Table 3: Finalized near-miss mothers’ program after applying validation changes
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Strategy 1: Psychological counseling
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Inputs
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Activities
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Results
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Short-term outcome
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Medium-term outcome
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Long-
term outcomes
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Reducing the psychological burden following a lifelong complication
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Human resources:
A midwife, holding an MSc degree in counseling, a clinical psychologist, a psychiatrist, staff capable of providing initial counseling
a team including a midwife, a psychologist, to do mental counseling at home
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Psychological support of mother at the time of the incident
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The ratio of counseled individuals at any given time to total near-miss mothers
The ratio of mothers satisfied with psychological counseling to total counseling mothers
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Awareness and skill of coping with the incident
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Mother’s attitudes for attempting to keep calm
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Proper behavior for higher adaptability with organ dysfunction in life
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Psychological counseling of mother at the hospital
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Improving awareness in alleviating concerns and identifying barriers in the mental health of mothers
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Creating a positive attitude in the early diagnosis of mental problems
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Preventing stress, anxiety, and depression
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Psychological counseling of mother at the time of discharge
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Improving mother’s awareness of mental disease symptoms
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Mother's readiness for psychological self-care with the new life situation
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Proper behavior for mother's discharge based on a standard checklist of psychological screening
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Psychological counseling of mother at post-discharge health care at home
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Improving awareness in early diagnosis of depression, anxiety, and post-stress trauma
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Sensitizing mothers for visiting a mental health expert or psychiatrist
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Timely treatment of psychological problems and resolution of conflicts in life in case the mother cannot attend for health care
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Psychological counseling of the husband
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Awareness and readiness of the husband of the mother’s problems
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Changing husband’s attitudes for supporting and dealing with the problems
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Reducing stress and anxiety levels in the spouse
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Psychological counseling of previous offsprings of the family
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Alleviating mental concerns created after the mother’s disease
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Assigning importance to the identification and screening of psychological problems in children
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Preventing emotional damages based on standard tools
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Strategy 2: Fertility / childbearing counseling
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Human resource:
A midwife skilled at childbearing
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Counseling in for the loss of fertility
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The ratio of people consulted to all high-risk mothers
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Mental readiness of the family for uterine dysfunction
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Creating a positive attitude in the mother for accepting the number and gender of children
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Counseling for accepting infertility and deciding to adopt children
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Reduction of severe labor morbidity
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Childbearing Counseling in high-risk pregnancies
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Increasing mothers' awareness of the complications of future pregnancies
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Creating a conscious intention for a planned pregnancy based on the type of organ dysfunction
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providing pre-pregnancy counseling for all mothers near death
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Childbearing Counseling for future pregnancies
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Increasing the mother's awareness of the risks of future pregnancies
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Developing a responsible attitude towards re-pregnancy
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Success in planning the number of children based on the mother's physical condition
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Strategy 3: Information Support
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Human resources:
Skilled midwife in hospital/health center, use of 24-hour hospital IVR depending on the type of organ dysfunction of mothers as an information reference
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Fulfilling information needs about the current problem
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Percentage of mothers who are fully aware of their problem
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Increasing awareness of mothers and families about the accident
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Correcting the mother's negative attitude and misinformation about the disease
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Performing mother self-care activities based on written information received in any type of dysfunction
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Providing complete coverage for the mother and family in different complication situations
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Fulfilling the information needs of family members
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Increasing awareness and empathetic understanding of the mother by the spouse and family members
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A positive effort for full support of the mother by the husband
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Emphasizing the role of the spouse in the supportive-caring activities of the mother
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Sexual counseling and marital education
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The ratio of counseled mothers / to total near-miss mothers
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Increasing husband’s awareness of how to have a sexual relationship again
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Creating an efficient attitude for identifying sexual problems based on screening with standard tools
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Counseling and skill behaviors for strengthening the marital relationship of the joint life
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Strategy 4: Socio-cultural support
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Human resources:
Mental health expert, social worker, midwife
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Counseling to reduce social isolation by a mental health expert
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The ratio of counseled mothers / to total near-miss mothers
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Increasing the mother's awareness of the reason for her isolation from society
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Increasing the positive attitude of the mother to start former social activities
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Having positive social activities to reduce the social burden of the disease
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Reducing the socio-cultural burden of the complication on mother and baby
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maternal support by peers
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Percentage of mothers who have joined peer/therapy groups.
