NEWS | Cotabato embraces Unang-Yakap

The Cotabato Regional and Medical Center (CRMC) completed a successful and festive EINC launch last August 18, 2011. It was attended by Mayor Japal Guiani, SOCCSKSARGEN CHD Director Dumama and ARMM DOH Secretary Dr. Sinolinding’s representatives, Medical Director Dr. Yambao, Dr.  Mansilla, Dr. Macalawan together with CRMC’s nursing staff. The walls of their dedicated EINC corner have been permanently painted with Unang Yakap colors. The Unang Yakap logo was made ubiquitous by rendering onto labels that were stuck to water bottles, hand disinfectant containers, tissue holder, ballpens, and Unang Yakap kits. To cap it off, cupcakes with the UY logo were served together with scrumptious food.  The highlight of the event was Mayor Guiani’s speech, in which he committed to issue an Executive Order implementing EINC in the barangays.

Meanwhile CRMC continues to make inspiring progress in the implementation of EINC, maintaining >95% performance of the four core steps of EINC in all deliveries as of the month of July. In addition to this, 98% of patients have already been delivering in a semi-upright position and 100% use of antenatal steroids for eligible patients is being observed. Equally impressive are the percentage of patients allowed to eat/drink and have companions of choice, from 40% in June to 95.8%. Likewise, not a single case of fundal pressure was reported for a month since a department policy has been issued to that effect.

Improvements in Pediatric practices have also been reported with the performance of EINC steps even in tachypneic but vigorous newborns as properly timed cord clamping is now being observed prior to separation for additional respiratory support. Commendable too are the breastfeeding advocacy strategies done by the team at the Outpatient Department and wards.  As result of the nursing staff ‘s effort to continue developing plans on improving sterility, asepsis and handwashing practices in critical areas of the hospital, steady decrease of sepsis rates have been observed with only 1 reported preterm death due to sepsis. Total mortality rate is very low at 2.9% and the ultimate low sepsis rate at 0.7% was achieved for the month of July.

And still, some challenges remain—such as pushing for more discriminating criteria for NICU admission as there are still cases of newborn being admitted just for “observation” without any true medical indication; improvements in timely referral system as well as increasing access to antenatal and prenatal care in CRMC’s catchment areas; and lastly intervention in the high cases of post-partum hemorrhage due to inappropriate use of methergine.

All, in all, CRMC is on its way to improving maternal and infant healthcare with the committed work it has put into making EINC the new standard of care. What with Mrs.  Nimia Juanday’s very comprehensive MNCHN EINC HPC Action Plan, activities to further strengthen EINC and MBFHI protocols have been set all the way to January 2012.

NEWS | ADPCN, APSOM to integrate EINC in nursing and midwifery curricula

Academic institutions and midwives may have already shared EINC with their students in the form of seminars and conventions, but both the Association of Deans of Philippine Colleges of Nursing (ADPCN) and Association of Phillipine Schools Of Midwifery (APSOM) are truly embracing the Unang Yakap spirit: Both academic umbrella organizations are preparing for its systematic integration in the pre-service curricula through a series of workshops to be supported by the UNICEF component of the Joint Program on Maternal and Neonatal Health (JPMNH). This crucial component of the strategy to institutionalize EINC will ensure the transfer of knowledge so that future health professionals in government and private health facilities consistently perform the evidence-based steps and avoid the harmful practices in maternal and neonatal care. 

 Commitment of APSOM and APDCN to integrate EINC in nursing and midwife curriculum cements the goal of such precedent efforts such as the implementation of DOH Administrative Orders 2008-0029 and 2009-0025

APSOM and ADPCN plan to convene department and curriculum chairpersons in all their member-schools and –colleges to stage the plan nationwide. Implementation will be overseen by DOH, UNICEF, UNFPA, and WHO. The Technical Panels on Nursing and Midwifery Education of the Commission on Higher Education are also expected to be involved, as well as representatives from the Association of Nursing Service Administrators of the Philippines (ANSAP), Maternal and Child Nurses Association of the Philippines (MCNAP), Critical Care Nurses Association of the Philippines (CCNAP), and the Operating Room Nurses Association of the Philippines (ORNAP).

