NATIONAL NEWBORN STAKEHOLDERS MEETING stakeholders... · 4 ACKNOWLEGMENTS The Ministry of Health and Ghana Health Service acknowledge the financial and technical support received

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NATIONAL NEWBORN STAKEHOLDERS

MEETING

28th to 30th JULY 2015

ACCRA, GHANA

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Table of Contents

ACKNOWLEGMENTS ..................................................................................................................................... 4

ACRONYMS AND ABBREVIATIONS ................................................................................................................ 5

KEY DEFINITIONS ........................................................................................................................................... 6

EXECUTIVE SUMMARY .................................................................................................................................. 7

THE PROCESS ............................................................................................................................................... 13

EXECUTIVE FORUM ..................................................................................................................................... 14

OBJECTIVES: ............................................................................................................................................ 15

WELCOME ADDRESS ............................................................................................................................... 15

STATEMENTS BY PARTNERS .................................................................................................................... 15

KEY MESSAGES FROM SPEAKERS ............................................................................................................ 18

WHAT IS HAPPENING WITH OUR PRETERM AND LOW BIRTH WEIGHT NEWBORNS? ....................... 18

THE NEWBORN HEALTH STRATEGY: PROGRESS SO FAR ..................................................................... 19

INVESTING IN NEWBORN HEALTH: THE CASE FOR THE PRETERM AND LOW BIRTH WEIGHT BABY .. 21

CALL FOR SUPPORT ................................................................................................................................. 22

KEYNOTE ADDRESS ................................................................................................................................. 23

TECHNICAL SESSION .................................................................................................................................... 24

SESSION 1: PROGRAMMES AND ACHIEVEMENTS UNDER THE NEWBORN STRATEGY ........................... 25

SESSION 2: IMPLEMENTATION OF EVIDENCE BASED INTERVENTIONS RELATED TO CARE OF PRETERM

AND LOW BIRTH WEIGHT NEWBORN WITHIN THE RMNCH STRATEGY ................................................. 29

SESSION 3: UNDERSTANDING KANGAROO MOTHER CARE: HISTORY, DEFINITION, EVIDENCE AND

PROGRAMMATIC APPROACHES .............................................................................................................. 32

SESSION 4: KMC EXPERIENCES AND IMPLEMENTATION IN GHANA ....................................................... 35

KEY OUTCOMES .......................................................................................................................................... 41

ANNEX ......................................................................................................................................................... 43

ANNEX 1: Summary of progress with the Newborn Health Strategy ..................................................... 43

ANNEX 2: Regional Progress and Next steps with the Newborn Health Strategy for 2015-2016 .......... 49

ANNEX 3: Programmatic Approaches to KMC implementation ............................................................. 51

ANNEX 4: Key Recommendations for KMC implementation .................................................................. 56

ANNEX 5: Discussion Points .................................................................................................................... 60

ANNEX 6: Summary of strengths and challenges with regard to KMC (and newborn care)

implementation identified in regional working groups .......................................................................... 63

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ANNEX 7: Regional KMC Implementation plans ..................................................................................... 74

ANNEX 8: Agenda for the meeting .......................................................................................................... 82

ANNEX 9: Participants list ....................................................................................................................... 86

ANNEX 10: References ............................................................................................................................ 91

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ACKNOWLEGMENTS

The Ministry of Health and Ghana Health Service acknowledge the financial and technical support

received from Governments, UNICEF, PATH, WHO and other partners in the implementation of the

National Newborn Strategy and Action Plan and the Fourth National Newborn Stakeholders Meeting in

Accra.

We would also like to thank the National Newborn Sub-Committee for their immense support in the

planning and coordination of the Fourth National Newborn Stakeholders Meeting.

Our sincere gratitude goes to all the chairpersons and speakers for their facilitation and insightful

presentations. We are especially grateful to Dr. Anne-Marie Bergh for her technical expertise and

support during the Kangaroo Mother Care session of the meeting.

We are truly grateful to our newborn care champions for supporting the Reproductive and Child Health

Unit of the Ghana Health Service in advocating for newborn health.

We specially thank the staff of the Family Health Division of the Ghana Health Service for their hard

work, dedication and support throughout the process of planning and organisation of this meeting.

