Presentation on theme: "Good morning everyone…"— Presentation transcript:
1 Making it Happen (MiH) programme Maternal and Neonatal Health Human Resource Capacity Building Good morning everyone….thank you Mr Chairman for those kind words of introduction and warm well come.My name is Charles Ameh clinical lecturer, Obstetrician, public health specialist, deputy Head of CMNH LSTM, a WHO collaboration centre for research in maternal and newborn health with various research activities in 11 countries in Asia and sub-Saharan AfricaI thank the organisers of this meeting for the opportunity to talk about our work in Kenya. I hope to share the experience of CMNH supporting MoH of Kenya to build the capacity of skilled health care workers to provide better quality of care for women and their newborns over the last 8 yearsIt’s a pleasure to be back in Kenya, supporting the great work of colleagues at the MoH and department of health at the countiesCharles A Ameh MB.BS, MPH, DRH, FWACS (OBGYN)Deputy Head, Centre for Maternal and Newborn Health
2 Presentation outline Introduction CMNH MNH interventions LSTM in Kenya ChallengesOpportunitiesAs we move from promises to action, I hope that at the end of this presentation that I will have described a background to our work in Kenya, our experience supporting MoH at various levels, key challenges and opportunities to accelarate progressToday is all about how, rather than does it work, so I will keep stats to a minimum
3 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 drugsNewborn respiratory support available in 72%Assisted vaginal delivery available in only 13%Brief recap of relevant stats from yesterdayInsert differential graph or picture of MMR in Kenya7% of sample hospitalsUNFPA 2014, KDHS 2008/9, KSPA 2010
4 Background Low EmOC knowledge N=881 (PPH=7%, Obstructed labour= 5% )<20%of health care workers be trained in EmONC
5 Determinants of maternal morbidity and mortality We were reminded by various speakers yesterday that there are several determinants of maternal health and they interact at various levels to affect the outcomes. So we need multidimentional approach to improving maternal healthLSTM intervenes at phase 3 and trys to coordinate with other stakeholders/partners working to prevent phase 1 and 2 delays via MoH foraThaddeus and Maine 1994
6 Key CMNH interventions EmONC trainingTOTTraining equipmentFacility improvement fund equipmentCD/quality assurance trainingEmONC training PackageQuality improvement workshopsMPDSRStandard based auditsQuality improvement packageMaking it Happen with Data workshopsMonitoring and evaluation +supervisionMonitoring and evaluationEffect of EmONC training and QI training onSBR, CFR, EOC Signal functions, deliveriesKnowledge and skills retention studyOperational research
7 EmONC training“Great emphasis on acquiring skills through repetition and in hands-on practice”Based on the ‘Behaviorist approach’ to learningLearners are rich resourcesCBT uses a problem rather than a subject centered approachAdult learning is collaborativeUses experiential techniques of inquiry (Knowles 1978)
8 Trained trainers and Course Directors Quality assured process, multidisciplinary, aim to get 10 trainers per county, 8 trainers and 1 Course Director required per course, database maintained of certified trainers by RMHS unit and LSTM
9 Training Equipment/Mannequins Airway Management TrainerUterine Pelvic Model (Boney Pelvis)Obstetric Phantom & Fetal DollCostOne Full Set of Equipment - £18,500 ≈ Kshs. 2,692,675Lucy & Lucy’s Mum - £3,000 ≈ Kshs. 436,650Obstetric Phantom - £700 ≈ Kshs. 101,885Venous Cut Down Pad - £60 ≈ Kshs. 8,733LogisticsItems not always available locallyReplacement Mannequins from the UKValueNo other training equipment at facility/venueLarge numbers of participants trainedLucy & Lucy’s Mum,
11 Making it Happen with Data workshop One day workshopTo increase the awareness of good quality data collected in facilitiesTo improve the skills of health care providers to manage and use the data collectedSo that is a bit about LSTM, what have we done in Kenya so far
12 LSTM in Kenya MiH II 2012-15 Western Central EHS 07-10NyanzaMiH I 09-1110 Level 5 HCFKenya Harmonized curriculum 2012MiH IIWesternCentralCompetency based training in Kenya since 2007DFID funded HSS programme, limited to six districts in Nyanza province,Introduced EmONC Training, equipment, SS, Support to MDR
13 Essential Health Services Kenya DFID funded HSS programme,limited to six districts in Nyanza province,Introduced short competency based EmONC training programmeEmONC training equipment,Supported MOH to analyze national maternal death reviewsBased on this success of the short EmONC training package, it was to be scaled up and evaluated at level 5 hospitals nationwide