Their commitment cements the goal of such precedent efforts such as the implementation of DOH Administrative Orders 2008-0029 and 2009-0025 which have to do with the transfer of knowledge on maternal and neonatal care to help curb both maternal and newborn mortality.  Optimism should not be conflated with ease, however. While green lights seem to be flashing everywhere for the integration of EINC into the curriculum, integration is not without its challenges.  The mismatch between actual environment and classroom theory is projected to be a hurdle they will need to leap over. Hospital policy reforms, for example, in line with the Mother-Baby-Friendly Hospital Initiative, Milk Code compliance, inclusion in regulatory and licensing requirements, and the scale-up of EINC implementation itself should all be happening simultaneously for optimum results. To compromise any of those is to compromise the whole of maternal and neonatal care. These projected problems do not seem to dampen their spirits, however, as the enthusiasm of the APSOM and ADPCN officers only seems to grow—they have even shown interest in followup activities they could bring to their respective nursing/midwifery chapters or base hospitals—with no indication whatsoever of waning.

NEWS Feature | Essential Intrapartum and Newborn Care in San Juan, Batangas

by Romelyn April P. Imperio, Straight Intern in Family and Community Medicine, UP-PGH 

Dr. Beverly Lorraine C. Ho, Project Staff, Team EINC

Through the auspices of the UP CDHP-San Juan Partnership and assistance of UP College of Medicine together with San Juan’s Municipal Health Office, EINC Training was held in San Juan, Batangas on February 18, 2011. The EINC Training was organized to broker the necessary path and support for the municipality’s rural health units, its staff and midwives to improve maternal and newborn health in the area.

Dr. Nestor Alidio, Municipal Health Officer of San Juan and Nurse Len Comia set up the logistics of the training invited all midwives working in the barangays. Meanwhile, DFCM Straight Intern Romelyn Imperio then communicated the training request to University of the Philippines College of Medicine alumni Dr. Beverly Lorraine Ho and project staff of Team EINC.

FEATURE | Kangaroo Mother Care at Eastern Visayas Regional Medical Center

Upon the request of Dr. Aileen T. Riel-Espina, OIC and Chief of Hospital III of Eastern Visayas Regional Medical Center (EVRMC), in coordination with Team EINC, the Bless Tetada Kangaroo Mother Care Foundation (KMCF) conducted the KMC training program at the hospital last June 6 to 10. Participants were Nelita P. Salinas, MD, FPPS [Medical Specialist II (Pediatrics)], Ma. Gemma Ramos, MD, DPPS FPPS [Medical Specialist II (Pediatrics)], Audrey Santo, MD, DPPS [Medical Specialist I (Neonatology)], Dolores Casio, RN, MAN (Head Nurse, NICU), Lea Demetria, RN, MAN (Nurse Staff, NICU), Rachel Quilario, RSW (Social Worker II), Janet Galangue, RSW (Department Head, Social Worker Services), and Susana S. Merida, MD, FPOGS [Medical Specialist II (OB-Gyn)].

Prior to the training proper, a KMC orientation was conducted, attended by about 35 

Graduates of KMC training

medical and administrative officers of EVRMC and representatives of the local media. At Dr. Riel-Espina’s opening remarks, she stated that the institutionalization of the KMC at EVRMC to would help in better managing the problem of housing mothers with low birth-weight babies still undergoing medical interventions. She also hoped that with this training and the eventual implementation of KMC, EVRMC would be able to satisfy the accreditation requirement of the KMC Foundation. 

At the press conference that followed, Dr. Socorro Mendoza, President of Bless-Tetada Kangaroo Mother Care Foundation-Philippines, and Dr. Espina were interviewed about the concept and benefits of Kangaroo Mother Care. Dr. Mendoza mentioned that, based on worldwide experiences and a large body of scientific evidence collected, the KMC program has contributed to the reduction in the risk of death among the low birth-weight babies; higher rates of breastfeeding among mothers; adequate infant growth, especially head circumference; better mother-child bonding; and reduction of costs incurred by families and hospitals.

