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Maternal, Newborn and Child Health

  • Cultural Sensitivity Builds Confidence in Maternal and Neonatal Health Services in Huehuetenango, Guatemala | Publications

    This short report describes how the USAID Health Care Improvement (HCI) project provided training to physicians on cultural sensitivity in birthing services in Guatemala, which resulted in increased patient satisfaction. In 2009, HCI and the Guatemalan Ministry of Health began a process of continuous quality improvement of care in the Todos Santos Cuchumatán’s Permanent Health Care Center.

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  • Studying Spread of Best Practices for Maternal and Newborn Care from Health Centers to Health Posts in San Marcos | Guatemala | Publications

    The Promotion and Essential Obstetric and Neonatal Care strategy (ProCONE) in Guatemala uses a collaborative learning methodology to improve the quality of maternal and neonatal care in health units and includes a focus on prenatal, postpartum and newborn ambulatory care. During the demonstration phase of this strategy, 25 health units (health care centers, Permanent Health Care Centers [CAP], and one Comprehensive Maternal and Child Health Care Centers [CAIMI]) in the department of San Marcos worked together to improve care. After the demonstration phase, experiences and "best practices" were consolidated into a document and the process continued with a spread phase to 135 health posts and minimal community units.

    This cross sectional study sought to answer 1) how were health posts in the spread phase in San Marcos exposed to the ProCONE strategy, methodology, and interventions from the demonstration phase and 2) what interventions resulting from the collaborative in San Marcos were adopted or replicated by the health posts in the spread phase.
     
    Results:
    The study found that none of the personnel representative of the health posts knew of the best practices document from the demonstration phase. According to health center directors, who coordinated the health districts, health posts were not exposed to the ProCONE strategy through this document, but instead through meetings and in an informal verbal manner from the coordinators or professional nurses of the centers to auxiliary nurses of health posts. The auxiliary nurses of health posts became part of quality improvement teams of the health centers. In health center meetings, the use of medical records and the monthly measurement of indicators were explained to personnel.
     
    Accordingly, of all the changes implemented by health posts, 13% (251) were replicas (identical or similar) of the changes implemented in the demonstration phase and 87% (1699) were new changes. The intervention replicated by most health posts (52%) was training in norms, procedures and/or clinical records of care for infants and young children. The second change most frequently replicated by health posts (48%) was home visits to increase the coverage of care for postpartum women. It is possible that home visits were also implemented in the case of neonates. Most new changes implemented by health posts related to content of care and information, and education and communication (IEC) activities. IEC activities were important to increase the coverage of care.
     
    The study concludes that the expansion of the Basic ProCONE strategy from health centers to health posts in San Marcos was informal and not based on proven and documented "change packages." The study recommends future spread activities make more deliberate use of existing documentation.However, the supposition that increased and more systematic use of best practices documentation leads to better implementation and more improvement in indicators could be the subject of another study. Further, the methodology used in collecting data for this study did not allow for a thorough understanding of the process of reception, adaptation and integration of "best practices" into the daily activities of health units. A complementary case study could gain a better understanding of these processes.

     

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  • Afghanistan| Balkh/Kunduz (Maternal, Newborn, and Child) MNC Community Demonstration Collaborative | Collaborative Profile
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  • Afghanistan| Kabul Maternity Hospital Demonstration Collaborative | Collaborative Profile
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  • Guatemala | ProCONE Basic Spread | Collaborative Profile
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  • Guatemala | ProCONE Complication Demonstration Collaborative | Collaborative Profile
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  • Guatemala | ProCONE Community Spread Collaborative | Collaborative Profile
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  • Mobile Technology & Community Case Management- Solving the Last Mile in Health Care Delivery | Community Resource

    This document is the report from a workshop that brought together public health and mobile technology experts. The group examined how the use of mobile phones and other related technology can improve health care delivery by supporting CHWs and integrated Community Case Management (iCCM) programs. The report presents scenarios that demonstrate how mobile technology can be used to: bridge gaps between suppliers and health providers; give voice to community demands; and, promote recognition of high-performing CHWs.

