DEVELOPMENT Dr Chisale Mhango MALAWI SCENARIO MOH has a number of guidelines in several national programmes RHU has an integrated Guidelines called Malawi National Reproductive Health Service Delivery Guidelines ID: 489593
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Slide1
CLINICAL GUIDELINES DEVELOPMENT
Dr. Chisale MhangoSlide2
MALAWI SCENARIO
MOH has a number of guidelines in several national programmes
RHU has an integrated Guidelines, called
“Malawi National Reproductive Health Service Delivery Guidelines”
These are elaborated by the
National Reproductive Health Standards
Clinical ProtocolsSlide3
MALAWI NATIONAL GUIDELINES
In Malawi, the
word
“guidelines”
is a generic term for various documents that describe how standards are achieved.
Two
broad types of guidelines exist at national level:
policy guidelines,
and
service
delivery
guidelines.Slide4
POLICY GUIDELINES
Malawi National Health Policy
All Malawi Programme Policies
Must be aligned to the National Health Policy
e.g. National Reproductive Health PolicySlide5
POLICY GUIDELINES
The Malawi National Health Policy is recently revised and is aligned to the
WHO
Policy Guidelines
African
Union Health Strategy,
and
Southern
African Development
Community
NB communities
that Malawi
belongsSlide6
Policy Guidelines
Policy
Guidelines describe:
Which services are to be officially offered
Who may receive these services
Where these services will be delivered
How often certain services are to be delivered and
What minimal acceptable level of performance is
to be offeredSlide7
Policy Guidelines
Policy guidelines do not contain the technical information needed to provide services; rather, they serve as a general outline for the provision of services.Slide8
1. Malawi Reproductive Health Policy
This recently revised.
It addresses all components of reproductive health
How much each of these components are covered depends on the SWAp programme of work
Cancer is just being covered in the SWAp PoW now hence the need for revising the policy.Slide9
2. Malawi Reproductive Health Policy
Recent changes in the delegation of the delivery of DMPA to HSAs, necessitated the revision of the policy.
It had to meet the values of the recently developed Health Policy.
Guiding principles are those identified in the Health Policy.
Cancer is just being covered in the SWAp PoW now hence the need for revising the policy.Slide10
1. Service Delivery Guidelines
Service Delivery Guidelines
serve
as
A
technical tool for achieving
standards.
T
hey highlight essential information on delivery of services.
They
are
a
source of specific,
up-to-date information
about the reproductive health services offered in a country. Slide11
2. Service Delivery Guidelines
They explain how healthcare providers should relate to clients and patients who seek reproductive health services.
They serve as a basis for RH learning, resource material and curriculum development.
They are logically are derived from the policy guidelines.
The are supplemented by the TRAINING MANUALSSlide12
Standards
WHO
defines
standards
as an agreed-upon level of performance that specifies what action should be taken.
They
serve as the benchmark upon which to make judgements.
They
must be
achievable
,
desirable
and
measurable
and most importantly, standards of care should be
evidence-based
with focus on client/patient needs.
Logically, the standards are derived from the service delivery guidelines
.
Slide13
PURPOSE OF MRHSDG
The
Malawi National Reproductive Health Service Delivery Guidelines
provide the most current up-to-date knowledge and direction on the various components of reproductive health,
as at the time of writing. Slide14
1. Objectives of Clinical Guidelines
To
assist service providers at all levels
of care to
deliver
high-quality
comprehensive and up to date RH services based on sound and acceptable principles of practice
.
They form a solid foundation from which service providers at all health facilities in both the public and private sectors, as well as non-governmental organisations, can provide
comprehensive
,
and
standardised
reproductive health care.
The
MoH
obliges all managers
, policymakers and training institutions to use of these
guidelines.Slide15
2. Objectives of Clinical Guidelines
In the health sector, there are many WHO and other international institutions guidelines.
As occurs in most countries, Malawi takes advantage of the international expertise that developed these guidelines, and adapts them.
On being adapted, the ownership of those guidelines changes: the become national guidelines.
