07/03/2014

International

International

Political Statement

Why do we need ALARM

course ?
Objectives :
1. Qualification
2. Standard of care
3. Reduction of MMR&PMR through EmOC

International

SMI (1989) Indonesia to reduce MMR

450 half (in 2000)
MPS (2001)
Every pregnancy should be wanted
Every complication should have
proper care
90% of delivery by skilled attendants

International

Reasons
High MMR & PMR

Standard
Guidelines
Training

International

Deaths could be prevented

Pregnancy - Labour
Complications mild
Complications severe deaths
Target : Skilled attendants that
competence in dealing with
complication (EmOC)
TRAINING

FACTS
MMR 228/100.000
CBR = 2.6
5.2 million deliveries/year
57% CPR
Unmet need 9%
63% delivery by Skilled
attendants
75% of Hospitals have OG

60.000 midwives deployed

in villages

PMR 30%o
150.000 Perinatal
deaths/year
QUALITY OF
ATTENDANTS ?
POVERTY (50%)
7000 HC+bed
underutilized

International

MMR
Indonesia 228(2010)
Subang district 110
Bali 88
Lombok 120
East Java (selected) 55

07/03/2014

International

International

Technology

Healthy Indonesia 2010

Postpartum hemorrhage AM3

+Misoprostol
Eclampsia MgSO4 + Nifedipine
Sepsis antibiotic
Unwanted pregnancy safe abortion
+ PAC
Prolonged labour partogram,
CS,vacuum ext.

MMR 125
IMR 15
ANC 1 =95%, ANC 4 =80%
Skilled attendant cov. 90%
80% Complications should be properly
cared

Colaboration of Ob-Gyn & Midwives

International

Cooperation

International

KONSIL
Kedokteran
POGI/IDI

Improve quality of
care
Standard of training
program
Extension of training
to every districts
(400+)
Monitoring &
evaluation

International

REGISTRASI

ALARM
Course

EmOC
(BEONC)

Lulusan
SpOG

SERTIFIKASI

Lisensi

Rumah
Sakit

Dinas
Kesehatan

REKOMENDASI

POGI
Cabang

International

Ob-Gyn

KOLEGIUM

RE-SERTIFIKASI
Nilai
Kredit
- ALARM
- Buku LOG, dsb

Rekomendasi atau Updating

Internasional :
WHO (RHL), SOGC, RCOG (NICE atau
NICE Clinical pathway), ACOG, GFMER.
Indonesia :
POGI, HKFM, PONED-PONEK, HTA
Kemkes

Midwives
Figure: ALARM certified Spesialist will be involved in the training of
EmOC for Health centres nurses, doctors and midwives

07/03/2014

What is evidence-based medicine?

International

International

Elements of Evidence-based Health

Care

Evidence-based medicine is the integration of

best research evidence with clinical expertise
and patient values
- Dave Sackett

Best
Evidence

Patient
Concerns
Best
research
evidence

Patient
Preference
and Values

EBM

Practitioner's clinical experience

Clinical
Expertise

Health systems

Medical
schools

International

Professional
Organizations

Clinical
Situation

(Quality of Evidence versus Strength of

Recommendations)

Professionals

Healthcare

Standard of
professional conduct:
Competence
Accountability
Altruism
Collegiality
Ethics

Standards of care

CPD

International

Questions: Facts versus

Decisions
Low, Moderate, or
High Quality
Evidence

Facts
Evidence
Clinical governance:
Education & training
Clinical effectiveness
Accountability
R&D
Clinical audit
Risk management

International

Values

Practicality

Costs
Decision
Weak or Strong
Recommendation
(for or against)

International

Organization
Headquarter
15 centres
Medan, Jakarta,
Semarang,
Surabaya &
Makassar...........
MALANG

Quality control
3-4 training
program/centre/year
Trainers : ALARM
certified faculty for
EmOC (Beonc)

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