Finally, we are grateful to Dr. Priscilla Wobil for her guidance and technical support. As consultant for

the meeting her insight and expertise in no small measure contributed to ensuring the richness of the

technical content of the meeting.

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ACRONYMS AND ABBREVIATIONS CHPS Community - based Health Planning and Services

CoC Continuum of Care

DHIMS2 District Health Information Management System

DHMT District Health Management Team

DHS Demographic Health Survey

ECEB Essential Care for Every Baby

EMBRACE Ensure Mothers and Babies Regular Access to Care

GHS Ghana Health Service

HBB Helping Babies Breathe

HBPNC Home Based Postnatal Care

HIMS Health Information Management System

IMNCI Integrated Management of Neonatal and Childhood

IPC Infection Prevention and Control

KATH Komfo Anokye Teaching Hospital

KBTH Korle-bu Teaching Hospital

KMC Kangaroo Mother Care

KNUST Kwame Nkrumah University of Science and Technology

KSH Kumasi South Hospital

LB Live Births

LBW Low Birth Weight

MASHAV Israeli Centre for International Cooperation, Ministry of Foreign Affairs

MBFFI Mother – Baby Friendly Facility Initiative

MBU Mother and Baby Unit

MCI Millennium Cities Initiative

MDG Millennium Development Goals

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MEBCI Making Every Baby Count Initiative

MMDAs Metropolitan, Municipal and District Assemblies

MOH Ministry of Health

NICU Neonatal Intensive Care Unit

NMR Neonatal Mortality Rate

PATH Program for Appropriate Technology in Health

PNC Postnatal Care

QI Quality Improvement

RCC Regional Coordinating Council

RCH Reproductive and Child Health

RHMT Regional Health Management Team

RMNCH Reproductive Maternal, Neonatal and Child Health

SANDS Stillbirth And Neonatal Death Study

SGH Suntreso Government Hospital

SWOT Strengths, Weaknesses, Opportunities and Threats

UNICEF United Nations Children’s Fund

USAID United States Agency for International Development

WHO World Health Organization

KEY DEFINITIONS Low birth weight Weight of less than 2,500 gm, irrespective of gestational age

Newborn death Death within 28 days of birth of any live born baby regardless of weight

or gestational age

Preterm baby A baby born less than 37 completed weeks of pregnancy

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EXECUTIVE SUMMARY

INTRODUCTION

Proven high impact interventions provided along the continuum of care have the potential to save

nearly 3 million newborn lives every year. The vision of the Every Newborn Action Plan is to have a

world in which there are NO PREVENTABLE DEATHS of newborns or stillbirths, where every pregnancy is

wanted, every birth celebrated, and women, babies and children survive, thrive and reach their full

potential (1). The Every Newborn target of a national Neonatal Mortality Rate (NMR) of 10 or less per

1000 live births (LB) is achievable by 2025. The question is whether we are willing to commit fully to the

course of saving every newborn. We must bear in mind that a single newborn death is a 100% loss to a

mother and family, and the repercussions of such a loss are indescribable. Obviously a lot is being done

in Ghana to improve newborn survival, but the pace is slow, and if we continue at this rate it will take

Ghana over 100 years to attain a NMR of 3/1000 LB(1). The newborns cannot wait, they will continue to

be born and we must be ready to make the right decisions actions to keep them alive and healthy. The

target of the National Newborn Strategy is to reduce the number of neonatal deaths by 5% every year

from 32/1000 LB in 2011 to 21/1000 LB in 2018; and reduce institutional neonatal mortality by at least

35% by 2018.

The day of birth which is supposed to be a day of rejoicing, is the time of greatest risk of death and

disability, with more than 1 million newborns dying. Per contra, this same day is a time when we can

achieve the biggest impact, saving 3 million newborn lives per year with a triple return on our

investments. The three main causes of newborn deaths are preterm birth complications, intrapartum

complications including birth asphyxia and neonatal infections, and 71% of these newborn deaths can be

prevented without intensive care(2).

