Peru’s Postabortion Care Program:Peru’s Postabortion Care Program: Improving Quality and AccessibilityImproving Quality and Accessibility

Funded by DFIDFunded by DFID

PATHFINDER INTERNATIONAL

30th Annual Conference, Global Health Council

Washington, DCMay 29, 2003

Miguel Gutiérrez, MDJhony Juárez, MDElvisa Loayza

SITUATION IN PERUSITUATION IN PERU

Abortion is the fourth leading cause of maternal mortality

Abortion is only considered legal when the mother’s life is at risk

Many women confronted with unwanted pregnancy seek clandestine abortions

SITUATION IN PERUSITUATION IN PERU

It is estimated that there are more than 350,000 induced abortions annually

Of these, 30% usually result in complications, the most frequent being incomplete abortion

Only 50% (60,000) women with these complications ever reach a hospital

PERU’S POSTABORTION CARE PERU’S POSTABORTION CARE PROGRAMPROGRAM

GOAL : To improve the reproductive health status of underprivileged women in Peru and contribute to the reduction of maternal deaths

PURPOSE: To improve the quality and availability of treatment for complications of incomplete abortion and postabortion family planning and counseling services

OBJECTIVESOBJECTIVES

Increase health professionals’ awareness of issues related to abortion and the treatment of emotional and physical consequences

Improve integration between postabortion care and family planning services

Develop appropriate IEC materials for PAC patients

Introduce MVA in MOH hospitals

IT IS A IT IS A WOMAN´S RIGHT WOMAN´S RIGHT

TO RECEIVE TO RECEIVE HUMANE CARE HUMANE CARE

WHEN WHEN SUFFERING FROM SUFFERING FROM

ABORTION ABORTION COMPLICATIONSCOMPLICATIONS

PERU’S PAC PROGRAM´S PHILOSOPHYPERU’S PAC PROGRAM´S PHILOSOPHY

OUTPATIENT CARE FOR COMPLICATIONS ABORTION WHEN IT IS MEDICALLY APPROPRIATE

USE OF MVA FOR THE EVACUATIONOF OVULAR REMAINS

EARLY DIAGNOSIS OF SECONDARY INFERTILITY AND REFERRAL IN ORDER TO RECEIVE TREATMENT.

PROVISION OF INFORMATION AND CONTRACEPTIVE SERVICES IMMEDIATELY AFTER TREATMENT FOR COMPLICATIONS

IDENTIFICATION OF PROBLEMS RELATED TO SEXUAL VIOLENCE WHICH COULD AFFECT WOMEN’S REPRODUCTIVE HEALTH AND THE RESPECTIVE REFERRAL TO RECEIVE TREATMENT.

DIAGNOSIS AND TREATMENT OF SEXUALLY TRANSMITTED DISEASES

IDENTIFICATION OF OTHER PROBLEMS RELATED TO REPRODUCTIVE HEALTH

Pathfinder International, 2003

Hospital assessmentsHospital assessments TrainingTraining Monitoring and follow-upMonitoring and follow-up AdvocacyAdvocacy

PERU’S POSTABORTION CARE PERU’S POSTABORTION CARE PROGRAM COMPONENTS:PROGRAM COMPONENTS:

PERU’S POSTABORTION CARE PERU’S POSTABORTION CARE PROGRAMPROGRAM

What is the postabortion care What is the postabortion care (PAC) model used by Pathfinder (PAC) model used by Pathfinder International in Peru?International in Peru?

Components of PAC Program Components of PAC Program Necessary for SustainabilityNecessary for Sustainability

Family Planning

Identifica-tion& Treatment of other RH problems

Diagnosis &Treatment ofSTDs

Diagnosis &Treatment ofSecondary Infertility

1.1. Comprehensive Comprehensive PACPAC

2. Continual

Training

3. Organization of services:Standarization (Norms &

protocols)Improvement of infrastructure

5. Logistics:Equipments

and supplies

4. Information Systems

6. Community Involvement

Control

Control of fears,Information procedureCounselingFP*,RH*

Patient’s admissionPatient’s admission

Medical Evaluation : Clinical records Physical Exam Diagnosis

MVA ProcedureVerbal support

for pain control during the procedure

Orientation on RH and FP *

Recovery

Information onpost procedure

care and referral if neccesary

DISCHARGE

Provision of contraceptive method C

oun

seli

ng

* FP = Family Planning RH = Reproductive Health

PATHFINDER´S PAC MODELPATHFINDER´S PAC MODEL

Distribution of Hospitals Where the PathfinderDistribution of Hospitals Where the PathfinderPAC Model Has Been Implemented PAC Model Has Been Implemented 1997- 20021997- 2002

