Uganda| Maternal Newborn Child Health (MNCH) Facility Collaborative
The overall aim of the MNCH Facility Collaborative is to contribute to the reduction of neonatal and maternal mortality in Uganda in two pilot districts, Masaka and Luwero.
The specific objectives of the collaborative are as follows:
1. Reduce the number of babies who die in the first month of life by:
a) Increasing proportion of newborns who receive evidence-based ENC, including resuscitation of asphyxiated newborns
b) Improving capability of birth attendants and CHWs who are able to resuscitate babies and who are able to identify danger signs and manage newborn infection.
2. Reduce number of women who get post-partum hemorrhage
3. Link pregnant mothers to HIV counseling and testing
Findings of a situation analysis of maternal, newborn, and child health care in two districts, Masaka and Luwero, suggested care providers were not adequately skilled in the provision of essential newborn care. To address this, MNCH district coaches with assistance from HCI, rolled out training in Active Management of Third Stage Labor (AMSTL) and Essential Newborn Care (ENC) including resuscitation using the Helping Babies Breathe method (HBB) and the use of locally made newborn doll and pelvis models. In early 2011, health care workers in the participating facilities were trained in MNCH, ENC, HBB and quality improvement (QI) methods. Following this training learning session 1 of the collaborative was held in April, 2011. A collection of tools were developed to assist with the delivery of this care; these tools include the MNCH coaching guide, newborn resuscitation job aids, and standard registry documents (see attached document for examples of each).
The key intervention measures tracked by teams include the following:
1. Number of babies who die in the facility within first month of life
2. Number of babies who receive 3 components of essential newborn care
3. Number of babies put to the breast within first hour of life
4. Number of mothers who can state 3 newborn danger signs
5. Number of babies examined by a skilled provider at 4- 7 days after birth
6. Number of health workers who have resuscitation skills
7. Number of facilities with soap and water / hand rub for hand hygiene
8. Number of women who get post-partum hemorrhage (PPH)
9. Number of mothers in whom active management of third stage of labor (AMSTL) was provided.
10. Number of pregnant women who deliver at the health facility with a known HIV status
• Representation at National Steering committee established to assist in the spread of results
• Representation at Maternal Child Health cluster meetings established to assist in the spread of results
• National Newborn Care Coordinator sitting in Child Health Division of MoH Uganda supported by HCI to coordinate roll out of ENC and HBB newborn resuscitation program nationally
In the two districts, there are a total of 100 health facilities in the MNCH collaborative. Masaka, 33 and Luwero 67. At these clinics, maternal child health services range from antenatal, family planning, deliveries, PMTCT including ART and postnatal services. The Luwero District, population is 416,000 and the Masaka District’s population is 250,000.
As part of a health systems strengthening approach, HCI trained district coaches to take the lead in the facility based coach sessions. Each of the 20 coaches in the districts of Luwero and Masaka have been provided with training from facility improvement collaborative coaches and materials that included: 20 sets of Neonatalie, 20 pelvic and baby models and 20 HBB facilitators’ flip charts. These materials assist the coaches to train other health care providers during the monthly coach sessions. In addition, to improve the records and information management at the facilities, MNCH care providers were trained on Ministry of Health data tools during the clinical training. Emphasis is put, not only on record keeping, but also on the use of data for planning and monitoring of service provision for improvement opportunities.
Through monthly coaching and quarterly learning sessions, district coaches supported 34 health facility quality improvement (QI) teams to improve maternal newborn care. In April 2011, quality improvement teams from each of the facilities attended LS1 which guided participants through the processes of postnatal examination of the mother and the newborn, discussed a list of indicators to show changes and the explained the use of a documentation journal though a case-scenario exercise. LS 2 is being planned to take place in late 2011.
Results reported from participating facilities show marked improvements in the monitored newborn and maternal indicators. Since trainings conducted in February and March of 2011 the following results have been reported:
• More mothers are counseled on danger signs, breastfeeding and linked to HIV testing. Partographs have been introduced at the facilities to better monitor the labor progress and as a reminder to use patient case management forms.
• 61 out of the 70 health facilities that conduct deliveries were provided with newborn and prime resuscitation equipment (Suction device, ventilator bags and masks) increasing the number of health facilities with resuscitation equipment from 23% to 81.4%. A total of 103 newborns were successfully resuscitated in a period of two months (February and March )
• There has been an improvement in the proper use of MOH patient monitoring tools and Continuing Medical Education (CME). To ensure that CME sessions are held regularly at the facilities, some facilities have scheduled two CMEs per month (3 sites) while in 4 sites CME coordinators have been identified to take the lead.
In addition to the above, since LS one, 7 collaborative facilities reported in October 2011 that of 95 babies asphyxiated at birth, 81% of them were successfully resuscitated by the health care workers, with 76% of those successfully resuscitated being discharged alive.