Standard 4.2 Reducing the number of maternal deaths and the number of infant deaths.

Standard 4.2 Reducing the number of maternal deaths and the number of infant deaths.

The program to reduce the number of maternal deaths and the number of infant deaths was carried out in an effort to improve health services towards universal health coverage, especially strengthening primary health services, by encouraging promotive and preventive efforts. Puskesmas provides health services for pregnant women, childbirth health services, postnatal health services, as well as newborn health services along with monitoring and evaluation in accordance with statutory provisions.

a. Criterion 4.2.1

Puskesmas provides health services for pregnant women, health services for mothers giving birth, health services for the postnatal period, and health services for newborns.

1) Main Thoughts:

a) Pregnant women's health services are every activity and/or series of activities carried out from the conception period until delivery.

b) Health services for pregnant women, childbirth, the postnatal period and newborns are carried out in accordance with the standards in the applicable guidelines.

c) Health service efforts for pregnant women are implemented in an integrated manner with cross-programs in the context of reducing stunting.

d) Services during pregnancy include services in accordance with quantity standards and quality standards.

(1) The quantity standard is a minimum of six visits during the pregnancy period (K6) with the following conditions:

(a) once in the first trimester.

(b) twice in the second trimester.

(c) three times in the third trimester

(2) Quality Standards, namely antenatal services that meet the 10 Ts which include:

(a) measurement of body weight and height;

(b) blood pressure measurement;

(c) measurement of upper arm circumference (lila);

(d) measurement of the height of the top of the uterus (fundus uterine);

(e) determination of fetal presentation and fetal heart rate (FHR);

(f) providing immunizations according to immunization status;

(g) administering blood supplement tablets of at least 90 tablets;

(h) laboratory tests;

(i) case management/handling; And

(j) conversation (counseling)

e) Determining stunting performance indicators is integrated with determining Puskesmas performance indicators.

f) Maternal health services, hereinafter referred to as delivery, are any activity and/or series of activities aimed at the mother from the start of labor until 6 hours after giving birth.

g) Services during childbirth according to standards include:

(1) normal delivery.

(2) labor with complications

h) The standard for normal delivery is Normal Childbirth Care (APN) according to the Standard, namely

(1) carried out in a health facility.

(2) a minimum of 3 helpers, consisting of:

(a) doctors, midwives and nurses; or

(b) doctor and 2 (two) midwives.

i) Standards for births with complications refer to the Maternal Health Services Pocket Book at FKTP and FKRTL.

j) Postnatal health services are any activities and/or series carried out aimed at the mother during postpartum (6 hours to 42 days after giving birth).

k) Postnatal health services are carried out at least four times, namely as follows.

(1) The first service is carried out 6 - 48 hours after delivery

(2) The second service is carried out 3 - 7 days after delivery

(3) The third service is carried out 8 - 28 days after delivery

(4) The fourth service is carried out 29 - 42 days after delivery.

Services are carried out with a scope that includes:

(1) examination and management using the postpartum management algorithm;

(2) identification of risks and complications;

(3) managing risks and complications;

(4) counseling; And

(5) recording in maternal and child health books, maternal cohorts and maternal cards/medical records;

l) Newborn health services are provided through essential neonatal health services in accordance with the Standards. Essential neonatal health services are provided when the baby is 0-28 days old.

m) Newborn baby services include services in accordance with quantity standards and quality standards.

(1) Standard service quantity is a minimum of three visits during the neonatal period with the following conditions:

(a) Neonatal Visit 1 (KN1) 6-48 hours

(b) Neonatal Visit 2 (KN2) 3-7 days

(c) Neonatal Visit 3 (KN3) 8-28 days

(2) The quality standards set are as follows:

(a) Essential Neonatal Services at Birth (0—6 hours).

