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Maternal, Newborn and Child Health

Author(s): 
Extending Service Delivery
Partners: 
USAID

Topics: Community health workers, Family planning, Training, Maternal, Newborn and Child Health, Reproductive Health

Year: 
2008
Language: 
English

This is a resource for trainers developing in-service training for facility-based healthcare providers and CHWs who already have some basic experience with reproductive health and family planning. It is a reference guide to be used by trainers and can be adapted depending on whether trainees are facility-based or community-based.

Fulltext URL: 
Healthy Timing and Spacing of Pregnancy: A Trainer's Reference Guide
Author(s): 
The Center for Development and Population Activities
Partners: 
The Enable Project, USAID

Region and Country: India

Year: 
2003

Topics: Family planning, Training, Maternal, Newborn and Child Health, Reproductive Health

Language: 
English

This Reproductive Health Manual for Trainers of CHWs was developed by CEDPA to help organizations that provide reproductive health services through the community-based distribution approach, to train their CHWs in reproductive health. The training manual is based on the premise that reproductive health is a fundamental human right and stresses that informed choice, quality of care, and increased sensitivity to women’s needs, focusing on family planning (FP) is an integral part of reproductive health. It includes four modules: 1.

Author(s): 
Prevention of Postpartum Hemhorrage Initiative (POPPHI)
Partners: 
USAID, BASICS

Topics: Community health workers, CHW role, Training, Maternal, Newborn and Child Health

Year: 
2009
Language: 
English

This training guide focuses on building the capacity of CHWs and volunteers to use counseling cards to promote the health of women and newborns at home through preventive care, identification of problems, and seeking appropriate care. The guide trains CHWs to identify and interact with women of reproductive age, as well as their families, community and religious leaders, and health care providers at facilities.

Author(s): 
Syed Moshfiqur Rahman, Nabeel Ashraf Ali, Larissa Jennings, M Habibur R Seraji, Ishtiaq Mannan Rasheduzzaman Shah, Arif Billah Al-Mahmud, Sanwarul Bari, Daniel Hossain, Milan Krishna Das, Abdullah H Baqui, Shams El Arifeen and Peter J Winch
Partners: 
Human Resources for Health

Region and Country: Asia, Bangladesh

Year: 
2010

Topics: Community health workers, Motivation/incentives, Recruitment, Retention of health workers/reducing attrition, Maternal, Newborn and Child Health

Language: 
English

This study investigates reasons for high rates of CHW attrition in Sylhet District in northeastern Bangladesh. The framework presented in this paper illustrates the decision-making process women go through when deciding to become, or continue as, a CHW. Factors such as job satisfaction, community valuation of CHW work, and fulfillment of pre-hire expectations all need to be addressed systematically by programs to reduce rates of CHW attrition.

Fulltext URL: 
Factors Affecting Recruitment and Retention of Community Health Workers in a Newborn Care Intervention in Bangladesh
Author(s): 
Prevention of Postpartum Hemorrhage Initiative (POPPHI)
Partners: 
USAID, BASICS

Topics: Community health workers, CHW role, Training, Maternal, Newborn and Child Health

Year: 
2009
Language: 
English

This document is part of a series that makes up the USAID/BASICS Newborn Health tool kit. The entire toolkit is comprised of a reference manual, technical presentations, facilitator’s guide, participant’s notebook, clinical logbook and tools for monitoring and evaluation.

Author(s): 
Save the Children

Topics: Community health workers, Community involvement, Family planning, Maternal, Newborn and Child Health

Year: 
2010
Language: 
English

The focus of this report is on the critical shortage of health workers in the developing world and the urgent need for more female health workers to save the lives of mothers, newborn babies, and young children. This report identifies countries that have invested in training and deploying more female health workers, shows how these women are delivering lifesaving health care to some of the poorest and hardest-to-reach mothers and babies, and identifies strategies and approaches that are succeeding in the fight to save lives.

Author(s): 
Mann, Vera

Region and Country: India

Year: 
2010

Topics: Community involvement, Training, Maternal, Newborn and Child Health

Language: 
English

The Comprehensive Rural Health Project (CRHP) is a community-based program that provides primary care services utilizing village health workers and mobile health teams. The researchers conducted an impact evaluation of CRHP on childhood mortality over the period of September 1992 and December 2007. They concluded that community-based programs such as CRHP can have a lasting impact on child mortality.

Motorbike ambulance -Saving pregnant mothers lives by saving delay in transfer when urgent interevention is needed

Improvement Report
Author(s): 
Biku Ghosh ( [email protected]) Aberra A Gobeze ([email protected]) , Metasabia Joffe([email protected])
The Report
Problem: 

More than 80% of maternal deaths worldwide are caused by five conditions namely hemorrhage, sepsis, obstructed labor, hypertensive disease of pregnancy and unsafe abortion. Timely intervention is regarded as the key to reducing maternal mortality. Ethiopia is well-known by high maternal, perinatal and infant mortality rates with the risk of 1in 27 women dying in pregnancy.

