Table 6 Essential interventions and effective practices included in the modelling, and estimated time requirement for delivery of each
Intervention | Time requirement per woman/girl/newborn (minutes) | Level(s) of care at which intervention delivered | ||
|---|---|---|---|---|
Primary | Secondary | Tertiary | ||
Pre-pregnancy | ||||
Family planning advicea | 20 | ✓ | ✓ | |
Delivery of condoms, vaginal barrier, vaginal tablet, other | 15 | ✓ | ||
Delivery of contraceptive pills, injectables | 20 | ✓ | ||
Delivery of contraceptive implants | 40 | ✓ | ||
Delivery of intrauterine devices (IUDs) | 35 | ✓ | ||
Female and male sterilisation | 70 | ✓ | ||
Prevention of HIV in all women of reproductive agea | 45 | ✓ | ||
Prevention of other sexually transmitted infections (STIs) in all women of reproductive agea | 14 | ✓ | ||
Syphilis managementa | 15 | ✓ | ✓ | ✓ |
Gonorrhoea managementa | 15 | ✓ | ✓ | ✓ |
Chlamydia managementa | 15 | ✓ | ✓ | ✓ |
Trichomoniasis managementa | 15 | ✓ | ✓ | ✓ |
HIV managementa | 240 | ✓ | ✓ | ✓ |
Folic acid fortification/supplementation | 10 | ✓ | ||
Pregnancy | ||||
Iron and folic acid supplementation, zinc supplementation, advice to increase dietary energy and protein intake/microsupplementation/interventions to increase frequency and ease of defecation | 15 | ✓ | ||
Tetanus toxoid vaccination | 5 | ✓ | ||
Prevention of malaria with insecticide treated nets (ITNs) and antimalarial medication | 5 | ✓ | ||
Management of malaria with ITNs and antimalarial medication | 4 | ✓ | ✓ | ✓ |
Screening for HIV for prevention of mother-to-child transmission | 30 | ✓ | ✓ | ✓ |
Treatment of HIV for prevention of mother-to-child transmission | 280 | ✓ | ✓ | ✓ |
Prevention of STIs as part of antenatal care | 6 | ✓ | ||
Gonorrhoea managementa | 10 | ✓ | ✓ | ✓ |
Chlamydia managementa | 10 | ✓ | ✓ | ✓ |
Trichomoniasis managementa | 10 | ✓ | ✓ | ✓ |
Screening for syphilisa | 15 | ✓ | ✓ | ✓ |
Treatment of syphilis | 10 | ✓ | ✓ | ✓ |
Antibiotics for treating bacterial vaginosis | 10 | ✓ | ✓ | ✓ |
Antibiotics for treating asymptomatic bacteriuria | 10 | ✓ | ✓ | ✓ |
Treatment for symptomatic urinary tract infections | 10 | ✓ | ✓ | ✓ |
Any topical treatment for vaginal candidiasis | 10 | ✓ | ✓ | ✓ |
Calcium supplementation to prevent hypertension | 8 | ✓ | ✓ | ✓ |
Interventions for cessation of smokinga | 16 | ✓ | ||
Antihypertensive drugs to treat high blood pressure (including low-dose aspirin to prevent pre-eclampsia)a | 50 | ✓ | ✓ | ✓ |
Magnesium sulphate for eclampsia (nurse or midwife) | 180 | ✓ | ✓ | ✓ |
Magnesium sulphate for eclampsia (ob/gyn) | 60 | ✓ | ✓ | |
Antibiotics for prevention of preterm premature rupture of membranes | 30 | ✓ | ✓ | ✓ |
Corticosteroids to prevent respiratory distress (nurse or midwife) | 40 | ✓ | ✓ | ✓ |
Corticosteroids to prevent respiratory distress (generalist doctor) | 30 | ✓ | ✓ | ✓ |
Safe abortion (vacuum aspiration or dilation & curettage) | 30 | ✓ | ✓ | |
Post-abortion care (auxiliary) | 90 | ✓ | ✓ | |
Post-abortion care (nurse or midwife) | 90 | ✓ | ✓ | ✓ |
Post-abortion care (ob/gyn) | 30 | ✓ | ✓ | ✓ |
Reduce malpresentation at term with external cephalic versiona | 107 | ✓ | ✓ | |
Induction of labour to manage pre-labour rupture of membranes at term | 86 | ✓ | ✓ | |
Digital perineal massage | 0 | ✓ | ✓ | ✓ |
Interventions intended to promote breastfeeding | 30 | ✓ | ✓ | ✓ |
Anti-D administration in pregnancy for preventing rhesus alloimmunisation | 1 | ✓ | ||
Antiplatelet agents for preventing pre-eclampsia and its complications | 30 | ✓ | ||
Interventions for preventing and treating pelvic and back pain in pregnancy | 15 | ✓ | ||
Psychological and psychosocial interventions for preventing postpartum depression | 30 | ✓ | ||
Labour and birth | ||||
Normal labour and delivery management and social support during childbirth (nurse or midwife) | 360 | ✓ | ✓ | ✓ |
Normal labour and delivery management and social support during childbirth (ob/gyn) | 30 | ✓ | ✓ | ✓ |
