Interim Guidance for RMNCH services in COVID 19 Pandemic

Family Welfare Division, Department of Health Services, Ministry of Health and Population
(Approved Date: 21-05-2020)

This guide has been developed by the RH sub-cluster which reports to the Health Cluster at MoHP and will be updated as and when new evidences are available.

Guiding principles for SRMNCH services

1. Ensuring access to RMNCAH services while ensuring physical distance (social distance)
2. Early detection and timely access to emergency services for women and newborn with complications
3. Protection of staff and pregnant women/newborn from COVID 19, and minimizing cross infections
4. Ensuring availability of equipment and commodities necessary of providing SRMNCAH services (PPE, drugs, commodities)
5. Supporting service providers for their movement and phone interaction with pregnant women and mothers
6. Ensuring pregnant women, mothers and newborn for their movement for access to health services.
7. This interim guidance for continuation of essential RH services includes overall guidance for
   program managers in Section 1 and guidance for specific services in Section 2.

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Guidance for Managers

For all services:

• Helpline is available for women to consult for problems during pregnancy and childbirth and for advice and accessing MNH, FP, SAS and Child health related services
• Ensure for health facilities to establish screening and triage of women visiting for all reproductive health services
• Ensure PPE at all health facilities as recommended in Annex 1.
• Pregnant or lactating should not be given duty at sites with possibility for direct care of COVID 19 cases (clinical care, sample extraction, emergency, ICU, fever clinic). Consider deploying the pregnant and lactating health service providers to support other activities such as education or training needs.
• All HP/PHC/hospitals including NGOs should provide ANC, delivery, PNC, SAS, child health and IMNCI, immunization and nutrition services as applicable.
• MNH providers will support mothers and newborn through ANC and PNC teleconsultation services. Pregnant women will be advised to come to the Health facility if necessary; home visit will be provided to Postpartum women and baby if necessary
• Health facilities need to follow up on postpartum mothers and newborns through phone on Day 1, 3, 7 and 28 and conduct home visit if necessary.
• All birthing centers, BEONC and CEONC sites should provide regular delivery services (C-section, complication management) for women without COVID 19 symptoms and ready to provide delivery service for women with COVID 19 symptoms when referral is not possible
• Provide short term family planning methods from HP/PHC/Hospitals/NGO clinics/Pharmacies.
• Surgical contraception will be deferred as per MoHP guidelines
• Supply of FP commodities (EC pills,Condom) in quarantine center exit point
• Ensure Condom boxes and condom supply in strategic location.
• Coordinate with kirana and hotels increase supply of condom and display the availability of condom in each shops (managers can supply the Condom in Kirana pasal for free distribution) but report should be kept how many supply in kiranas. Monitor regularly the availability in such stores/shops
• Manage telehealth service for FP client and disseminate this information in local catchment area/people with use of public media
• Routine SAS including MA, MVA, second trimester abortion and Post abortion care services including post abortion Family Planning services will be provided from listed health facilities and certified health services providers
• Managers in Palika to ensure availability of adequate PPE, drugs, FP, SAS, MA, MNH, Child Health and immunization related commodities and supplies including Misoprostol (Matri Surakshya Chakki), Clean delivery kits and Chlorhexidine for new born cord care.
• Ensure FP commodities are also available at listed MA sites.
• Lifting of the 200m/500m rule for MA dispensation to ensure continued access to MA against an issued prescription.
• Home service / out-of-facility provision of MA by trained providers of I/NGOs.
• All registered Chemists and pharmacists allowed to store and dispense MA drugs approved by DDA.
• Support and arrange transport and ensure availability of free ambulance services (ensure PPE for drivers and cleaning of ambulance) for referral services.
• Coordination and facilitation with local government for movement of clients/beneficiaries to the health facility.

Guidance for Health Facility in-charge and service providers:

1. General Preparation and planning

• Be aware about the local plan for COVID-19 – testing sites for COVID and designated hospitals (Annex 2)
• Prepare a referral plan including contact details of ambulance
• Ensure IPC and PPE is available
• Triage or screening facility is available at the health facility
• Have a dedicated room for COVID suspected or confirmed cases.

Note:

• Routine infection control precautions should be instituted for care during every service delivery regardless of whether or not the woman and child has symptoms of COVID 19.
• Respectful maternity care should be provided to all women.

2. Establish screening place at the entrance of health facility to screen all patients/clients and accompanying person entering the health facility

• Consider arranging single entrance for clients into the health facility.
• Ensure physical distancing in the waiting room of at least 1 meter between two clients
• Use separate site and equipment to screen pregnant women
• Follow IPC and PPE as per the PPE guideline (Annex 1)
• All waste should be treated as potentially infectious waste. The Healthcare Waste Management Guidelines, MoHP (2014) and Nepal Medical Council Interim Guidance for Infection Prevention and Control When COVID-19 is Suspected (April 2020) should be followed for disposal of waste management
• Arrange for mask and sanitizer for clients
• Have posters available on the safe removal of masks
• Arrange for facility for hand washing with soap and water or alcohol-based sanitizer.
• Reduce the waiting period and restrict attendance or visitors where possible.

3. OPD/ANC clinic set-up/FP/SAS clinic

• The room has hand washing/alcohol based hand rub for use.
• Staff should follow regular hand hygiene practices – hand washing before and after touching each patient.
• Offer hand wash or alcohol hand rub for the women before entering the health facility and leaving the health facility
• All surfaces should be cleaned thoroughly after any contact by patient or staff

READ MORE: DOWNLOAD ENGLISH VERSION

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