In Ethiopia more than 80% of people live in rural areas, majority living more than 5km from any health centre (HC) and 20% living beyond 10km. HC are typically between 30- 100 km from any nearby hospital. Access to the HC and subsequent transfer to hospital for seriously ill patients and mother with complications in pregnancy is made more difficult because of lack of any proper road and no ambulance.

During the link’s visit in November 2007 a MOU with the Health centre staff, local health council, the local community and the link was developed to work together to improve delivery of health care in the Yirgacheffe, Alaba and Wondogenet health centres each serving around 100,000 population. During the open discussion with the community leaders, mothers groups and the HC staff recurring theme was serious problem in managing critically ill patient such as patients with complications of pregnancy, following trauma or other serious acute illness due to the absence of any mode of transport for these patients. It was not uncommon for these patients requiring to walk or be carried on makeshift stretcher between 10-20 km to travel to the HC on rough terrain and if needed then from the HC to the hospital which is 60km in the back of a truck only if lucky to have one available. A survey was carried out recently in one of the district hospitals for pregnant mothers with complications who needed urgent obstetric operation. Average time taken for them to reach the hospital, once the decision was made for them requiring transfer, was 8 hours. In some instances it was over 12 hours and in one instance the mother was carried by family on home made stretcher for 14 hours to reach the hospital. I in 5 mothers and 3 in 4 newborns did not survive. The local communities desperately needed help with safe transport of these critically ill patients to improve care and reduce maternal and new born mortality in particular. 

Intervention: 

The  E-Ranger Motorbike ambulance, already used in other African countries, was considered by the link to be the best solution. This is due to relatively low cost, ease of training, low maintenance cost and more importantly being user friendly in the difficult terrain and improper road surface.

In 2008 November the link donated a motorbike ambulance each to Yirgacheffe and Alaba HC, to be followed by one to Wondogenet HC in March 2009, another to Shone HC in November 2009 and a motorbike ambulance each to Chelelektu and Chichu HCs in November 2010.The link is proud to have introduced motorbike ambulance for the very first time in Ethiopia. Initial training of the motorbike ambulance drivers was supported by the link. But since then the already trained drivers train future drivers for other HCs. The cost of fuel, which is minimal and the allowances for the drivers are taken care by the local community. The link has agreed strict guidelines with local community and HC about usage of these important vehicles.

Results: 

Our link coordinators in Ethiopia regularly monitor and report usage of these motorbike ambulances which is also verified by us during our 6 monthly visits to Ethiopia from UK. In November 2010 we visited and evaluated the use of motorbike ambulances in all of the above 4 HCs. In all of these places the motorbike ambulances are regarded by the HC staff and the community as a very special gift and highly valued.  All the vehicles were in good working order although now in need of full servicing which the link has agreed with the local team. By March 2011 between them these motorbike ambulances have so far made over 2200 patient journeys, mostly with pregnant mothers. Many of these have been in the nights and often over 20km distances and in one instance over 40 km. No doubt between them they have so far saved many lives of mothers and babies.

‘We express our appreciation on behalf of benefited mothers and our community. The ambulance service has minimized delay of transportation ------. It has a great economic, social and psychological relief not only for mothers but also for family members, community and the health workers’ 

Wubeshet Mekuria, Head, Gedeo Zonal Health, SNNP Region, Ethiopia 

Few examples of motor bike ambulances benefiting the community:

Alaba - January 2009 –

In the last week of January 2009 in Chobare village 18 year old Shemsia Sultan was going to have her first baby. Unfortunately her labour went on for many long hours without any progress and by the evening she was getting weaker. The nearest medical help was in Alaba health centre 40 kilometers away through poor road conditions and the nearest hospital was over 100km away. Shemsia’s family had heard of the recent arrival of motorbike ambulance in Alaba health centre and the training of the midwives there. They telephoned the health centre in the middle of the night and soon the motorbike ambulance was on its way. Later that night Shemsia gave birth in the health centre, with help from the trained midwife, to her 3kg baby girl. Thanks to the Link donating the ambulance and training the staff, Shemsia did not become part of the statistics for maternal death or serious complications with fistula still so high in Ethiopia.

Yirgacheffe- November 2009:  The community leaders cited an example of use where the husband walked 15km to contact the health centre and motorbike ambulance went to collect the seriously ill pregnant woman from home. It took a total of 1 ½ hours but had a good outcome. The Mayor said he had feedback that there were big celebrations in the village following the mothers return home with the baby, both alive, which has so far been uncommon, and thanked the link for the service.

