By: Madeline Taskier, Partnership Coordinator at Women Deliver
Ayacucho is a mountainous and isolated region in the southeast corner of Peru. While the country has reduced its maternal mortality rate by 61% since 1990, rural women face serious barriers to quality emergency obstetric care (EmOC). Ayacucho is ranked 20th among the 24 Peruvian regions for health indicators with only 3.7 OBGYNs working per 10,000 women of reproductive age. In response to these challenges, CARE and the Averting Maternal Death and Disability Program collaborated to improve EmOC for 48,000 rural women in the Ayacucho region.
Prior to the program launch in 2000, the Government of Peru initiated national scale-up of maternal and child projects to increase community use of health services. These programs did not address the poor quality of EmOC or the lack of clinicians’ awareness of indigenous birthing practices, further deterring local women from the health facilities. The programs also lacked comprehensive data collection which stunted proper evaluation and progress.
The CARE FEMME Project (Foundations to Enhance Management of Maternal Emergencies) sought out to improve quality within the health centers, coordinate a referral system in the mountainous region, streamline data collection, and promote a human rights approach to care.
To start, the project upgraded 5 existing health facilities with strategic renovations, which included: the creation of an immediate intensive care unit for critically ill women with obstetric complications; the addition of elbow tap sinks outside of operating rooms for increased sanitation; private rooms for patients; provision of more emergency drugs for hypertensive disorders; and the creation of a separate space for radio communication in the patient referral system. The project team also streamlined data collection from 20 different sources to three registries documenting emergency treatment, prenatal care, and delivery. Additionally, 42 physicians, midwives, and nurses at the health centers underwent a two-week EmOC training at the Maternal Perinatal Institute in Lima.
Several outcomes came out of this comprehensive 5-year program. First, health workers were motivated about their improved capacity to address EmOC, resulting in the creation of two 24-hour on-call physician shifts. The trainings instituted new procedures like vacuum extraction and educated midwives about active management of third stage labor. In one center, the health team designed an adjustable birthing chair to cater to indigenous women’s vertical birthing position preference. Finally, the project team created an evidence-based guideline for the management of obstetric emergencies that was later passed by the regional government as the official EmOC protocol.
From 2000 to 2005, met need for EmOC increased from 30% to 84% for pregnant women in the Ayacucho Region. Emergency services are offered 24 hours a day, 7 days a week, applying human rights approaches to care with the integration of indigenous cultural practices and language into the health care. The maternal mortality rate has decreased and the CARE project is helping to shape health services policy in Peru.