Support to the Re-Establishment of Health Care Services for Birthing Mothers and Newborns in Areas Affected by the

7.2 Magnitude Earthquake in Bohol through Essential Intrapartum and Newborn Care (EINC) Trainings,
Training of Trainors, January 22,2014

Introduction to EINC | NO UNAUTHORIZED REPRODUCTION 1

Support to the Re-Establishment of Health Care Services for Birthing Mothers and Newborns in Areas Affected by
the 7.2 Magnitude Earthquake in Bohol through Essential Intrapartum and Newborn Care (EINC) Trainings,
Training of Trainors, January 22,2014

Introduction to EINC | NO UNAUTHORIZED REPRODUCTION 2

Support to the Re-Establishment of Health Care Services for Birthing Mothers and Newborns in Areas Affected by
the 7.2 Magnitude Earthquake in Bohol through Essential Intrapartum and Newborn Care (EINC) Trainings,
Training of Trainors, January 22,2014

The EINC Program is under the umbrella of the Maternal, Newborn, Child Health and
Nutrition Strategy of the Department of Health. To understand where the EINC
program is situated in the sea of programs promoted by the DOH, it is important for
us to be familiar with the Maternal, Neonatal and Child Health and Nutrition Strategy.

Introduction to EINC | NO UNAUTHORIZED REPRODUCTION 3

Support to the Re-Establishment of Health Care Services for Birthing Mothers and Newborns in Areas Affected by
the 7.2 Magnitude Earthquake in Bohol through Essential Intrapartum and Newborn Care (EINC) Trainings,
Training of Trainors, January 22,2014

The MNCHN Strategy was put forward in AO 2008-0029,

This strategy guides the development, implementation and monitoring/evaluation of
various programs aimed at women, mothers and children, with the ultimate goal of
rapidly reducing maternal and neonatal mortality in the country. This goal is to be
achieved through the provision and use of integrated MNCHN services which will
create the following results:
• Every pregnancy is wanted, planned and supported
• Every pregnancy is adequately managed
• Every delivery is facility-based and managed by skilled health professional
• Every mother and newborn pair secures proper postpartum and postnatal care…

Introduction to EINC | NO UNAUTHORIZED REPRODUCTION 4

Support to the Re-Establishment of Health Care Services for Birthing Mothers and Newborns in Areas Affected by
the 7.2 Magnitude Earthquake in Bohol through Essential Intrapartum and Newborn Care (EINC) Trainings,
Training of Trainors, January 22,2014

MNCHN Service Delivery Network or SDN refers to the 3-tier network of

facilities and providers within the province or city health system offering
integrated MNCHN services in a coordinated manner with a functional 2 way
referral system. It also includes transportation and communication systems
supporting this network.

At the first level are the community health teams (composed of lay leaders,
barangay nutrition scholars, the “hilots” etc) who are tasked with pregnancy
tracking, birth planning; at the 2nd level are the BEMONC (Basic Emergency
Obstetric and Newborn Care (BEMONC) facilities which include district
hospitals, RHUs with skilled birth attendants (SBAs) and private lying in clinics.
These facilities are capable of normal vaginal delivery, parenteral
administration of emergency drugs (oxytocin, magnesium sulfate,
dexamethasone, antibiotics), imminent breech delivery, essential newborn
care, basic newborn resuscitation. At the 3rd level are the Comprehensive
Emergency Obstetric and Newborn care (CEmONC) facilities which are the
end referral facilities – tertiary hospitals including DOH retained and regional
hospitals with capabilities for blood transfusion, cesarean section and
advanced neonatal care in addition to BEmONC services.

Introduction to EINC | NO UNAUTHORIZED REPRODUCTION 5

Support to the Re-Establishment of Health Care Services for Birthing Mothers and Newborns in Areas Affected by
the 7.2 Magnitude Earthquake in Bohol through Essential Intrapartum and Newborn Care (EINC) Trainings,
Training of Trainors, January 22,2014

The integrated MNCHN services refer to a package of services for women, mothers
and children that follow the life cycle approach (read slide).
Programs which start from the pre-pregnancy period include VAWC, Adolescent, FP
and Reproductive Health …..

During Pregnancy, we have the safe motherhood program and the WHSMP.

Essential Intrapartum and Newborn Care (EINC) falls under the Antenatal, Birth and
Delivery and Postnatal period, and its components are also incorporated into the
other programs such as MBFHI and BEmONC.