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  • Community-Based Intervention to Reduce Neonatal Mortality in Bangladesh | Community Resource

    This report summarizes the implementation and findings of the Project for Advancing the Health of Newborns and Mothers (Projahnmo) in Bangladesh. Projahnmo was conceived to test the effectiveness of two different service delivery models of a community-based maternal and newborn care intervention package provided by CHWs, traditional birth attendants and community mobilizers. The study identified an effective model to reach newborns at home after delivery; the authors conclude that it suggests a model for integrated community-based care of newborns in rural Bangladesh.

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  • Improving outcomes of Premature and Low Birth Weight Babies through Kangaroo Mother Care | Publications

    As a component of its work to address neonatal mortality, the USAID Health Care Improvement Project (HCI) is working with Ministries of Health to implement national Kangaroo Mother Care (KMC) programs in five Latin American countries: Guatemala, El Salvador, Honduras, Nicaragua and Ecuador. This short report describes the technical assistance that HCI is providing to support the implementation and scale-up of the KMC program throughout all phases.

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  • Aplicación del Método Madre Canguro en Bebés Prematuros y de Bajo Peso en 4 Países de América Latina | Publications

    Volante sobre los avances del proyecto HCI en la aplicación del Método Madre Canguro en cinco países de América Latina.

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  • Qualitative Process Evaluation of the Implementation and Evolution of Community-Based Quality Improvement for EONC | Afghanistan | Publications

     

    This study proposes to document and describe the development, evolution and early lessons learned from applying modern quality improvement (QI) methods to strengthen coverage, quality, and health systems linkages of community-level maternal and newborn care services in Afghanistan. While QI methods and approaches have been extensively implemented at the facility level for improving maternal and newborn care in developing countries, little is known about best practices for implementing QI at the community level to improve community health worker service delivery, community stakeholder engagement, and critical community linkages to the formal health system. HCI began implementing such activities in Afghanistan and Mali in 2010. This study will use focus group discussions (FGDs) with community-based QI stakeholders as part of data collection to answer two questions: First, what strategies and methods did key stakeholders perceive as effective at facilitating the QI process at the community level? Second, how did CHWs and other key stakeholders modify initially ineffective strategies and methods in order to facilitate community-based QI? The results of this study will be used to determine best practices for future scale-up.
     
    This study uses a mixed methods design, with quantitative data from concurrent study efforts providing a backdrop for the primary qualitative results. The most useful data for improving the efficiency of the community-based QI method is expected to come from consensus as a result of interaction of a group of individuals with knowledge of the community-based QI process at different levels. Focus group discussions will be conducted with CHWs and community stakeholders from four to five health facility catchment areas where community-based QI collaboratives are being implemented. The goal of the FGDs is to elicit responses which will reveal methods and strategies most relevant to the successful implementation of the community-based QI program. 

     

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  • Afghanistan| Maternal Newborn and Child (MNC) Facility Spread Collaborative (2 waves) | Collaborative Profile
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  • Afghanistan| Balkh/Kunduz Facility Maternal Newborn Care (MNC) Demonstration Collaborative | Collaborative Profile
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  • Mali| Community Essential Obstetric and Newborn Care (EONC) Demonstration Collaborative | Collaborative Profile
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  • Mali| Facility Essential Obstetric and Newborn Care (EONC) Demonstration Collaborative | Collaborative Profile
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  • Uganda| Maternal Newborn Child Health (MNCH) Community Collaborative | Collaborative Profile
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  • Expanding the learning: spread of innovations in MNCH to new teams | Nicaragua | Publications

    In 2003 the Nicaraguan Ministry of Health (MINSA), in collaboration with the USAID Quality Assurance Project (QAP) and its successor, the Health Care Improvement (HCI) Project, began establishing continuous quality improvement (CQI) collaborative focusing on essential obstetric and pediatric hospital care in health units. During the initial demonstration phase, a small number of facilities worked together to quickly achieve significant improvements in processes, quality, and efficiency with the intention of disseminating methods and results to other facilities within MINSA during the spread phase, which began in 2004. Both phases ended in 2007, since which HCI has supported post-collaborative CQI strengthening.

