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

University Research Co., LLC

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)

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.

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!

Level 1, All facilities: Essential Obstetric and Newborn Care

Level 3, HRR:

Advanced Newborn

Care Unit

REGIONAL LEARNING NETWORK

3

Skills lab HOIMA

RRH

Kiboga District

Masindi District

Kiryandongo District

Buliisa District

Kyankwanzi 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

QI Collaborative

16 MNH QI teams

• Bi- weekly coaching visits

• Rapid PDSA Cycles & learning

sessions

• Monitoring monthly indicators

Other engagements

• Data Quality Assessments

• District Partner Coordination

• Community engagementsLevel 2, Health Centers and district hospitals:

Basic Newborn Care Units

THE TRAINING/SKILLS LAB.

AIM:

• Provide for practical in-service and pre-service 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

• Training in QI methodology

• Mentor District Coaches

• Bi-monthly PDSA Cycles

• Bi- weekly Coaching visits

• Quarterly Learning Sessions

MNH QI

Projects

Partograph use

Essential Newborn

Care

Newborn Resusci-

tation

Kangaroo & Care for

preterm babies

Antenatal Cortico-steroids

Infection prevention

and Control

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Basic Drugs and Supplies Basic EquipmentKnowledge Check

Topic Baseline Endline

Components

of ENC73% 96%

KMC 31% 62%

Infection

control84% 100%

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)

64 64

14 14

77

92

38

93

Incubator OxygenConcentrator

oxygenCylinder

infantwarmer

Baseline Endline

64

86

43 50

7

72 64

0

7792

38

93

8

100 100 100

Baseline Endline

Pre-term Care Baseline Endline

# cases Identified 30 275

Gestation Age Assessed 0 40%

KMC 0% 100%

Referred 40% 3%

Progress in Key inputs and processes of Care June 2016 (Baseline) –June 2017 (Endline)

2. Progress in Key Processes of MNH Care

7

Stock out of Vit K and

TEO in some facilities

Handover of mothers

with Partographs

Weekly partograph

Review meetings

Faulty BP

Machines

Prepacking forms in

Admission files

Improved

documentationSimulation Drills

%Provision of Essential Newborn Care % Partograph Use to monitor labour

% of Newborns not breathing spontaneously

successfully resuscitated % Partographs correctly filled

Gestation age assessment and use of Antenatal

corticosteroids

3. Progress in outcome indicators in 14 Facilities of the RLN

8

Reduction

in Referrals

Identify space within or close to the maternity ward

Equip the unitwith essential

equipment and supplies

Provide Newborn caretrainings for

staff

Improvedocumentation.

Set up of Newborn Care Units

Early Institutional Newborn mortality Fresh Still Births and Partographs

correctly filledDeaths due to prematurity and

Provision of KMC

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.

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A collaborative effort of Ministry of Health Uganda, Save the Children and University Research Co., LLC