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Marshall Sue

Abstract

Background: Maternal health care, and sexual and reproductive services are high priorities in the Kiribati Ministry of Health Plan and key targets areas in the Sustainable Development Goals.  They are fundamental to reducing unsafe abortion, maternal and perinatal mortality, and improving social, financial and physical wellbeing. This review was conducted with three aims. Firstly to determine strengths and gaps of sexual and reproductive health services across 14 community clinics in South Tarawa, Kiribati. Secondly review alignment with other health services and actions for improvement.  Thirdly, to distribute I-Kiribati resources on cervical screening, an antenatal tool, and emergency birth kits.


Methods: An investigative approach using a questionnaire and an audit of basic resources, information and equipment was carried out in each of the 14 clinics over a 5 day period.  An I -Kiribati nurse conducted the majority of the interviews in I - Kiribati and English with the other investigators taking notes, photos and recording observations. The information was then collated, and analyzed with a report developed on findings and recommendations.


Findings: This review found specific areas for improvement are required across the 14 clinics if the key targets of the SDGs are to be met. Specifically these are access, standardisation and  education


 Clinics are impacted by the availability of contraceptive commodities and the knowledge, confidence and skill of staff to provide the full range of contraceptive methods. There is reduced access to cervical screening which is only available in two locations as is pregnancy testing using standard pregnancy testing kits. Availability of routine blood testing in pregnancy is influenced by the current requirements to provide HIV testing as a separate process.  Equipment including emergency equipment is not standard in all clinics affecting safety, services and quality of care. Leaflets for contraceptive methods and on cervical screening are not available as take home information.


 There is a lack of standardized care evident in differences in numbers of antenatal visits, tetanus toxoid immunisation and scanning frequency in pregnancy.


Staff identify areas for education including family planning, diagnosis and treatment of sexually transmitted infections (STIs), breastfeeding updates and child health.


Conclusions: Despite challenges and limitations community clinic staff demonstrate commitment in serving their communities to provide primary health care services.


 Recommendations include ensuring all frontline staff are knowledgeable, confident, and skilled to improve the quality of services.  Limitations in resources including  emergency equipment, a functioning phone service, and accessible contraceptives  are also required to be addressed. Pregnancy testing at site and routine blood screening including HIV would also strengthen the quality of care to women.


Developing guidelines and adherence to existing policies for antenatal care, tetanus toxoid immunisation and scanning in pregnancy to improve safety, continuity and consistency in services.  


These improvements to maternal, sexual and reproductive health are likely to increase access, safety, and health outcomes for women and their families.

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Section
Short Reports