    Research questions/objectives:
    This retrospective, descriptive study sought to better understand the spread process. Specifically, it focused on the following research questions:
    1. How was the spread phased organized and developed to disseminate CQI and the better care practices established during the demonstration phase of the collaborative?
    2. What intermediate results were achieved as a result of this spread phase (e.g., efficiency of the spread, an enabling environment for improved services and CQI, and institutional support)?
    3. What results were achieved in relation to the quality of care and implementation of CQI in participating health facilities (e.g., geographic expansion, implementation of CQI and best practices in relation to duration of the spread phase)?
     
    Conclusion:
    During the implementation of the spread phase, QI teams from the demonstration phased continued working within the collaborative and supporting those health units involved in the spread phase, which allowed for immediate transmission of knowledge to spread sites. This motivated and created expectations for spread sites and illustrates that it is not necessary to wait for one phase to end before embarking on the next phase.
     
    In Nicaragua, training of health staff had a greater emphasis on capacity development in clinical processes and less emphasis on QI methodologies, but recommends that both clinical and QI capabilities should be equally emphasized in trainings to support the institutionalization of QI and ensure sustained improvements. 
     
    The regulatory framework, including protocols, guidelines, standards, quality indicators, algorithms, and checklists, was of the utmost importance for dissemination and implementation of best practices as it was closely linked to the standardization of care processes and the sustainability of improvements.
     
    Technical support provided by HCI served a dual purpose: to develop clinical skills of the QI teams at the health units; and to strengthen national and local authorities to manage and supervise the quality of care.
     
    The inter-agency work on spread was essential. MINSA aspired to achieve complete coverage of QI in maternal and child care, which was difficult to achieve as a single institution. Combining resources from several agencies allowed for coverage in 16 of Nicaragua’s 17 SILAIS.

     

     
     

     

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  • Uganda| Maternal Newborn Child Health (MNCH) Facility Collaborative | Collaborative Profile
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  • Evaluation of Medical and Nursing Competencies in Antenatal, Delivery, and Newborn Care in Five SILAIS in Nicaragua | Publications

    In 2005 the Ministry of Health (MINSA) conducted the first study of competencies of health staff who provide maternal and newborn services. Based on these results, MINSA, in conjunction with external agencies and projects, developed norms, protocols, and clinical practice guides which allowed for national-level standardization of clinical competency. In addition, MINSA and other agencies worked together to develop tools for continual monitoring of the quality of services. Five years after this initial evaluation, MINSA was interested to know whether the interventions to improve staff competencies had an impact. This led to a follow-up research question: Has the gap in knowledge and skills among health staff providing services for women during pregnancy, labor and delivery, and post-delivery and for newborns been reduced in five SILAIS (Managua, Chontales, Jinotega, RAAN and RAAS) over the course of five years? The USAID Health Care Improvement (HCI) Project conducted this follow-up evaluation to assess changes over time in knowledge and skills of health care personnel.

     
    This study found significant improvement in competencies for maternal and neonatal care between 2005 and 2010. There was an overall improvement in knowledge from 58% in 2005 to 72% in 2010 and an improvement in skills from 59% in 2005 to 67% in 2010. All of the improvements in scores achieved between 2005 and 2010 were statistically significant, with the exception of breastfeeding for which knowledge was already high (97%) in 2005. Health provider knowledge about breastfeeding, bleeding during the second stage of labor, AMTSL, post-partum surveillance, and prevention of post-partum hemorrhage and sepsis scored above the average of 72%. Knowledge of infection prevention, surveillance during delivery, interpretation of the partograph to identify risk factors, immediate care of the newborn, prevention of neonatal asphyxia, neonatal resuscitation, gestational hypertension, and management of hemorrhagic shock all received scores below the average. These are all contributing causes to maternal and neonatal mortality in Nicaragua. Based on these findings, the report provides recommendations to address these knowledge and skills gaps.
     
    Below is summary report in English. The full Spanish-language version of this report is available here: http://www.hciproject.org/node/2890

     

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