Eighty percent of newborn deaths occur in small babies of which two-thirds are preterm, and according

to the Born Too Soon report (2, 3), prematurity is the number one cause of under five mortality. Preterm

births are increasing all over the world with unacceptably high rates of mortality. We have the

knowledge and tools to end needless deaths among babies born too soon and too small. Donors, policy-

makers and governments must make newborn health a priority and ensure adequate investment to

improve quality care for every newborn.

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BACKGROUND

Ghana joins countries worldwide in a deep commitment to protecting mothers and infants during

pregnancy, birth and the first weeks of life. Recognizing that NMR in Ghana remains high 29/1000 LB,

the Ministry of Health (MOH) and the Ghana Health Service (GHS) developed the Ghana National

Newborn Health Strategy and Action Plan(4). The plan is an integrated, comprehensive, and data driven

road map to measurably improve services and care for newborns by 2018. It is guided by 14 key

strategies targeted at developing and implementing newborn health policies, capacity building of health

workers, health system strengthening, increasing health financing, and intensifying monitoring and

evaluation mechanisms.

Following the launch of this strategy and action plan, the MOH/GHS with support from various bilateral

and multilateral agencies is implementing key interventions of the action plan. At the national level, the

Newborn Sub-Committee is actively coordinating, advocating, mobilising resources and monitoring the

implementation of the strategy. With support from partners, GHS has organised three National

Newborn Stakeholders Meetings in July 2012, July 2013 and July 2014. The Newborn executive forum

was organised as part of the “Committing to Child Survival: A Promise Renewed” launch in Ghana.

The Ministry of Health (MOH) and Ghana Health Service (GHS) under the coordination of the National

Newborn Sub-Committee held the fourth Newborn Stakeholders Meeting in Accra, from the 28th to the

30th of July, 2015 under the theme “Born Too Soon, Born Too Small, Help Us Live.” The executive

forum held on 28th July 2015, targeted government officials, partners, donors, business organisations,

United Nations Systems, international and local agencies, the media, MOH and GHS officials at national

and regional levels, professionals in academia and newborn champions. The meeting drew over 140

participants with two main objectives.

1. Review the progress of implementation of the Newborn Strategy since 2014.

2. Educate and advocate for support to improve care of the preterm and low birth weight

newborn.

The technical session took place from 29th to 30th November 2015. A major part of the agenda was

dedicated to orienting participants on KMC and planning for its implementation in Ghana.

The objectives of this session were to focus attention on improving evidence-based quality care

for preterm/low birth weight newborns with particular emphasis on KMC introduction and

expansion in Ghana.

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The executive forum was moderated by Dr. Gifty Anti a Newborn care ambassador and chaired by Dr.

Victor Ngongala, Chief - Health and Nutrition Section, UNICEF.

KEY MESSAGES

Commitment from Government

The Honourable Minister for Health, Dr. Alex Segbefia in his keynote address stated that Ghana is

signatory to global goals to end preventable child deaths, and he reaffirmed government’s support and

commitment to newborn care as the nation redoubles its efforts to accelerate a decline in neonatal

mortality.

National Progress with the Newborn Health Strategy

According to the National Child Health Coordinator – Dr. Isabella Sagoe-Moses, considerable progress

has been made over the past year.

Ten Regional focal persons for newborn care have been appointed to coordinate newborn care

activities.

Capacity of facility-based health workers in Helping Babies Breathe (HBB) and Essential Care for

Every Baby (ECEB) has been scaled up.

Key newborn indicators have been identified and included in the District Health Information

Management System (DHIMS2).

A Mother and Baby Friendly Facility Initiative (MBFFI) is also being introduced to improve quality

of care during the intrapartum and early neonatal period within the framework of the National

Newborn Strategy.

However, more partners are needed to take effective interventions to scale and more government

funding is needed for sustainability. At the Executive Forum, a number of stakeholders and newborn

care champions called for support to accelerate quality health care services for newborns in Ghana.

What is happening with our preterm and low birth weight newborns?

