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CBK Info: Notes from PATHs “Basic Delivery Kit Guide”

LOVE these chapters from PATH’s “Basic Delivery Kit Guide.”  Such a great resource for anyone looking to do this work:

I started taking notes on Sections 2 & 3.

http://www.path.org/files/MCHN_BDKG_Section_2.pdf

http://www.path.org/files/MCHN_BDKG_Section_3.pdf

Here are some notes paraphrased from Section 3:

General things for me to keep in mind:  The CBK program should be added to and strengthen existing maternal and child health MCH programs.  Examples of good places that would be a good fit include traditional birth attendants (TBAs) or medical provider trainings and antenatal care clinics.

Overall project goals:

• contributing to the decrease in maternal and neonatal mortality and morbidity caused by puerperal sepsis, cord infection, and tetanus;

•  improving clean delivery practices of delivering women and trained and

untrained birth attendants; and

• establishing a sustainable basic delivery kit project as one component of a clean delivery program

Sustainable…hmmm. I am assuming sustainable means kits produced in-country and sold to pay for inputs/wages.  This is a must I know and I want to do it.  But it will have to be phase two.  I will start with the pilot.  And then see what is possible on the ground.

Specific Goals:

• annual number of kits produced;

• number of assembly sites established;

• number of assemblers hired and trained;

• number of promotional channels, and number of potential users reached per year;

• number of distribution channels;

• number of kits distributed, types of users receiving the kit, and areas reached;

• number of kit outlets (such as retail stores, voluntary women’s groups, NGOs, and health posts); and

• number of TBAs, midwives, and community health workers who use the kit during all deliveries by an established date

Very simple questions to ask when determinig whether to do this, paraphrased:

Do they need CBKs?  Are CBKs available already?

Would that fit in with their program?

Do they have regularly scheduled trainings where the CBKs could be introduced?

And from Section 2 more questions to ask:

Births per year.

Numbers of deliveries conducted at home;

Persons helping with delivery;

Traditional delivery process;

Understanding of “cleanliness” among TBAs and pregnant women;

Types of TBAs;

How women delivering alone prepare for the birth;

Availability of basic equipment such as cord-cutting instruments, cord ties,

water, and facilities to boil water;

Traditional equipment used in delivery;

Feasibility of introducing delivery kits — Specific contents.

Availability of locally assembled kits or United Nations (UN) kits.

Community involvement

Maternal Health: Key steps for maternal and newborn health care in Humanitarian Crisi

This is a WHO guide for ” maternal and newborn health experts as well as reproductive health experts coordinating and assisting with emergency care during the humanitarian crisis.”

The document emphasizes the need for clean birth practices and identifies these specifics for birthing kits for “self delivery”:

Reproductive Health Sub kit 2. Clean delivery

This kit is composed of 200 individual packets containing material and a pictorial instruction sheet for self delivery plus material for birth attendants. They are designed for 10,000 people for 3 months and are for use at the community level.

These packets have two parts

Part A: To be distributed to all women more than six months pregnant.

Part B: Equipment for birth attendants (for universal precautions)

Considering a birth rate of 4%, 100 deliveries will occur in 3 months for a population of 10,000

Number needed: 200 for a population of 10,000: 100 kits for those delivering in the initial 3 monthperiod, and another 100 kits for deliveries in the subsequent 3 month period.

Note: no oxytocin is available. If a skilled attendant is providing childbirth care, 400 ampoules of oxytocin, syringes, needles and antiseptic swabs should be added.

Maternal Health: TBAs in Guatemala

This is an article about the controversy surrounding training TBAs.  TBAs attend 60% of Guatemalan births and up to 90% among certain groups.  However, statistically, training TBAs has not led to the prevention maternal deaths.  Since TBAs are often the only choice and are preferred by ill-treated indigenous populations, this subject has hardly been laid to rest.

To me, it seems like CBKs and TBAs are a good fit, since CBK trainings should be simple and straightforward.

My CBK Project: Who needs CBKs?

I’ve been thinking about starting a women empowering non-profit for a decade. I honed in on CBKs in January.  My life — kids, teaching yoga, doula work — has prevented me from spending as much time as I’d like getting down to it.  But I’m ready now.

Don’t get me wrong, I love nothing more than thinking about what country I will head to next.  I have read guide books, blogs, US State Dept blogs on numerous destinations.  But it’s not as easy as picking a country. I want to make an impact and to do so the project must be a good fit.

I had a great experience volunteering for Shanti Uganda — my strengths and experience were just what they needed.   Read about it here.   I want to make sure that my CBK project advances the mission of the organization that I will supply.

I have in mind Central America.  There is need.  It is warm, close to the US and Spanish speaking.  Nicaragua in particular gets decent marks for safety, which matters to me since I will be bringing my kids eventually. Guatemala, which gets poor safety marks, has some very interesting maternal health programs, such as Clinicas Maya.

The other country that I have thought of is Laos, which last year graduated its first class of midwives in 20 years. Article here.  Having spent nearly two years in neighboring Thailand and traveled somewhat extensively in Laos, I have a feel for the place.  Again weather good; safety better than Central America. However, I have yet to find a small organization working with women. Most work seems to be driven by the Ministry of Health. And it’s a long and expensive flight.

I will keep learning about effective CBK projects already in place, while researching potential organizations/clinics that may be open to a CBK project.

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