Introduction to EINC | NO UNAUTHORIZED REPRODUCTION 6

Support to the Re-Establishment of Health Care Services for Birthing Mothers and Newborns in Areas Affected by
the 7.2 Magnitude Earthquake in Bohol through Essential Intrapartum and Newborn Care (EINC) Trainings,
Training of Trainors, January 22,2014

There are various capacity enhancement training programs for health workers:
1. EINC QA workshop (2014 enhanced edition) – THREE day workshop for all skilled
birth attendants covering Essential Intraprtum and Newborn Care – emphasizes
the TIME BOUND interventions; Antepartum, Intrapartum Care, Monitoring
Progress of Labor using the Partograph. The revised training module includes
Postpartum/Postnatal care, Basic Newborn Resuscitation, KMC, and IYCFE.
Importantly, the module on STEP by STEP Implementation provides tips on how to
implement the protocol in their facilities. Practice Sessions consisting of demo-
return demonstrations help the learners unlearn outdated practices and to
practice the EINC protocol on manikins/dolls and delivery kits.
2. Capacity Enhancement Training for MW (including POGS MDG, Fabella’s
Postgraduate courses on the Revised MW Law etc...) – Aside from ENC and
Antepartum, Intra and Postpartum Care, it includes skills laboratory on IV, IE and
suturing plus initial mgt and referral of pre-eclampsia, postpartum hemorrhage,
imminent breech delivery, cord prolapse and shoulder dystocia. It includes an
actual hands on exposure to patients during the 4 days practicum.
3. BEmONC is a comprehensive 11 day course for a team of doctors, nurses and MW
in primary level (RHUs, lying-in clinic and Level I hospitals) and includes all of EINC
and Capacity Enhancement Training PLUS principles of good care (communication,
universal/standard precautions ...) counseling, community support, newborn
resuscitation and care of the small baby. The practicum in the OPD, admission
room, labor and delivery is for six days. Another requirement is the submission of
the action plan with goals, objective and strategies to implement what was
learned in their respective facilities.

Introduction to EINC | NO UNAUTHORIZED REPRODUCTION 7

Support to the Re-Establishment of Health Care Services for Birthing Mothers and Newborns in Areas Affected by
the 7.2 Magnitude Earthquake in Bohol through Essential Intrapartum and Newborn Care (EINC) Trainings,
Training of Trainors, January 22,2014

This slide illustrates the interrelationship between the current “training” course
offerings and workshops.

Introduction to EINC | NO UNAUTHORIZED REPRODUCTION 8

Support to the Re-Establishment of Health Care Services for Birthing Mothers and Newborns in Areas Affected by
the 7.2 Magnitude Earthquake in Bohol through Essential Intrapartum and Newborn Care (EINC) Trainings,
Training of Trainors, January 22,2014

This is the Essential Newborn Care Clinical Practice Pocket Guide that was produced
using a validated, evidence-based process. It was launched in December 2009 with
the signing of the administrative order Adopting New Policies and Protocol on ENC.

A DOH administrative order (AO 2009-0025) was signed by Health Secretary Francisco
Duque III on December 7, 2009, making ENC mandatory for all public and private
health care providers involved in maternal and newborn care.

Introduction to EINC | NO UNAUTHORIZED REPRODUCTION 9

Support to the Re-Establishment of Health Care Services for Birthing Mothers and Newborns in Areas Affected by
the 7.2 Magnitude Earthquake in Bohol through Essential Intrapartum and Newborn Care (EINC) Trainings,
Training of Trainors, January 22,2014

Meanwhile, the CPG on Intrapartum and Newborn Care, an update of the DOH
guidelines on facility based delivery was launched in September 2012. (Read Slide)

It is to be used by all health professionals …..

Introduction to EINC | NO UNAUTHORIZED REPRODUCTION 10

Support to the Re-Establishment of Health Care Services for Birthing Mothers and Newborns in Areas Affected by
the 7.2 Magnitude Earthquake in Bohol through Essential Intrapartum and Newborn Care (EINC) Trainings,
Training of Trainors, January 22,2014

Scale-up of Essential Intrapartum and Newborn Care utilizes a 4-pronged approach in

its implementation campaign in the Philippines. Its components are:

• Health Sector reform agenda

• Forming a network of centers of excellence
• Curriculum changes
• Social marketing campaign

Introduction to EINC | NO UNAUTHORIZED REPRODUCTION 11

Support to the Re-Establishment of Health Care Services for Birthing Mothers and Newborns in Areas Affected by
the 7.2 Magnitude Earthquake in Bohol through Essential Intrapartum and Newborn Care (EINC) Trainings,
Training of Trainors, January 22,2014

The Aquino Health Agenda is a focused approach to health reform implementation.