Ghana ranks 25th in the world in terms of number of preterm births

14.5% of all deliveries are preterm

“…….. if we could all come together and prevent Ebola from coming to Ghana, I strongly believe that together we can save our newborns. WE CAN DO IT! I implore all of you to contribute to support the newborn care programme.” Honourable Mavis Ama Frimpong, Deputy Regional

Minister for Eastern Region & Newborn Care Ambassador

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Prematurity accounts for 7,200 neonatal deaths every year

What can be done to save our preterm/low birth weight newborns?

Despite all these alarming figures, evidence has shown that preterm/LBW newborns can be saved with

low cost interventions along the continuum of care. Some of these interventions include family

planning, antenatal corticosteroids for preterm labour, essential care such as resuscitation, early and

exclusive breastfeeding, and extra care for the preterm/LBW newborn including KMC.

Beyond survival

Caring for a preterm baby can be very stressful for mothers. Preterm babies are at increased risk of

lifelong problems and disabilities such as visual impairment and learning difficulties, and need long term

follow up. At the community level, preterm birth myths and misconceptions still exist, and it is necessary

to take into account the sociocultural beliefs and practices surrounding preterm birth, and constantly

provide a supportive environment for mothers. Psychosocial support for parents in particular should

also be an integral part of the preterm/LBW follow up programme.

Kangaroo Mother Care – standard of care for preterm and LBW newborns

KMC is a programme for preterm/LBW babies consisting of three components - prolonged skin

to skin contact, early and exclusive breastfeeding and early discharge and follow up.

At the 2013 KMC acceleration meeting in Istanbul, newborn stakeholders reached a consensus

that, based on available evidence, KMC should be adopted and accelerated as standard of care

as an essential intervention for preterm newborns. Success was defined as augmented and

sustained global and national level action to achieve 50% coverage of KMC among preterm

newborns by the year 2020 as a part of an integrated RMNCH package(5).

With universal coverage, KMC could prevent close to 531,000 preterm deaths every year by

2025(6).

To effectively implement and scale up KMC in Ghana, participants worked in groups to brainstorm on

the facilitators, challenges and possible solutions to KMC implementation within their regions, using the

WHO Health System Building blocks.

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Recommendations for KMC implementation

Dr. Anne-Marie Bergh, a Senior Researcher at the Medical Research Center, University of Pretoria, South

Africa shared various programmatic approaches to KMC implementation. One key approach that has

been used extensively in Africa is the stages of change approach (Figure 1).

1. Create awarenessGet acquainted with KMC

Know the problem (survival)

2. Commit to implementAdopt the concept

3. Prepare to implementTaking ownership

4. ImplementEvidence of practice

5. Integrate

into routine

practice

6. Sustain new

practice

- Mobilisation of resources (human, space & equipment)*****

- Conscious decision to implement*****

- Babies in KMC position - Patient records- Staff orientation

*****

- Awareness by management

- 1-2 year audit evidence

- Staff development*****

- Evidence of all threecomponents of KMC

- Policies and other written documents*****

STAGE PROGRESS MARKERS

STAGES OF CHANGE

Figure 1:Stages of change approach with progress markers, Courtesy Anne-Marie Bergh

KEY RECOMMENDATIONS FOR IMPROVING CARE OF PRETERM AND LBW NEWBORNS IN GHANA

National level

1. Intensify and scale up competency-based training modules for critical staff involved in newborn

care with particular focus on the preterm/LBW newborn.

2. Develop or adapt KMC guidelines with clear indications for KMC services at various levels of the

health care delivery system

3. Advocate for more investment in newborn care and KMC through public-private partnerships.

Regional level

1. Build stronger collaborations between paediatricians, obstetricians and midwives at all levels of

the health care delivery system.

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2. Increase availability and accessibility to newborn care and KMC services in every region.

