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

[email protected]

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