Transcript Road Map for accelerating the attainment of the MDGs
Making it Happen (MiH) programme
Maternal and Neonatal Health Human Resource Capacity Building
Charles A Ameh MB.BS, MPH, DRH, FWACS (OBGYN) Deputy Head, Centre for Maternal and Newborn Health Reproductive and Maternal Health Services Unit
Presentation outline
• Introduction • CMNH MNH interventions • LSTM in Kenya • Challenges • Opportunities
Reproductive and Maternal Health Services Unit
Background
• 98.7% of maternal deaths occur in 15 counties • Only 50% of government own hospitals have ANC, normal delivery and C/S services (n=690) • 80% have EmoC drugs • Newborn respiratory support available in 72% • Assisted vaginal delivery available in only 13%
UNFPA 2014, KDHS 2008/9, KSPA 2010 Reproductive and Maternal Health Services Unit
Background
• Low EmOC knowledge – N=881 (PPH=7%, Obstructed labour= 5% ) • <20%of health care workers be trained in EmONC
Reproductive and Maternal Health Services Unit
Determinants of maternal morbidity and mortality
Thaddeus and Maine 1994
Reproductive and Maternal Health Services Unit
Key CMNH interventions EmONC training Package Quality improvement package
• EmONC training • TOT • Training equipment • Facility
improvement fund equipment
• CD/quality assurance training • Quality improvement workshops • MPDSR • Standard based audits
Monitoring and evaluation
• Making it Happen with Data workshops • Monitoring and evaluation +supervision
Operational research
• Effect of EmONC training and QI training
on
• SBR, CFR, EOC Signal functions, deliveries
Reproductive and Maternal Health Services Unit
EmONC training
Reproductive and Maternal Health Services Unit
Trained trainers and Course Directors Reproductive and Maternal Health Services Unit
Training Equipment/Mannequins
Airway Management Trainer Uterine Pelvic Model (Boney Pelvis) Lucy & Lucy’s Mum, Obstetric Phantom & Fetal Doll
Reproductive and Maternal Health Services Unit
Facility improvement fund equipment Reproductive and Maternal Health Services Unit
Making it Happen with Data workshop
• One day workshop • To increase the awareness of good quality data collected in facilities • To improve the skills of health care providers to manage and use the data collected
Reproductive and Maternal Health Services Unit
LSTM in Kenya Reproductive and Maternal Health Services Unit
Essential Health Services Kenya
• DFID funded HSS programme, • limited to six districts in Nyanza province, • Introduced short competency based EmONC training programme • EmONC training equipment, • Supported MOH to analyze national maternal death reviews
Reproductive and Maternal Health Services Unit
LSTM in Kenya Reproductive and Maternal Health Services Unit
MiH programme
Goal: Reduce Maternal and Child mortality Objective: To improve the availability and quality of Emergency Obstetric Care and Newborn Care
Reproductive and Maternal Health Services Unit
‘Making it Happen’ programme Reproductive and Maternal Health Services Unit
Making it Happen
delivered in partnership with:
Centre for Injury Prevention and Research, Bangladesh
FMOH Nigeria HMB FCT Abuja Nigeria With funds gratefully received from Reproductive and Maternal Health Services Unit University of Zimbabwe
MiH outputs
• Output 1: Increased health service provider capacity to provide Emergency Obstetric and Newborn Care (EmONC) • Output 2: Increased availability of EmONC for mothers and babies • Output 3: Strengthened accountability for results with increased transparency • Output 4: Strengthened capacity to sustain improvements in maternal and newborn health service delivery • Output 5: Evidence generated by programme disseminated in order to inform national, regional and global agenda
Reproductive and Maternal Health Services Unit
MiH Phase 1: 2009-2011
• All 8 provinces • 10 level 5 CEmOC hospitals EmONC training Master trainers and training equipment Supportive supervisors Monitoring and evaluation
Reproductive and Maternal Health Services Unit
Lessons learnt from MiH phase 1 Optimal training impact:
1. Critical numbers need to be trained 2. Local supervision capacity critical 3. EmOC equipment provision in sync with training 4. Pre-service training input required
Health system challenges
1. Poor coordination of in-service EmOC training 2. Poor quality of HCF records 3. Weak maternal death review system
Reproductive and Maternal Health Services Unit
LSTM in Kenya
Reproductive and Maternal Health Services Unit
National EmONC training Curriculum
• The EmONC curriculum was launched in 2012 • Standards for EmONC training • Mentorship package
Reproductive and Maternal Health Services Unit
LSTM in Kenya Reproductive and Maternal Health Services Unit
MiH phase 2: 2012-15
15 Counties 3 Provinces Level 3-5 HCFs
Reproductive and Maternal Health Services Unit
MiH phase 2: Key challenges so far
• Poor coordination of MNH partners • Low standards of trainings among MNH implementing partners • Poor maintenance of EmOC training equipment • Lack of investment in EmOC training equipment and TOT pool • Obtaining permission for training from MoH in timely manner • Poor retention of trained maternity care workers post training •
Reproductive and Maternal Health Services Unit
Coordination and mapping Who, what, where?