There is no obligation to use international guidelines, but all are obliged to abide by national guidelinesSlide16
Process of Developing the Clinical
Service Delivery
Guidelines
Multi-sectoral: the current MNRHSG acknowledges 38 technical persons from 23 organisations who participated in the development of the 2
nd
edition of these guidelines in 2007.
These persons used
their field experiences as well as recent scientific literature and current research findings to formulate a document that is consistent with
good clinical conduct through several workshops.Slide17
FINALISATION OF THE CLINICAL GUIDELINES
The draft Guidelines were then circulated to various stakeholders to review
each and every chapter thoroughly, ensuring that each component is consistent, technically sound and evidence-based. Slide18
How is the
Clinical Guidelines are structured
Part I:
Quality of care
Counselling
Client assessment
Infection prevention
Family planning
Post abortion care
Adolescent reproductive healthcare
Maternal and neonatal health
Sexually Transmitted Infections (STI’s)
Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV and AIDS)
Prevention of Mother to Child Transmission (PMTCT) of HIV
Reproductive health for special groups
Prevention and early detection of cancers of the reproductive system
Infertility
Gender Based Violence
Harmful practices
Logistics Management System
Part II:
WHO Medical Eligibility Criteria for Contraceptive use
Who Can Provide FP services
Standard Equipment and Supplies for RH servicesSlide19
Limitations
of the Malawi National RH Service Delivery Guidelines?
These
guidelines are comprehensive in scope,
but they
do not provide
detailed
procedures in
service
provision
.
They
only highlight the essential information that
guide the delivering of
RH services
.
If
the reader/user needs to know the detailed steps in the various chapters,
s/he is to
consult
clinical
protocols
,
agreed upon
standards
and/or
procedure
manuals
.
What is possible is
dictated national available resources (e.g. VIA instead of Pap smear)Slide20
ETATMBA OBSTETRIC PROTOCOLS
The arrangement of the Service Delivery Guidelines in Malawi is different from those of Tanzania.
The Malawi RH Service Delivery Guidelines are generic for all health workers
Hence while ETATMBA has revised the Tanzania Service Delivery Guidelines for the NPCs, in Malawi ETATMBA has upgraded the
OBSTETRIC PROTOCOLS,
as these will be what is required to meet the needs of Clinical Officers – the target group for the ETAMBA intervention.Slide21
TO ENSURE BEING UP TO DATE
DFID/USAID/UNICEF/UNFPA
.
Malawi Demographic and Health Survey,
December
2005
FHI/USAID. September 1997.
Reproductive Health of Youth
Adults
Hatcher R A,
et al.
July 1997. Essentials
of Contraceptive
Technology
http://
www.aidsinfo.nih.gov
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www.niaid.nih.gov
http://
www.oncolink.org
JHPIEGO/USAID/ ENGENDERHEALTH. April 2003.
Post-abortion Care Course Notebook for Trainers,
JHPIGO.1999.Reproline-Reproductive
Health
Ministry of Health. /NAC,
Guidelines for the Use of ARV’s in Malawi
, First Edition October
2003
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)
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2004
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2006
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, November 2002
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of Health/NAC,
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Second Edition Vo. 03 May
2004
Online.http://
www.reproline.jhu.edu
Tietjen L, Cronin W, March 1992.
McIntosh N, Infection Prevention for
Family Planning Service
Programs
WHO/UNFPA/UNICEF/WORLD BANK. 2003.
Managing Newborn
Problems
Winkler J, Oliveras E, McIntosh N, 1994.
Postabotion Care Reference Manual for Improving Quality of
Care
World Health Organization (WHO).
2004. World Health Organization Medical Eligibility Criteria for Contraceptive
Use
World Health Organization(WHO). 2002.
Managing Complication in Pregnancy and Child Birth (Addendum for use in the African Region,)
2002
World Health Organization(WHO). 2002.
Managing Complications in Pregnancy and Child Birth (A guide for midwives and child health
)
Ministry of Health of Kenya.
Family Planning Guidelines for Service Providers March
2005
Hatcher, RH, Rinehart, W, Blackburn, R, Geller, J.S., and Shelton, J.D
. The Essentials of contraceptive Technology. Baltimore, Johns Hopkins University School of Public Health, Population Information Program, 1997
.