Any perineal technique during the second stage of labour | 0 | ✓ | ✓ | ✓ |
Immersion in any bathtub or pool during labour | 0 | ✓ | ✓ | ✓ |
Upright positions assumed by women in first stage of labour | 0 | ✓ | ✓ | ✓ |
Acupuncture or acupressure for pain management in labour | 0 | ✓ | ✓ | ✓ |
Massage, reflexology and other manual methods for pain management in labour | 0 | ✓ | ✓ | ✓ |
Relaxation techniques | 0 | ✓ | ✓ | ✓ |
Restrictive episiotomy | 0 | ✓ | ✓ | ✓ |
Any inhaled analgesia during labour | 0 | ✓ | ✓ | ✓ |
Active management of third stage labour (to deliver placenta) to prevent postpartum haemorrhage (including uterine massage, uterotonics and controlled cord traction) | 10 | ✓ | ✓ | ✓ |
Oxytocin given prophylactically for third stage of labour | 0 | ✓ | ✓ | ✓ |
Prophylactic use of ergot alkaloids in third stage of labour | 0 | ✓ | ✓ | ✓ |
Rapid versus stepwise negative pressure application for vacuum extraction | 0 | ✓ | ✓ | ✓ |
Screen for HIV during childbirth if not already testeda | 11 | ✓ | ✓ | ✓ |
Manage HIV during childbirth if not already testeda | 120 | ✓ | ✓ | ✓ |
Caesarean section for maternal/foetal indication (including prophylactic antibiotic for C-section) - auxiliarya | 210 | ✓ | ✓ | |
Caesarean section for maternal/foetal indication (including prophylactic antibiotic for C-section) - nurse or midwifea | 90 | ✓ | ✓ | |
Caesarean section for maternal/foetal indication (including prophylactic antibiotic for C-section) – ob/gyna | 90 | ✓ | ✓ | |
Induction of labour for prolonged pregnancy (midwife or nurse) | 40 | ✓ | ✓ | |
Induction of labour for prolonged pregnancy (ob/gyn) | 20 | ✓ | ✓ | |
Management of postpartum haemorrhage (PPH) (manual removal of placenta and/or surgical procedures and/or oxytocics)-auxiliary | 120 | ✓ | ✓ | |
Management of PPH (manual removal of placenta and/or surgical procedures and/or oxytocics)-nurse or midwife | 60 | ✓ | ✓ | |
Management of PPH (manual removal of placenta and/or surgical procedures and/or oxytocics)-ob/gyn | 90 | ✓ | ✓ | |
Interventions intended to promote breastfeeding | 30 | ✓ | ✓ | ✓ |
Alternative institutional birth environment | 0 | ✓ | ✓ | ✓ |
Midwife-led continuity models of care | 0 | ✓ | ✓ | ✓ |
Labour assessment programmes aimed at delaying admission to the labour ward | 0 | ✓ | ✓ | ✓ |
Postnatal: mother | ||||
Postnatal preventive care | 80 | ✓ | ✓ | ✓ |
Detect and treat postpartum sepsis (auxiliary) | 150 | ✓ | ✓ | ✓ |
Detect and treat postpartum sepsis (nurse or midwife) | 60 | ✓ | ✓ | ✓ |
Continuous versus interrupted sutures for episiotomy/ second degree tears | 0 | ✓ | ✓ | ✓ |
Psychological and psychosocial interventions for preventing postpartum depression | 30 | ✓ | ✓ | ✓ |
Single administration of paracetamol for early postpartum pain | 5 | ✓ | ✓ | ✓ |
Any type of approved analgesia for after-birth pains (vaginal birth) | 0 | ✓ | ✓ | ✓ |
Antibiotic regimens for endometritis after delivery | 15 | ✓ | ✓ | ✓ |
Analgesic rectal suppositories for relief of perineal pain | 0 | ✓ | ✓ | ✓ |
Postnatal: newborn | ||||
Neonatal resuscitation with bag and maska | 20 | ✓ | ✓ | ✓ |
Kangaroo Mother Care | 30 | ✓ | ✓ | ✓ |
Skin-to-skin contact between mother and baby | 5 | ✓ | ✓ | ✓ |
Immediate thermal care | 5 | ✓ | ✓ | ✓ |
Extra support for feeding small and preterm babiesa | 90 | ✓ | ✓ | ✓ |
Management of newborns with jaundice | 150 | ✓ | ✓ | ✓ |
Initiate prophylactic antiretroviral therapy (ART) for babies exposed to HIVa | 30 | ✓ | ✓ | ✓ |
Presumptive antibiotic therapy for newborns at risk of bacterial infectionsa | 40 | ✓ | ✓ | ✓ |
Surfactant to prevent respiratory distress syndrome in preterm babiesa | 60 | ✓ | ✓ | ✓ |
Continuous positive airway pressure (CPAP) to manage babies with respiratory distress syndromea | 120 | ✓ | ✓ | ✓ |
Interventions intended to promote breastfeeding | 60 | ✓ | ✓ | ✓ |
Exclusive breastfeeding for at least 6 months | 0 | ✓ | ✓ | ✓ |