In October 2018, implementation of the Plan for Immediate Post-Obstetric Contraception and Manual Vacuum Aspiration (MVA) began, an initiative that has led to 30.882 medical interventions, including the placement of 15,265 intrauterine devices and 4,892 implants, the administration of 3,616 ampoules of medroxyprogesterone, the dispensing of 5,520 misoprostol tablets and the performance of 1,589 MVAs.
The data were presented during the conference held in Caracas from November 18 to 22, 2019, which gathered more than 90 participants, including national health authorities, health directors and technical teams from Venezuela's 24 states, experts from PAHO's Latin American Center for Perinatology, Women's Health and Reproductive Health (CLAP) and the Venezuelan Society of Obstetrics and Gynecology. The activity was also attended by the Ambassador of the Swiss Confederation, Didier Chassot, whose country supports the implementation of this plan in Venezuela.
Avoiding unplanned pregnancies as a strategy to reduce maternal mortality
According to World Health Organization (WHO) estimates, family planning has the potential to reduce maternal deaths by 30% and newborn deaths by 10%. In addition, it ensures a healthy interval between pregnancies for women and newborns.
"Avoiding unplanned pregnancies is a key intervention to reduce maternal mortality, and the timing of a woman's contact with the hospital for a delivery, cesarean section or abortion is a golden opportunity to access modern contraceptive methods," said Ariel Karolinski, PAHO/WHO Family Health Advisor, Health Promotion and Life Course.
On her part, Marisela Bermúdez, Vice Minister of Collective Health Networks of the Ministry of the People's Power for Health, emphasized: "We hope this will have an impact by 2020, we must continue to make progress in strengthening the installed capacities, and that the health teams have the necessary knowledge and experience".
The Plan for Immediate Post-Obstetric Contraception and MVA began with a "trainer of trainers" workshop in which 49 obstetrics and gynecology specialists were certified and pre-selected for their experience, teaching skills and areas of action. For participation and certification in the Immediate Post-Obstetric Contraception and MVA workshop implied a commitment to lead the training of other colleagues in their respective states.
This teaching activity was organized jointly by the PAHO representation in Venezuela and CLAP and had the collaboration of the Society of Obstetrics and Gynecology of Venezuela, and the organization IPAS of Bolivia and Mexico.
After one year, and 52 replicas of this workshop that includes the use of anatomical models and hospital practices with clinical simulation, Venezuela has 1,476 health professionals trained in Immediate Post-Obstetric Contraception and MVA, including specialists, Resident Doctors, Comprehensive Community Doctors and others.
Rosa Rubio, head of the Gynecology Service at Castillo Plaza Maternity Hospital in Estado Zulia, western Venezuela, was one of the professionals who received training months later: "The training that took place in mid-April in our state was of great benefit to the users of our service and has improved their quality of life and prepared them to be in better condition in future pregnancies. PAHO trained us and we have been replicating to other specialists and we have raised awareness among the population to avoid unwanted pregnancies and to extend the intergenital periods".
Reducing maternal and neonatal mortality requires more than just trained health personnel; it also requires services that are equipped to care for pregnant women and their newborns.
In order to ensure the provision of the medicines and supplies needed to implement the plan, 357,216 units of 13 essential products to prevent or treat the main causes of maternal and neonatal deaths have been delivered to 31 hospitals in the 14 priority states, in addition to 14,400 implants received and to be distributed.
Regionalization of perinatal care
The management committees and technical visits are one of the pillars in the implementation of the plan. In each of the priority states, the aim is to strengthen the national strategy for the regionalization of perinatal care, known as the Maternal Route, and the surveillance, analysis and response committees for the prevention of serious morbidity and maternal and neonatal mortality, as essential tools for the identification and resolution of critical nodes in the care of pregnant women and newborns. To date, 35,703 km have been travelled and 100 per cent of the priority states have been visited, some on more than one occasion.
During the conferences, participants were able to exchange on the main work areas identified to contribute to the improvement of maternal and perinatal health in Venezuela. Thus, authorities, technical teams, PAHO experts and scientific societies, together with the CLAP team, analyzed the basis for implementing the regionalization of perinatal care.
The preliminary results of the application of the Essential Conditions Assessment tool in prioritized maternity and neonatal hospitals, the maternal mortality estimates for the 2014-2018 time series based on the BIRMM methodology (Intentional Search and Reclassification of Causes of Maternal Mortality) were also made available, the presentation of the "Diploma course in women's, children's and adolescents' health from a life-course approach and strengthening Immediate Post-Obstetric Contraception ", and the dissemination of the "Comprehensive Community Health Approach" with emphasis on indigenous peoples in Estado Amazonas and the Amacuro Delta.
CLAP presented the experience of the CLAP Network for epidemiological surveillance and operational research (Maternal Near Miss and Women in situation of abortion -MUSA-) and the good regional practices and main contributions of the Perinatal Information System (SIP) to start its implementation in Venezuela.
The director of CLAP-SMR, Suzanne Serruya, said that "in addition to enabling the debate on maternal health, sexual and reproductive health and the health of newborns in Venezuela, these workshops have led to important agreements that are key to advancing the well-being of women, pregnant women and newborns, especially those living in the most vulnerable conditions.
Neonatal Health
Neonatal mortality is one of the priorities of public health in Venezuela, which is why during the first two days of the conference there were discussions on perinatal health with the participation of the main actors in the field. In this context, experiences were shared and the characteristics of the perinatal care network in Venezuela were analyzed, with a view to moving toward regionalization in the country.
In order to improve perinatal health, it is necessary to face several challenges, such as "empowering the community to exercise their rights, achieving the regionalization of perinatal care in all sub-national instances, ensuring that 100% of institutional deliveries take place in maternity hospitals with essential conditions and, depending on the complexity, achieving the best quality standards of care," said Pablo Durán, CLAP's regional advisor on perinatal health.
Based on the discussions, three stages were identified to continue the work. On the one hand, the elaboration of a situation diagnosis with data on service networks and their distribution, neonatal statistics and Essential Conditions Assessment results, and then the design of a plan with steps to follow in the implementation and monitoring and evaluation of the regionalization plan for perinatal care.
