12 WEDNESDAY, SEPTEMBER 6

uR3.02.04 THE SURGICAL MANAGEMENT OF RECURRENT STRESS URINARY INCONTINENCE .I. A. Schulz, H. Mount Sinai Hospital, Toronto, ON, Canada

Recurrent stress urinary incontinence is a distressing problem. It scauses are multifactorial and the literatire continually provides suggestions for changes to the surgical approach. Over 200 surgical procedures exist for the treatment of stress urinary incontinence, and this leaves the practising surgeon with an overwhelming range of choice. This article will review current available techniques for the surgical treatment of recurrent stress urinary incontinence.

SS3.03 SAFE MOTHERHOOD: ENSURING SKILLED ATTENDANCE AT BIRTH

ss3.03.01 SETTING MIDWIFERY STANDARDS: A MULTI-COUNTRY EXPERIENCE D. Sunzkhobol, World Health Organization, Regional Office for South- East Asia, New Delhi, India.

Maternal mortality and morbidity are a major public health concern in many countries of the World Health Organization South-East Asia Region, and the Region still accounts for 40 per cent of the world’s maternal deaths. Statistics reveal that more than 50 per cent of deliveries in the Region occur at home and are mostly assisted by unskilled attendants. Maternal health services in many countries in the Region are particularly inadequate. In response to the needs expressed by Member States, the Regional Office has developed Standards of Midwifery Practice for Safe Motherhood. The standards, which include management of selected obstetric complications and emergencies, were developed specifically for use in countries of the Region with their active involvement. They support evidence-based care and are intended to be “prototype” standards for adaptation according to countries’ needs. These standards were field tested in four countries of the Region where midwifery services are at different stages of development. The field test has demonstrated that by implementing the standards the quality of midwifery services has improved, client satisfaction has increased, and the competence and self-confidence of midwifery-trained personnel have been enhanced. The lessons learnt during this process were used in finalizing the standards. Several countries in the Region have now set their own midwifery standards by adapting the “prototype” standards. The use of these standards will assist countries in ensuring and enhancing the quality of midwifery services in order to address the problems of high maternal mortality and morbidity.

ss3.03.02 IMPROVING LIFE SAVING SKILLS Joseuh Tavlor, Sandra Buffington, Diana Beck, Deborah Armbruster, Central Hospital, Koforidua, Ghana

The Life Saving Skills (LSS) program was developed to meet specific needs identified in the field and is based on real-life experience of health care providers, particularly midwives and physicians. LSS responds to the needs of many countries by proving a practical, hands-on and systematic way to reduce maternal mortality and morbidity by training midwives, and other health care providers, to provide women with emergency obstetric services. The Life Saving Skills Performance Improvement Approach It is critical for the improvement of the LSS program that a Performance Improvement Approach (PIA) to training be taken. A PIA implies not only the systematic development of a quality training program including preparation, competency-based training and follow-up, but also the development of a number of interlinking systems that support each other to produce an overall Training and Continuing Education System. This approach requires an investment of human resources during the set-up phase and the ongoing monitoring and support. By following this LSS Performance Improvement Approach to training, an in-service training and continuing education system can be designed that is focused on provider and community needs and reflects agreed upon clinical protocols.

Follow-up of trainees with supportive supervision and a continuing education structure supports what has been taught. Supportive supervision provides feedback to the midwife or provider and the supervisor on performance of the midwife as well as retention of skills and knowledge. When problems with performance are identified, this information is fed into the continuing education component and contributes to the overall sustainability of the system. Conclusion: Begining in 1987, the Safe Motherhood initiative brought the magnitude and tragedy of women and infants dying in childbirth to the world’s attention. The Life-Saving Skills program is one of the programs developed to decrease maternal and infant mortality and serious morbidity.

ss3.03.03 COMMUNITY MIDWIFES HOW EFFECTIVE ARE THEY? Ms.Yanne IBI, Jakarta, Indonesia

One alternative solution decided by The Government of Indonesia to meet the high maternal mortality in the country was accelerate the midwifery training programme. Between 1989-1996 there are 3 midwifery programmes two basic midwifery programmes (Types A & C) and one post basic programme for instructors (type B). The quality of the graduates depended on many factors, among others, local situations, existing teachers &facilities and availability of clinical practice (in hospital & community). Focus of the midwifery programme at that time was more on quantity rather that on quality of the graduates. The government was in a hurry to place one midwife in each village (& 65.000 villages). Several continuing education programme have been conducted to upgrade and improve the knowledge and skills of these midwives (community/village midwives). Many studies have been conducted on the community midwives, on their performances, their workload and also on their competence in technical skills. Even so, many community midwives are doing well in their respective village and they are integrated in the everyday life of the village. The main problem now, is that most of them are only on a 3 years contract with the government to work in the village (the government is not able to employ them on full-time basis as government employee). After 3 years they may extend their contract to three more years. But some also left the village after their contract expired and to find work else where. Data on how many of them are still working as a midwife or doing some other work, no accurate data is available yet.

ss3.03.04 THE ROLE OF NATIONAL PROFESSIONAL ORGANISATIONS Christine Uganda Private Midwives Association, Kampala, Uganda

Objectives: The aim of the study was to: ?? Identify roles and responsabilities for National Professional

organisations. ?? Encourage formation of National profesional organisations. ?? Formulate National/Regional collaboration between organisations. Study Methods: Fifty percent (50%) questionnaires were distributed to members of two National Professional organisations to find out the role of their organisation: how they have assisted the country. Also how they have collaborated with other organisation outside the country. Results: Eighty percent (80%) of questionnaires were received back with what they thought was the roles or how they collaborated with other outside organisations. Conclusions: National Professional organisations are available resources which can be uterized and supported to expand National Programmes more especialy in community. My presentation will elaborate on what Uganda Women Medical doctors have done. The preservation will also indicate the need for National and regional National Organisation collaboration where we can build our roles and responsabilities by using National/Regional Experienced personnel to provide knowledge & skills to other organisations.