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Reproductive and Maternal Health Services Unit Making it Happen (MiH) programme Maternal and Neonatal Health Human Resource Capacity Building Charles A.

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Presentation on theme: "Reproductive and Maternal Health Services Unit Making it Happen (MiH) programme Maternal and Neonatal Health Human Resource Capacity Building Charles A."— Presentation transcript:

1 Reproductive and Maternal Health Services Unit 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

2 Reproductive and Maternal Health Services Unit Presentation outline Introduction CMNH MNH interventions LSTM in Kenya Challenges Opportunities

3 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

4 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

5 Reproductive and Maternal Health Services Unit Determinants of maternal morbidity and mortality Thaddeus and Maine 1994

6 Reproductive and Maternal Health Services Unit Key CMNH interventions EmONC training TOT Training equipment Facility improvement fund equipment CD/quality assurance training EmONC training Package Quality improvement workshops MPDSR Standard based audits Quality improvement package Making it Happen with Data workshops Monitoring and evaluation +supervision Monitoring and evaluation Effect of EmONC training and QI training on SBR, CFR, EOC Signal functions, deliveries Knowledge and skills retention study Operational research

7 Reproductive and Maternal Health Services Unit EmONC training

8 Reproductive and Maternal Health Services Unit Trained trainers and Course Directors

9 Reproductive and Maternal Health Services Unit Training Equipment/Mannequins Lucy & Lucy’s Mum, Obstetric Phantom & Fetal Doll Airway Management Trainer Uterine Pelvic Model (Boney Pelvis)

10 Reproductive and Maternal Health Services Unit Facility improvement fund equipment

11 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

12 Reproductive and Maternal Health Services Unit LSTM in Kenya EHS Nyanza MiH I Level 5 HCF Kenya Harmonized curriculum 2012 MiH II Nyanza Western Central

13 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

14 Reproductive and Maternal Health Services Unit LSTM in Kenya EHS Nyanza MiH I Level 5 HCF Kenya Harmonized curriculum 2012 MiH II Nyanza Western Central

15 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

16 Reproductive and Maternal Health Services Unit ‘Making it Happen’ programme

17 Reproductive and Maternal Health Services Unit With funds gratefully received from Making it Happen delivered in partnership with: FMOH Nigeria HMB FCT Abuja Nigeria University of Zimbabwe

18 Reproductive and Maternal Health Services Unit 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

19 Reproductive and Maternal Health Services Unit MiH Phase 1: All 8 provinces 10 level 5 CEmOC hospitals EmONC training Master trainers and training equipment Supportive supervisors Monitoring and evaluation

20 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

21 Reproductive and Maternal Health Services Unit LSTM in Kenya EHS Nyanza MiH I Level 5 HCF Kenya Harmonized curriculum 2012 MiH II Nyanza Western Central

22 Reproductive and Maternal Health Services Unit National EmONC training Curriculum The EmONC curriculum was launched in 2012 Standards for EmONC training Mentorship package

23 Reproductive and Maternal Health Services Unit LSTM in Kenya EHS Nyanza MiH I Level 5 HCF Kenya Harmonized curriculum 2012 MiH II Nyanza Western Central

24 Reproductive and Maternal Health Services Unit 15 Counties 3 Provinces Level 3-5 HCFs MiH phase 2:

25 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

26 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

27 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

28 Reproductive and Maternal Health Services Unit DFID MNH programme ( ) LSTM UNICEF TBD SP EmONC training National scale up HSS Bungoma, Turkana, Homabay Kakamega, Garissa, Nairobi Coordination role Innovations fund Bungoma county

29 Reproductive and Maternal Health Services Unit MiH national expansion phase: All 47 counties in Kenya Support to National level MPDSR/QI coordination Support programme M&E Support pre-service EmONC training

30 Reproductive and Maternal Health Services Unit DFID MNH Programme coordination Steering group Implementation working group

31 Reproductive and Maternal Health Services Unit Coordination: County input LSTM UNICEF SP Innovation fund DFID Kenya MNH SP CHMTs County Health forums TWG RH/MNH HRH/RH ICC MoH

32 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

33 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

34 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

35 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

36 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

37 Reproductive and Maternal Health Services Unit Thank you Asante sana!

38 Reproductive and Maternal Health Services Unit Additional slides: Scaling up targets Regions 3+ 5 EOC training sites (37 additional sets) EOC 3500 (6200)5504 (7520) TOT 180 CD MiH data QI Baseline surveys 410


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