scholarly journals Scaling up newborn care technologies from tertiary- to secondary-level hospitals in Malawi: an implementation case study of health professional perspectives on bubble CPAP

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Mai-Lei Woo Kinshella ◽  
Sangwani Salimu ◽  
Tamanda Hiwa ◽  
Mwai Banda ◽  
Marianne Vidler ◽  
...  
Keyword(s):  
Health Workers ◽  
Health Management ◽  
Scale Up ◽  
Newborn Care ◽  
Secondary Level ◽  
Scaling Up ◽  
Tertiary Hospital ◽  
District Health ◽  
District Hospitals ◽  
Bubble Cpap

Abstract Background While Malawi has achieved success in reducing overall under-five mortality, reduction of neonatal mortality remains a persistent challenge. There has, therefore, been a push to strengthen the capacity for quality newborn care at district hospitals through the implementation of innovative neonatal technologies such as bubble continuous positive airway pressure (CPAP). This study investigates tertiary- versus secondary-level hospital differences in capacities for bubble CPAP use and implications for implementation policies. Methods A secondary analysis of interviews was conducted with 46 health workers at one tertiary hospital and three secondary hospitals in rural Southern Malawi. Grounded theory was utilized to explore the emerging themes according to health worker cadres (nurse, clinician, district health management) and facility level (tertiary- and secondary-level facilities), which were managed using NVivo 12 (QSR International, Melbourne, Australia). Results We identified frequent CPAP use and the availability of neonatal nurses, physicians, and reliable electricity as facilitators for CPAP use at the tertiary hospital. Barriers at the tertiary hospital included initiation eligibility disagreements between clinicians and nurses and insufficient availability of the CPAP machines. At secondary-level hospitals, the use was supported by decision-making and initiation by nurses, involving caretakers to assist in monitoring and reliable availability of CPAP machines. Bubble CPAP was hindered by unreliable electricity, staffing shortages and rotation policies, and poor systems of accountability. Conclusion While this study looked at the implementation of bubble CPAP in Malawi, the findings may be applicable for scaling up other novel neonatal technologies in low-resource settings. Implementation policies must consider staffing and management structures at different health services levels for effective scale-up.

scholarly journals Health workers' views on factors affecting caregiver engagement with bubble CPAP

2020 ◽  
Author(s):  
Sangwani Salimu ◽  
Maggie Woo Kinshella ◽  
Marianne Vidler ◽  
Mwai Banda ◽  
Laura Newberry ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Workers ◽  
Health Management ◽  
Care Providers ◽  
District Health ◽  
Severe Respiratory Distress ◽  
Good Communication ◽  
District Hospitals ◽  
Bubble Cpap

Abstract Background Severe respiratory distress is a leading cause of mortality among neonates in Malawi. Despite evidence on the safety, cost effectiveness and efficacy of bubble continuous positive airway pressure (CPAP) in managing the condition, its use in Malawian health facilities is limited and little is known about caregivers' engagement with perspectives of bubble CPAP. The purpose of this study was to explore caregiver perspectives for bubble CPAP at both central and district hospitals and key factors that enable effective caregiver engagement in Malawi. Methods This was a descriptive qualitative study employing secondary analysis of 46 health care worker in-depth interviews. We interviewed the health workers about their thoughts on caregiver perspectives regarding use of bubble CPAP. We implemented the study at a tertiary facility and three district hospitals in southern Malawi. This was a part of a larger study to understand barriers and facilitators to implementing neonatal innovations in resource-constrained hospitals. Interviews were thematically analysed in NVivo 12 software (QSR International, Melbourne, Australia). Health workers were purposively selected to include nurses, clinicians and district health management involved in the use of bubble CPAP.Results Emerging issues included caregiver fears around bubble CPAP equipment as potentially harmful to their new-borns and how inadequate information provided to caregivers exacerbated knowledge gaps and was associated with refusal of care. However, good communication between health care providers and caregivers was associated with acceptance of care. Caregivers’ decision-making was influenced by relatives and peer advocates were helpful in supporting caregivers and alleviating fears or misconceptions about bubble CPAP.Conclusions Since caregivers turn to relatives and peers for support, there is need to ensure that both relatives and peers are counselled on bubble CPAP for improved understanding and uptake. Health workers need to provide simplified, accurate, up-to-date information on the intervention as per caregivers’ level of understanding. Notably, contextualised comprehensible information will help alleviate caregivers’ fear and anxieties about bubble CPAP.

