BEmONC/CEmONC
Health Facilities
Batoy, Allen & Barredo, Ciara
EmONC
Emergency obstetric and newborn care (EmONC) is defined
as set of life-saving interventions, that treat the major
obstetric and newborn causes of morbidity and mortality. To
assess the level of care, these functions are classified as Basic
EmONC (BEmONC) or Comprehensive EmONC (CEmONC)
levels of care.
Importance
Save lives around 280,000 woman/ year
Save lives of 3M of Newborns/ year
Prevention of millions of disabled conditons
(timely, effective EmONC
BEmONC
BEmONC stands for Basic Emergency Obstetric and
Newborn Care. It refers to a set of essential interventions and
care provided to women and newborns during childbirth and
the immediate postnatal period.
BEmONC encompasses a range of interventions and skills that
are typically provided at the primary healthcare level or in low-
resource settings where access to comprehensive emergency
obstetric care may be limited.
Key Components of BEmONC
1. Management of complications during pregnancy and
childbirth: This includes the identification and management of
conditions such as hemorrhage (excessive bleeding), sepsis
(infection), hypertensive disorders, and obstructed labor.
2. Clean delivery practices: Ensuring a clean and sterile
environment during childbirth to prevent infections in both the
mother and newborn.
3. Neonatal resuscitation: Providing basic resuscitation
interventions to newborns who do not breathe spontaneously
at birth.
4. Prevention and management of postpartum
hemorrhage: This involves the use of uterotonic drugs, such as
oxytocin, to prevent excessive bleeding after childbirth.
5. Management of newborn complications: This includes the
identification and initial management of common newborn
conditions, such as birth asphyxia, infection, and low birth
weight.
BEmONC
essential medical interventions
Antibiotics to prevent puerperal infection
Anticonvulsants for treatment of eclampsia and
preeclampsia
Uterotonic drugs
Manual removal of placenta
Assisted or instrumental vaginal delivery
Renewal or retrained products of conception; and
Neonatal resuscitation
CEmONC
CEmONC stands for Comprehensive Emergency Obstetric
and Newborn Care. It refers to a higher level of care
compared to BEmONC and is designed to address more
complex and severe obstetric and newborn emergencies.
CEmONC encompasses a broader range of interventions and
capabilities compared to BEmONC.
In addition to the components included in BEmONC,
CEmONC includes the following:
Cesarean section- CEmONC facilities are equipped and staffed to perform
cesarean sections when necessary. A cesarean section is a surgical
procedure in which the baby is delivered through an incision in the
mother's abdomen and uterus. It is used when vaginal delivery poses risks
to the mother or baby or when complications arise during labor
Blood transfusion service- CEmONC facilities have the capacity to provide
blood transfusions for women experiencing severe bleeding during
childbirth or other obstetric complications that require blood replacement.
Management of severe preeclampsia/eclampsia- CEmONC
facilities are equipped to manage severe forms of hypertensive
disorders in pregnancy, including pre-eclampsia and eclampsia.
These conditions can be life-threatening for both the mother
and baby and require specialized care.
Neonatal intensive care- CEmONC facilities have neonatal
intensive care units (NICUs) or specialized newborn care units to
manage and provide advanced care for newborns with severe
complications or conditions that require intensive medical
support.
CEmONC services are essential for managing complex obstetric
emergencies and improving maternal and neonatal outcomes.
Access to CEmONC is particularly important in situations where
BEmONC services are insufficient to meet the needs of high-risk
pregnancies and childbirth complications. By providing
comprehensive and timely care, CEmONC plays a vital role in
reducing maternal and neonatal mortality and morbidity rates.
Provider facilities: are departmentalized district, provincial and
regional hospitals. These hospitals shall provide the following services:
1) Pre-pregnancy care
2) Prenatal care package
3) Complete childbirth package
4) Postpartum/ postnatal care
NATIONAL SAFE
MOTHERHOOD PROGRAM
Vision
For Filipino women to have full access to health services towards making their pregnancy
and delivery safer
Mission
Guided by the Department of Health FOURmula One Plus thrust and the Universal Health
Care Frame, the National Safe Motherhood Program is committed to provide rational and
responsive policy direction to its local government partners in the delivery of quality
maternal and newborn health services with integrity and accountability using proven and
innovative approaches
OBJECTIVES
The Program contributes to the national goal of improving women’s health and well-being by:
1.Collaborating with Local Government Units in establishing
sustainable, cost-effective approach of delivering health services
that ensure access of disadvantaged women to acceptable and
high quality maternal and newborn health services and enable
them to safely give birth in health facilities near their homes
2. Establishing core knowledge base and support systems that
facilitate the delivery of quality maternal and newborn health
services in the country.
PROGRAM COMPONENTS
Component A: Local Delivery of the Maternal–Newborn Service Package
This component helps LGUs establish and mobilize a service delivery network of public and private providers
to offer integrated maternal-newborn services. The following actions will continue in each province and city:
1. Establishment of critical capacities to provide quality maternal-newborn services through the
organization and operation of a network of Service Delivery Teams consisting of:
a. Barangay Health Workers
b. BEmONC Teams composed of Doctors, Nurses and Midwives
c.
2. In collaboration with the Centers for health Development and relevant national offices:
Establishment of Reliable Sustainable Support Systems for Maternal-Newborn Service Delivery
through such initiatives as:
a. Establishment of Safe Blood Supply Network with support from the National Voluntary Blood Program
b. Behavior Change Interventions in collaboration with the Health Promotion and Communication Service
c. Sustainable financing of maternal – newborn services and commodities through locally initiated
revenue generation and retention activities including PhilHealth accreditation and enrolment.
