# Health Journey Mnch - Amakomaya Nepal FHIR Implementation Guide v2.0.0

* [**Table of Contents**](toc.md)
* **Health Journey Mnch**

## Health Journey Mnch

This story outlines how maternal, newborn, and child health (MNCH) data is captured and exchanged using FHIR resources in the EHMIS system.

### Objective

To support longitudinal tracking and reporting of services provided during the continuum of care—from pregnancy to postnatal and child health—using standardized FHIR resources.

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### Actors

* Pregnant Woman (Patient)
* Family Members (RelatedPerson)
* Female Community Health Volunteer (FCHV)
* Auxiliary Nurse Midwife (ANM)
* Health Facility Staff (e.g., HA, Medical Officer)

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### Workflow Steps

1. **Registration of Pregnant Woman**
* Collect personal and demographic information
* FHIR Resource: `Patient`
* Link to household members if needed (`RelatedPerson`)

1. **Antenatal Care (ANC) Visits**
* Record each ANC visit (`Encounter`)
* Capture vitals, test results, symptoms (`Observation`)
* Risk conditions (`Condition`)
* Counseling provided (`Procedure` or `ServiceRequest`)

1. **Delivery Event**
* Record delivery details: date, place, method, outcome
* FHIR Resource: `Procedure` (for delivery)
* Birth outcome, complications: `Observation`, `Condition`

1. **Postnatal Care (PNC)**
* Newborn registration (`Patient`)
* Postnatal visits for mother and baby (`Encounter`)
* Observations (e.g., temperature, breastfeeding, danger signs)
* Immunizations recorded (`Immunization`)

1. **Child Health Follow-up**
* Child growth monitoring (`Observation`)
* Vitamin A, deworming (`Procedure`)
* Illness episodes and treatment (`Condition`, `MedicationRequest`)

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### FHIR Resources Used

| | |
| :--- | :--- |
| `Patient` | Mother and newborn identification |
| `RelatedPerson` | Family linkage |
| `Encounter` | ANC, PNC, delivery, child visits |
| `Observation` | Vitals, test results, birth weight |
| `Condition` | Risk factors, complications |
| `Procedure` | Delivery, counseling, supplements |
| `Immunization` | Child vaccinations |
| `MedicationRequest` | Prescriptions for mother or child |

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### Example: First ANC Visit for Pregnant Woman

* **Patient**: 25-year-old woman, registered at rural health post
* **Encounter**: First ANC visit on 2025-08-01
* **Observation**: 
* Blood pressure: 110/70
* Hemoglobin: 11.5 g/dL
 
* **Condition**: No risk factors identified
* **Procedure**: Counseling on danger signs
* **ServiceRequest**: Laboratory test for HIV and syphilis

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### Reporting Considerations

* ANC visit coverage (ANC1, ANC4)
* Delivery by skilled birth attendant
* Postnatal visit within 48 hours
* Newborn weight and immunization coverage
* Monthly reporting to DHIS2 or national HMIS