Essential neonatal care at birth includes:

1. neonate care in the first 30 seconds;

2. keeping the baby warm;

3. cutting and caring for the umbilical cord;

4. early initiation of breastfeeding (IMD);

5. providing identity;

6. vitamin K1 injection;

7. administering antibiotic ointment/eye drops;

8. physical examination of the newborn;

9. determination of gestational age;

10. immunization (injection of hepatitis B0 vaccine);

11. monitoring danger signs; And

12. Referral of cases that cannot be treated in a stable condition in a timely manner to more capable health facilities.

(b) Essential Neonatal Services After Birth (6 hours - 28 days).

Essential neonatal care after birth includes:

1. keeping the baby warm;

2. counseling on newborn care and exclusive breastfeeding;

3. health examination using the Integrated Management Standards for Sick Toddlers (MTBS) and the KIA book;

4. giving vitamin K1 to those born not in a health facility or who have not received a vitamin K1 injection;

5. Hepatitis B immunization injection for babies less than 24 hours old who were born without assistance from health personnel;

6. care using the kangaroo method for low birth weight (LBW) babies; And

7. handling and referring cases of neonatal complications.

n) Community health centers that provide delivery services must carry out services and provide equipment, medicines and infrastructure for maternal and newborn health services, including standard maternal emergency equipment in accordance with their authority based on statutory provisions.

o) To ensure the success of implementing the program to reduce the number of maternal deaths and the number of infant deaths, promotive and preventive efforts are carried out with cross-program and cross-sector involvement as well as community empowerment. The form of involvement in this activity can be the formation of coordination within a team which aims to reduce the number of maternal deaths and the number of infant deaths at the sub-district level, namely by having the Desa Siaga program with a birth planning and complication prevention (P4K) program approach, Husband Standby, and empowerment activities. other.

p) The Community Health Center measures the performance indicators that have been determined and achieves an analysis. Analysis of indicator achievements is carried out using analytical methods in accordance with applicable guidelines/guidelines, for example by referring to the situation analysis method contained in the Community Health Center Management Guidebook.

q) Recording and reporting of health services for pregnant women, postpartum women, postpartum mothers, newborns and infants is carried out manually or electronically completely, accurately, on time, and in accordance with procedures covering the scope of the family health program, cohort recording, reporting of maternal deaths, stillbirths and neonatal deaths, post-natal infant deaths, as well as filling out and utilizing the KIA book. Reporting to the head of the community health center and district/city regional health service and/or other parties refers to the provisions of statutory regulations. Reporting to the head of the community health center can be done in writing or delivered directly through meetings such as monthly mini workshops, management review meetings, and other forums.

r) The program plan to reduce the number of maternal deaths and the number of infant deaths is prepared by prioritizing promotive and preventive efforts based on the results of an analysis of the problem of maternal mortality and infant mortality in the Puskesmas work area by involving cross-programs that are integrated with the RUK and RPK of UKM services as well as UKP, laboratories and pharmacy.

Assessment Elements:

a) Establishment of performance indicators and targets in order to reduce the number of maternal deaths and the number of infant deaths accompanied by achievements and analysis (R, D, W).

b) Establish a program to reduce the number of maternal deaths and the number of infant deaths (R,W).

c) Available tools, medicines, consumables and supporting infrastructure for maternal and newborn health services including standard maternal and neonatal emergency equipment in accordance with standards and managed in accordance with procedures (R, D, O, W).

d) Provide health services during pregnancy, delivery, postnatal period, and for newborns in accordance with established procedures; It is stipulated that it is mandatory to use a partograph during delivery assistance and pre-referral stabilization efforts in cases of complications, including services at Community Health Centers capable of PONED, in accordance with established policies, guidelines, procedures and terms of reference (R,D,W).

e) Coordinated and implemented programs to reduce the number of maternal deaths and the number of infant deaths in accordance with regulations and activity plans prepared jointly across programs and across sectors (R, D, W).

f) Monitoring, evaluation and follow-up are carried out on the implementation of the program to reduce the number of maternal deaths and the number of infant deaths, including health services during pregnancy, childbirth and for newborns at Community Health Centers (D, W).

g) Recording is carried out, then reporting is carried out to the head of the community health center and the district/city regional health service in accordance with established procedures (R, D, W).