scholarly journals “Those women have hope in us and if you explain properly, they understand”: Health workers' views on factors affecting caregiver engagement with bubble CPAP

2020 ◽  
Author(s):  
Sangwani Salimu ◽  
Maggie Kinshella ◽  
Marianne Marianne ◽  
Mwai Banda ◽  
Laura Newberry ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Workers ◽  
Health Management ◽  
Care Providers ◽  
District Health ◽  
Severe Respiratory Distress ◽  
Good Communication ◽  
District Hospitals ◽  
Bubble Cpap

Abstract Background Severe respiratory distress is a leading cause of mortality among neonates in Malawi. Despite evidence on the safety, cost effectiveness and efficacy of bubble continuous positive airway pressure (CPAP) in managing the condition, its use in Malawian health facilities is limited and little is known about health workers engagement with perspectives of bubble CPAP. The purpose of this study was to explore caregiver perspectives for bubble CPAP at both central and district hospitals and key factors that enable effective caregiver engagement in Malawi. Methods This was a descriptive qualitative study employing secondary analysis of 46 health care worker in-depth interviews. We interviewed the health workers about their thoughts on caregiver perspectives regarding use of bubble CPAP. We implemented the study at a tertiary facility and three district hospitals in southern Malawi. This was a part of a larger study to understand barriers and facilitators to implementing neonatal innovations in resource-constrained hospitals. Interviews were thematically analysed in NVivo 12 software (QSR International, Melbourne, Australia). Health workers were purposively selected to include nurses, clinicians and district health management involved in the use of bubble CPAP. Results Emerging issues included caregiver fears around bubble CPAP equipment as potentially harmful to their new-borns and how inadequate information provided to caregivers exacerbated knowledge gaps and was associated with refusal of care. However, good communication between health care providers and caregivers was associated with acceptance of care. Caregivers’ decision-making was influenced by relatives and peer advocates were helpful in supporting caregivers and alleviating fears or misconceptions about bubble CPAP. Conclusions Since caregivers turn to relatives and peers for support, there is need to ensure that both relatives and peers are counselled on bubble CPAP for improved understanding and uptake. Health workers need to provide simplified, accurate, up-to-date information on the intervention as per caregivers’ level of understanding. Notably, contextualised comprehensible information will help alleviate caregivers’ fear and anxieties about bubble CPAP. Key words : bubble CPAP, neonates, caregiver, perspectives, peers, Malawi

scholarly journals Perspectives and engagement of caregivers in the care of babies under on Bubble CPAP

2020 ◽  
Author(s):  
Sangwani Salimu ◽  
Maggie Kinshella ◽  
Marianne Marianne ◽  
Mwai Banda ◽  
Laura Newberry ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Workers ◽  
Health Management ◽  
Care Providers ◽  
District Health ◽  
Severe Respiratory Distress ◽  
Good Communication ◽  
District Hospitals ◽  
Bubble Cpap