3. Improve data collection and track preterm/LBW morbidity and mortality outcomes.

“… we are all reminding ourselves of our promise and the commitment to do our best in protecting

the smallest of Ghanaians from needless illnesses and death.” Nora Maresh, Family Health Team

Lead – USAID

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THE PROCESS

The National Newborn Sub-Committee chaired by the National Child Health Coordinator was formed in

2012 to help facilitate, coordinate and oversee development and updating of policies, standards,

guidelines, indicators for monitoring and evaluation and financing mechanisms related to Newborn

health. In line with the responsibilities of the Newborn Sub-Committee, members were tasked to

facilitate the planning and execution of the fourth newborn stakeholders meeting in 2015. Since the

launch of the Newborn Strategy and Action Plan in 2014, it was decided that at each annual

stakeholders meeting, one of the three major causes of newborn deaths will be selected as the main

focus of the meeting. Since complications of prematurity accounted for the highest number of neonatal

deaths and being the number one cause of under five deaths globally, “Care of the preterm and low

birth weight newborn” was selected as the topic for discussion at this year’s meeting. The committee

brainstormed and carefully selected the theme for the meeting – “Born Too Soon, Born Too Small: Help

Us Live!” A concept note was developed which contained the summary of the proposed agenda for the

3-day Newborn stakeholders meeting, it included the following:

An executive forum on the first day was targeted at partners, donors, health professionals in

academia, business organisations, newborn champions, the media and government officials,

with the objective of educating and advocating for support for the preterm and low birth weight

newborn. The second objective was to review progress with the Newborn strategy since 2014.

The technical session was to take place on day 2 and 3, with one full day dedicated to KMC to

set the stage for KMC introduction and expansion in Ghana.

A National Consultant was appointed to provide support to develop the agenda, assist the Sub-

Committee to plan and execute the programme and submit a written report at the end of the meeting.

A smaller group planning team was formed to support the National consultant. They included staff from

the Reproductive and Child Health Unit, PATH Ghana, UNICEF and the National Child Health Coordinator.

A series of meetings were held at the Ghana Health Service Headquarters in Accra, with a number of

email correspondences and Skype meetings.

Questionnaires on Regional Newborn Care Action Plans and implementations plans for 2014 – 2015

were adapted from the previous year and sent to the 10 Regional Focal Persons for Newborn care to

complete and submit to the National Child Health Coordinator.

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The agenda for the meeting was finalised and invitation letters were sent out a month prior to the

meeting to all stakeholders, both local and international.

EXECUTIVE FORUM

The Executive Forum of the Fourth Newborn Stakeholders Meeting of the Ghana Health Service and the

Ministry of Health was held in Accra, Ghana, July 28, 2015 at the Miklin Hotel. The meeting drew over

140 participants made up of newborn care ambassadors, government officials, media practitioners,

lecturers, public health physicians, researchers, policy makers, health managers, administrators, general

nurses, paediatric nurses, midwives, medical officers and specialist paediatricians. Participants came

from all the 10 regions of Ghana, South Africa and the United States of America. Participants

represented the government, development partners, United Nations Systems, nongovernmental

organisations, private sector, international agencies, research institutions, academia, health institutions

including Teaching hospitals, Quasi government hospitals, Regional hospitals and District hospitals, and

the National Headquarters of the Ghana Health Service.

H.E Claudia Turbay Quintero, Colombian Ambassador to Ghana, Dr. Gloria Quansah-Asare-Deputy Director General GHS, Dr. Patrick Aboagye-Director Family Health Division GHS, Dr. Alex Segbefia-Hon. Minister for Health, Dr. Victor Ngongala, UNICEF-Chief of Health and Nutrition, Nora Maresh, Family Health Team Lead USAID Ghana, Hon. Mavis Ama Frimpong, Deputy Regional Minister Eastern Region/Newborn Care Ambassador

The meeting started at 9:00am with an opening prayer by one of the participants. The meeting was

chaired by Dr. Victor Ngongala, UNICEF – Chief of Health and Nutrition Section, and the Master of

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ceremonies was Dr. Gifty Anti, a former media practitioner, the Chief Executive Officer of GDA Concepts

and a Newborn care ambassador.

OBJECTIVES:

1. To raise awareness about the importance of improving care for preterm and low birth

weight babies so that they survive and thrive

2. To advocate for resources to improve the care of preterm and low birth weight newborns

along the continuum of care

3. Review progress on the implementation of the Newborn Health Strategy 2014 – 2018

WELCOME ADDRESS

Dr. Patrick Aboagye, Director of Family Health Division of the Ghana Health

Service (GHS) gave the welcome address on behalf the Director General of

the Ghana Health Service. Since 2012, the GHS in collaboration with

partners have been organising annual newborn stakeholder meetings

aimed at raising awareness and focusing attention on the newborn.

