Document

Report
NATIONAL NEWBORN CARE
UPDATE JAN 2015
@ 18 MONTHS
N R RHODA
NEONATAL CARE IMPROVEMENT ADVISOR
NDOH - RMCH
TTM 19TH JANUARY 2015
CONTRACT
REQUIREMENTS?
• Newborn care (NBC) added in July 2013
with appointment of nCIA
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OBJECTIVES
 Goal #1: Develop a platform for the national
co-ordination of neonatal care within NDOH
by means of structures and function.
 OBJECTIVE 1:
• Conceive , design and facilitate the establishment of a national neonatal
forum under the Child directorship within MCWHN - ie National
Neonatal Co-ordinating Committee (NNCC) and include the global and
national partners and NGOs in NBC
• Develop a National policy framework - 5 pillars of newborn care
 OBJECTIVE 2:
Allow for the co-ordination of the NNCC with the National perinatal
Morbidity and Mortality meetings (NaPeMMCo)
OBJECTIVES
Goal # 2: Improving the Quality of Care of
newborn health care/services at all levels
 OBJECTIVE 3:
Dissemination of standard treatment guidelines and protocol of care to support
implementation of Good Clinical Governance practices (enabling environment)
 OBJECTIVE 4:
Capacity building and improving skills to care for sick and small newborns
• OBJECTIVE 5:
Undertaking quality improvement activities such as mortality audits and infection
control dashboards evaluations
• OBJECTIVE 6:
Support for equipment and supplies—standards for newborn care: CPAP etc
 OBJECTIVE 7:
Data driven decision making: planning, implementing (key interventions) and
monitoring
•
OBJECTIVE 8:
Supporting demand creation activities through health promotions and removing
barriers to access—WBOTS, outreach teams, mHealth, etc.
OBJECTIVES
Goal # 3: Support the monitoring and
evaluation systems using the DHIS and
PPIP data
 OBJECTIVE 9:
DHIS data quality - Evaluate the current DHIS data flow
from facility upwards to NDOH in order to identify the
bottlenecks
 OBJECTIVE 10: -in progress
Documenting lesson learned and best practices
TECHNICAL ASSISTANCE PACKAGE
Health systems
• Advocacy: National - structure formation + Policy input
• Provincial approach – Groups ABCD
• District – strengthen DCST Paed + Paed Nurse + Midwive
• Facility based data driven action plans
Clinical
• Capacity building
– Provincial master trainings – HBB+MSSN
– National roll out for coverage at facility level
– Midwives – HBB and MSSN routine care
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LESSONS LEARNT
• Don’t take process for granted – establishing an enabling
environment is paramount
– Employment of nCIA at start of programme would have made a
difference
– Setting up NBC structures across the continuum is critical
• National - 1 year
• Provincial - ongoing
• District – led by the DCST so best access
– Finance for roll out of interventions
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LEGACY - INSTITUTIONALISATION
NATIONAL
Focus on NBC and incorporating
NBC in all maternal
Structure at NDOH
POST
FORUM
Appointment of Assistant
Director post within NDOH
National Neonatal Coordinating Committee
(NNCC) – chaired by DD
MCWH
PROVINCIAL
no dedicated NBC champion
The need to focus on NBC and
incorporating NBC in all maternal
Structure at provincial DOH
MCWH provincial meetings
DISTRICT
Appointment of DCST dyads
– Paediatrician
- Paed nurse
Varies per province – DMT,
MCWH-Propemmco
FACILITY
-
Functional
PNMM
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POLICY TRANSLATION
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HPCSA / SANC
Input to the update of the MBChB undergraduate curriculum for NBC
Milani Wolmarans: (NDOH Chief operations officer)
Input to the new and essential NBC data elements for DHIS
Clinical NBC expertise for geographic mapping using the neonatal signal functions
Introduction of NBC quality of care indicators
Highlight the need for surveillance surveys eg: Congenital Syphilis
Dr Carol Marshall (NDOH office of standards compliance)
Inclusion of the NBC standards to the national core standards
Dr Lesley Bamford (NDOH equipment Bid committee)
Developing the CPAP package for district hospitals
Input to the bid specifications and tender process
Raised awareness of a the need for an equipment maintenance MOU with tender companies
Dr Terence Carter (DDG tertiary hospitals)
Creating a platform to discuss the neonatal neurosurgical agenda
Highlighting the need for planning of tertiary services for the next 20 years
Dr Pearl Holele
A core member of the National Task team for the “State of Midwifery in South Africa” – a relook at the
maternal directorate policy and structure Provided input to the “ideal neonatal structure” by submitting
with permission of the Western Cape HOD Dr Engelbrecht – the neonatal levels of care, case definitions
and competencies at all levels of care.