News | Breastfeeding under special conditions

IPA/ICM/FIGO issues a joint statement on breastfeeding, including breastfeeding by HIV- infected mothers. In light of the changing evidence on transmission risks and recommendations on the use of anti retroviral drugs for treating pregnant women and preventing HIV infection in infants, we welcome the new recommendations on HIV and infant feeding: 


1. Balancing HIV protection with protection from other causes of child mortality
2. Integrating HIV interventions into maternal and child health services. 

3. Setting national or subnational recommendations, based on evidence, for infant feeding in the context of HIV. 

4. Informing mothers known to be HIV infected about infant-feeding alternatives
5. Supporting mothers known to be HIV infected who wish to breastfeed so that they can do so safely. 

6. Providing services to specifically support mothers to appropriately feed their infants. 

7. Avoiding harm to infant-feeding practices in the general population.
8. Advising mothers who are HIV uninfected or whose HIV status is unknown. 

9. Investing in improvements in infant-feeding practices in the context of HIV.

IPA/ICM/FIGO welcome the recommendation that mothers known to be HIV infected should exclusively breastfeed their infants for the first 6 months of life, introducing appropriate complementary food thereafter, and continue breastfeeding for the first 12 months of life. Bottle feeding should be considered the best alternative only when specific conditions are met. The conditions under which bottle feeding is preferred are commonly referred to as AFASS—affordable, feasible, acceptable, sustainable, and safe—and are more specifically described in the new WHO recommendations.

NEWS | 1st MNCHN EINC Advocacy Partners Forum held in Manila

July 13 to 15 at the Century Park Hotel in Manila saw the realization of the first MNCHN (Maternal Child Health and Nutrition Policy) EINC (Essential Intrapartum and Newborn Care) Advocacy Partners Forum to meet the demand for EINC training by building up the pool of speakers for rapid scaling up efforts. The forum was carried out for the benefit of new EINC trainers who themselves require not only training but also updates on the Department of Health’s ongoing efforts in the Scale-Up Project. Their motto being “I commit to life”—it is the first declaration in their official Partners Pledge—the group by way of this forum also commits to keeping their advocacy alive by empowering their personnel with the expertise necessary for pursuing the quality of maternal child health they aspire for.


Funded by JPMNH and WHO, EINC has either trained or oriented approximately 9000 healthcare workers in the short timespan between May and October 2011–a testament to the ongoing demand for capacity building in EINC among various key medical institutions. Requests for training come from both private and public hospitals, some even outside the National Capital Region, no to mention a handful of LGUs and private institutions. This is possibly due to the effectiveness of the EINC social marketing plan and training methodology, where administrative circulars as well as technical and professional training are brought directly to facility-based healthcare workers, emphasizing the significance of a peer-to-peer system of learning. 

The course was designed to build up a speakers bureau comprised of of EINC advocates–the healthcare professionals who, after training, are committed to improving dominant hospital practices when it comes to caring for mothers and newborns–and dedicated to ginding even more advocates given the abovementioned demand for EINC training. The demand is expected to grow further once Philhealth goes public with its new packages meant to address issues of maternal and newborn healthcare–a demand to be met by the pool of advocacy partners in collaboration with DOH and its Centers for Health Development.

After receiving their official IDs after completion of training, healthcare professionals maintain their status as EINC advocates by conducting workshops, the progress of which will be monitored via the EINC Advocacy Partners Forum website. The engagement of Advocacy Partners such as those coming from professional societies can also function as a kind of PPP mechanism of the Centers of Health Development, identifying specialists per region who can voluntarily lead orientations and trainings for the CHDs who will fund such venues for training. Besides the CHDs, the Advocacy Partners will also be working closely with DOH hospitals and their Health Education and Promotions Officer (HEPO), the DOH Family Health Office/NCDPC, the National Center for Health Promotions (NCHP), and the Local Government Unit (LGU).

