Every month this year, 39 women have died in Colombia. According to a recent National Public Health Surveillance System (SIVIGILA, for its Spanish acronym) up to last December the 11th there have been 470 cases of maternal deaths, a concerning information as these deaths could have been be prevented.
One of the reasons that Colombia is one of the countries with the highest maternal deaths in the world –4th in South America in 2013– is inequality, which is uncontained and greater in peripheral Colombian provinces. Universidad Nacional de Colombia (UNal) researchers proved that most maternal death reports come from the provinces of Chocó, Vaupés and Guainía, and the least from Casanare, Córdoba, and Quindío.
Although the gaps are not only between provinces but also within the cities. For instance in Bogotá, the figures between neighborhoods are also concerning; while in Engativá there were 30 deaths for every 100,000 live births (LB), in Ciudad Bolívar there were 104, last year.
The most frequent causes of maternal deaths in Colombia are:
In face of this inequality scenario, UNal proposes a first excellence model for personalized care within the so-called “Maternal-child and Woman Route.” UNal Faculty of Medicine Deputy Dean of Research Professor Javier Eslava Schmalbach says that the model hopes to reduce deaths in pregnant women, children under 5 five years of age and all women. In this regard, the goal of the Decennial 2012-2021 Public Healthcare Plan is for Colombia to have “zero tolerance in face of avoidable mortality, morbidity, and disability cases.”
In comparison, in Germany, 6 women die for every 100,000 LB and 353 in Ethiopia, while Colombian Ministry of Health projection for 2018 indicate that figure will be 36.1.
According to Eslava, “These figures are unexplainable in the context of the Colombian healthcare system, which has one of the highest coverages in history, although it cannot solve the maternal death situation which could be prevented.”
UNal experts proposed the Office of the Health Secretary of Bogotá to implement the “Model of Health Excellence,” and since 2017 the university is working in an agreement with this office to achieve healthcare for pregnant, children and women to have the same healthcare path: “We consider that it is necessary to care for women in all their vital moments, some of which are fundamentally tied together with the lives of a newly born and infants,” said UNal Department of Gynecology and Obstetrics Professor Dr. Arturo Parada.
The novelty of the system is that it ties care because in the past women could be remitted from one healthcare institution to another, passing from hospital to hospital without effective care. This new model solves the needs of the patient in a fast and effective manner.
Dr. Parada says that UNal is working on offering quality, humane and resolute care in order to guarantee personalized attention in:
The proposal includes actions directed to women in all the vital moments, i.e. birth, adolescence, sexual initiation, pregnancy and so on. This is the goal of promoting healthcare, diminish unwanted pregnancies at least by 50% as well as diminish unsafe abortions, maternal, newborn and infant deaths due to cervical and breast cancer. This is what they analyzed tin he existent models in order to reach the “Healthcare Excellence Model.”
Some examples of vital women moments are the reproductive decision, pregnancy, pelvic floor issues, and incontinence. These situations have personalized care in the Healthcare Excellence Model offered by the Bogotá CAPS, specialized CAPS, and hospitals, which are comprised of several components:
The system has up-to-date equipment and tools for suitable diagnostics. The idea is to provide a resolute consultation, meaning that although the delays are not over, or the issues solved in only one consultation, most healthcare needs of pregnant women will be taken care of.
The CAPS offer services required by the pregnant woman in a decentralized manner: specialized consultation, lab tests, ultrasound scans, monitoring, and drugs, besides nutritional, dental and mental health assessments. If there is a specific disease they will be transferred to the CAPS for high-risk subspecialized and diagnostic care, besides fetal therapy.
Having prevention as the goal, the model seeks to provide anticipated risk management with early detection of possible complications through screening. The model emphasizes timely prevention and diagnostics of diseases such as high blood pressure, preeclampsia-eclampsia, gestational diabetes, preterm birth, malformations, and gestational syphilis, among others.
By unifying the clinical stories in the four Bogotá subnetworks, information is shared and prenatal maternal risk may be detected for both the mother and child. In this manner, an individual subformat for each facility is avoided. This provides greater mobility which has to go from one subnetwork to the next. This also strengthens telehealth for specialized consultations between subnetworks.
The model strengthens human talent competencies –from the communitarian manager to the specialist MD and the entire administrative and logistical support– as well as the managerial positions to take better decisions in personalized humanized care of women. This means it goes far beyond the accreditation and quality certification processes and turns more resolute in shorter times.
As the mission of the university is to educate, research, and innovate, with this component they can form human undergraduate and postgraduate talent with different from conventional educations schemes which emphasize on significant learning with cognitive-constructivist strategies, where the student is an active subject in the process. An example of this one on one model is when the student assumes attitude care conditions for dignified, compassionate and empathic care with hospitalized patients.
Since 2017 the Office of the Health Secretary and a Health Providing Entity, known as EPS Capital Salud, changed the hiring model with the subnetworks to a global prospective payment model with incentives for results. This model focuses on anticipative risk management and comprehensive and integral care. This is part of an improvement process. Before, payments were not tied to incentives for diminishing morbidity and mortality nor had any kind of anticipation to what could occur for the health of its patients, while today they do.
Academic and technical-scientific regency is an UNal proposal for personalized care to strengthen governance in health territorial agencies in each of the comprehensive care routes. In Resolution 3280 of August of 2018, the Ministry of Health published the guidelines for “Promotion Route” and “Route for perinatal maternal comprehensive healthcare.” Regency refers to universities and professional who define the guidelines of what must be done in this field.
There is a great challenge for the Excellence Model in the maternal, perinatal and infant care route. It is imperative to diminish maternal mortality in Colombia as other counties in the world have achieved, trying to close the gap between the rich and the poor provinces and trying to reduce the inequities between neighborhoods.
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