Hospitals a catalyst away from kick starting quality improvement
With a little bit of creativity and harnessing locally available resources can be the starting point for improving the quality of care for maternal and newborn health in health facilities.
This is the inference from a recent stakeholder review meeting of the maternal and newborn scale-up (MANeSCALE) project of Makerere University School of Public Health in partnership with ten districts in East Central Uganda with support from Elma Foundation and Social Initiative of Sweden.
MANeSCALE is playing the catalyst towards the establishment of a network of facilities – mostly Health Centre IVs and hospitals which collaboratively work to improve care for mothers and babies through improved referral and quality of care for mothers and babies around the time of birth.
Listing improved monitoring of mothers using partographs, better newborn resuscitation skills, establishing dedicated newborn care rooms or corners, empowering midwives to use antenatal cortical steroids and allowing maternity wings to have buffer stocks of emergency supplies among other reasons for the current improved care indicates that with a catalytic push, quality improvement can be set into motion.
According MANeSCALE Principal Researcher Prof Peter Waiswa, what health workers list as success factors are “home-made” solutions over which the hospitals and health centre IV facilities have greater control.
“It would beat my understanding for a hospital head to for instance prioritise paracetamol over a drug that is used to stop a woman from bleeding. Yet we know that without that drug the woman is going to die,” he argued. “I am happy that through leadership engagement we are seeing health facilities having buffer stocks of essential supplies for maternal and newborn care. Does making this decision require outside influence?”
MANeSCALE and sister projects by Makerere University and partners have provided some catalytic supplies in form of essential equipment and critical medicines, as well as conducting refresher trainings, mentorship and leadership engagement in participating facilities.
With the now built capacity, Prof Waiswa told the meeting, it was time for the health facilities to use the acquired and renewed skills to work towards contributing to the country’s efforts to attain the targets of the WHO Quality of Care Network of which Uganda is part of the initial focus countries.
Though 8 standards, the Quality of Care Network aims to improve experience of care and reduce maternal and newborn mortality in health facilities in target country districts by 50 percent over five years and to halve intra-partum stillbirths.
Commending Makerere University for the various MNCH initiatives, stakeholders argued that continuous medical education is critical in health care and the university needed to create a lasting partnership especially regarding training and mentorship.
“What trainers and mentors bring is not nothing new but the novelty in the person delivering the message and probably the words they are using or emphasis they put matters. Knowledge also decays over time. So, there is a need for this constant sustained training of people and reminding them” noted Dr Andrew Muleledhu, the Kamuli Mission Hospital Medical Superintendent.