According to the 2014 Demographic Health Survey report (DHS)(7), under

five mortality is down to 60% from about 150% in the 1990s. However, 40% of all under five deaths

occur within the newborn period, hence the increased attention and focus on the newborn. “Ghana

would have to account for her stewardship of the Newborn Action plan in 2018, and therefore

entreated all stakeholders to commit to take action to reduce preventable newborn deaths

particularly among those born too soon and too small.”

STATEMENTS BY PARTNERS

United Nations Systems – UNICEF, WHO

Dr. Victor Ngongala, UNICEF-Ghana made a statement on behalf of the United Nations Systems supporting the Health Sector.

The number of newborn lives being lost – 29,000 every year, is a huge economical loss for Ghana

considering the cost of antenatal care, delivery services, maternity leave and breastfeeding hours.

Ghana did not meet the target for Millennium Development Goal (MDG) 4, but we have made some

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progress in reducing under five mortality. “There is evidence that we can change the trends, but what

we need is commitment, resources that have been equitably distributed nationwide, support at all

levels and accountable managers who will take the interventions to scale,” he said. Improving the

quality of care during the intrapartum and early newborn period is critical to save the lives of

Ghanaian mothers and their newborns.

USAID

Statement by Nora Maresh, Family Health Team Lead on behalf of USAID

“We are here today because we are all reminding ourselves of our promise and the commitment to do

our best in protecting the smallest of Ghanaians from needless illnesses and death,” she said.

There is substantial evidence that two-thirds of newborn deaths can be prevented using low cost

interventions. USAID is pleased to support the efforts of the Government of Ghana and their leadership

in answering the moral imperative which is ending preventable child deaths within a generation. She

concluded her statement with a quote by the President of the United States of America – “This is our

first task—caring for our children. It’s our first job. If we don’t get that right, we don’t get anything

right. That’s how, as a society, we will be judged.”

PATH

Dr. Goldy Mazia, Newborn Advisor for PATH, Washington DC, made a statement on behalf of PATH

Ghana. The MEBCI (Making Every Baby Count Initiative) project being implemented by PATH, is

supporting the Newborn Strategy of the MOH/GHS in four regions in Ghana – Brong-Ahafo Region,

Eastern region, Volta region and Ashanti region (figure 2). The support is not only in the implementation

of evidence-based interventions to reduce newborn morbidity and mortality, but also at the National

level giving input to guidelines and tools. Ghana has pioneered a lot of evidence based interventions

and already is showing lessons learned that we can share with the world.

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Figure 2: Map of Ghana

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KEY MESSAGES FROM SPEAKERS

WHAT IS HAPPENING WITH OUR PRETERM AND LOW BIRTH WEIGHT NEWBORNS?

By Dr. Gyikua Plange-Rhule - Lawyer, Senior Specialist Paediatrician, Senior Lecturer-Kwame Nkrumah University of Science and Technology (KNUST)/Komfo Anokye Teaching Hospital (KATH)

Ghana ranks 25th in the world in terms of the number of preterm

births(8) (Figure 3).

The increase in the number of facilities providing assisted

conception in Ghana, could also account for the rise in premature births in Ghana.

Prematurity accounts for 14.5% of all deliveries in Ghana, and compared to babies born term,

preterm babies are 25 times more likely to die in the first month of life(9, 10).

The knowledge and skill of the health care provider largely affects the quality of care and

survival of the preterm newborn

Being a preterm mother herself, she shared some of the distressing moments mothers go through

particularly with feeding, while caring for their preterm babies. “I am a mother of a preterm baby and

my daughter is all grown up 28 years old and a lawyer. But I still remember how really distressing it is

when they are born. The nurses would ask for breastmilk, and you express and express and nothing

comes. And I remember the very first milk I expressed looked watery and I sent it to the nurses and

they said, No! your breastmilk is not good, throw it away, and don’t bother to express anymore.”

Breastfeeding myths still exist in communities. Results from the NEWHINTS trial in

Kintampo(11), in 2007, revealed that mothers believe that ‘breast milk must look like tinned

milk, and must go from the breast to the baby otherwise it is not good.’