Its main goal is to ensure that all Filipinos have equitable access to affordable health
care (KALUSUGANG PANGKALAHATAN), and it outlines strategies for the attainment
of the health-related MDGs .

Introduction to EINC | NO UNAUTHORIZED REPRODUCTION 12

Support to the Re-Establishment of Health Care Services for Birthing Mothers and Newborns in Areas Affected by
the 7.2 Magnitude Earthquake in Bohol through Essential Intrapartum and Newborn Care (EINC) Trainings,
Training of Trainors, January 22,2014

The implementation of the new policies and protocol on newborn care as part of the
Maternal Care Package (MCP) and Normal Spontaneous Deliveries (NSD)Packages and
of PhilHealth will motivate health facilities to be accredited, and for health
professionals to qualify for PhilHealth benefits.

Here are the new rates for NSD and CS deliveries. MCP is higher in Level 1 hospitals –
normal uncomplicated pregnancies are encouraged to deliver in Level I facilities.
MCP includes postpartum care.

Introduction to EINC | NO UNAUTHORIZED REPRODUCTION 13

Support to the Re-Establishment of Health Care Services for Birthing Mothers and Newborns in Areas Affected by
the 7.2 Magnitude Earthquake in Bohol through Essential Intrapartum and Newborn Care (EINC) Trainings,
Training of Trainors, January 22,2014

The Newborn Care Package has likewise been increased.

Introduction to EINC | NO UNAUTHORIZED REPRODUCTION 14

Support to the Re-Establishment of Health Care Services for Birthing Mothers and Newborns in Areas Affected by
the 7.2 Magnitude Earthquake in Bohol through Essential Intrapartum and Newborn Care (EINC) Trainings,
Training of Trainors, January 22,2014

The Newborn Package is now PhP 1,750 and it is unbundled, meaning that
compensation can be given even if not all of the services were rendered. The amount
will correspond only to the services availed of by the patient.

Note that in the new package, the caregiver will now receive PhP 500 but this
requires physical examination of the newborn, provision of breastfeeding support and
doing the 4 core steps of EINC.

Hearing screening has also been added.

Introduction to EINC | NO UNAUTHORIZED REPRODUCTION 15

Support to the Re-Establishment of Health Care Services for Birthing Mothers and Newborns in Areas Affected by
the 7.2 Magnitude Earthquake in Bohol through Essential Intrapartum and Newborn Care (EINC) Trainings,
Training of Trainors, January 22,2014

The first advanced implementation site was Quirino Memorial Medical Center which
adopted the program in 2008. It is a 350-bed government hospital in Quezon City
that is a tertiary referral center for high-risk deliveries.

The first private hospital that committed to ENC was St. Luke’s Medical Center in
Quezon City (one of 3 hospitals accredited by the Joint Commission JCIA, an
international third party accrediting body)

Introduction to EINC | NO UNAUTHORIZED REPRODUCTION 16

Support to the Re-Establishment of Health Care Services for Birthing Mothers and Newborns in Areas Affected by
the 7.2 Magnitude Earthquake in Bohol through Essential Intrapartum and Newborn Care (EINC) Trainings,
Training of Trainors, January 22,2014

The EINC scale-up project was initiated in 10 more hospitals in addition to QMMC. In
Luzon: PGH, Dr. Jose Fabella Memorial Hospital, Jose R. Reyes Memorial Medical
Center, East Avenue Medical Center, Tondo Medical Center, San Lorenzo Ruiz
Women’s Hospital, Dr. Jose N. Rodriguez Memorial Hospital.

In the Visayas region: Eastern Visayas Regional Medical Center in Tacloban, Leyte
In Mindanao: General Santos City Hospital (an LGU-maintained facility) and Cotabato
Regional and Medical Center (a DOH-retained hospital) in Cotabato City

Introduction to EINC | NO UNAUTHORIZED REPRODUCTION 17

Support to the Re-Establishment of Health Care Services for Birthing Mothers and Newborns in Areas Affected by
the 7.2 Magnitude Earthquake in Bohol through Essential Intrapartum and Newborn Care (EINC) Trainings,
Training of Trainors, January 22,2014

Through partnerships with PRIVATE HOSPITALS, LGUs, NGOs and WHO, UNANG
YAKAP has expanded its reach to these regions.

