University Research Co., LLC IMPROVING QUALITY OF NEWBORN CARE IN HOIMA REGION THROUGH A REGIONAL LEARNING NETWORK A collaborative effort of Uganda ministry of Health, Save the Children and University Research Company IHI Africa Forum for Quality and Safety Durban, South Africa February 20th 2018 Cutting Edge MNCH programming from across Africa
Uganda is especially burdened by high Neonatal Mortality Years Neonatal Mortality (*UDHS,2016) 2016-2012 27 2011-2007 28 2006-2002 24 Western region where the RLN is being implemented, neonatal mortality 25 deaths / 1000 live births (*UDHS 2011) Uganda has made Significant national-level commitments and policies e.g (National Roadmap for Maternal and Newborn Survival, RMNCH sharpened plan) But Translation from policy to practice is still a challenge! Regional Learning Network AIM: Improved survival and health of mothers and babies in the region Objectives : 1. Employ QI methodology; including a training lab based at the regional referral hospital to address critical gaps in providing high quality MNH care. 2. Produce new knowledge and learning on the best approaches to improve MNH care. 3. To spread, share, and document learning with other Referral Hospitals and lower-level facilities.
REGIONAL LEARNING NETWORK Level 1, All facilities: Essential Obstetric and Newborn Care Kiboga District Level 3, HRR: Advanced Newborn Care Unit Buliisa District A learning and referral Network of: 6 Districts 14 Facilities: 1 Regional Referral Hospital(RRH) 4 District Hospitals 6 HC IVs 3 HC IIIs Developing MNH knowledge/skills: Training center/ skills lab Mentorship Kyankwanzi District HOIMA RRH Masindi District Skills lab Kiryandongo District QI Collaborative 16 MNH QI teams Bi- weekly coaching visits Rapid PDSA Cycles & learning sessions Monitoring monthly indicators Level 2, Health Centers and district hospitals: Basic Newborn Care Units Other engagements Data Quality Assessments District Partner Coordination Community engagements 3
AIM: THE TRAINING/SKILLS LAB. Provide for practical in-service and preservice training for health workers, medical and nursing students Model: Practical setting with hands-on skills combined with theoretical session Curriculum: Comprehensive context specific to MNH 98% (151/157) of MNH health workers trained in the region
FUNCTIONALIZING CQI 14 MNH QI teams formed Meeting weekly, Bi-weekly or Monthly Partograp h use Training in QI methodology Mentor District Coaches Bi-monthly PDSA Cycles Bi- weekly Coaching visits Quarterly Learning Sessions Infection prevention and Control Antenatal Corticosteroids MNH QI Project s Essential Newborn Care Newborn Resuscitation Kangaroo & Care for preterm babies
Progress in Key inputs and processes of Care June 2016 (Baseline) June 2017 (Endline) Knowledge Check Basic Drugs and Supplies Basic Equipment Topic Baseline Endline Baseline Endline Baseline Endline Components of ENC 73% 96% KMC 31% 62% Infection control 84% 100% 77 64 8692 4338 93 50 7 8 100 100 100 72 64 0 77 64 64 92 38 14 14 93 Incubator Oxygen Concentrator oxygen Cylinder infant warmer Resuscitation Equipment Baseline Endline Adequate surface 21% (3/14) 100% Oxygen cylinder 31% (4/14) 62% Bag & Mask 71% (10/14) 100% Penguins 0% 85 % (12/14) Pre-term Care Baseline Endline # cases Identified 30 275 Gestation Age Assessed 0 40% KMC 0% 100% Referred 40% 3% 6
2. Progress in Key Processes of MNH Care %Provision of Essential Newborn Care % Partograph Use to monitor labour Prepacking forms in Admission files Gestation age assessment and use of Antenatal corticosteroids Stock out of Vit K and TEO in some facilities Handover of mothers with Partographs % of Newborns not breathing spontaneously successfully resuscitated % Partographs correctly filled Weekly partograph Review meetings Improved documentation 7 Simulation Drills Faulty BP Machines
3. Progress in outcome indicators in 14 Facilities of the RLN Early Institutional Newborn mortality Fresh Still Births and Partographs correctly filled Deaths due to prematurity and Provision of KMC Set up of Newborn Care Units Reduction in Referrals Identify space within or close to the maternity ward 8 Equip the unit with essential equipment and supplies Provide Newborn care trainings for staff Improve documentation.
Reflections 1. Improvements in the availability of essential inputs, knowledge of evidence-based care among health care providers, and delivery of key MNH services can make a substantial difference to improving the outcomes of mothers and newborns 2. Improving health worker knowledge, skills and work environment boosts confidence, reduces on unnecessary referrals and is a big motivator for health workers 3. The experience of the Regional Learning Network in using QI techniques and hands-on skills training to improve MNH care by tackling the above dimensions of quality demonstrates evidence of this and provides useful insight for spread tp other facilities seeking to improve MNH care in similar settings. A collaborative effort of Ministry of Health Uganda, Save the Children and University Research Co., LLC 9