Abstract Background Severe respiratory distress is a leading cause of mortality among neonates in Malawi. Despite evidence on the safety, cost effectiveness and efficacy of bubble continuous positive airway pressure (CPAP) in managing the condition, its use in Malawian health facilities is limited and little is known about health workers engagement with perspectives of bubble CPAP. The purpose of this study was to explore caregiver perspectives for bubble CPAP at both central and district hospitals and key factors that enable effective caregiver engagement in Malawi. Methods This was a descriptive qualitative study employing secondary analysis of 46 health care worker in-depth interviews. We interviewed the health workers about their thoughts on caregiver perspectives regarding use of bubble CPAP. We implemented the study at a tertiary facility and three district hospitals in southern Malawi. This was a part of a larger study to understand barriers and facilitators to implementing neonatal innovations in resource-constrained hospitals. Interviews were thematically analysed in NVivo 12 software (QSR International, Melbourne, Australia). Health workers were purposively selected to include nurses, clinicians and district health management involved in the use of bubble CPAP. Results Emerging issues included caregiver fears around bubble CPAP equipment as potentially harmful to their new-borns and how inadequate information provided to caregivers exacerbated knowledge gaps and was associated with refusal of care. However, good communication between health care providers and caregivers was associated with acceptance of care. Caregivers’ decision-making was influenced by relatives and peer advocates were helpful in supporting caregivers and alleviating fears or misconceptions about bubble CPAP. ConclusionsSince caregivers turn to relatives and peers for support, there is need to ensure that both relatives and peers are counselled on bubble CPAP for improved understanding and uptake. Health workers need to provide simplified, accurate, up-to-date information on the intervention as per caregivers’ level of understanding. Notably, contextualised comprehensible information will help alleviate caregivers’ fear and anxieties about bubble CPAP. Key words : bubble CPAP, neonates, caregiver, perspectives, peers, Malawi

scholarly journals Stakeholder Perceptions and Context of the Implementation of Performance-Based Financing in District Hospitals in Mali

2019 ◽  
Vol 8 (10) ◽  
pp. 583-592 ◽  
Author(s):  
Tony Zitti ◽  
Lara Gautier ◽  
Abdourahmane Coulibaly ◽  
Valéry Ridde
Keyword(s):  
Reproductive Health ◽  
Health Personnel ◽  
Health Workers ◽  
Health Management ◽  
Participant Observation ◽  
Pilot Project ◽  
District Health ◽  
Performance Based Financing ◽  
District Hospitals

Background: To improve the performance of the healthcare system, Mali’s government implemented a pilot project of performance-based financing (PBF) in the field of reproductive health. It was established in the Koulikoro region. This research analyses the process of implementing PBF at district hospital (DH) level, something which has rarely been done in Africa. Methods: This qualitative research is based on a multiple, explanatory, and contrasting case study with nested levels of analysis. It covered three of the 10 DHs in the Koulikoro region. We conducted 36 interviews: 12 per DH with council of circle’s members (2) and health personnel (10). We also conducted 24 non-participant observation sessions, 16 informal interviews, and performed a literature review. We performed data analysis using the Consolidated Framework for Implementation Research (CFIR). Results: Stakeholders perceived the PBF pilot project as a vertical intervention from outside that focused solely on reproductive health. Local actors were not involved in the design of the PBF model. Several difficulties regarding the quality of its design and implementation were highlighted: too short duration of the intervention (8 months), choice and insufficient number of indicators according to the priority of the donors, and impossibility of making changes to the model during its implementation. All health workers adhered to the principles of PBF intervention. Except for members of the district health management team (DHMT) involved in the implementation, respondents only had partial knowledge of the PBF intervention. The implementation of PBF appeared to be easier in District 3 Hospital compared to District 1 and District 2 because it benefited from a pre-pilot project and had good leadership. Conclusion: The PBF programme offered an opportunity to improve the quality of care provided to the population through the motivation of health personnel in Mali. However, several obstacles were observed during the implementation of the PBF pilot project in DHs. When designing and implementing PBF in DHs, it is necessary to consider factors that can influence the implementation of a complex intervention

scholarly journals Communication between mothers and health workers is important for quality of newborn care: a qualitative study in neonatal units in district hospitals in South Africa

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Christiane Horwood ◽  
Lyn Haskins ◽  
Silondile Luthuli ◽  
Neil McKerrow
Keyword(s):  
South Africa ◽  
Qualitative Study ◽  
Health Workers ◽  
Newborn Care ◽  
Well Being ◽  
Structured Interview ◽  
Observation Data ◽  
Good Communication ◽  
District Hospitals

