Questions/Answers

maternal death in 8 provinces in the northern of Thailand was ranked second in the nation from 50,000 mothers giving birth annually. Therefore, Health region 1 initially took an action by being the first region to assemble Lanna Maternal and Child Health Board in order to lessen the number of maternal death below world health organization target, with the policy and commitment saying “No woman should die in pregnancy and childbirth”. The difference of geography causes difficulty of transportation while the difference of ethnics causes difficulty of communication and inequality in health and social care. 1 out of 5 populations in this region is considered to be ethnics group, which consists of over a million of migrant labors from Burma, Laos, and Cambodia. However, health region 1 has been improving mother and child health service system for over 5 years in order to meet the standard both in proactive and receptive ways by promoting safe birth in remote areas with traditional midwifery, and collaboration among border patrol polices of Thai-Laos Collaboration 2017-2020. It is the first time in history of health region 1 that maternal death rate has lessened to 10.5 out of 100,000 live births in 2018.

To improve maternal health, reduce global maternal death, raise standard of health service system for maternal and child, gives priority to safety birth, and focuses on “quality of birth and growth”. In addition, also standardizes health service system for every pregnant women and postpartum mothers despite races or ethnics background, by emphasize collaboration between public health departments and associate networks. In accordance with WHO’s Recommendation focuses on strong health systems; with trained health worker and essential medicines, and improve access to quality care before, during and after childbirth.

The alignment with the SDGs 1, “ending maternal death” in this health region by sustainability collaboration with all networking. This work aims to raise maternal and child health service standards. In the past 10 years, 103 hospitals have been nationally certified. Therefore, 99% of pregnant women can access the services and the number of maternal death decreases accordingly to WHO standard. Health region 1 also collaborate with Laos PDR in agreement of reducing maternal death among 2 countries. The main tasks are to reduce inequality gap in women’s health service access among developing countries.

Results of positive effect 1) established maternal and child health service system standard management in Health region 1 among 103 hospitals, which result to “safe child birth and safe mother” 2) maternal death rate has decreased. There is 10.3 deaths out of 100,000 live births (includes ethnic groups and migrant workers), (maternal death of Thais are calculated as 5: 100,000 live births) 3) 99% of pregnant women and postpartum mothers access standard services 4) Integration with Emergency Medical Services and Referral management system 5) “LABOR” strategy is built to be used thorough region in order to end preventable maternal death; L= Quality Labor room , A = Assessment on Postpartum Hemorrhage if >300 CC mean Alert and action line, B = successful stop bleeding within 30 minutes with ready-blood and medical supply to use, O = On time 6) elaborate build on the concept of Lanna Maternal and Child Health Board : The power of connection 7) 3 out of 8 provinces from overall have been continually reaching zero maternal death for 3-6 years 8) “No woman should die in pregnancy” 9) established “Chiang Rai Charter” the idea of ending preventable maternal death.

Health region 1 initiates process innovative and take “LABOR” measure into action. The standout point is voluntary integrations involve both proactive and receptive process, develop from TPSA 2016 the process is as follows; 1.1) form MCH Board of interdisciplinary for CQI and collaborative problem-solving 1.2) capacity building 1.3) using MCH Zone in remote areas, with Emergency Medical System, 1.4) report of maternal death in areas within 24 hours 1.5) using Region 1 MCH DATA for management 1.6) Integrate Clinical Practice Guideline with regional, provincial, and district associate networks to expand knowledge.

This project develops from Thailand Public Service Awards 2016 “Lanna Maternal and Child Health Board : The power of connection” health region 1. Health Promotion center region 1 get certified from office of the Civil Service Commission Thailand and continuous to develop this project “Reduce Maternal Death in Health region 1 Thailand; dream come true”.

The output has expanded into provincial, district, and regional collaborations, and to different parts of Thailand. In addition, there are operations under MOU agreement between Thailand and Lao People's Democratic Republic which aims to reduce maternal mortality rate in Laos. Health region 1 manages to share maternal death prevention information via using management system such as strategy planning, national cooperation conference about preventing maternal mortality, Advance Life Support for reduce maternal death Training, create clinical practice guideline, and give safe birth training to border patrol polices and midwifery to promote equality for women and “safe child birth and safe mother”.

Sustainability demands on key resources, which are public health personnel and allied associate networks: 1) Academic centers in region, consist of Health Region 10, Rajanagarindra Institute of Child Development, Neurological hospital 2) interdisciplinary team, consists of Obstetrician, pediatrician, professional nurse Public health academician, Medical Technician, Pharmacist, and Nutritionist .

In economic terms, health region 1 and public health center 1 support general hospitals, community hospitals, and affiliated Ministry of Public Health hospitals with fund and materials. Moreover, health region 1 and public health center 1 ensure that resources are thoroughly and transparently distributed to all public health offices for the purpose of cost-effectiveness and maximum benefits.

Yes

An internal evaluation, this project was evaluated from MCH board in 2 level i.e., 1) National Level, Thailand Maternal and Child health board site visit provincial hospitals for evaluation and empowerment staffs to improve the quality service standard. 2) Regional Level, Maternal and child health board site visit provincial hospitals and district hospitals in region 1 for evaluation and enhance skill for the staffs and train by role play test.

Indicators of the assessment consist of maternal mortality rate, newborn mortality rate, birth asphyxia rate, low birth weight rate, and teen pregnancy.

Results from reducing maternal death project lead to 1) monitor and control regional maternal and child health database 2) report information to board of maternal health and child in order to monitor and find out solutions 3) potential improvement of all levels of personnel, by researching new body of knowledge for up-to-date changes improvement, knowledge exchange, and presenting of academic works and innovation 4) establish supportive supervise system, by visiting remote hospitals and hospitals with insufficient resourcing problem 5) create integrated service plan among 3 fields; Obstetrics, Pediatrics, and Maternal and Child Health as unidirectional standard, and higher services quality.

Without unity, there is no success. Therefore, collaboration of partnership significantly takes part in sustainable development as follows: - Health region 10, an affiliate of health department, takes part in the secretariat of Maternal and Child Health Board region 1 - Health region 10/ Rajanagarindra Institute of Child Development, Neurological hospital (affiliated with department of medical service), interdisciplinary team (Obstetrician, pediatrician, professional nurse Public health academician, Medical Technician, Pharmacist, and Nutritionist), are accountable for collaborative analysis, planning, and applying measures to practice with supports from communities as well as voluntary taking care of some related issues. - General hospitals, community hospitals, and affiliated Ministry of Public Health hospitals take parts in managing maternal and child health service system, and to ensure all hospitals pass an assessment test. - Allied associate networks include Local administration, district Office, Provincial Health Office, district Agricultural Extension Office, Teaches, and Public Health Volunteers participate conferences and plan operations in communities.

The work are the key findings of successful, found that health zone 1 had - A broad vision of empowering the network - Strong leaders who are knowledgeable and well-qualified experiences in both domestic and international academic research. - The potential of the board is strengthened. Qualifications and experience in mother and child health in each branch. - Cooperation and commitment of the Board. The management of maternal and child health services is in line with the standard. - Collaboration of network: Department of Mental Health, Department of Health, Department of Health, Department of Disease Control, local administration.