AM

AZ

ON

AS

TUMBES

PIURA

CA

JAM

AR

CA

LAMBAYEQUE

LA

LIBERTAD

SAN

MARTIN

ANCASH HUANUCO

PASCO

UCAYALI

JUNIN

HU

AN

CA

VE

LIC

ACUZCO

APURI-MAC

AY

AC

UC

HO

ICA

PUNO

LIMA

AREQUIPAM

OQ

UE

GU

A

TACNA

L O R E T O

MADRE DE

DIOS

• Hospital Apoyo Sullana

• Hospital Belén• Hospital Reg. De Trujillo• CS Viru

• Hospital La Caleta

• Instituto Materno Perinatal• Hospital Hipólito Unanue• Hospital San Bartolomé• Hospital Dos de Mayo• Hospital Local Vitarte• Hospital Apoyo Puente Piedra• Hospital Sergio Bernales

(Collique)

• C.S. Canto Grande• Hosp. Huaycan• Hosp. Huacho• Hosp. Chancay• Hosp. Cañete

• Hosp. Regional de Pucallpa

• Hospital Amazonico

• Hospital Daniel A. Carrión

• Hospital Antonio Lorena• Hospital Regional de Cusco• CS Acomayp• CS Urubamba

• Hospital Carlos Monge Medrano• Hospital Regional de Puno

• Hospital Goyeneche• C.S. Zamacola

• Hospital Regional de Cajamarca

• Hospital Apoyo de Iquitos• Hosp.Santa Gema

Yurimaguas

• Hospital de Tacna

• Hosp. Pisco

• Hosp. • Chincha• Hosp• .Ica

• Hosp. Hermilio Valdizan

• CentroMaternoTarapoto• H. Rural Tocahe• H. Rural Rioja• H. R. Nueva Cajamarca

• Hospital las Mercedes

PERU’S POSTABORTION CARE PERU’S POSTABORTION CARE PROGRAMPROGRAM

How does offering PAC on an How does offering PAC on an outpatient basis reduce costs outpatient basis reduce costs and increase access?and increase access?

Average Total Cost Per PatientAverage Total Cost Per Patient (US Dollars) (US Dollars)

MVA vs. D&CMVA vs. D&CPathfinder International 1995Pathfinder International 1995

00

2020

4040

6060

8080

100100

MVAMVAMVAMVA D&CD&CD&CD&C D&C/HospD&C/Hosp..D&C/HospD&C/Hosp..

84.1184.1184.1184.11

16.7016.7016.7016.7016.3016.3016.3016.30

PERU’S POSTABORTION CARE PERU’S POSTABORTION CARE PROGRAMPROGRAM

OUTPATIENT BASISOUTPATIENT BASIS

Transferto

floor

5'

12'

Transferto floor

3'

4'Transfer

toO.R.

GynecologicalExamination

30'

Physical preparation for hospitalization

DISCHARGE

209'Hospitalizationpost-procedure

722'

32'

Operating Room

PROCEDURE(D&C )

Operating Room

PROCEDURE(D&C )

ENTRANCE

Hospital’s Emergency

Service

Cashiers

21'

158'

158'

MedicalExamination

Drugstore

35'Hospitalization

pre-procedures

physical preparation

404'

Average Time: 27.25 hours; 1.1 days

EXIT

Emergency

Doctor’s Rounds

Patients Treated for Incomplete Abortion in the Regional Hospital in Trujillo (Peru) Before the ProgramBefore the Program

Transferto

floor

5'

Post-procedurehospitalization

120'

GynecologicalExamination

30'

Physical preparation for hospitalization

4'Transfer

toO.R.

20'

Operating Room

PROCEDURE(MVA)

Operating Room

PROCEDURE(MVA)

ENTRANCE Emergency

Admission 30'

158'

MedicalExamination

Drugstore

15'

Average Time: 4.3 hours

DISCHARGE

10'

EXIT

(5)10'

Cashier

(2) (2) (3)

Hospitalization pre-procedure

Physical preparation

20'

Transferto floor

3'(20)

(6)

Emergency

Patients Treated for Incomplete Abortion in the Regional Hospital in Trujillo (Peru) After the ProgramAfter the Program

How can the lessons learned from Peru´s PAC Program be applied to improve quality and accessibility in PAC programs in other developing countries?  

PERU’S POSTABORTION CARE PERU’S POSTABORTION CARE PROGRAMPROGRAM

POSTABORTION CARE PROGRAM

We must convince policy-makers and governments to be sensitive towards women suffering from abortion complications in order to guarantee the implementation and expansion of the Postabortion Care Program.

POSTABORTION CARE PROGRAMPOSTABORTION CARE PROGRAM

It is not always necessary to invest a large amount of financial and human resources in order to implement a PAC Program.

The strength of the PAC Program is that it not only implements a new technology (MVA), but even more important, develops a comprehensive program which encompasses other key issues important for the sustainability of the project.

POSTABORTION CARE PROGRAMPOSTABORTION CARE PROGRAM

The fundamental elements of the project carried out in health facilities must be considered from its initiation.

Baseline data is needed to evaluate the impact at the end of the project.

Follow-up is the foundation for the implementation and sustainability of the project.