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Increasing knowledge in forming peer groups
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Motivate the mother to reduce the feeling of loneliness and isolation
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Guiding and referring mothers to peer associations and groups
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correspondence with the Welfare Organization for referring mothers before hospital discharge
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Percentage of mothers covered by welfare through hospital referrals
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Informing the welfare organization of the existence of mothers close to death
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Measures to reduce social pressures on near-miss mothers by other organizations
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Allocating special conditions facilities for near-miss mothers by welfare
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Risk assessment of mothers in terms of socio-cultural dimensions
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Percentage of mothers assessed in terms of socioeconomic class based on standard tools
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Increasing knowledge in early identification of high-risk cases in terms of the socio-economic and cultural level
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اReadiness to plan for increased follow-up care of the vulnerable
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Appropriate behavior for more socio-cultural support
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Strategy 5: Improving financial/geographical access:
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Facilities:
Increasing insurance coverage,
Infrastructure for receiving in-person/automated appointments from the clinic
Facilities:
Increasing insurance coverage,
Infrastructure for receiving in-person/automated appointments from the clinic
Human resources:
Social worker
Arrangement:
Charity
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Assigning a monthly budget for near-miss mothers
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Percentage of mothers who have received the allowance.
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Increasing knowledge on how to reduce the costs imposed following the complication
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Supportive attitude to long-term nutritional costs and follow-up treatment
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Reduced convalescence from illness due to financial barriers based on hospitalization days
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Improving mothers' financial/geographical access to equitable services
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insurance coverage for childbirth complications of near-miss mothers stated in the promotion package of the health system reform plan/ Supplementary insurance for morbidities
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Percentage of discount to the total cost
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Helping to reduce treatment and paraclinical costs
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Efforts to reduce financial barriers leading to a lack of timely diagnostic care
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Financial measures to help reduce the economic burden on the family following maternity leave
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financial accountability for legal negligence in the health system
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Percentage of cases for which compensation for legal negligence has been paid
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Mother’s feeling of financial support in response to medical malpractices
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Sensitization of medical staff to be responsible for lack of professional accountability
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Legal accountability of the health justice system
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charity support/social working
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The ratio of mothers who have used social work support costs to total mothers
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Increasing knowledge on how to reduce hospital costs
Reducing family financial bankruptcy
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A supportive attitude of institutions in reducing the loss of living capital due to medical expenses
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Contributing to the financial well-being of mothers based on measures taken based on standard tool of backbreaking costs
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scheduling a pre-arranged appointment to the clinic at the time of the mother's discharge
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Percentage of mothers whose clinic appointment is pre-arranged
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Increasing knowledge about the benefits of reducing the cost/time of follow-up after discharge
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Ensuring that all mothers are followed up and returned to the clinic for follow-up
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Providing timely treatment and care if needed
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Identifying mothers with poor financial status
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Percentage of mothers identified with poor socioeconomic status to all mothers
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Increasing awareness in segregation and evaluation of mothers with financial problems
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Planning on financial support to improve care
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Correct behavior for timely diagnosis and treatment for low-income families based on scientific guidelines
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Strategy 6: Breastfeeding counseling
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Human resources:
Midwife in the health care center
Milk expert
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Facilitating mother-infant bonding to start breastfeeding
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Percentage of mothers who met the baby at the first opportunity / Total near-miss mothers
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Increasing awareness in strengthening maternal feelings by starting early breastfeeding
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Creating an effective attitude in employees to provide the possibility for mother and baby to meet to strengthen the emotional bond
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Helping the mother to breastfeed successfully based on the hours and frequency of breastfeeding
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Promoting baby feeding and breastfeeding
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Facilitating the process of using formula/milk bank
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Percentage of mothers who have used the formula to total near-miss mothers
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Increasing awareness to start proper and timely feeding of the baby
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Positive efforts to prevent the effects of not breastfeeding
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Improving the growth and development of the baby based on the booklet of health charts
