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Child Health Care Improvement Programme in Nkandla hospital

Improvement Report
Mbuso Mntambo

Topics: Maternal, Newborn and Child Health

Region and Country: South Africa

Organization: Nkandla hospital
The Report

Prior to year 2009, there was as high as 10% child mortality in the hospital. This was due to many hospital and patient related factors. Due to lack of audits, these factors were not known with certainty and, consequently, no proactive actions were being taken to address them.


The introduction of an active CHIPP (Child Health care Problem Identification Program) in the hospital laid the foundation for monthly audits of paediatric deaths, using the National Health Guidelines. As a new Programme, there were many challenges such as shortage of clinical audit staff, inadequate hospital operational resources, high incidence of retro-viral disease as well as use of hazardous traditional remedies. Much effort was made to cultivate the culture of clinical paediatric audits in the hospital. The marketing of the program to clinicians and supervisors eventually led to its acceptance and implementation. Since its inception, in the past four years, monthly CHIPP audit meetings are scheduled for the whole year in the hospital calendar.

The driving force behind CHIPP audits is the formulation and implementation of action plans to address modifiable factors identified during the audits. External support from the health region as well as University Research Co. (URC) is pivotal in the implementation of policies and action plans.

In spite of the inherent challenges associated with the rural nature of the area, Nkandla hospital is today used as the benchmark for the CHIPP program by health districts.


See attached full report



  1. It is possible to improve quality of care with the available minimal resources.
  2. Audit of clinical practices coupled with management supervision is essential in health care.
  3. The HIV status of the child is not enough reason to justify mortality.
  4. In order to minimize child mortality, both hospital and patient factors need regular monitoring and addressing.
  5. The main contributing but modifiable factors for child mortality in Nkandla hospital are diarrhoeal diseases, inadequate ante-natal attendance, poor nutrition, use of traditional herbal remedies, late diagnoses as well as the HIV disease.
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