Abstract Background There is a high global burden of neonatal mortality, with many newborn babies dying of preventable and treatable conditions, particularly in low and middle-income countries. Improving quality of newborn care could save the lives of many thousands of babies. Quality of care (QoC) is a complex and multifaceted construct that is difficult to measure, but patients’ experiences of care are an important component in any measurement of QoC. We report the findings of a qualitative study exploring observations and experiences of health workers (HWs) and mothers of babies in neonatal units in South Africa. Methods A qualitative case study approach was adopted to explore care of newborn babies admitted to neonatal units in district hospitals. Observation data were collected by a registered nurse during working hours over a continuous five-day period. Doctors and nurses working in the neonatal unit and mothers of babies admitted during the observation period were interviewed using a semi-structured interview guide. All interviews were audio recorded. Observation data were transcribed from hand written notes. Audiotapes of interviews were transcribed verbatim and, where necessary, translated into English. A thematic content analysis was used to analyse the data. Results Observations and interviews were conducted in seven participating hospitals between November 2015 and May 2016. Our findings highlight the importance of information sharing between HWs and mothers of babies, contrasting the positive communication reported by many mothers which led to them feeling empowered and participating actively in the care of their babies, with incidents of poor communication. Poor communication, rudeness and disrespectful behaviour of HWs was frequently described by mothers, and led to mothers feeling anxious, unwilling to ask questions and excluded from their baby’s care. In some cases poor communication and misunderstandings led to serious mismanagement of babies with HWs delaying or withholding care, or to mothers putting their babies at risk by not following instructions. Conclusion Good communication between mothers and HWs is critical for building mothers’ confidence, promoting bonding and participation of mothers in the care of their baby and may have long term benefits for the health and well-being of the mother and her baby.

scholarly journals Scaling up interventions for depression in sub-Saharan Africa: lessons from Zimbabwe

2016 ◽  
Vol 3 ◽  
Author(s):  
D. Chibanda ◽  
R. Verhey ◽  
E. Munetsi ◽  
S. Rusakaniko ◽  
F. Cowan ◽  
...  
Keyword(s):  
Health Workers ◽  
Core Competencies ◽  
Scale Up ◽  
Health Care Facilities ◽  
Sub Saharan Africa ◽  
District Health ◽  
Key Stakeholders ◽  
Extensive Consultation ◽  
Sub Saharan ◽  
Hiv Programs

BackgroundThere is a dearth of information on how to scale-up evidence-based psychological interventions, particularly within the context of existing HIV programs. This paper describes a strategy for the scale-up of an intervention delivered by lay health workers (LHWs) to 60 primary health care facilities in Zimbabwe.MethodsA mixed methods approach was utilized as follows: (1) needs assessment using a semi-structured questionnaire to obtain information from nurses (n = 48) and focus group discussions with District Health Promoters (n = 12) to identify key priority areas; (2) skills assessment to identify core competencies and current gaps of LHWs (n = 300) employed in the 60 clinics; (3) consultation workshops (n = 2) with key stakeholders to determine referral pathways; and (4) in-depth interviews and consultations to determine funding mechanisms for the scale-up.ResultsFive cross-cutting issues were identified as critical and needing to be addressed for a successful scale-up. These included: the lack of training in mental health, unavailability of psychiatric drugs, depleted clinical staff levels, unavailability of time for counseling, and poor and unreliable referral systems for people suffering with depression. Consensus was reached by stakeholders on supervision and support structure to address the cross-cutting issues described above and funding was successfully secured for the scale-up.ConclusionKey requirements for success included early buy-in from key stakeholders, extensive consultation at each point of the scale-up journey, financial support both locally and externally, and a coherent sustainability plan endorsed by both government and private sectors.

scholarly journals Digital Health Innovations, Tools, and Resources to Support Helping Babies Survive Programs

PEDIATRICS ◽  
2020 ◽  
Vol 146 (Supplement_2) ◽  
pp. S165-S182
Author(s):  
Sherri L. Bucher ◽  
Peter Cardellichio ◽  
Naomi Muinga ◽  
Jackie K. Patterson ◽  
Anu Thukral ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Nursing Education ◽  
Data Collection ◽  
Health Workers ◽  
Digital Health ◽  
Scale Up ◽  
Newborn Care ◽  
Training Data ◽  
Dissemination And Implementation ◽  
Health Innovations

