Improve Maternal, Newborn and Child Health requires strengthening the health systems in most countries. This is being done in Uganda using BFHI and linking it to EMNoC, PMTCT and IMCI in Kitgum district.
3. Introduction
• Women and children play a crucial role in
development. Therefore;
– Investing more in women’s and children’s health is not
only the right thing to do;
• it also builds stable, peaceful and productive societies.
• Yet;
– Every year 9.2 million children in the world die before
their fifth birthday, as do
– more than half a million pregnant women.
Source: Lancet
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4. Situation is not any different in Uganda
• Child mortality
– Under five mortality rate is 90 per 1,000 live births
– Infant mortality rate is 54 per 1,000 live births
• Maternal health
– Maternal mortality ratio is 438 per 100,000 live births
– Contraceptive prevalence rate is only 30.0%
– Antenatal care coverage: four or more visits by any provider
47.6%
– Unmet need for family planning 34.3%
5/02/2013
Source: UDHS 2011
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5. How about Kitgum District
• The morbidity rate among children is at 66.9%
• 70.1% of the mothers exclusively breastfed
• 15% of newborns are never breastfed
• 27.2% of children in Kitgum are fully immunized
• Full ANC (4 visits) attendances, 12%
Source: EAMNCH Baseline Report, 2011
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6. Kitgum situation cont.….
• 97.7% of health workers have no capacity to implement
BFHI
• 68.8% have not received any mentoring
• Health facilities have no IEC materials on IYFC
– 5 health facilities have not maternity registers
• Low staffing levels
– Only 4 general doctors in the district
• Only 2 functional theatres
5/02/2013
Source: BFHI Baseline Draft Report 2013
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7. What have we not done right?
– How much time and resources do we spend
innovating knew interventions and systems?
– And what are our perceptions to the current
systems?
How about strengthening the health
systems just like we do for our own
“body systems”!
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8. System strengthening
• Access, coverage, quality, or efficiency of interventions for
improved maternal and child health outcomes can be
achieved if;
– Initiatives and strategies that improves one or more of the
functions of the health system
– Look at the mothers and child as one
• Integration of BFHI, IMCI, EMNoC, eMTCT among others
• In Uganda;
– health-system strengthening activities
however focus and clarity are critical.
are
encouraging,
– System strengthening is apriority in The National health policy.
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9. Why health system strengthening for BFHI
• BFHI is framework to improve
interventions for the mothers and child
others
• BFHI requirements are based on strengthening
health system positive practices for sustainability
of programs
• Provided an opportunity
for the system to be
evaluated
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10. Health system opportunities to implement BFHI
At National level (Ministry of Health)
– Basing on lessons learnt from past experience of
implementing BFH
– Technical officers from Nutrition, Child Health, and
Reproductive Health divisions
– National materials (Training packages, IEC and
supervisory tools)
– Cluster meetings (MCH and Nutrition)
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11. Opportunities cont.…
At Kitgum district
– Committed district leadership
– Established Health facilities
(1 Government hospital,
1 Non-for-profit hospital, 1 HC IV, 8
HC IIIs and 10 HC IIs.)
– Human resource despite the low staffing levels
– Partners (NGO and Local government support)
– Community linkages
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12. Linkage of IMCI, EMNoC, IYCF and eMTCT to BFHI
EMNoC
(Goal-oriented
ANC, delivery in
facility)
IYCF
Requirements
4, 5, 6, 8, 9, 11
Exclusive breastfeed,
positioning and
attachment
Requirements 12,
3, 4, 7
“Mother-baby friendly” facility
(BFHI)
Requirements 1, 2,
Requirements
14, 15, 16
Requirement 9,
13
IMCI
Vitamin A,
immunization, CHC
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eMTCT
HIV and Infant Feeding
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13. Current status of implementation
Orientation of the district on BFHI
• MoH contribution
– Pledged support to the district and provided
platform for consultation and guidance
• Kitgum district contribution
– District informed and committed
– Identified officials to guide implementation in the
district
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14. Status cont.….
Baseline study in the district
– District role
• Coordinated study especially communicating to health
facilities
• Validating the data collected
• Key system findings
– Inadequate capacity to implement BFHI, IMCI and
EMNoC
– Irregular and poor quality supervision
– Lack of equipment especially for resuscitation
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15. Status cont.….
Capacity building for Health workers on BFHI
– Technically guided by MoH officials
– District Trainer facilitated some sessions
– Over 60 health workers
trained
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16. What Lies Ahead?
Build capacity of
health workers in;
IMCI;
(47.7% not trained)
⁻ Using ICATT
EMNoC
(81.8% not trained)
⁻ Helping Babies Breathe
⁻ 47.9% of HW offer resuscitation
⁻ Only 25% can confidently offer the service
⁻ Babies born too soon
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⁻ Only the hospitals have Special care units
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17. WHAT LIES AHEAD?
• Follow up of the trainees
– Assess uses of knowledge attained and address gaps
– Review actions plans developed
• Mentoring and coaching
– Learning sessions based on QI principles
• Self-appraisals
– Monthly reporting to the district
– Trying out mHealth approaches
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18. What lies ahead cont.…..
• Internal Assessment of the Health Facilities
– MoH evaluating status of implementation
• Addressing gaps from Internal Assessment
– Strengthening positive practices to address the gaps
• Community support group activity evaluation
– Strengthening community linkages for improve maternal and
child health
• External Assessment of the Health Facilities
– Accrediting facilities mother-baby friendly centers
• Quality check for sustainability
– Assessing level of integration and developing plans for
sustainability
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