MAKER MOVEMENT FOR MATERNAL NEWBORN AND CHILD …

MAKER MOVEMENT FOR MATERNAL

NEWBORN AND CHILD HEALTH Needs Assessment Results from KNH

Natasha Kanagat & Emily Stammer

JSI Research & Training Institute, Inc.

March 2014

www.innovationsformnch.org

Contents

Introduction

Objectives

Methods

Analysis

Results

Conclusions


Introduction

Innovations aims to and creative interventions and strategies that can address barriers to improving coverage of basic MNCH services.

Maker Movement for Maternal, Newborn

and Child Health (“Maker”)

Innovations for

Maternal, Newborn

& Child Health

(“Innovations”)

initiative.


Introduction

The Maker Movement for MNCH aims to address gaps in the supply and availability of functioning MNCH medical equipment at Kenyatta National Hospital (KNH) and select health

facilities that refer women to KNH for labor and delivery


Objectives of Needs Assessment

Describe procurement and

maintenance processes

Assess magnitude and causes of

shortage

Assess availability and functionality of

equipment

Document trends in maternal and

neonatal mortality

Develop shortlist of equipment


Methods: Data Collection

Key Informant Interviews

Document Reviews

Patient Tracing


Methods - Key Informants

• Nurse on duty, Scrub nurse, Deputy midwife, Chief midwife, Resident

Labor and Delivery

• Nurse on duty, Resident, Head of Neonatology, Chief Nurse, Deputy Nurse

Newborn Unit

• Medical Engineering Technologist, Head of Biomedical team Biomedical

• Supplies Officer, Head of Procurement, Accounts Clerk (Finance), Supply Management Officer Procurement


Methods: Tools for KIIs


Methods: Timeline


Methods: Data Collection Team

Procurement Consultants Supply Chain and Procurement, Labor and Delivery Ward & Theatre, Newborn Unit and NICU, Biomedical Unit, Finance, Accounting, Legal, Resource Mobilization

OB/GYN Consultant Labor and Delivery Ward & Theatre

Neonatology Consultant Newborn Unit and NICU

JSI team Biomedical Unit, Hospital statistics


Methods

Key Informant Interviewer Selection

Convenience sampling

Expertise and experience at KNH

Quality Assurance Mechanisms

Daily debriefs


Methods

Data Management

Stored on secure network

No identifying information

Limitations

Some respondents not comfortable signing full name on consent


Analysis

Individual assessments

Summary reports

Synthesized findings


Results – Labor and Delivery*

56%

44%

Delivery Type

Vaginal

Caesarean

Section

12,860 deliveries

97% live births

120 maternal deaths

*2013 data from hospital records


Infrastructure and General Layout

Capacity

-------------------------------------------------------------------------

30 deliveries a day | Intended

Sometimes 60 deliveries a day | Actual

------------------------------------------------------------------------

Operating Theatre Capacity

2 Operating Theatres

Patients in line to deliver


Results: Main causes of maternal mortality *

Sepsis from complicated abortions and obstructed labor, cardiac failure,

malaria, complications of HIV, embolism, poor general anesthesia reversal,

and renal failure.

*2013 data from hospital records

Post-partum

hemorrhage

Eclampsia

18 41

120 maternal deaths


Results – Labor and Delivery

Consumables

All consumables except hand soap, available and functional

Equipment Categories

Available

Functional

In use



Equipment

Available, functional and in use

Includes: Many pieces of equipment

Oxygen flow meters

Infusion sets

Central Sterilizer

Sphygmomanometer

Fetal Stethoscope

Delivery beds

Defibrillator

Cord clamping set

Suturing set



Equipment

Available, functional

and not in use

Point of use ultrasound

Available, with limited

function and in use

CTG Machines

Patient beds

Lack of training

Reason/s not in use or not fully

functional

Lacks paper for printing

Difficult to maneuver



Equipment

Available and non-

functional

Portable and mounted

examination lights

Vacuum extractor

Sphygmomanometer

Operating table

Vital signs monitor

Electric fault

Reason/s not fully functional

Suspected electrical fault, lacking

suction cup

Mercury leak

Not maneuverable

Screen broken



Equipment

Unavailable but essential equipment

Refrigerator Thermometers

Wall Thermometers

Infusion pumps/dosimeters

Critical care equipment (e.g. vital signs monitors and resuscitation equipment)