14 LSTM in Kenya MiH II 2012-15 Western Central EHS 07-10NyanzaMiH I 09-1110 Level 5 HCFKenya Harmonized curriculum 2012MiH IIWesternCentralCompetency based training in Kenya since 2007DFID funded HSS programme, limited to six districts in Nyanza province, Training, equipment, SS, Support to MDR
15 MiH programmeGoal: Reduce Maternal and Child mortality Objective: To improve the availability and quality of Emergency Obstetric Care and Newborn CareMulti-countryMiH: Maternal and Neonatal Health Human Resource Capacity BuildingAim: The Making it Happen programme, funded through DFID, contributes to a reduction in maternal and newborn mortality and morbidity (MDG4 and MDG5) by increasing the availability and improving the quality of Essential (Emergency) Obstetric and Newborn Care (EOC&NC).
16 ‘Making it Happen’ programme Introduced and evaluated simultaneously in Kenya and 5 other countries from 2009 (countries in red) and from 2012 six other countries were added all in SSA and Sasia.This is achieved by delivering a country adapted competency based training package to improve healthcare providers’ capacity to deliver EOC and early NC.
17 University of Zimbabwe Making it Happendelivered in partnership with:FMOH NigeriaHMB FCT Abuja NigeriaUniversity of ZimbabweFunds for implementation are largely from UK Aid, UNICEF and UNFPA Acknowledgement and implemented through the RH/MNH programmes of the various National governments, UN agencies, research institutions and professional medical associations in these countriesWith funds gratefully received from
18 MiH outputsOutput 1: Increased health service provider capacity to provide Emergency Obstetric and Newborn Care (EmONC)Output 2: Increased availability of EmONC for mothers and babiesOutput 3: Strengthened accountability for results with increased transparencyOutput 4: Strengthened capacity to sustain improvements in maternal and newborn health service deliveryOutput 5: Evidence generated by programme disseminated in order to inform national, regional and global agendaMIH implemented in country x from 2012 to 2015 has 5 outputs
19 MiH Phase 1: 2009-2011 All 8 provinces 10 level 5 CEmOC hospitals EmONC trainingMaster trainers and training equipmentSupportive supervisorsMonitoring and evaluationSo back to Kenya5 sets of training equipment, distributed to 10 intervention sites, used for primary training and retraining by trained supervisors and Master trainers within those institutions. Capacity of MoH in terms of supervision was strenghtened
20 Lessons learnt from MiH phase 1 Optimal training impact:Critical numbers need to be trainedLocal supervision capacity criticalEmOC equipment provision in sync with trainingPre-service training input requiredHealth system challengesPoor coordination of in-service EmOC trainingPoor quality of HCF recordsWeak maternal death review systemThese formed the basis for design of phase 2Based on the results from phase 1, there was enough evidence and momentum to revised the national uorriculum, and harmonise the various EmOC training packages
21 LSTM in Kenya EHS 07-10 Nyanza 10 Level 5 HCF MiH I 09-1110 Level 5 HCFKenya Harmonized curriculum 2012MiH IIWesternCentralBut harmonisation of all EmONC training programmes in the country had to be achieved, improving coordination, developing training standards and monitoring these standards
22 National EmONC training Curriculum The EmONC curriculum was launched in 2012Standards for EmONC trainingMentorship packageLSTM supported MoH to formally adapt the LSTM EmOC training package, the national curriculum was published in 2012, other training materials have been adapted similarly from the LSTM materials with some input from other existing materials. LSTM has supported MoH to draft standards for running such training based on her extensive experience in internationally and in KenyaFHIWHOJiepigo/MCIP
23 LSTM in Kenya EHS 07-10 Nyanza 10 Level 5 HCF MiH I 09-1110 Level 5 HCFKenya Harmonized curriculum 2012MiH IIWesternCentralCompetency based training in Kenya since 2007DFID funded HSS programme, limited to six districts in Nyanza province, Training, equipment, SS, Support to MDR
24 15 Counties 3 Provinces Level 3-5 HCFs MiH phase 2:15 Counties 3 Provinces Level 3-5 HCFsCounties located in 3 former provinces were selected for support of MiH by DFH MOPHS
25 MiH phase 2: Key challenges so far Poor coordination of MNH partnersLow standards of trainings among MNH implementing partnersPoor maintenance of EmOC training equipmentLack of investment in EmOC training equipment and TOT poolObtaining permission for training from MoH in timely mannerPoor retention of trained maternity care workers post trainingHowever key challenges encountered are….
