Interim Guidance for RMNCH services in COVID 19 Pandemic 2077

Family Welfare Division
Department of Health Services
Ministry of Health and Population

Approved Date: May 21, 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

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

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 (ECpills,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 tele health service for FP client and disseminiate 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.
• Relevant administrative officials/officers of provincial and local governments should issue clear directives/administrative orders that ensure easy and uninterrupted access to all SRH services including MHN, FP, SAS.
• 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.
Routine Antenatal care should be provided from all HP/PHCC/Hospitals
➢ Ensure check-up and advice, supplementation, medications as per need or referral if necessary
➢ History and Physical check-up: usual physical check-up and request women to face opposite of you during check-up. Ensure to ask and check for pregnancy complication signs and symptoms and COVID symptoms
➢ Pregnant women should be counseled on (repeat this even you have already counseled her during tele ANC consultation):
o On COVID-19 infection prevention practices
o On breast feeding with COVID symptoms
o On birth preparedness and institutional delivery
o On danger signs (usual pregnancy danger signs and COVID – difficulty in breathing)
and where to seek care
o On how and when to use “helpline” and provide helpline number and your phone
o provide women with nearby ambulance number
➢ Additional to usual antenatal check-up and supplementation (deworming, Td, ect.), the antenatal women should be
a. provided with IFA tablets for three months
b. provided misoprostol tablet (3 tablets), Chlorhexine, and clean/safe delivery kit at 8th months (or earlier) of pregnancy in case she faces difficulty in reaching to health facility/hospital for delivery care


Guidance for Health Facility in-charge and service providers:

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