Management Action Plan

Unit VII Management Action Plan

Introduction

Maternal health care is a broad area that handles the health of expectant females, new mothers, and infants. The care cuts across the whole spectrum of preconception, family planning, prenatal care, and postnatal care. Maternal healthcare's objective is to avert mortality rates and improve positive health experiences for mothers and infants. As such, maternal care starts after conception and proceeds until the infant's health is stable and assured. Despite being such a critical phase of procreation and human development, a significant percentage of mothers and infants still suffer from maternal health challenges (Saunders et al., 2018).

Opportunity for Improvement

In 2017, the United Nations Population Fund (UNFPA) estimated that 295,000 women died of pregnancy-related complications (Case & Deaton, 2017). The figure is in tandem with the World Health Organization reported in 2019 that 810 women died daily in 2017 due to pregnancy-related complications (World Health Organization, 2019). The most disturbing part of the statistics is that 94 percent of these complications occurred in low and middle-income regions; a clear indication that socioeconomic factors are the main determinants of maternal and child health. In low-income areas, the WHO reports a maternal mortality rate (MMR) of 462 per 100,000 versus 11 per same sample size in high-income regions. Age disparities also indicate that adolescents, aged 10 to 14 years, are at an increased risk than older age groups (World Health Organization, 2019). Therefore, these insights present rural maternal females as highly susceptible to maternal and child health complications. This management action plan identifies causes of these deaths among rural females and infants, recommends action plans to mitigate the public health challenge, and finally elaborates assessment and measurement plan to ascertain the effectiveness of the proposed plans.

Causes of Disparities

Identifying causes of mortalities among mothers and children from rural and low-income regions is critical in the quest to establish mitigation measures to curb this public health problem. The WHO (2019) reports that these deaths are majorly caused by severe bleeding after successful childbirth, infections after birth, high blood pressure, complications during delivery, and unsafe attempted abortions. Other causes account for only 15 percent of the total deaths. Therefore, tackling these five causes of death would tremendously reduce 75 percent of fatalities, forming the bulk of the reported cases. The risk of severe bleeding caused by irregularities in the contraction of the uterus and tears within the cervical and virginal tissues is increased by the number of previous births and prolonged labor. The second cause, infections after delivery, comes in the form of chorioamnionitis, endometritis, myometritis, and parametritis uterine infections. Factors that elevate risks of uterine infections are delays between membrane rapture and delivery, prolonged labor, failure to remove placental fragments in the uterus, anemia, and low maternal age. The third cause of death, high blood pressure, increases the number of preterm births, thus increasing child mortality. The high pressure may be in the form of preeclampsia, gestational hypertension, or chronic hypertension. High blood pressure in maternal patients is elevated in younger women, black women, and women who have babies at intervals of less than two years. Malnutrition in mothers and infants is linked to a weakened immune system, increasing susceptibility to opportunistic diseases (Black et al., 2008). This cause of mortality profoundly affects infants due to their already weaker immune system. Other complications during delivery and attempted abortions include unprogressive labor, tears, baby's abnormal heart rate, and water breaking earlier than 24 hours to delivery. Perinatal asphyxia, characterized by deprived oxygen to a fetus, and shoulder dystocia are common complications that endanger baby and mother's life (Office of Communications, 2017). These complications are fuelled by inadequate prenatal, maternity, and postnatal care.

Measurable Goal

This plan's main measurable goal is to continuously decrease the annual maternal and child death in rural and low socioeconomic regions, which currently translates to 94 percent of such deaths. A yearly evaluation process that compares deaths from low-income areas with deaths from high-income areas will establish a measurable trend to assess the plan's effectiveness. The plan also seeks to continuously increase prenatal and postnatal visits from the current 49.5 percent reported in the rural and economically disadvantaged regions. Eliminating the mortality disparities among regions and socioeconomic classes, along with an improvement on turn up to maternal and child healthcare services, will provide a critical step towards the implementation of the plan.

