Data Driven Quality
Improvement in Uganda
Annie Clark, URC Sr. QI Advisor MNCH
1
What are we trying to accomplish in Uganda?
• Support the MOH and USAID strategy for improving
maternal and newborn health outcomes in Uganda
• Demonstrate the effectiveness of modern quality
improvement approaches in improving maternal and
newborn care at both the facility and community level.
• Operationalize the MOH community strategy
USAID HEALTH CARE IMPROVEMENT PROJECT
Findings of the facility baseline assessment in
Luwero and Masaka districts by HCI/URC in
December 2010
• Standard of newborn care could not be ascertained since
services were not adequately documented at facilities.
• Only 32% of health facilities surveyed had equipment for
resuscitation of newborns
• 46% mothers discharged before 24 hours for facility
deliveries
• Health workers still emphasized postnatal follow-up 6
weeks after delivery
• No mother/newborn and health worker interface during first
week of life for home or facility births except in presence of
danger signs noted by mothers
• Staff unaware of MOH newborn care standards.
USAID HEALTH CARE IMPROVEMENT PROJECT
Facility Collaborative Interventions
Provision of locally made cloth childbirth models for
ENC/AMTSL training
Provision of Helping Babies Breathe training equipment,
educational material and job aids
Equipment supplied to facilities in Masaka and Luwero
Locally Made Newborn Resuscitation Tables. Bag, Masks and
Penguin Suction Device
6
TOT for 20 District Coaches in ENC/HBB/AMTSL and
Quality Improvement
USAID HEALTH CARE IMPROVEMENT PROJECT
Training of 82 providers in ENC/HBB/AMTSL & Quality
Improvement by the Coaches supported by URC/HCI Staff
USAID HEALTH CARE IMPROVEMENT PROJECT
Coaches Preparing Action Plans for Visits to their
Assigned Health Facilities
9
USAID HEALTH CARE IMPROVEMENT PROJECT
Monthly Coaching Sessions of Maternal/Newborn Care
Providers in Masaka & Luwero Districts
10
USAID HEALTH CARE IMPROVEMENT PROJECT
Facility Improvement Collaborative Learning Session
% Newborns who received 3 components of ENC, initiated early BF, and examinied by a skilled
provider 4-7 days after birth in 34 sites in Luwero and Masaka districts, Uganda, Nov. 2010 - May. 2012
100
80
Percentage
60
Jun 11: TEO stock outs
40
Dec 10: Introduction of ENC
registers
20
Mar 11: Training health
workers in ENC
Nov 10: Training MNCH
district coaches on ENC
0
Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12
Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11
MayMayJun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12
11
12
% of newborns who received
3 components of ENC
1
24
26
49
51
71
78
74
70
68
60
72
60
65
66
74
94
76
83
# of Sites Reporting
8
18
20
24
28
32
34
34
34
34
34
34
34
34
34
34
24
18
18
% of newborns put to the
breast within 1 hour of birth
1
18
21
34
40
47
55
59
66
59
64
73
68
73
73
79
96
74
84
# of Sites Reporting
8
18
21
24
28
32
34
34
34
34
34
34
34
34
34
34
24
18
18
% of newborns examined by skilled
provider at 4 to 7 days after birth
0
9
8
17
17
13
18
19
22
22
20
21
16
21
24
22
30
33
26
# of Sites Reporting
8
18
21
24
28
32
34
34
34
34
34
34
34
34
34
34
24
18
18
Coverage and effectiveness of newborn resuscitation in 34 facilities in
Masaka and Luweero districts, Uganda Jan - May 2012
number of live newborns
120
80
40
0
Jan-12
Total no. of live births
No. of sites reporting
No. of newborns that needed resuscitation
No. of newborns resuscitated
No. of newborns successfully resuscitated
No. of successfully resuscitated newborns
discharged alive
Feb-12
Mar-12
Apr-12
May-12
Jan-12
1315
34
69
59
36
Feb-12
1236
34
99
88
87
Mar-12
1198
34
88
86
83
Apr-12
1358
34
105
102
82
May-12
1353
33
99
85
77
35
87
79
78
69
Assessment of Maternal/Newborn Care at
Community Level
• No VHTs trained in ENC
• No job aids
• No postpartum visits to
mothers and newborns
• Poor data collection
• No quality improvement
strategy for VHTs
• No supportive supervision
mechanism in place
USAID HEALTH CARE IMPROVEMENT PROJECT
HCI Community Collaborative Improvement
Interventions
Training VHTs in Essential
Newborn Care, Quality
Improvement, and Data
Collection
USAID HEALTH CARE IMPROVEMENT PROJECT
Percent of mothers able to state 3 newborn danger signs and percent of newborns examined by a
VHT at 2-3 and 4-7 days after birth in eight villages of zirobwe subcounty luwero district , Sept
2011 - May 2012
100
Counseling cards provided
80
1st learning session
ENC Registers provided
Percent
60
40
Coaching visits started
20
ENC Tech training for
VHTs
0
Percent of mothers able to state 3
newborn danger signs
Percent of newborns who have an
examination by a VHT 2-3 days after
birth
Percent of newborns who have an
examination by a VHT 4-7 days after
birth
Sep-11
Oct-11
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
Apr-12
May-12
Sep-11
Oct-11
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
Apr-12
May-12
0
21.88
96.43
95.83
100.00
93.75
100.00
100.00
100.00
0
75.00
78.57
95.83
100.00
100.00
100.00
100.00
100.00
0
65.63
78.57
83.33
88.89
100.00
80.00
95.75
83.33
USAID HEALTH CARE IMPROVEMENT PROJECT
Looking Ahead - Sustaining Gains and Scaling Up
Uganda:
• Demonstrated effectiveness of QI to improve
MNH in Uganda
• Harvest Meeting September 2012
• Dissemination Meeting September 2012
• CORE funded MNCH Project ends Sept. 2012
• Opportune time for scale-up
USAID HEALTH CARE IMPROVEMENT PROJECT