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Strategy 7: Nutritional counseling
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Human resources:
Nutrition expert
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Performing nutritional counseling at the time of hospitalization/health care
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Percentage of mothers visited by a nutritionist to total near-miss mothers
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Increasing awareness in the use of diet appropriate for the physical problem
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Improving staff attitude for improving physical condition and shorter convalescence from illness through nutritional counseling
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Reduction of nutritional deficiencies and micronutrients caused by an improper diet based on experiments
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Improving nutritious and proper nutrition
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Strategy 8: Promoting the care quality in near-miss mothers
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Infrastructures
Human resources:
Forming a working group of all specialties depending on the type of organ dysfunction
Hospital non-assigned experts in the field of mothers to supervise the activities, a skilled midwife as a supervisor of the obstetrics and gynecology block, an inspector of high-risk mothers with background experiences from different fields of work
Educational environment: holding classes and workshops, having a standard room for classes and workshops
Financial costs: Costs allocated for holding classes, workshop teacher salaries, purchase of accessories and educational aids, preparation of pamphlets and educational materials, Infrastructure: reviewing the guidelines of the Ministry of Health, the integrated national system of maternal health
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Empowering staff/managers for legal accountability
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Percentage of employees participating in workshops to total staff
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Making mothers aware of their rights
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Creating a positive attitude in finding the root of avoidable negligence by using RCA files
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Accountability of the health system for its mistakes
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Improving the quality of care in near-miss mothers
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Empowering staff in terms of ethics and professional behavior
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Increasing awareness and effective communication skills in line with the spirit of near-miss mothers
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Increasing staff’s supportive motivation for respecting and paying attention in the most critical living conditions
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Respectful and ethical behavior of employees
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empowering staff in terms of clinical skills
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Increasing the knowledge and awareness of staff in midwifery emergencies
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Increasing sensitivity of staff/service providers to the initial complaint in all areas of the mother's physical and mental health
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Careful and sufficiently skilled behavior
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reviewing educational curricula
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Percentage of parts changed and revised in the educational curriculum
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Increasing knowledge about the educational content for near-miss mothers
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Basic midwifery training on specific skill / behavioral attitudes in near-miss mothers
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Increasing the number of skilled graduates to provide services to near-miss mothers
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providing intensive care for near-miss mothers in health care,
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Percentage of near-death mothers who are in intensive care
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Increasing knowledge to care intermittently
Maternal awareness of ongoing care
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Adopting an insistent attitude to provide home care tailored to the specific flowchart of each type of dysfunction
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Reducing late-diagnosed events which are due to medical team availability
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reviewing existing programs to prevent or physically rehabilitate mothers
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Percentage of programs revised to meet the needs of near-miss mothers / total current programs
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Eliminating the implementation of polyvalence plan in midwives to provide efficient care
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Increasing the cost/effectiveness of care based on research
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Increasing the achievement of the desired result of care based on indicators and including the type of special care for these mothers in the service package for adolescents, the middle-aged, and the elderly
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establishing a coherent relationship between health care and treatment
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Percentage of universities that provide prenatal care within the integrated health care system.
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Awareness of hospital staff of the condition and number of high-risk mothers referred to by the healthcare center
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Effective preparation for the implementation of appropriate hospital care based on proper systemic records and history
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Integrated health care through ongoing communication using the knowledge of the mother's condition
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Establishment of a provincial working group for near-miss mothers through the centralized registry of mothers and covering several sub-hospitals
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Percentage of near-miss mothers followed by the working group / total mothers
Percentage of professional errors occurred to total occupational errors based on cases in mothers' morbidity committees
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Increasing the knowledge and awareness of service providers about the identification, treatment, and follow-up of near-miss mothers
Decreasing the number of avoidable maternal professional errors/faults
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Increasing the motivation and sensitivity of employees related to the field of mothers to prevent avoidable factors
Increasing the supervising attitude and process improvement of managers to be more accountable
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Improving clinical processes using behavior change associated with work conscience in service providers
Reduction of multiple complications associated with maternal organ dysfunction caused by lack of proper follow-up
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