national rollout to strengthen basic emergency obstetric and newborn care in ethiopia. tyigzaw....
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Supporting the National Rollout toStrengthen Basic Emergency
Obstetric and Newborn Care inEthiopia: Collaborative ProjectTegbar Yigzaw, Hannah Gibson, Alemnesh Tekleberhan,Moltotal Mekuria, Mintwab Gelagay, Abdo Bedru, AmarechGashaw, Tadele Bogale, Nega Tesfaw, Hone Belete
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Presentation Outline
Background
Project Description
Results Challenges and Lessons Learned
Conclusions
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I. Background
Population: 87 million (PRB, 2012)
MMR: 676/100,000 live births (CSA, 2011)
Skilled attendance: 10 % (CSA, 2011) Only 10 % of facilities met criteria for fully
functioning EmONC services (MOH, 2008)
Facilities lacked essential equipment and/or skilledproviders
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II. Project Description
Reduction of maternal mortalityby strengthening provision of
BEmONC 2 year program (November
2010-June 2013)
Guided by Ministry of Health
and Regional Health Bureaus
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FMOH
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III. Result 1: Establish 15 BEmONC Training
Sites
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Selection 15 hospitals identified based on selection criteria
Assessment 14 of the 15 hospitals assessed
Skillsstandardization
Facility providers trained in BEmONC
10 of the 15 hospitals used as training site
Infrastructurestrengthening
Training materials (anatomic models, midwifery kits
and training facilities) provided to 7 sites
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Result 2: Develop 64 National BEmONC
Trainers Training of trainers
course for 65
providers 16 Midwifery
Association trainers
50 co-trained in
BEmONC courses
Skills standardization
Trainingskillscourse
Mentoredco-trainingexperience
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Trainer development pathway
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Result 3: Training 2000 Providers in BEmONC
82 rounds of BEmONCtraining conducted
24 by Jhpiego and 58 byMidwifery Association
1289 (64.5 %) providerstrained
Post-training phone follow-up of 390 trained providers
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Findings of Phone Follow-up
Most reported they were providing competentBEmONC services
58.7 % and 21.4 % reported lack of essentialequipment and drugs
MVA, newborn resuscitation equipment
MgSO4, Oxytocin, parentral antibiotics
Need for onsite supervision
Low caseload
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Result 4: Strengthen BEmONC in Hospitals
and Health Centers Performance and quality
improvement initiated in 6
hospitals 1st and 2nd module
workshops conducted
45 Px each (6-9 per facility)
Assessments and gapfilling interventions done
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Essential Maternal and Newborn Care
Standards for HospitalsAreas # Standards
Antenatal Care 5
Normal Labor, Childbirth and Immediate Newborn Care 10
Postpartum Care 4
Management of Obstetric Complications 9
Infection Prevention 14
Laboratory 12
Pharmacy 4Human, Physical and Material Resources 8
IEC and Community Participation 6
Management Systems 7
Total 79 10
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Baseline and Internal Monitoring
Assessment Findings (%) in 5 Hospitals
36
2733
68.9
51.9
0
45 52
0
57.3
0
10
20
30
40
50
60
70
80
Assosa Pawie Gambella Karamara Godie
Baseline
Internal Monitoring
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IV. Challenges and Lessons Learned #1
Frequent discussions with MOH, RHBs, UNICEFand EMA helped to identify and resolve
implementation challenges promptly Partnership with EMA contributed to strengthening
local capacity and cost-effective training cascade
Phased approach and PQI to address low
caseload and lack of equipment
Engaging facility providers as co-trainers helped toimprove their cooperation
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Challenges and Lessons Learned #2
Resource and labor intensive training (6 coursesper month, 3 wks duration, 4 trainers)
Develop more trainers, pilot blended course (2 wks) Resource and distance barriers to post-training
support and follow-up
Phone follow-up and support
Trained regional MNH focal persons on supervision
Assuring BEmONC training quality nationally
Standardized national training package
Training of trainers, training site establishment 13
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V. Conclusions
The collaborative is on track to meet targets ofstrengthened BEmONC skills of providers
Partnership with EMA strengthened midwiferycapacity and enabled efficient rollout of training
Lack of essential equipment remains achallenge
Phone follow-up and support works but someneed on-site visit
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Acknowledgement
Ministry of Health
Regional Health Bureau
UNICEF Ethiopian Midwifery Association
Headquarter experts: Sheena Currie, Maya
Tholandi
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