Results – Labor and delivery

Equipment

Available but inadequate in number

Equipment # Have Additional #

Needed

Patient bed 30 10

Delivery bed 3 2

Drip stands 15 30

Operating table 1 1


Table 1: Most problematic equipment in labor ward floor

*Equipment that breaks most Parts that break Reasons why they break

1.Blood pressure machine

-mercury overflowing

-Electrical fault for automatic ones

-Use by untrained personnel

-Over use due to the large number of patient

-They are few hence get moved from room to room causing

damage

2.Suction machine -Lack of vacuum pressure

-Electrical fault

-Poor quality of suction machines procured

3.Delivery couches/beds -Inability to manipulate the bed i.e. faulty

hydraulic system

-Torn mattresses

-Wheels cannot move

-Poor quality

-Staff not all trained on use

-Old

4.Drip stands -The hangers break

-The knobs break

-The stand break then becomes imbalanced

-Poor quality

5.CTG machine -Electrical faul -Not known

6.Examining light -Bulb gets burnt often

-The electric plugs are stole

-The screws holding the glass get loose

-Cheap bulbs

-Poor maintenance

-Poor quality

7.Doppler fetoscope -Batteries get low -Takes long to replace batteries

8.Spot light -Batteries get low

-Electric fault

-Poor quality

-Takes long to replace batteries

9. Resuscitator -Oxygen flow cannot be regulated

-Heat cannot be controlled

-Old

10. thermometer -For automatic batteries get low

-Breaking

-Takes long to replace batteries

-They are fragile

*Not in any order


Table 2: Most problematic equipment in Labor ward theatre *Equipment that breaks most Parts that break Reasons why they break

1.Vital signs Monitors

- Blood pressure monitoring part

-Oxygen saturation part

-Electric fault

-Gives wrong readings

-Electric cord connection break

-Dropping of equipment

-Improper handling

-Poor maintenance

2.Operating tables -Inability to manipulate the table i.e. faulty hydraulic

system -Poor maintenance

-Old

-Over use due to patient load

-Lack of maintenance

3.Diathermy -Diathermy lead

-Diathermy patient plate

-Foot pedal (switch)

-Electric fault


-Poor maintenance

-Careless handling by all staff

4.Suction Machine -Part that creates vacuum

-Lack of suction tubes

-Broken collecting bottles

-Electric fault

-Poor maintenance

-Poor handling


5.Macerator -The spinning plate for crushing

-Electric fault

-Careless handling

-Poor maintenance

-Overuse due to patient load

6.Anaesthetic machine -Ventilator

-Electric fault

-Oxygen tubes

-Container that carries sodalime

-Knobs

-Blood pressure cuff


-Careless handling

-Poor maintenance

7.Instruments e.g. sponge holding forceps,

artery forceps

-The joints break

-They get blunt

-Long soaking in jik

-Rusting

-Old

8. Trolleys

-The wheels come out

-The surface comes off

-Lack of lubrication

-Jik pours on it when washing floors

-Rusting

*Not in any order


Users and Staff Training on Use of Equipment

Users

Doctors

Nurses

Training Received

Largely on-the-job training


Results – Newborn Unit

2013 Statistics

1,115 neonatal deaths

~73/month admitted - LBW

Capacity

Intended for 50 neonates

Operates at double capacity (sometimes triple)

NICU – 4 bed capacity but often have 5-6 beds


Results: Main causes of neonatal mortality

(Feb 2014 snap shot)

Sepsis, respiratory distress syndrome , neonatal jaundice, congenital malformations,

post op complications, complicated surgical cases.