The Helping Babies Survive (HBS) initiative features a suite of evidence-based curricula and simulation-based training programs designed to provide health workers in low- and middle-income countries (LMICs) with the knowledge, skills, and competencies to prevent, recognize, and manage leading causes of newborn morbidity and mortality. Global scale-up of HBS initiatives has been rapid. As HBS initiatives rolled out across LMIC settings, numerous bottlenecks, gaps, and barriers to the effective, consistent dissemination and implementation of the programs, across both the pre- and in-service continuums, emerged. Within the first decade of expansive scale-up of HBS programs, mobile phone ownership and access to cellular networks have also concomitantly surged in LMICs. In this article, we describe a number of HBS digital health innovations and resources that have been developed from 2010 to 2020 to support education and training, data collection for monitoring and evaluation, clinical decision support, and quality improvement. Helping Babies Survive partners and stakeholders can potentially integrate the described digital tools with HBS dissemination and implementation efforts in a myriad of ways to support low-dose high-frequency skills practice, in-person refresher courses, continuing medical and nursing education, on-the-job training, or peer-to-peer learning, and strengthen data collection for key newborn care and quality improvement indicators and outcomes. Thoughtful integration of purpose-built digital health tools, innovations, and resources may assist HBS practitioners to more effectively disseminate and implement newborn care programs in LMICs, and facilitate progress toward the achievement of Sustainable Development Goal health goals, targets, and objectives.

scholarly journals Effectiveness of self-managed continuous monitoring for maintaining high-quality early essential newborn care compared to supervision visit in Lao PDR: a cluster randomised controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sayaka Horiuchi ◽  
Sommana Rattana ◽  
Bounnack Saysanasongkham ◽  
Outhevanh Kounnavongsa ◽  
Shogo Kubota ◽  
...  
Keyword(s):  
Continuous Monitoring ◽  
Health Workers ◽  
Controlled Trial ◽  
Intervention Group ◽  
Lao Pdr ◽  
Newborn Care ◽  
Essential Newborn Care ◽  
Skill Scores ◽  
District Hospitals ◽  
The Government

Abstract Background Thousands of neonatal deaths are expected to be averted by introducing the Early Essential Newborn Care (EENC) in the Western Pacific Region. In Lao People’s Democratic Republic (Lao PDR), the government adopted the EENC programme and expanded it to district hospitals. With the expansion, maintaining the quality of EENC has become difficult for the government. Methods A cluster randomised controlled trial with four strata based on province and history of EENC coaching was implemented to evaluate the effectiveness of self-managed continuous monitoring compared with supervisory visit in Lao PDR between 20 July 2017 and 2 April 2019. Health workers who were routinely involved in maternity care were recruited from 15 district hospitals in Huaphanh (HP) and Xiangkhouang (XK) provinces. The primary endpoint was the score on the determinants of EENC performance measured by the Theory of Planned Behaviour (TPB). Secondary endpoints were set as the knowledge and skill scores. A linear mixed-effects model was applied to test the effects of intervention over time on the endpoints. Results Among 198 recruited health workers, 46 (23.2%) did not complete the final evaluation. TPB scores were 180.9 [Standard Deviation: SD 38.6] and 182.5 [SD 37.7] at baseline and 192.3 [SD 30.1] and 192.3 [SD 28.4] at the final evaluation in the intervention and control groups, respectively. There was no significant difference in changes between the groups in the adjusted model (2.4, p = 0.650). Interviews with participants revealed that district hospitals in HP regularly conducted peer reviews and feedback meetings, while few hospitals did in XK. Accordingly, in stratified analyses, the TPB score in the intervention group significantly increased in HP (15.5, p = 0.017) but largely declined in XK (− 17.7, p = 0.047) compared to the control group after adjusting for covariates. Skill scores declined sharper in the intervention group in XK (− 8.78, p = 0.026), particularly in the practice of managing nonbreathing babies. Conclusions The study indicates that self-managed continuous monitoring is effective in improving behaviour among district health workers; however, additional measures are necessary to support its proper implementation. To maintain resuscitation skills, repeated practice is necessary. Trial registration This trial was registered at UMIN Clinical Trials Registry on 15/6/2017. Registration number is UMIN000027794.