All these discussions are pivotal to addressing and correcting the NBC problems within NDOH
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GAPS – objectives
• OBJECTIVE 5:
Undertaking quality improvement activities such as mortality audits and
infection control dashboards evaluations
• OBJECTIVE 6:
Support for equipment and supplies—standards for newborn care: CPAP etc
65 targeted hospitals for CPAP provision - none have received to date!
 OBJECTIVE 7:
Data driven decision making: planning, implementing (key interventions) and
monitoring
• OBJECTIVE 8:
Supporting demand creation activities through health promotions and removing
barriers to access—WBOTS, outreach teams, mHealth, etc.
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GAPS – key
• National : Ability to perform central planning and strategy
Equipment procurement eg: CPAP May 2013
• Province: Appoint the provincial paediatricians to lead
Establishment of a provincial NBC teams that includes – MCWH,
Paed lead, RTC and DCST NBC and plan according to HHAPINeSS recommendations
Data verification and audit by appointed audit co-ordinators
Involvement of the DCST in provincial planning sessions
• District:
Use of 7 step implementation booklet & the SAINC toolkit
Robust M&E at district level
• Facility
Roll out of CPAP
Task a NBC champion to implementation plan
• Community Task shifting (esp in providing education in NBC according to HHAPI-
NeSS, eg: PTL and steroids, exclusive breast feeding importance and
adherence, ambulatory KMC involvement in getting mothers to book ear
in ANC
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KEY RECOMMENDATIONS
1. ENABLING ENVIRONMENT (STRUCTURES).
NBC leadership at all levels of care
• National – Establish a Neonatal directorate within NDOH
• Provincial – appoint the Provincial paediatric specialist (only 3/9 provinces appointed)
• District – increase uptake of the DCST Paediatrician (only 19/52 districts appointed)
MINIMUM
REQUIREMENT
TO EFFECT
CHANGE
Table 1: % reduction btw 2012/13
Figure: NBC leadership across the LOC
KEY RECOMMENDATIONS
2. RESOURCES
2.1 Financial: Ring fence money for neonatal care (2012 recommendation)
2.2. Human:
2.2.1 Minimum requirements=Prov Paed + 50% Paed DCST
2.2.2 Appointment of a provincial data co-ordinator
3. CO-ORDINATED PLAN – in progress already
3.1 National neonatal implementation and monitoring plans √
3.2 Standardised Provincial plans √
3.3 Strategic District plans X
3.4 Facility plans √
KEY RECOMMENDATIONS
4. TRAINING – in progress
4.1 Prioritise national roll out of newborn interventions in all districts
4.1.1.Reducing Asphyxia - increase coverage of HBB to 50% by March 2015.
4.1.2.Reducing Premature birth – “preterm package”:
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Tocolytics to all mothers in Preterm labour
Antenatal steroid use at PHC, CHC and DH especially
CPAP implementation
MSSN training in districts
4.1. 3 Reducing Infection prioritise hand washing
5. MONITORING AND EVALUATION –
5.1 Standardised template across the country aligned with ENAP NBC
indicators
5.2 Led by the DCST
MONITORING AND EVALUATION
• Indicators
1. Quality of care indicators (PPIP)
– Intrapartum care (FSB>2,5kg)
– Neonatal resuscitation (FSB+ENNDR >2,5kg)
– Neonatal facility care (ENNDR 1-1499g)
2. Process indicators
– Newborn signal functions
– HBB
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Amount of HBB master trainer
Amount of people HBB trained
Amount of facilities HBB trained
Amount of facilities with 1 HBB facilitators
3. Outcome indicator
Early NNDR
What must be maintained in order to
sustain the reduction in perinatal deaths?
• National :
– Central planning and strategy
– Maintain the 2 forumso NNCC for co-ordination of national NBC with partners
o NaPeMMCo for communication with provinces and development of
national recommendations
• Province:
– Task of the provincial paediatric lead clinician to develop NBC
plan according to HHAPI-NeSS recommendations
– Data verification and audit by appointed audit co-ordinators
– Involvement of the DCST in provincial planning sessions
– Establishment of a provincial NBC teams that includes – MCWH,
Paed lead, RTC and DCST
What must be maintained in order to
sustain the reduction in perinatal deaths?
• District
TA package: strengthening 6 NBC pillars
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Use the 7 step implementation neonatal booklet to renew the action plans
Use the SAINC toolkit to track progress in NBC at district level
Task a NBC overseer to do M&E and evaluate NBC practices at facility level
Oversee the CPAP roll out (DCST)
• Facility
– Task a NBC champion to implementation plan
– Allow data analysis and discussion at facility level to continue
- Ensure widespread use of the newborn care guidelines
Community
– task shifting (esp in providing education in NBC according to HHAPI-NeSS,
eg: PTL and steroids, exclusive breast feeding importance and adherence,
ambulatory KMC involvement in getting mothers to book early in ANC
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THANK YOU

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