Asphyxia

Prematurity complications

32 24

215 admissions (Feb 2014)

88 neonatal deaths



Consumables

All consumables except hand sanitizer, available and functional

Equipment Categories

Available

Functional

In use



Equipment

Available, functional and in use

Includes: Select equipment, but not in adequate number

Refrigerator with thermometer

Infant radiant warmer

Flow meters

Neonatal thermometers

Central sterilizer

Fetal stethoscope

Infusion sets

Drip stands



Equipment

Available, functional

and not in use

One CPAP Machine

Available, with limited

function and in use

Incubators

Ventilators

Baby Cots

Radiant Warmers

Demonstration

Unit

Reason/s not in use or not fully

functional

Broken humidifying component

Broken doors and sleeves

Not maneuverable

Broken heating component, light

not always functional, suction

not working



Equipment

Unavailable but essential equipment

Wall thermometer

Bilrubinometer

Haemogas analyzer (part of mini lab)

Transport incubators

Minilab equipment

Echocardiography machine with neonatal probes for ultra sonography



Equipment

Available but inadequate

in number

Equipment # Have Additional #

Needed

Incubator 15 7

Ventilator 6 4

Radiant

heater/resuscitation

tables

7 6


Users and Staff Training on Equipment – NBU

Users

Clinicians

Nurses

Training Received

Formal

On the job

Remains a challenge


Most Problematic Equipment | Breakdown

Incubator

Ventilator

machine

Photo

therapy

lamp

Fluid pump

Radiant

warmer

Suction

machine

Over use

Poor handling


Results – Biomedical Unit

31 staff: engineers, technologists & technicians

8 Workshops across user areas

Types of maintenance

Planned preventive maintenance

Corrective maintenance

Breakdown maintenance

Maintenance Requests

Phone


Biomedical Unit: Staff Training

Formal Training

Stipulated by Contract

Informal Training


Biomedical Unit: Budget

Daily operations

Maintenance

Procurement

(spares)

What is included


Biomedical Unit: Budget

Timing

Annual

History of purchases and

forecasted equipment

needs

Other departments

contribute funds for repairs

and procurement

(depends on the piece of

equipment)


Role in Procurement: Biomedical Unit

Developing Specifications

Work with the users (medical and nursing staff) to develop

specifications when ordering new pieces of equipment

Challenges with developing user specs

Iterative process

Challenge to involve stakeholders during each iteration

User ownership of specs document

New developments

Multi-disciplinary committee established


Biomedical Unit: Equipment most difficult to fix /calibrate

Equipment Parts of the

equipment that

break down

Reasons for

breakdown

Reason for delay in

repair/calibration/maintenance

Infant Incubator Oxygen sensor

Power board

Overuse

Power surges

Age of equipment

Lack of spare parts locally

Infant Ventilator Oxygen sensor

Flow sensor

Overuse Lack of spare parts locally

Patient monitors Multi Measurement

Server module

Overuse Lack of spare parts locally

Suction Machines

TBD

Vacuum extractor

Weighing Scale

Nebulizer

Phototherapy Unit* Lack of calibration equipment

Obstetric ultrasound Power supply board

Probe

Power surges

Probe is expensive

Lack of spare parts locally and lack of

knowledge/skills within the biomedical

team

Resuscitation table Heating element

Oxygen control knobs

Over use

Mishandling by users

Lack of technical knowledge/skills within

the clinical team


Results - Procurement

Background

Public Procurement and Disposal Act, 2005

Increase transparency and accountability of use of

public funds used to purchase medical equipment and

consumables at KNH, as well as define a process for

open and competitive procurement.

For KNH, emphasizes general equipment

specifications instead of outlining specific

brands/models



Procurement Process


Procurement Challenges

Standardization User Specs

Financial constraints



Procurement of Spare Parts

Inventory management done by the biomedical unit for all

clinical units/departments

Financial constraints limit the biomedical unit from

stocking adequate supply of parts for all equipment; the

unit is reliant on the reliability of suppliers to provide the

replacement parts in a timely manner.

Equipment is not standardized spare parts are not

standardized either. This lack of standardization

undermines the efficient use of financial resources for

ensuring a reliable supply and availability of functional

equipment.


Limitations

No data on behavioral interventions within KNH

Respondent Bias

Appropriate population statistics not available


How will results be used?

Results of KNH Needs Assessment will be combined

with results from Health Facility Assessment

2 day workshop on March 26-27 to decide on critical

pieces of equipment that Maker will build

Your feedback and comments are critical to the

success of this workshop


Thank you KNH for your cooperation and

enthusiastic participation. This study would not have

been possible without you.

Thank you


Acknowledgements

Documents

MAKER MOVEMENT FOR MATERNAL NEWBORN AND CHILD …