scholarly journals District health managers perspectives of introducing a new service: a qualitative study of the community-based newborn care programme in Ethiopia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Della Berhanu ◽  
Iram Hashmi ◽  
Joanna Schellenberg ◽  
Bilal Avan
Keyword(s):  
Qualitative Study ◽  
Health System ◽  
Community Health ◽  
Health Workers ◽  
Newborn Care ◽  
District Level ◽  
District Health ◽  
Community Based ◽  
Care Programme

Abstract Background The planning, resourcing, implementation and monitoring of new programmes by district health managers is integral for success and sustainability. Ethiopia introduced the Community-Based Newborn Care programme in 2014 to improve newborn survival: an innovative component allowed community health workers to provide antibiotics for young infants with possible serious bacterial infection when referral was not possible. Informed by the World Health Organization health system building block framework, we aimed to study the capacity and operational challenges of introducing this new health service from the perspective of programme implementers and managers at the district level 20 months after programme initiation. Methods This qualitative study was part of a programme evaluation. From November to December of 2015, we conducted 28 semi-structured interviews with staff at district health offices, health centres and implementing Non-Governmental Organisations in 15 districts of four regions of Ethiopia. Verbatim transcripts were analysed using a priori and emerging themes. Results In line with the government's commitment to treat sick newborns close to their homes, participants reported that community health workers had been successfully trained to provide injectable antibiotics. However, the Community-Based Newborn Care programme was scaled up without allowing the health system to adapt to programme needs. There were inadequate processes and standards to ensure consistent availability of (1) trained staff for technical supervision, (2) antibiotics and (3) monitoring data specific to the programme. Furthermore, Non-Governmental Organizations played a central implementing role, which had implications for the long-term district level ownership and thus for the sustainability of the programme. Conclusion In settings where sustainable local implementation depends on district-level health teams, new programmes should assess health system preparedness to absorb the service, and plan accordingly. Our findings can inform policy makers and implementers about the pre-conditions for a health system to introduce similar services and maximize long-term success.

scholarly journals Constraints, synergies and avenues for scaling up breastfeeding, antibiotics for pneumonia and IMCI interventions in the Cusco region, Peru

F1000Research ◽  
2012 ◽  
Vol 1 ◽  
pp. 60 ◽  
Author(s):  
Giselle Sarganas ◽  
Robert Scherpbier ◽  
Christian A Gericke
Keyword(s):  
Low Income ◽  
Exclusive Breastfeeding ◽  
Rural Areas ◽  
Health Workers ◽  
Local Level ◽  
Health Centre ◽  
Scale Up ◽  
Scaling Up ◽  
System Level

Objective: The purpose of this qualitative case study was to assess the feasibility of scaling up exclusive breastfeeding for 6 months, antibiotics for pneumonia and integrated management of childhood illness (IMCI) child interventions in three districts of the Cusco region, Peru.Methods: During field visits, constraints, synergies and solutions to the implementation of the selected interventions were collected through observational recording and interviews of mothers, health workers, and health managers/decision makers. Results are presented for each intervention according to the health system level where they occurred: mother/community, health worker, health centre, and political/managerial levels.Findings: This case study demonstrates that it is feasible to scale up exclusive breastfeeding, antibiotics for pneumonia and IMCI interventions in poverty-stricken rural areas of a low-income country. Factors that helped and hindered the implementation were identified for each intervention.Conclusions: The need for a coherent multi-sector approach that includes regulation, implementation and monitoring of health policies and education of all involved stakeholders was apparent. This study also demonstrates that global health interventions need to undergo local adaptation. Identifying local constraints and facilitating factors in a systematic way as proposed in this study is a useful step to increase their effectiveness and reach at the local level and to identify areas for improvement in the original intervention policies.

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