Another example was cited in Yirgacheffe when a heavily pregnant woman with obstructed labour walked for several miles from her home trying to get to health centre. Nearly 5km from health centre she could not walk any more because of exhaustion. They were spotted by a passerby with a mobile phone who telephoned the health centre and soon the motorbike ambulance came to collect her. Fortunately she also had a successful outcome.

Shone March 2010 - 25 year old Tayech Ermias lives 5km away from Shone health centre. She knew that last year one woman near her home died in labour. ''The woman could not get to the health center in time because of lack of transport. After many long hours in labour by the time her family could bring her to the health center she had already passed away''.

Tayech heard about the motorbike ambulance during her antenatal check up. When she went to labour around 4:00pm her family called to Eshetu, the motorbike ambulance driver, who came within 20 minutes and brought her to the health center. Dawit, the midwife (trained by the link in October 2009) helped her to give birth around 6:00pm to a 3kg healthy baby boy. She stayed at the health center for 3 hours. During these 5 hours the driver waited for her to take her back to her home. She is very happy with whole service and was keen to come back to the health centre to tell her story."

Shone November 2010- We visited 19 year old Workenesh with her one month old boy Yetanette in her home. Workenesh had to use the motorbike ambulance in the middle of the night when she went into labour in her first pregnancy. She spoke very highly of the service she received. Also as she is herself is a community health extension worker, and has already seen the benefit of the motorbike ambulance in Shone for the rural communities with other pregnant mothers. 

Lessons: 

Motorbike ambulances have been ideal solution in rural Ethiopia for transport of pregnant mothers with complications who needed urgent intervention in health care facilities. In rough terrain where there is no proper road these light weight vehicles can be used with ease. They are relatively cheap, easy to maintain and highly valued by the community and the health workers.

The lessons learnt in Ethiopia from our inititaive has been taken forward by other UK health links with other sub Saharan African countries and motorbike ambulances have been introduced in Uganda and to be introduced shortly in Timbaktu and Kenya.

More recently following our contact and request Liya Kebede, World Health Organization's Goodwill Ambassador for Maternal Newborn and Child Health, from USA of Global Philanthropy group, has been very interested in this project and visited Ethiopia last week to see one of our motrobike ambulance being used in a rural health centre and since has discussed with the key people in Ethiopian Govermnent regarding  how more can be introduced.   

Region and Country: Ethiopia

Topics: Maternal, Newborn and Child Health

Year: 
2010
Related Documents: 
application/pdf iconEthiopia motor bike ambulance photos.pdf
Fulltext URL: 
Southern Ethiopia Gwent Healthcare Link

Best improvememt reports from KwaZulu-Natal, Republic of South Africa

Improvement Report
Author(s): 
ntombifuthi
The Report
Problem: 

Improvement occured at Ngwelezana clinic, Ndlangubo clinic, Eshowe PHC service, and Nkandla hospital in KwaZulu-Natal Province, Republic of South Africa. The main aim was to reduce the mortality rate in these facilities.

Intervention: 

Implementation of new PMTCT guidelines at Ngwelezana clinic.

Cervical cancer screening improved at Eshowe PHC facility.

Integration of HIV & AIDS, VCT, STI and TB at Ndlangubo clinic.

TB management at Nkandla hospital.

PMTCT services at the district  level.

Results: 

At Eshowe PHC facility, a total of 688 smears were taken from 2006 to 2010. Out of 688, only six were not received back and five were broken in transit. Abnormalities were detected early.

Proper management of TB: all HIV-positive TB patients are now initiated on co-trimoxazole regardless of CD4 results.

Newly diagnosed patients receive HIV counselling. 

Staff become more motivated and attitudes of staff improved.

Lessons: 

Importance of recording.

Integration of HIV&AIDS, VCT, STI and TB improved the management through early detection.

PMTCT reduces maternal and child mortality rate.

Region and Country: South Africa

Topics: Maternal, Newborn and Child Health

Year: 
2010
Related Documents: 
application/msword iconPMTCT Services at Ngwelezana Clinic
application/msword iconNdlamgubo HIV&AIDS, VCT, STI and TB intergration
application/vnd.ms-powerpoint iconPMTCT Services at District level
application/msword iconProper managemamt of TB reduces mortality rate amongst KZN citizens
application/vnd.ms-powerpoint iconCervical cancer screening at Eshowe PHC facilties
application/msword iconPresentations

Child Health Care Improvement Programme in Nkandla hospital

Improvement Report
Author(s): 
Mbuso Mntambo
The Report
Problem: 

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.

Intervention: 

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.

Results: 

See attached full report

Lessons: 

 

 
  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.

Region and Country: South Africa

Topics: Maternal, Newborn and Child Health

Year: 
2010
Related Documents: 
application/msword iconNkandla Hospital Report