essential newborn package of care - child health...
TRANSCRIPT
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Essential Newborn Package of Care Anne Robertson Limpopo Initiative for Newborn Care, Child Health Priorities Conference, 4th December 2015
+ “Confessions of the Package Thief” These were stolen or borrowed from....
disguised and repackaged by....
where possible you have been acknowledged
There is nothing new and original
Thanks to those individuals and organisations who have allowed and supported us
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Overview of presentation
What is the Essential Newborn Care Package?
What is MSSN? ( Management of Sick and Small Newborns)
Why did we develop the package?
For whom is the plan developed?
How did we develop the package?
What is in the package?
Important components?
Who uses the package?
What is new?
How can you contribute to and use the package?
+ What is the Essential Newborn Care Package?
“Essential newborn care is the care required by all newborns in the first 28 days of life, if they are healthy, or if they are sick or small. It includes the care they require to prevent illness in the newborn period and later on in life. This care takes place at home, in clinics, and in hospitals. Some newborns require intensive or specialised care in a tertiary unit. We strive for equal access to essential and specialised newborn care.”
Package
Collection of “useful material” that will help you “WALK THE TALK”
for all who work with newborns and have newborn babies
Package is dynamic
Can be unpacked, repacked, downsized, upsized
+ Why did we develop the newborn care package?
Newborn care services are very different dependent on where you are born.
Urban areas a 1200 g baby with RDS will receive NICU in a tertiary hospital
Rural area a 1200 g baby with RDS will receive basic newborn care in a district hospital maternity sideroom
Care and outcomes are vastly different
There was a need to assist rural provinces in developing newborn care services
norms and standards
guidelines, protocols
training
job aids
+ How did we develop the package?
Evolved over time – packaged and repackaged
First the norms and standards
Guidelines
Job aids
Targetted frontline health workers, mentors, leaders, managers
Who has been involved to date in the development
LINC Team members
Limpopo DoH
Consultants
Saving Newborn Lives
Unicef
Centre for Rural Health
National Department of Health
RMCH
Many others
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What is in the package?
Norms and standards
Guidelines
Training package
Tools and resources
Additional materials
How to improve newborn care
Assessment
Monitoring
Accreditation
+ Norms and standards Essential care
Essential newborn care services
Levels of care
Hospital facilities
Number of beds
Infrastructure
Equipment
Human resources
Numbers
Skills
Infection prevention and control
Standard Clinical Care
Neonatal transfer and transport
How the norms and standards were developed
Work done by Perinatal Priorities association 1990’s
NDoH committee in 2000..
Compared with and discussed with colleagues from other provinces – especially KZN
Research on maternity staff numbers – Dr Greenfield
International texts and materials
Consultation with experts
Developed before OSHC – not yet compared them
+ Implementation Plan: Stepwise
Set up a team
Leadership for process and planning
Developing a vision for newborn care
Advocacy for action
Assessing the situation
Norms and standards
Tool
Infrastructure / equipment
Services
Staffing / skills
Quality of care
Data / quality of data
Developing an action Plan
Implementing the action plan
Strengthening the health care environment
Strengthening health worker competencies
Tracking progress and accreditation
Inputs
Outputs
Outcome
Impact
+ HHAPINESS implementation package
H – Health System
H – Human Resources
A – Asphyxia – prevention and care
P – Premature – prevention and care
I – Infection - prevention and care
NES – NEonatal Survival - monitoring
S – Social determinants and community engagement
Aligning different processes into one strategy – HHAPINeSS Plans
National Newborn Care framework and plan
Provincial, District and Facility Plans
Assessment, Support and Monitoring of HHAPINESS
For use by DCST or outreach team
+ HHAPINESS and other approaches
