How a Regional Learning Network improved care for mothers and babies in Uganda
September was Infant Mortality Awareness Month. This blog takes a look at efforts in western Uganda to reduce infant mortality and improve care for women through better coordination among health facilities and shared learning.
The Uganda Ministry of Health (MoH) has over the years made several commitments to improve reproductive, maternal, newborn, and child health (RMNCH) but translation of such commitments and policies into practice has largely been a challenge . Meanwhile 17 maternal deaths, 94 still births, and 110 neonatal deaths continue to occur each day in Uganda due to causes that are largely preventable. To translate these commitments into high quality care for mothers and newborns at health facility level, the MoH piloted a Regional Learning Network (RLN) in March 2016 in western Uganda with support from Save the Children’s Saving Newborn Lives (SNL) program and technical assistance from the Center for Human Services/University Research Co., LLC.
The Regional Learning Network comprises 14 health facilities across 6 districts including and within the catchment area of the Hoima Regional Referral Hospital (RRH). These 14 facilities are linked through an improvement collaborative to provide high-quality maternal and newborn health (MNH) services based on national evidence-based standards and guidelines. Health facilities were organized to provide coordinated newborn services across two levels of care – standard and specialized care – each with clear clinical roles. Each facility formed a quality improvement team which addressed gaps in quality of care through testing of changes to care delivery using a Plan-Do-Study-Act cycle. Teams were supported through regular coaching and mentorship visits by CHS/URC and district coaches. QI teams measured improvement against performance monitoring indicators defined by MoH and WHO guidelines and shared progress against these indicators at quarterly learning sessions. A Skills/Learning Lab was established at the RRH to facilitate learning and enhancing skills of health workers in the region.
Through the work of the network, facilities were able to achieve substantial improvements across inputs, processes and outcomes of care within one year. The impressive results, include:
- The number of facilities with an adequate neonatal resuscitation surface increased from 3 to 14 (100%) facilities.
- The availability of other key resuscitation tools also increased. Initially, 71% of facilities had a functional resuscitation bag, 7% had a mask, and no facilities had a penguin sucker. By the end of the project, these tools were available in 100% of facilities.
- Availability of essential drugs like ampicillin and gentamicin at 14 facilities increased from less than half to 85% and 100% respectively.
- Correct use of a partograph to monitor labor increased from 30% deliveries to 83% of 350 deliveries sampled.
- Correct dose of dexamethasone for 96 (87%) of 110 cases of threatened preterm births at end line compared to 67% (8/12) initially.
- Kangaroo care (skin-to-skin) provision increased from 7% to 100%.
- Delivery of essential newborn care also improved significantly, with 92% of providers washing their hands prior to delivery compared to none before.
Overall, reduction in unnecessary referrals due to improved capacity of lower facilities to manage newborn babies as all health centers and hospitals established basic newborn care units. Most importantly, we observed a reduction in fresh still births and institutional newborn deaths.
The experience of the Regional Learning Network in organizing newborn care in two levels of care, using quality improvement techniques and hands-on skills training to improve maternal and newborn care provides useful insights to other health facilities and regions in similar setting seeking to improve care for mothers and newborns.
To learn more about how health care providers and improvement teams can plan, test, implement, continuously assess, refine, and sustain interventions to improve care of mothers and babies, check out this guide on Improving Care of Mothers and Babies from the Survive & Thrive Network.