Introduction to EINC | NO UNAUTHORIZED REPRODUCTION 18

Support to the Re-Establishment of Health Care Services for Birthing Mothers and Newborns in Areas Affected by
the 7.2 Magnitude Earthquake in Bohol through Essential Intrapartum and Newborn Care (EINC) Trainings,
Training of Trainors, January 22,2014

Curriculum changes are imperative to ensure that what is being practiced is taught to
the students before their clinical exposure in the hospitals.
Orientation workshops have already been conducted with the Association of
Philippine Medical Colleges Foundation (APMC), the Association of Deans of
Philippine Colleges of Nursing (ADPNC), and the Association of Philippines Schools of
Midwifery (APSOM). We are working with them for the integration of EINC in the
curriculum.

Introduction to EINC | NO UNAUTHORIZED REPRODUCTION 19

Support to the Re-Establishment of Health Care Services for Birthing Mothers and Newborns in Areas Affected by
the 7.2 Magnitude Earthquake in Bohol through Essential Intrapartum and Newborn Care (EINC) Trainings,
Training of Trainors, January 22,2014

Under the social marketing campaign, a logo was created depicting the mother’s
arms embracing the baby with the slogan UnangYakap: Yakap ng Ina, Yakap ng Buhay.

Next:
Because we know that newborn survival is intimately connected to maternal health
and mortality, the program has evolved and is now also emphasizing the international
standard of care in the intra-partum period to complement ENC. Hence our program
is now called Essential Intra-partum and Newborn Care (EINC).

In the new logo, the mother and baby are equally prominent with both of their faces
showing. The mother is embracing the baby and now included in the tagline is MDG
4 & 5 to denote that we are aiming to reach Millennium Development Goals 4 and 5
which specifically address the issues of maternal health and child mortality.

The halo around the mother and the newborn is us – health care workers providing
care and support for the birthing mother and her baby.

Introduction to EINC | NO UNAUTHORIZED REPRODUCTION 20

Support to the Re-Establishment of Health Care Services for Birthing Mothers and Newborns in Areas Affected by
the 7.2 Magnitude Earthquake in Bohol through Essential Intrapartum and Newborn Care (EINC) Trainings,
Training of Trainors, January 22,2014

The first MNCHN EINC Advocacy Partners Forum trained 55 new partners from all
regions in the country to further help in escalating the EINC campaign. Several other
TOTs have been conducted to help spread EINC.

Introduction to EINC | NO UNAUTHORIZED REPRODUCTION 21

Support to the Re-Establishment of Health Care Services for Birthing Mothers and Newborns in Areas Affected by
the 7.2 Magnitude Earthquake in Bohol through Essential Intrapartum and Newborn Care (EINC) Trainings,
Training of Trainors, January 22,2014

You can find us on Facebook, our Facebook page is “Unang Yakap-EINC. “

You can course your questions, requests for training through our Facebook page. We
are checking the page 5-6x a day to respond to your queries.

You can check out the Links and Notes for EINC material.

You can also view your pictures taken at today’s workshop on our page.

Click:
Start by “liking” us!

Introduction to EINC | NO UNAUTHORIZED REPRODUCTION 22

Support to the Re-Establishment of Health Care Services for Birthing Mothers and Newborns in Areas Affected by
the 7.2 Magnitude Earthquake in Bohol through Essential Intrapartum and Newborn Care (EINC) Trainings,
Training of Trainors, January 22,2014

Last year, the WHO in collaboration with DOH launched an interactive self
instructional module on EINC. It is available for free to those who attend the
workshop. A Tagalog version will be coming out soon.

Introduction to EINC | NO UNAUTHORIZED REPRODUCTION 23

Support to the Re-Establishment of Health Care Services for Birthing Mothers and Newborns in Areas Affected by
the 7.2 Magnitude Earthquake in Bohol through Essential Intrapartum and Newborn Care (EINC) Trainings,
Training of Trainors, January 22,2014

Introduction to EINC | NO UNAUTHORIZED REPRODUCTION 24

Support to the Re-Establishment of Health Care Services for Birthing Mothers and Newborns in Areas Affected by
the 7.2 Magnitude Earthquake in Bohol through Essential Intrapartum and Newborn Care (EINC) Trainings,
Training of Trainors, January 22,2014

The current state of maternal and newborn care needs urgent action. Evidence-based
interventions are not practiced sufficiently.
The EINC Protocol provides an evidence-based, low cost, low technology package of
interventions that will save tens of thousands of lives.
Each of us, as individuals and as organizations, have to look inward to find ways to
implement EINC .

Join us in the campaign to bring UnangYakap to your community.

Introduction to EINC | NO UNAUTHORIZED REPRODUCTION 25