Facility Assessment and Support tool
Using it in Limpopo, FS, and EC
Able to do quarterly monitoring to identify good quality of care and bottlenecks
Developing an APP to facilitate easier monitoring of all elements of newborn care
HHAPINeSS Indicator Target for Q2 Q2 14 Q1 Q2 Q1 Q2 Q1 Q2 Q2 14 Q2 Q2
H – Health Systems
Leadership Facility Plan and Vision
Plans Good
Snr Doctor in NNU
Neonatal Unit manager
Paediatricians Reg Hosp
> 3 2 n/a na
Obstetricians Reg Hosp
> 3 n/a na na na
Financing Neonatal plan funded Fully funded
Infrastructure Infrastructure assesnment FAST 2
Facility Assessed
54 65 59 59 69 75 76, 78 75 76 63
Infrastructure development plan
plan
Equipment Equipment assessment FAST 3
> 80% 88 68 39 89 63 63 60 64 60 55 65
Equipment aquisition plan
> 60%
Supplies and drugs
Drugs and supplies FAST 4
> 80% 88 63 71 74 64 79 85 96 78 80
Infection control Infection Assessment FAST
> 80% 97 67 74 72 63 61 81 74 68 87
HHAPINeSS Indicator Target for
2015 / 2016 Q2 Q2 Q1 Q2 Q1 Q2 Q1 Q2 Q2
A-asphyxia
Resucitation equipment FAST 10
>80% 79 89 79
Quality of intrapartum care
TBD
P-prematurity
Quality of premature care FAST 7
>60% 87 n/a 58 62 72 70 45 76
KMC unit >80% 87 67 74 55
Quality of KMC FAST 8
>80% 87 90 50 64 78 76 55 77
No of CPAP machines
>40% 1 3 3 1 1 1
Quality of CPAP implementation TBD
Use of Antenatal steroids
>80%
+ Newborn care charts: Routine care at birth and Management of sick and small newborns
+ Job Aids:
Comprehensive record
Front page, ballard, bilirubin charts, KMC Score, HIE, Etc
Neonatal observation charts
Posters
Ward register
Monthly data summary sheet
All available for you to adapt to your facility, district or province
+ Skills Development
Helping Babies Breathe – from the American Academy of Pediatrics
Learner workbook
Facilitator Chart
Osce Assessments
Implementation Package
Neonatalie resources
Facilitator training course
Helping Babies Breathe Advanced trraining
Management of sick and small newborns
Training package
Training modules
Exercise modules
Materials for running a course
Presentations
Facilitator material
Facilitator training package
Helping Babies Breathe Management of Sick and Small
Newborns
+ Skills development cont
CPAP training module
Pumani Bubble CPAP training package
Pumani CPAP implemenation package
Materials for doctors training
NELS
Perinatal Education Programme
CPAP Other
+ E-learning in development
MSSN training package
Modules will be placed on an e-learning and ICATT type platform
Doctors
Nurses
Practical component will still be required
Video material still required
Will be available on LINC and other websites or on a DVD
Other Neonatal e-learning material will be available for CPD
Welcome participation in development of materials
Effective, LOW COST innovations are the answer!
The Pumani bCPAP was developed at Rice University & Texas
Children’s Hospital
●Evaluated at QECH
+ Sensory stimulation and community engagement – in development
Developing a package for parents to use while in KMC
Skin to skin and KMC
Early CHildhood development
Includes video’s, IEC material for mothers and for health workers
Follow up of preterm babies
On-going breastfeeding, growth, and developmental support
+ In – development: Improving antenatal and intrapartum care
Package for pregnant woman on antenatal care, including video’s
For use at PHC clinics, by Community Health workers and health workers
Doulas support by Community Health workers
+ How to use the package
Open it and look at what is there
Use what you need
Adapt it to suit your needs and repackage it
KZN has reinvented a KINC – y version
DCST’s from provinces dip into the “dropbox” and adapt to their needs
+ Where to get the package?
Newborn care Charts – from National DoH
Essential Newborn Care Quality Improvement Toolkit
Training material - DCST Dropbox
HHAPINeSS tools and monitoring – DCST Dropbox
Linc Website – from January 2016 www.lincare.co.za
+ Your role in developing the package
Share your innovative materials and tools that you have developed
e.g Walk the Talk productions .....ask some kids about newborn care
KZN – Charts for tablet use etc etc
VIdeos
ECD materials
Breast feeding resources
Maternal Health materials
Planning a network where we can easily access resources which we can package
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