbirth. Health workers are trained to provide HIV testing and counselling. HIV testing kits and ARV medicines are available at the Primary health-care Knowledge and skills of care providers This Guide assumes that professionals using it have the knowledge and skills in providing the care it describes. Other training materials must be used to bring the skills up to the level assumed by the Guide. Adaptation of the Guide It is essential that this generic Guide is adapted to national and local situations, not only within the context of existing health priorities and resources, but also within the context of respect and sensitivity to the needs of women, newborns and the communities to which they belong. An adaptation guide is available to assist national experts in modifying the Guide according to national needs, for different demographic and epidemiological conditions, resources and settings. The adaptation guide offers some alternatives. It includes guidance on developing information and counselling tools so that each programme manager can develop a format which is most comfortable for her/him. ASSUMPTIONS UNDERLYING THE GUIDE