systems strengthening for quality mnh service data management kidula... · the problem while kenya...
TRANSCRIPT
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Systems strengthening for quality MNH service data management:
Experience from 4 pilot hospitals
Global Maternal Health Conference Arusha, Tanzania; 16, Jan 2013
Dr. Nancy A. Kidula
Snr. RH/FP Advisor
Jhpiego Kenya
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The problem
While Kenya does have a strong HMIS, indicators collected on MNH at the facility level are limited
data is often incomplete, inaccurate,
reporting is poor- Some indicators not captured
data is rarely available for use in planning
lack of data limits MNH service availability and quality
“Improvement of MNH data management and utilisation” is the top priority of the Kenya MNH Road Map (August 2010)
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Testing a solution
USAID MCHIP is partnering with DRH/MOPHS
to pilot an MNH surveillance system in Kenya
GOK/DRH
M-CHIP MNH Surveillance
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Step 1: Advocating for change
1. USAID - MCHIP Kenya sought concurrence from DRH/MOPHS for the pilot
2. Site Selection
Used based on predefined criteria
Four public district Hospitals selected
3. Baseline Survey done to assess facility readiness and situation analysis
Map with sites circled
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Results of Baseline Survey
Different versions of MNH data tools in use
Data recording / capturing was inconsistent, incomplete
MOH designated codes were rarely used
Use of the partograph in labour was poor
Health service providers in all facilities
had not received any updates or in-service
training in the BEmONC
National MNH guidelines not available
at point of use
BEmONC equipment sets were incomplete or missing; supplies were lacking or not
available at point of use
Data was rarely utilised at facility level for for
decision making
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Common situation- before intervention
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Step 2: Capacity Building
Workshop
• 3 days
• 5 people from each facility
• Administrator, Nursing officer in charge, Maternity in-charge, Medical records, midwife
• Introduced importance of data management
• How to generate data
• Practicum: Shared their data sets and challenges
Site Visits
• Participants identified site specific problems
• Participants identified areas that did not require project help
• Procurement of basic supplies;
• reorganisation of services;
• maternal and perinatal death audits,
• communication etc;
Onsite Interventions
• Training:
• Data management and use
• Service skill updates in key MNH interventions
• e.g., Pre-eclampsia, neo-natal resuscitation, etc.
• Tools
• Job aids, guidelines, policies
• Data collection tools (sup. Register, data use wkbk,
Supportive supervision and
mentorship
• Weekly visits from the MCHIP/MOH team
• Worked with all clinical staff
• Observation and on-job coaching
• Feedback sessions and discussion
• Training on MNH skills
• Monthly Data Supervision visits
• Worked with records personnel and nurses
• Reviewed reporting tools
• Audited summary tools
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Results:
Outputs: At least 60 health workers
have been updated in EmONC skills and in data management
Procured basic equipment and supplied
Reorganized work flow
Outcomes:
More complete and accurate reporting of MNH indicators including the partograph use
Data is being used at the facilities for decision making- MDR; timely referrals, partograph
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Well and fully completed partograph
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Box with emergency supplies for management of ecclampsia ready for use in the labour ward
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Maternity Registers appropriately & well filled
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Data Reporting and presentation enhanced; facilitates interpretation and use
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Impact
? Reduced Maternal and Perinatal Morbidity and Mortality
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Quotes from the field
“We were practicing witchcraft before the
HBB training.” (Dr at Makindu Hospital)
“The updates have really helped us . some of us are retiring and had never been
updated. You are removing us from mud.” (Matron at Gilgil Hospital)
“ As nurses we feared magnesium sulphate but
now we can use it and save lives.”
(Nurse-in-charge Makindu maternity)
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Key Insights
Numbers alone are not useful – they have to
be good numbers
What makes a GOOD number?
Common definition of what the indicator is
attempting to capture
Everybody is counting the same thing in the
same way
E.g. Asphyxia and resuscitation
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Conclusion
For an effective MNH surveillance system, data management skills building MUST BE accompanied by:
1. Clinical skills standardization &
2. Systems strengthening
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Acknowledgements
DRH/MOPHS- Kenya
Administration and Staff of Naivasha, Makindu, Gilgil and Kangundo Hospitals
USAID MCHIP- Washington- Barbara and Maya
USAID MCHIP Kenya team
Jhpiego Kenya Thank you all for listening
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