Transcript Tier 1 - Kenyatta National Hospital

Status and Preparedness of the
Kenya health System to Support
Critically ill neonates
R Nyamai
NCAHu
07 Feb 2014
Scope of Presentation
• Magnitude of problem in Target Population
• The interventions aimed at better outcomes
for neonates
• The health System-Kenyan Context
• Policy environment
• The health system performance for neonatal
care
Maternal and Child Mortality in kenyaKDHS 2008
•Maternal mortality is 488/100,000 live births
•Neonatal mortality is 31/1000 live births
•Infant mortality is 52/1000live births
•Under five mortality is 74/1000 live births
Trends in under fives and infant
mortality from 1990-2008-9 - Kenya
Kenya Health System organization
Gazeted names
KEPH
Standards
Current
Proposed
National Referral
Hospital
Level 6
Tier 4
Provincial General
Hospitals
Level 5
Tier 3
District Hospitals
Level 4
Tier 3
Sub-district Hospitals
Level 4
Tier 3
Health Centres
Level 3
Tier 2
Dispensaries
Level 2
Tier 2
Community
Level 1
Tier 1
The Health System-Kenya context
•
•
•
•
•
•
Human resources
Medical products and other technologies
Finance
Service delivery
Health information System
Leadership and governance
High Impact Interventions targeted at
Neonates
Hand washing with soap by caregiver
Newborn temperature management
Early initiation and EBF
Antibiotics for neonatal infections
Newborn resuscitation
Antenatal steroids
ARV prophylaxis

Priority High Impact Interventions for neonates
by Level of Care, and Intervention Area
Community-L1 (Tier 1)
Newborn temperature
management
Hand washing with soap by
caregiver
Early initiation and EBF
Level 2;3;4 (tier 2 and 3)
Hand washing with soap by
caregiver
Temperature management
Antibiotics for neonatal
infections
Newborn resuscitation
 ARV prophylaxis
Policy environment
Guidelines
• Mother child Booklet
• Integrated Community case Mangement Manual
• Integrated Management of Childhood Illness (IMCI)
Guide for healthcare workers August, 2012 Edition
• Ministry of Health Basic Paediatric Protocols for ages
up to 5 years July 2013
• GOK Clinical Management and Refferal Guidelines 2009
• Managing Newborn Problems WHO A guide guied for
doctors Nurses and midwives
• Pocket Book of Hospital Care for children WHO
Case management of the small young
infant
Integrated Management of Childhood Illnes
• iCCM
• IMCI
• ETAT+
The 6 major steps in IMCI Case
Management approach
1.
2.
3.
4.
5.
6.
Assessment
Classification
Identify Treatment
Treat the child
Counsel the mother
Follow Up care
Sick Young Infant
Assessment at the community
• Watch for signs often found in sick young
babies and refer
Classification at the outpatient
•
•
•
•
•
Make decision on severity of illness
Colour coded triage system
Pink-Admission or pre-refferal treatment
Yellow-Specific medical Treatment and adcice
Green- not serous, mostly no drugs needed,
advice mother
System Readiness for Neonatal Care
•
•
•
•
KDHSs
KSPA surveys
Rapid assssment
Targeted supervision
Safe Delivery
KDHS 2008
• 43% of Births are conducted in a health
Facility
• 56% of births take place at Home
KSPA survey 2010
• Weighing the newborn, Rooming in, vit A to
were well practiced across the facilities
• Newborn respiratory support available in
92%of Hospitals
• New born respiratory Support available in 7
out of 10 facilities offering delivery services
• External heat source was available in 67%of
Hospitals
Facility Readiness
17 level 4 and five Hospitals rapid survey
• 64% of the NBU nursing staff had inadequate
knowledge to resuscitate a newborn baby
• Although 88% of the facilities had a
resuscitation tray ready for immediate use,
only 41% of facilities had an up to date
resuscitation tray check list
• Only 11 hospitals had sterile delivery packs for
inpatient mothers
Findings from Hospital reforms
supervision
2009
2010
2012
%Hospital with at least two rooms for
admitting sick neonate and preterm
27
47
66
% of PGHs with 10 functional incubators
26
85
100
% of hospitals with at least one oxygen
source in the newborn unit
46
86.3
100
% of hospital with basic paediatric protocols
immediately available at clinical area
38
80
96
Challenges in Scaling up
•Health Systems Challenges
Human resources- numbers, skills, attitude,
Health Financing
Reliable Data
Referrals
Commodity security
Governance
gaps at community level service delivery
•Access
Geographic, Financial, Cultural
Low male involvement
•Multi-sectoral challenges
Infrastructure, safe water, status of women
Thank you
Table 2a: Cost Effective Preventive Interventions: Lancet 2003
Breastf eeding
ITM
Complementary f eeding
Zinc
Clean delivery
Hib Vaccine
Antenatal steroids
Water Sanitation Hygiene
New born Temperature Management
Tetanus Toxoid
Nevirapine and replacement f eeding
Antibiotics f or premature rupture of membranes
Antimalarial f or IPT in pregnancy
0%
5%
10%
15%
Neonatal contribution to underfive
mortality in Kenya
Distribution of causes of deaths among under fives in kenya, 20002003
26,000
3%
babies die
per yr in
the first
24% month
5%
Neonatal causes
HIV/AIDS
Diarrhoeal diseases
measles
20%
malaria
pneumonia
15%
14%
injuries
0thers
3%
16%