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Systems strengthening for quality MNH service data management:

Experience from 4 pilot hospitals


Global Maternal Health Conference Arusha, Tanzania; 16, Jan 2013

Dr. Nancy A. Kidula Snr. RH/FP Advisor Jhpiego Kenya

The problem
While Kenya does have a strong HMIS, indicators collected on MNH at the facility level are limited data is often incomplete, inaccurate, reporting is poor- Some indicators not captured data is rarely available for use in planning lack of data limits MNH service availability and quality Improvement of MNH data management and utilisation is the top priority of the Kenya MNH Road Map (August 2010)

Testing a solution
USAID MCHIP is partnering with DRH/MOPHS to pilot an MNH surveillance system in Kenya
GOK/DRH

M-CHIP

MNH Surveillance

Step 1: Advocating for change


1. USAID - MCHIP Kenya sought concurrence from DRH/MOPHS for the pilot 2. Site Selection

Map with sites circled

Used based on predefined criteria Four public district Hospitals selected

3. Baseline Survey done to assess facility readiness and situation analysis

Results of Baseline Survey


Different versions of MNH data tools in use Data recording / capturing was inconsistent, incomplete Health service providers in all facilities had not received any updates or in-service training in the BEmONC MOH designated codes were rarely used

Use of the partograph in labour was poor

National MNH guidelines not available at point of use

BEmONC equipment sets were incomplete or missing; supplies were lacking or not available at point of use

Data was rarely utilised at facility level for for decision making

Common situation- before intervention

Step 2: Capacity Building


Workshop
3 days 5 people from each facility Administrator, Nursing officer in charge, Maternity incharge, Medical records, midwife Introduced importance of data management How to generate data Practicum: Shared their data sets and challenges

Site Visits
Participants identified site specific problems Participants identified areas that did not require project help Procurement of basic supplies; reorganisation of services; maternal and perinatal death audits, communication etc;

Onsite Interventions
Training: Data management and use Service skill updates in key MNH interventions e.g., Pre-eclampsia, neo-natal resuscitation, etc.
Tools Job aids, guidelines, policies Data collection tools (sup. Register, data use wkbk,

Supportive supervision and mentorship


Weekly visits from the MCHIP/MOH team Worked with all clinical staff Observation and on-job coaching Feedback sessions and discussion Training on MNH skills
Monthly Data Supervision visits Worked with records personnel and nurses Reviewed reporting tools Audited summary tools

Results:

Outputs:
At least 60 health workers have been updated in EmONC skills and in data management Procured basic equipment and supplied Reorganized work flow

Outcomes:
More complete and accurate reporting of MNH indicators including the partograph use Data is being used at the facilities for decision making- MDR; timely referrals, partograph

Well and fully completed partograph

Box with emergency supplies for management of ecclampsia ready for use in the labour ward

Maternity Registers appropriately & well filled

Data Reporting and presentation enhanced; facilitates interpretation and use

Impact
? Reduced Maternal and Perinatal Morbidity and Mortality

Quotes from the field


As nurses we feared magnesium sulphate but now we can use it and save lives.
(Nurse-in-charge Makindu maternity)

We were practicing witchcraft before the HBB training.


(Dr at Makindu Hospital)

The updates have really helped us . some of us are retiring and had never been updated. You are removing us from mud.
(Matron at Gilgil Hospital)

Key Insights
Numbers alone are not useful they have to be good numbers What makes a GOOD number?
Common definition of what the indicator is

attempting to capture Everybody is counting the same thing in the same way
E.g. Asphyxia and resuscitation

Conclusion
For an effective MNH surveillance system, data management skills building MUST BE accompanied by: 1. Clinical skills standardization & 2. Systems strengthening

Acknowledgements
DRH/MOPHS- Kenya Administration and Staff of Naivasha, Makindu, Gilgil and Kangundo Hospitals USAID MCHIP- WashingtonBarbara and Maya USAID MCHIP Kenya team Jhpiego Kenya

Thank you all for listening

THANK YOU!

www.mchipnet

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