26 Coordination and mapping Who, what, where?11 organisation providing EmoNC trainings3 providing country wide coverageMost Nairobi & Rift Valley (6)Least in Eastern/Coast counties (1)Follow up with partners, to update and share information regularly
27 Key achievements in phase 2 Database of Master trainers created for MoH and countiesCMNH provides technical advice to other EmONC implementation partnersSharing training equipmentSupports MoH to map and coordinate EmONC training partnersIdentify input for support to pre-service trainingPS KenyaDANIDASCAMREFWorld bankICAPChristian AidFunzo KenyaUniversities UoN and Musindo Muliro UniversityFH/Options Kenya
29 MiH national expansion phase: 2014-18 All 47 counties in KenyaSupport to National level MPDSR/QI coordinationSupport programme M&ESupport pre-service EmONC trainingOffice expansion consistent with scale up.By region: all the 5 additional regions in Phased approachCommences 1 Region Q (Nairobi)Three additional Regions in Q2 ( NE/RV/Coast )1 Region in Q 3 (Eastern)Q3 2014: All regions active.
30 DFID MNH Programme coordination Steering groupImplementation working group
31 Coordination: County input DFID Kenya MNH SPLSTMUNICEFSP Innovation fundCounty Health forumsCHMTsMoHTWG RH/MNHHRH/RH ICCImplementing so far started from 15 counties and good welcome, support and engagement with counties so far
32 MiH national scale up phase: Challenges so far Training qualityPoor selection of traineesTraining impactPoor staff retention after trainingLack of EmOC equipment post trainingTraining costSecurity concernsLack of investment in training equipment and Master trainersTraining venues
33 Summary Multi-dimensional approach to improving maternal health needed Quality of care determines 3rd delayKnowledge and skills of SBA in EmOC is poorBoth pre and in-service interventions requiredStructures for sustained in-service training system set up at county levels
34 Recommendations for action and sustainability National policy to consolidate and sustain interventionDesignated accredited training centresCompulsory periodic training in EmOC-with shared responsibilityAnnual practice license linked to appropriate CPD trainingModified staff rotation policy to ensure staff retention post training
35 Action for counties for accelerated impact Support/provide venues for trainingProper staff selection for EmONC trainingsSupport and synchronize delivery of EmOC equipment with trainingImproved coordination of EmOC training partnersStorage and maintenance of training equipmentAdvocate with relevant bodies for policies to sustain interventions
36 Acknowledgements Division of family health Reproductive and Maternal Health Services UnitCounty RH coordinatorsCounty Directors of HealthDFID, UNICEFLSTM Kenya and Liverpool Teams
Maternal Deaths & Maternal Death Surveillance and Response (MDSR): Definitions, the National Guidelines and Action Plan Midwife in Sudan. UNFPA www.evidence4action.net/wp-content/uploads/2011/09/en_SOWMR_ExecSum.pdf.
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