The feedback has been positive with participants excited to return to their communities and impart their new learning's. Dr. Catherine Torres-Jison of Bacolod, for instance has committed to conduct EINC trainings and workshops at The Corazon Locsin Montelibano Regional Hospital, Bacolod City Lying-In Clinis and at University of St. Las Salle. She shares "learning about the evidence-based practices has empowered us to push for the advocacy because we are confident that the safety and wellness of both mother and baby are always prioritized over everything else." Moreover, she is anticipating that "bringing EINC to medical schools" as the best way to promote EINC protocol that way "[future] doctors and other health professionals will no longer be confused."

The 70 “graduates” who have completed the training were enjoined to know by the heart the

MNCHN EINC Advocacy Partners Pledge, a simple oath comprised of seven lines that capture the essence of what EINC stands for:

          “I commit to life. / From its earliest stirrings in a mother’s womb, through

          its intricate journey of development, until the moment of birth. / I will safeguard the      

          mother’s wellbeing, to maintain a nurturing environment for the life growing within. / I will

          shield this new life, and ensure it begins its existence safely nestled in a mother’s warm  

          embrace. / I will protect this new life, and allow only milk from a mother’s breast for

          nourishment. / I will zealously preserve the bond between mother and child. / All these

          things I hold sacred, and will form my lifelong commitment.”

NEWS | Upcoming Technical Conference on EINC Best Practices

Almost a year has passed since Essential Intrapartum and Newborn Care (EINC) began “Unang Yakap” or “First Embrace,” its social marketing campaign, designed to transform hospitals with interventions aimed at the high-risk periods of labor, delivery, and immediate postpartum. Now that its practices have been established and are ready to be implemented in 11 DOH hospitals—thanks to the efforts not only of the EINC team but also of these hospitals, JPMNH, WHO Philippines, and the National Center for Disease Prevention and Control/Family Health Office—EINC is eager to share its experience with health stakeholders for adoption and replication on a national scale by way of a conference.

The MNCHN EINC Scale Up Project Technical Conference, to be held on September in Metro Manila, is meant to convene such stakeholders, including DOH Centers for Health Development and more hospitals who can surely benefit from EINC’s progressive methods and learnings. Heads of professional societies, key personnel from medical academies, as well as physicians, nurses, and midwives have been invited to attend. Expected presentations include a showcase of the results of the EINC Scale Up Project that mark improvements in the deployment of practices from baseline to project completion, an enumeration of the best practices carried out in model hospitals that are worth emulating, even a set of technical recommendations for the adoption of EINC in all health facilities across the entire nation in order to arrest maternal and newborn within this high-risk period.

NEWS | EINC-friendly Birth center to open at EAMC

This July, East Avenue Medical Center (EAMC) is slated to complete its Birthing Center. To be headed by Dr. Elenita Veloso, the Birthing Center now has a spacious examination room, a spacious EINC area to accommodate mother-baby dyads with 30 reclining beds, and an OR for emergency CS cases.

After touring the premises, the EINC working group has expressed its satisfaction with
the Birthing Center’s steady development, forseeing further improvement in the OB Department’s already impressive statistics. Since EINC was implemented in April, performance of unnecessary practices have steadily gone down, and there has been very good compliance with performance of complete EINC, even in CS deliveries. From July 11-17, 2011, out of 123 normal deliveries, 58.5% had episiotomies and these were mostly young primigravid teenage mothers with tight perineums. 52.8% were not given IV fluids, and the remaining patients with IVs were OB complicated cases which comprise the majority of their admissions (65.7% of all admissions). The wall to wall stretchers in the DR don’t allow for patients’ mobility or having position of choice during labor, but 69.9% are able to deliver in the semi-upright position. More commendable is the 100% use of antenatal steroids, 100% EINC in CS deliveries, and performance of core steps 1-3 even in symptomatic patients. This ensures that all patients benefit from EINC even if they are eventually admitted to the NICU. 

With the new birthing center mothers can now deliver in non-supine position with these reclining beds

The Birthing Center, however, is not without room for improvement in its facilities. The EINC working group has suggested the addition of a sink in the IE room, the expansion of the labor room by way of converting the large area around the nurses’ station, the addition of handwashing stations in the delivery room, and the installation of exhaust fans. There remain many opportunities for the physical improvement of the space.

