System Strengthening for BFHI by the Diet Clinic, Uganda

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Improve Maternal, Newborn and Child Health requires strengthening the health systems in most countries. This is being done in Uganda using BFHI and linking it to EMNoC, PMTCT and IMCI in Kitgum district.

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System Strengthening for BFHI by the Diet Clinic, Uganda

  1. 1. CONTRIBUTION TO SYSTEM STRENGTHENING THROUGH THE BABY FRIENDLY HEALTH FACILITY INITIATIVE A CASE OF KITGUM DISTRICT Ministry of Health
  2. 2. Presentation outline • • • • • • • Introduction Situation Analysis snap shot System strengthening Health system opportunities to implement BFHI Linkage of IMCI, EMNoC, IYCF and eMTCT to BFHI Current status of implementation What lies ahead? 5/02/2013 2
  3. 3. Introduction • Women and children play a crucial role in development. Therefore; – Investing more in women’s and children’s health is not only the right thing to do; • it also builds stable, peaceful and productive societies. • Yet; – Every year 9.2 million children in the world die before their fifth birthday, as do – more than half a million pregnant women. Source: Lancet 5/02/2013 3
  4. 4. Situation is not any different in Uganda • Child mortality – Under five mortality rate is 90 per 1,000 live births – Infant mortality rate is 54 per 1,000 live births • Maternal health – Maternal mortality ratio is 438 per 100,000 live births – Contraceptive prevalence rate is only 30.0% – Antenatal care coverage: four or more visits by any provider 47.6% – Unmet need for family planning 34.3% 5/02/2013 Source: UDHS 2011 4
  5. 5. How about Kitgum District • The morbidity rate among children is at 66.9% • 70.1% of the mothers exclusively breastfed • 15% of newborns are never breastfed • 27.2% of children in Kitgum are fully immunized • Full ANC (4 visits) attendances, 12% Source: EAMNCH Baseline Report, 2011 5/02/2013 5
  6. 6. Kitgum situation cont.…. • 97.7% of health workers have no capacity to implement BFHI • 68.8% have not received any mentoring • Health facilities have no IEC materials on IYFC – 5 health facilities have not maternity registers • Low staffing levels – Only 4 general doctors in the district • Only 2 functional theatres 5/02/2013 Source: BFHI Baseline Draft Report 2013 6
  7. 7. What have we not done right? – How much time and resources do we spend innovating knew interventions and systems? – And what are our perceptions to the current systems? How about strengthening the health systems just like we do for our own “body systems”! 5/02/2013 7
  8. 8. System strengthening • Access, coverage, quality, or efficiency of interventions for improved maternal and child health outcomes can be achieved if; – Initiatives and strategies that improves one or more of the functions of the health system – Look at the mothers and child as one • Integration of BFHI, IMCI, EMNoC, eMTCT among others • In Uganda; – health-system strengthening activities however focus and clarity are critical. are encouraging, – System strengthening is apriority in The National health policy. 5/02/2013 8
  9. 9. Why health system strengthening for BFHI • BFHI is framework to improve interventions for the mothers and child others • BFHI requirements are based on strengthening health system positive practices for sustainability of programs • Provided an opportunity for the system to be evaluated 5/02/2013 9
  10. 10. Health system opportunities to implement BFHI At National level (Ministry of Health) – Basing on lessons learnt from past experience of implementing BFH – Technical officers from Nutrition, Child Health, and Reproductive Health divisions – National materials (Training packages, IEC and supervisory tools) – Cluster meetings (MCH and Nutrition) 5/02/2013 10
  11. 11. Opportunities cont.… At Kitgum district – Committed district leadership – Established Health facilities (1 Government hospital, 1 Non-for-profit hospital, 1 HC IV, 8 HC IIIs and 10 HC IIs.) – Human resource despite the low staffing levels – Partners (NGO and Local government support) – Community linkages 5/02/2013 11
  12. 12. Linkage of IMCI, EMNoC, IYCF and eMTCT to BFHI EMNoC (Goal-oriented ANC, delivery in facility) IYCF Requirements 4, 5, 6, 8, 9, 11 Exclusive breastfeed, positioning and attachment Requirements 12, 3, 4, 7 “Mother-baby friendly” facility (BFHI) Requirements 1, 2, Requirements 14, 15, 16 Requirement 9, 13 IMCI Vitamin A, immunization, CHC 5/02/2013 eMTCT HIV and Infant Feeding 12
  13. 13. Current status of implementation Orientation of the district on BFHI • MoH contribution – Pledged support to the district and provided platform for consultation and guidance • Kitgum district contribution – District informed and committed – Identified officials to guide implementation in the district 5/02/2013 13
  14. 14. Status cont.…. Baseline study in the district – District role • Coordinated study especially communicating to health facilities • Validating the data collected • Key system findings – Inadequate capacity to implement BFHI, IMCI and EMNoC – Irregular and poor quality supervision – Lack of equipment especially for resuscitation 5/02/2013 14
  15. 15. Status cont.…. Capacity building for Health workers on BFHI – Technically guided by MoH officials – District Trainer facilitated some sessions – Over 60 health workers trained 5/02/2013 15
  16. 16. What Lies Ahead? Build capacity of health workers in;  IMCI; (47.7% not trained) ⁻ Using ICATT EMNoC (81.8% not trained) ⁻ Helping Babies Breathe ⁻ 47.9% of HW offer resuscitation ⁻ Only 25% can confidently offer the service ⁻ Babies born too soon 5/02/2013 ⁻ Only the hospitals have Special care units 16
  17. 17. WHAT LIES AHEAD? • Follow up of the trainees – Assess uses of knowledge attained and address gaps – Review actions plans developed • Mentoring and coaching – Learning sessions based on QI principles • Self-appraisals – Monthly reporting to the district – Trying out mHealth approaches 5/02/2013 17
  18. 18. What lies ahead cont.….. • Internal Assessment of the Health Facilities – MoH evaluating status of implementation • Addressing gaps from Internal Assessment – Strengthening positive practices to address the gaps • Community support group activity evaluation – Strengthening community linkages for improve maternal and child health • External Assessment of the Health Facilities – Accrediting facilities mother-baby friendly centers • Quality check for sustainability – Assessing level of integration and developing plans for sustainability 5/02/2013 18
  19. 19. Thank you 5/02/2013 19

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