Integrating improvement methodology into the Essential Care for Every Baby (ECEB) Protocol

Jorge Hermida, M.D.

Senior QI Advisor, MNCH, and Latin America Regional Director, USAID ASSIST Project/URC

In May I had the pleasure of participating in and presenting at the Essential Care for Every Baby (ECEB) workshop, on behalf of URC and the USAID ASSIST Project in Addis Ababa, Ethiopia. The four -day workshop was organized jointly by USAID, MCHIP, the American Academy of Pediatrics, Save the Children, and the Laerdal Foundation. The objective was to introduce nearly 100 delegates from MOHs and cooperating agencies from 10 African countries to this newly developed training program on essential newborn care based on latest WHO guidelines. It gave me great pleasure to have the opportunity to present and lead discussions about what a quality improvement approach entails, why it’s critical to newborn health, and how the quality improvement approach can be applied to the ECEB protocol to improve its implementation and quality.

Essential Care for Every Baby Workshop held in Addis Ababa, Ethiopia. Photo by the American Academy of Pediatrics.

Too often health care organizations assume that just by training personnel on a new care intervention it will be widely implemented and that such implementation will be of high quality. In reality, it is much more likely that training alone will result in poor levels of implementation and that quality could be compromised. Thus the basic point I made was that training is one of the inputs –necessary but not sufficient- to ensure improvement in the way care is provided to the newborn. In addition, several other inputs will be necessary, and what is even more important, is that the actual process of providing newborn care needs to be constantly examined, and its quality measured and systematically improved. This is what a quality improvement approach to ECEB is, and I believe it will result in much higher chances of implementation and quality, and thus any investment in it is worthwhile. 

In leading a small group working session on the topic of measuring the quality of the process of newborn care, I asked participants to identify a feasible indicator related to inputs, one related to process and one related to results in relation to the ECEB protocol, and concrete major obstacles to the implementation of ECEB related to quality. All groups were able to produce important examples of indicators, such as the existence of working scales or vitamin K –for inputs; and the percentage of babies that were correctly classified as having danger signs and given the right antibiotic –for processes. One group even experienced putting together a “bundle” indicator, grouping several actions that need to be taken when preventing disease in a newborn, such as eye care, cord care and giving vitamin K.  

A consensus was reached that it is absolutely necessary that a quality improvement approach be included together with the clinical training for successful implementation. For me this was a sign that integrating improvement methodology into the ECEB clinical training package was a success.  The main take-away from the workshop is that clinical training - including the knowledge and skills of health workers - is necessary but not sufficient, and that a method for continuous monitoring and improvement of newborn care is absolutely needed. This was something that was very clear and well accepted by organizations and participants in attendance at the ECEB workshop.

It seemed that the improvement methods and tools we have developed at URC over the course of the USAID Health Care Improvement Project and now through the USAID ASSIST Project were easily understood and manageable by participants who didn’t have a strong background in quality improvement.  And as a result, I believe that quality improvement should and will be linked to the future rollout of ECEB. I hope that we can continue to collaborate to further with this work, including streamlining our USAID ASSIST quality improvement training module to fully integrate improvement science with the ECEB clinical training in the expected rollout of ECEB in Africa and elsewhere.
 

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