JHPIEGO TrainerNews™ |
The Skilled Provider: A Key Player in
Saving the Lives of Women and Newborns
(October 2001)
Inexpensive, low-technology measures could prevent or effectively manage the majority of maternal and newborn deaths in developing countries.
Approximately 515,000 women die annually during pregnancy, childbirth or the postpartum period
An estimated 9.3 million late fetal and neonatal deaths occur annually
The majority of maternal and newborn deaths are caused by complications or conditions that could be prevented or more effectively managed through inexpensive, low-technology measures. The single most critical intervention in saving the lives of women and newborns is the presence of a skilled provider during childbirth and the immediate postpartum/newborn period. The skilled provider can assist in normal deliveries and also manage or stabilize and refer for complications–all of which are critical interventions in reducing maternal and newborn mortality. Although most deaths occur during the immediate postpartum/newborn period, skilled care is also beneficial during the antenatal and postpartum/newborn periods. The Maternal and Neonatal Health (MNH) Program is committed to promoting the training and accessibility of skilled providers.
Skilled Attendance During Pregnancy and Childbirth
Skilled attendance is a system of services that function together to provide essential care to women and newborns from pregnancy through the postpartum/newborn period. In order for skilled attendance to have the greatest impact in reducing maternal and newborn mortality, all elements of this system must be in place. Key elements are the support of a policy environment that promotes the provision of and access to skilled care, existence of a functioning system for stabilization and referral, the availability of essential equipment and supplies and the presence of a skilled provider.
Providing the Care Women and Newborns Need to Stay Alive
A skilled provider is a healthcare provider with the knowledge, skills and qualifications necessary to deliver essential maternal and newborn care. The settings in which care may be delivered include the home, community health-post, health center and district hospital. The exact qualifications necessary to be considered a skilled provider differ from country to country. And the term skilled provider is not specific to any one profession; rather it designates a person (midwife, doctor, nurse or other healthcare provider with midwifery skills) who provides women and newborns the care they need to stay alive and healthy.
Skilled Provider Competencies and Responsibilities
The core competencies described below include midwifery and life-saving skills. They reflect the minimum skill set of the skilled provider. The skilled provider also has core responsibilities in helping to establish and maintain safe and effective healthcare services.
Core Competencies
Management of the normal pregnancy, childbirth or postpartum/newborn period
- Gathers relevant information about the woman or newborn through targeted history taking, physical examination and
screening
- Ensures that the pregnancy, childbirth or postpartum/newborn period is progressing normally and anticipates potential
problems
- Provides preventive care and promotes healthy practices to maintain a normal pregnancy, childbirth or postpartum/newborn period
- Helps the woman and her family prepare for birth and possible emergencies
- Assists in normal labor and childbirth and performs essential postpartum/newborn interventions
Early detection and diagnosis of major complications/conditions
- Recognizes signs and symptoms of complications/conditions
- Further investigates abnormal signs and symptoms when needed
- Makes an accurate diagnosis
Skilled and timely management or stabilization and referral for major complications/conditions
- Performs lifesaving interventions
- Manages complications/conditions or
- Facilitates stabilization and referral of woman or newborn to a higher level of care as appropriate
Demonstration of key skills in all aspects of maternal and newborn healthcare
- Approaches clinical care in an organized and rational manner
- Individualizes care to meet the needs of the woman and her newborn and family
- Shows courtesy and respect for the woman and her newborn, family and culture
- Effectively communicates with the woman and her family
- Uses standard maternal and newborn practices (including infection prevention practices)
- Keeps careful records
Core Responsibilities
In helping to establish and maintain safe and effective healthcare services, the skilled provider
- uses all available and appropriate means to protect and promote the health and survival of the woman and newborn
- pursues continuing education and further development of skill set;
- provides care that is in accordance with national policies and standards and clinical care guidelines, and is appropriate to
available resources
- continually assesses existing services
- builds on strengths, identifies gaps and works on practical solutions to fill any gaps
- supports activities that advocate or facilitate linkages among providers, facilities, communities and other key stakeholders in the care provision system
Skilled Providers Key to Saving Lives
The MNH Program is committed to developing a cadre of skilled providers throughout the countries where it has projects. The projects are working to develop these core competencies and responsibilities through collaborative training and standard-setting with local service providers and collaboration with policymakers. Advocacy, community and social mobilization, and behavior change are other important components in this effort.The skilled provider is a key player in saving the lives of women and newborns, and bringing about sustainable change is a complex process that requires awareness, commitment and action at all levels of decision-making and care provision.
For more information about the MNH Program visit their website: www.mnh.jhpiego.org
This publication was made possible through support provided by the Office of Health and Nutrition, Center for Population, Health and Nutrition, Bureau for Global Programs, Field Support and Research, U.S. Agency for International Development, under the terms of Award No. HRN-A-00-98-00043-00. The opinions expressed herein are those of the author(s) and do not necessarily reflect the views of the U.S. Agency for International Development.