PROGRAM COMPONENTS
Component B: National Capacity to Sustain Maternal-Newborn Services
1. Operational and Regulatory Guidelines
a. Identification and profiling of current FP users and identification of potential FP clients and
those with unmet need for FP (permanent or temporary methods)
b. Mainstreaming FP in the regions with high unmet need for FP
c. Development and dissemination of Information, Education Communication materials
d. Advocacy and social mobilization for FP
2. Network of Training Providers
a. 31 Training Centers that provide BEmONC Skills Training
3. Monitoring, Evaluation, Research, and Dissemination with support from the Epidemiology
Bureau and Health Policy Development and Planning Bureau
a. Monitoring and Supervision of Private Midwife Clinics in cooperation with PRC Board of
Midwifery and Professional Midwifery Organizations
b. Maternal Death Reporting and Review System in collaboration with Provincial and City Review
Teams
c. Annual Program Implementation Reviews with Provincial Health Officers and Regional
Coordinators
PARTNERS INSTITUTION
Local Government Units
Development Partners
POLICIES AND LAW
Republic Act No. 10354: Responsible Parenthood and Reproductive
Health Law (RPRH Act of 2012)
POLICIES AND LAW
1. Administrative Order 2008-0029: Implementing Health Reforms to Rapidly Reduce
Maternal and Neonatal Mortality
2. Department Order 2009-0084: Guidelines Governing the Payment of Training Fees relative
to the Attendance of Health Workers to Basic Emergency Obstetric and Newborn Care Skills
Training Course at Duly Designated Training Centers
3. Administrative Order 2011-0011: Establishment of Basic Emergency Obstetric and
Newborn Care Training Centers in Regional Hospitals and Medical Centers
4. Administrative Order 2015-0020: Guidelines in the Administration of Life Saving Drugs
During Maternal Care Emergencies by Nurses and Midwives in Birthing Centers
5. Administrative Order 2016-0035: Guidelines on the Provision of Quality Antenatal Care in
All Birthing Centers and Health Facilities Providing Maternity Care Services
6. Administrative Order 2018-0003: National Policy on the Prevention of Illegal and Unsafe
Abortion and Management of Post-Abortion Complications
PROGRAM
ACCOMPLISHMENTS
/STATUS
The Department of Health through the National Safe Motherhood
Program shall continue to update its strategies to address critical
reproductive health concerns including control of sexually transmitted
infections and mother to child transmission of HIV while confronting both
demand and supply side obstacles to access for disadvantaged women
including indigenous women of reproductive age. Among the changes, the
following have been systematically mainstreamed into the safe
motherhood service delivery network (BEmONC-CEmONC network):
Safe Motherhood Service Delivery
Network (BEmONC-CEmONC)
1. Strategic Change in the Design of Safe Motherhood Services
These changes involve (1) a shift in emphasis from the risk
approach that identifies high-risk pregnancies during the
prenatal period to an approach that prepares all pregnant for the
complications at childbirth – this change brought about the
establishment the BEmONC – CEmONC network within the bigger
Service Delivery Network (SDN), (2) improved quality of FP
counseling and expanded service availability of post-partum
family planning in hospitals and primary birthing centers and (3)
the integration of cervical cancer, syphilis, hepatitis B and HIV
screening among others into the antenatal care protocols.
Safe Motherhood Service Delivery
Network (BEmONC-CEmONC)
2. An Integrated Package of Women’s Health and Safe Motherhood Services
The above changes in service delivery also involved a shift from centrally
controlled national programs operating separately and governed
independently at various levels of the health system to an LGU governed
system that delivers an integrated women’s health and safe motherhood
service package. This service delivery strategy is focused on maximizing
synergies among key services that influence maternal and newborn health
and on ensuring a continuum of care across levels of the referral system.
At the ground level, this implies that a woman, whatever her age and
specially if she is disadvantaged, who seeks care from a public health
provider for reproductive health concerns, could expect to be given a
comprehensive array of services that addresses her most critical
reproductive health needs.
Safe Motherhood Service Delivery
Network (BEmONC-CEmONC)
3. Reliable Sustainable Support Systems
Support systems for Maternal-Newborn service delivery is
anchored on Philhealth accreditation of birthing centers and
individual membership or enrolment into the Sponsored
Program. This mechanism ensures sustainable financing of
quality maternal-newborn services efficiently eliminating
out-of-pocket expenditures for antenatal, facility delivery
and postnatal care. The system likewise includes systems for
safe blood supply and stakeholder behavior change, through
a combination of advocacy and interpersonal
communication during clinic visits.
Safe Motherhood Service Delivery
Network (BEmONC-CEmONC)
4. Stronger Stewardship and Guidance from the DOH Program Manager and
Regional Coordinators
DOH provides stewardship and guidance through (1) evidence-
based guidelines and protocols on maternal – newborn services;
(2) a system for recognizing providers of emergency obstetrics
and newborn care (BEmONC) training program; and (3)
monitoring, evaluation and research on the new maternal-
newborn strategies.
Establishment of Safe Motherhood Program Monitoring and
Evaluation System in collaboration with Epidemiology Bureau
and Health Policy Development and Planning Bureau by 2019
PROGRAM
ACCOMPLISHMENTS/STATUS
The Program shall continue to monitor the implementation of its policies and evaluate
effectiveness in improving maternal outcomes and consequently translate these to maternal
and newborn mortality reductions. LGUs shall be continuously encouraged to address local
health system’s gaps identified during maternal death reviews.
Relevant policies that responds to maternal needs have been passed that include among
others for 2018, the policy of prevention of illegal and unsafe abortions and management of
post – abortion complication. Implementation of this policy is expected to reduce maternal
death by at least 21%. The Program shall continue to pass policies based on death review
results.
To date, 95% of Birthing Centers have teams trained on basic emergency obstetric and
newborn care.
THANK YOU