NEWS | More comfort from mommy-friendly beds in JRRMMC

June 3, 2011 – All delivery beds in Jose Reyes have been made “mommy-friendly” by fitting them with special wedges so mothers now deliver in non-supine positions. “Mothers are more comfortable, there have been no complaints, reported Dr. Francesca Tatad-To, Team EINC Co-Convener.

This was reported during a weekly review of EINC progress in May 2011. This innovation is a welcome addition to the low sepsis rates among term babies and low mortality rates, both at less than 1%. During this period, NICU admission rate was 10% of all deliveries.

The innovation of letting mothers have a “position of choice” comes as a result of the repeat delivery observations and time motion studies. Other changes have been instituted. The ER pharmacy is ensuring that dexamethasone is in stock. The OBGYN doctors are now revising their NPO orders to allow mothers to eat/drink. The partographs are going to be placed in charts in a more timely manner. Footprinting, a cause of potential infection for newborns, is going to stop with changes being done to hospital forms after reviewing the new guidelines in AO 2009-25.

NEWS | Unang Yakap Embraces 8,962 Healthcare Professionals!

Participants follow Dra Izza Flores lead in proper hand hygiene technique at EINC Training in General Santos City

Dr. Mianne Silvestre, EINC Team Convenor and WHO Consultant, reports that at least 8,962 healthcare professionals are now aware or knowledgeable in essential intrapartum and newborn care (EINC) practices. We believe this means that mothers and newborns will benefit from safer, quality care from these health facilities.

“From October to May 2011, we tripled our goals when requests for the EINC training course, spontaneously came from private hospitals (12%) and public hospitals in provinces outside NCR (6%). 




The biggest chunk of awareness still comes from those who attended lectures of our EINC team or talks provided at special forum (53%). But this number appears understated.

Dr. Silvestre pointed out that it does not capture the number of readers or listeners who have heard the DOH National Center for Disease Prevention and Control Director Dr. Ed Janairo or Family Health Office’s Dr. Anthony Calibo on radio and television talk about the benefits of adopting the EINC practices.

NEWS | Drop in Maternal and Newborn Deaths marks 8th week of EINC in General Santos City

Health professionals in General Santos city attending the second round of EINC Orientation Workshop held last May

Dr. Orlando Marius Oco Jr, Chairperson of the Local Health Board of General Santos City said they were encouraged by the feedback that there has been a dramatic drop in the NICU admissions, decreasing rates of preterm and sepsis deaths and an overall decrease in maternal and newborn deaths after 8 weeks of implementation of the EINC Scale Up Project.

Dr. Oca said this as he welcomed the participants, project staff, conveners and resource speakers of the orientation workshop on Essential Intrapartum and Newborn Care last May 25, 2011.  
     

Dr. Oca cited the recent world health report which seeks to make every mother and child count. The United Nation says that almost 11 million children under 5 years of age will die from causes that are largely preventable. Among them are 4 million babies who will not survive the first month of life. At the same time, more than half a million women will die during pregnancy or childbirth. The report says that reducing this toll in line with the Millennium Development Goals depends largely on every mother and every child having the right access to healthcare from pregnancy through childbirth, the neonatal period and childhood.

                

The Health Board Chair said the City of General Santos was grateful that General Santos City Hospital had been identified by the Department of Health as the collaborating institution in the SOCCSKARGEN Region to implement the Essential Intrapartum and Newborn Care protocol in the area. 

More than  500 health professionals from General Santos City, Kidapawan, Sultan Kudarat, Tacurong, Polomolok etc braved the rains to attend the EINC orientation workshop held over 3 days at the Lagao Auditorium in General Santos City. 

He ended his welcome by reminding the health professions that “we do not rest on our laurels or wallow in defeat, we will take honor in this opportunity to learn and serve and in this privilege to host this workshop”.  And with the warm salutation “ You are in the home of the Generals!!!  Good day to all and “ Magandang Gensan”!