List of Possible Actions

Possible actions towards the elimination of mortalities will follow the Lavesque et al. (2013) approach, which targets availability, affordability, appropriateness, approachability, and acceptability of maternal and child healthcare services. Possible actions enlisted in the plan are:

1. Lobbying for the federal and state government interventions to increase in the number of clinics that specialize in offering maternal and child healthcare services in rural and economically disadvantaged regions

2. Lobbying for an increased number of specialists and physicians in healthcare facilities within rural areas and low socioeconomic regions

3. Increase nurses involvement in policymaking, cultural sensitivity training, and decision making in the provision of maternal and child healthcare services

4. Increased resources allocated to clinical support services to avert infections and injuries

5. Roll out free maternal and child health services in affected areas

6. Roll out free family planning services in the affected areas

7. Provide free emergency ambulatory services in the affected areas

8. Marketing of maternal and child health care services in the form of patient education to increase prenatal and postnatal turn-ups

9. Establish and market patient education programs on nutrition to avert malnutrition-related deaths

10. Marketing of free family planning services to improve spacing between pregnancies and prevent young age pregnancies

Key Action Steps

The first key action steps involve efforts to achieve maximum utilization of the available facilities. With barely 50 percent of mothers seeking to access maternal and healthcare services, it implies there is inadequate information within the public on the availability and importance of these services. The initial phase will involve patient education and marketing of the available prenatal, maternity, postnatal, and family planning services.

The second phase will involve the improvement of available resources to increase accessibility and quality of services. This will entail lobbying funds and establishing policies that would introduce free ambulatory services, build more specialized facilities, increase staffing, and provide the equipment necessary for maternal and child healthcare (Scutchfield & Keck, 2003, p. 330). These will come in handy to reduce deaths resulting from pregnancy complications, medical errors, and prolonged labor.

Management Action Plan: Accountability, Measurement and Monitoring

The management action plan these recommendations will commence with cultural sensitivity training, patient education in all identified areas and marketing of the available resources as indicated. This will be followed by lobbying and establishing policies that will seek to improve existing resources and come up with new services such as the aforementioned free ambulatory services.

Upon the initial phase's acquisition and execution, the implementation phase will involve the allocation of roles and responsibilities to different stakeholders who shall be mandated to implement the plan. Healthcare providers and staff will carry the bulk of duties in patient education, marketing, and internal cultural sensitivity training that will seek to improve turn-ups.

The measurement and monitoring phase will be a continuous initiative that will use raw data from hospitals in the affected regions to establish annual trends. The data will be analyzed and compared to previous patterns and current trends from high socioeconomic areas to develop projections and levels of disparities. This will form a basis on which the effectiveness of the plan shall be evaluated. The monitoring process will also establish corrective plans and adjustments to the initial plan for continuous improvement of maternal and child health.

Conclusion

Maternal and child health challenges continue to persist despite efforts to curb these public health problems. However, with data indicating that over 94 percent of the affected women and children are from rural and low socioeconomic class, recommendations and action plans should put emphasize these regions. Therefore, this management action plan began by identifying the causes of these mortalities that fall within availability, accessibility, affordability, and approachability obstacles. Solutions such as patient education, marketing, free ambulatory services, setting up more clinics, and equipping the facilities with adequate staff and equipment, are meant to eliminate these obstacles, thus paving the way to easy access and quality service delivery. Sufficient data collection, analysis, and trending of future mortality rates after the implementation of this plan are expected to show a continuous and steady improvement that will portray decrease in mortality rates, decrease in disparities, and increased awareness and turn up for prenatal, maternity, and postnatal services in rural areas and regions of low and medium socioeconomic status.

References

Black, R. E., Allen, L. H., Bhutta, Z. A., Caulfield, L. E., De Onis, M., Ezzati, M., Mathers, C., & Rivera, J. (2008). Maternal and child undernutrition: Global and regional exposures and health consequences.  The Lancet ,  371 (9608), 243-260.  https://doi.org/10.1016/s0140-6736(07)61690-0

Case, A., & Deaton, A. (2017). Mortality and morbidity in the 21st century.  Brookings papers on economic activity ,  2017 (1), 397-476.

Levesque J-F, Harris MF, Russell G. (2013). Patient-Centered access to health care: Conceptualizing access at the interface of health systems and populations. International Journal of Equity Health . 12(1):18.

Office of Communications. (2017, September 1).  What are some common complications during labor and delivery?  National Institutes of Health. Retrieved June 21, 2020, from  https://www.nichd.nih.gov/health/topics/labor-delivery/topicinfo/complications

Saunders, J. B., Jarlenski, M. P., Levy, R., & Kozhimannil, K. B. (2018). Federal and state policy efforts to address maternal opioid misuse: gaps and challenges.  Women's health issues ,  28 (2), 130-136.

Scutchfield, F. D., & Keck, C. W. (2003). Principles of public health practice (4th ed.). Cengage Learning.

World Health Organization. (2019, September 19).  Maternal mortality .  https://www.who.int/news-room/fact-sheets/detail/maternal-mortality