SKILLED CARE DURING CHILDBIRTH - Family Care International

Skilled Care During Childbirth: Country Profiles Sri Lanka
FIGURE 2 >
PERCENTAGE OF DELIVERIES IN GOVERNMENT HOSPITALS
INVESTIGATING EACH
MATERNAL DEATH
A system to investigate maternal
deaths has been in place
since the late 1950s. Initially,
the Medical Officer of Health
conducted the investigation into
a maternal death using a prescribed
form, and determined
whether any follow-up action
was necessary. In the 1980s, a
formal system of maternal death
reviews was introduced where
a committee—chaired by the
Director General of Health
Services and comprising administrators,
obstetricians, Medical
Officers of Health,
and members of the medical
professional organisations—
reviews the cause and
circumstances surrounding
each maternal death.
Annual and quarterly maternal
death reviews are conducted
at the regional and central levels.
Each death is analysed in-depth
(not to find fault but to
identify corrective action) using
the Three Delays model. The
appropriate measures that
need to be taken to prevent
such deaths are discussed with
programme managers and
service providers. The Family
Health Bureau acts as the focal
point for this system, and
provides feedback on the issues
discussed and the appropriate
corrective actions needed
for the future. Some examples
of action taken as a result of
maternal death reviews:
establishing 24-hour ambulance
systems, and appointing
two specialist obstetricians to
a referral institution. (4)
PERCENT %
100
80
60
40
20
0
1960 1965 1970 1975 1980 1985 1990 1995
YEAR
Monitoring & Evaluation Systems to Improve the Quality of Services
In the period between 1960–1990, the Government placed greater emphasis on improving the quality
of services through developing monitoring and evaluation systems. At the national level, all MCH and
family planning activities were brought under one division, the Bureau of Family Health, headed by
a MCH Director. The field reporting system was revamped in an effort to provide regular, systematic
assessments of the programme and to identify areas needing improvement. (4)
The Family Health Bureau coordinates routine monitoring and evaluation activities, including:
• Annual maternal death audits at the regional and central levels (see sidebar);
• Quarterly and annual maternal death reviews at the district level.
A set of MCH-Management Information System (MIS) indicators has been developed for each of these
activities, to guide supervision of health workers at the district, province, and national levels.
Feedback and corrective guidance is promptly offered to health workers.
Standards and protocols: Standards and protocols have been developed for most MCH activities. They
guide training and organisation of health services, and are also prepared and circulated periodically
among health workers to update their knowledge. Examples include:
• A comprehensive manual for peripheral-level health workers on MCH and family planning (currently
being revised) is used as a reference by health staff in their daily activities.
• Protocols on management of obstetric emergencies and resuscitation of newborn infants have been
prepared and given to the relevant staff.
• Two new manuals are currently being prepared on Management of Obstetric Emergencies in the
Periphery and Human Resource Development for Health Personnel with assistance from expert agencies
in the field.
• A national system has been developed to review each maternal death (see sidebar).
A recent quality assessment of maternal care has identified some deficiencies in primary-level
institutions, specifically with regard to communication and transport systems. For example, although
most hospitals have ambulances and telephones, smaller institutions still lack such services and face
difficulties in emergency transfer of patients to referral centres. Shortages of certain categories of
health staff exist in particular regions of the country, and have hampered the provision of better
quality care.
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