• 11 organisation providing EmoNC trainings • 3 providing country wide coverage • Most Nairobi & Rift Valley (6) Least in Eastern/Coast counties (1) • Follow up with partners, to update and share information regularly
Reproductive and Maternal Health Services Unit
Key achievements in phase 2
• Database of Master trainers created for MoH and counties • CMNH provides technical advice to other EmONC implementation partners • Sharing training equipment • Supports MoH to map and coordinate EmONC training partners • Identify input for support to pre-service training
Reproductive and Maternal Health Services Unit
DFID MNH programme (2014-2018)
LSTM
•EmONC training •National scale up
UNICEF
•HSS •Bungoma, Turkana, Homabay •Kakamega, Garissa, Nairobi •Coordination role
TBD SP
•Innovations fund •Bungoma county
Reproductive and Maternal Health Services Unit
MiH national expansion phase: 2014-18
All 47 counties in Kenya Support to National level MPDSR/QI coordination Support programme M&E Support pre-service EmONC training
Reproductive and Maternal Health Services Unit
DFID MNH Programme coordination
• Steering group • Implementation working group
Reproductive and Maternal Health Services Unit
Coordination: County input
DFID Kenya MNH SP • LSTM • UNICEF • SP Innovation fund County Health forums CHMTs MoH • TWG RH/MNH • HRH/RH ICC
Reproductive and Maternal Health Services Unit
MiH national scale up phase: Challenges so far Training quality
• Poor selection of trainees
Training impact
• Poor staff retention after training • Lack of EmOC equipment post training
Training cost
• Security concerns • Lack of investment in training equipment and Master trainers • Training venues
Reproductive and Maternal Health Services Unit
Summary
• Multi-dimensional approach to improving maternal health needed • Quality of care determines 3 rd delay • Knowledge and skills of SBA in EmOC is poor • Both pre and in-service interventions required • Structures for sustained in-service training system set up at county levels
Reproductive and Maternal Health Services Unit
Recommendations for action and sustainability
• National policy to consolidate and sustain intervention – Designated accredited training centres – Compulsory periodic training in EmOC-with shared responsibility – Annual practice license linked to appropriate CPD training – Modified staff rotation policy to ensure staff retention post training
Reproductive and Maternal Health Services Unit
Action for counties for accelerated impact
• Support/provide venues for training • Proper staff selection for EmONC trainings • Support and synchronize delivery of EmOC equipment with training • Improved coordination of EmOC training partners • Storage and maintenance of training equipment • Advocate with relevant bodies for policies to sustain interventions
Reproductive and Maternal Health Services Unit
Acknowledgements
• Division of family health • Reproductive and Maternal Health Services Unit • County RH coordinators • County Directors of Health • DFID, UNICEF • LSTM Kenya and Liverpool Teams
Reproductive and Maternal Health Services Unit
Asante sana!
www.mnhu.org
Thank you
Reproductive and Maternal Health Services Unit
Additional slides: Scaling up targets Regions 2012-2015
3
2014-2018
+ 5
EOC training sites
6 + 41 (37 additional sets)
EOC TOT CD MiH data QI Baseline surveys
3500 (6200) 180 40 166 180 4 5504 (7520) 180 + 128 + 480 + 480 10
Reproductive and Maternal Health Services Unit