We need to constantly provide a supportive environment for mothers and take into account

the sociocultural beliefs and practices surrounding preterm birth.

“Mortality from prematurity is unacceptably high, and we need to focus attention on how

to reduce preterm births. It is also important to keep in mind that most preterm babies

become healthy adults if they are managed well as newborns.”

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Figure 3: Born too soon The Global Action Report on Preterm birth 2010

THE NEWBORN HEALTH STRATEGY: PROGRESS SO FAR

Dr. Isabella Sagoe-Moses, the National Child Health Coordinator made

this presentation on behalf of the National Newborn Sub Committee.

A number of newborn interventions were already ongoing in Ghana before the launch of the Newborn

Strategy in 2014. “Having a separate newborn health strategy will help maintain a better focus on the

newborn and serve as a guide for the health sector, the government, development partners and all

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stakeholders,” Dr. Sagoe-Moses told conference participants, adding that the strategy has two main

goals and thirteen strategic objectives. In order to address the major causes of newborn deaths, the

strategy has FOUR MAIN INTERVENTION PACKAGES:

1. Basic essential newborn care

2. Management of adverse intra-partum events (including birth asphyxia)

3. Care of the preterm/low birth weight/growth restricted baby

4. Management of neonatal infections/sick newborn

SUMMARY OF PROGRESS (see details in Table 2, under ANNEX 1)

10 Regional Newborn focal persons have been appointed

Helping Babies Breath (HBB) is already in use in-country and Essential Care for Every Baby

(ECEB) training materials have been adapted and in use

Newborn Indicators identified for inclusion in the District Information Management System

(DHIMS2)

Scorecard for Reproductive Maternal Newborn and Child Health (RMNCH) developed

List of essential equipment for newborn care at various levels developed

Newborn section included in peer review tool for health facilities

Newborn issues included in national integrated supervisory tool

Advocacy and communication strategy developed

Despite the fact that considerable progress has been made, challenges of inadequate staff versus work

load at various levels, inadequate infrastructure in health facilities, difficulties in implementing the

newborn strategy to scale and inadequate flow of government funds still persist. “We need more

partners to take effective interventions to scale and more government funding to ensure sustainability

of our newborn care programmes.” Dr. Isabella Sagoe-Moses

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INVESTING IN NEWBORN HEALTH: THE CASE FOR THE PRETERM AND LOW BIRTH WEIGHT

BABY

Dr. Yaa Adoma Fokuo, Specialist Paediatrician, Dormaa Presbyterian Hospital, Brong-Ahafo Region

“In July 2015, a newspaper article showed 3,514 excited university students

looking splendid in their graduation gowns and ready to conquer the world.

If 112 students out of these 3,514 graduates were to die, it would be

breaking news. But that is how many newborns we lose – 29/1000 LB.

So why are newborn deaths not an issue but accepted as normal? We

forget that newborns actually have more potential than these graduates

for potential can only be lost as you grow. The interventions to save our newborns are not expensive or

difficult to do so why then are we losing so many of our newborns? It is not a matter of funding or

equipment or even human resource. It is simply a matter of priority.

Do we use our funding to build mothers hostels knowing that the small baby will be on

admission for a long period and the mum cannot continue to lie on the bare floor for a month?

Do we not use our funding to take care of administrative issues and lucrative adult oriented

ventures at the expense of the small baby?

Do we not choose fuelling our hospital cars over purchasing oxygen for the small baby who

might have breathing problems as a result of his immature lungs?

Do we have small baby sized equipment or we just make do with adult sized equipment?

Culturally, we don’t name newborns early because they might die. And when they die, we say loftily to

the mum, ‘you will get pregnant again’ as if the baby never mattered at all…nameless he dies and no

one notes his passing.

Investing in newborn health and survival helps achieve health and development goals and honours

newborns’ human rights(12, 13). It makes economic sense because healthier households spend less

savings on healthcare and the value of a nation is measured by how it takes care of its most vulnerable

population. What then must be done since it is clear that we need to invest in the health of the LBW and

preterm baby?

We need the political will to ensure that the health of every newborn is guarded as jealously as

any other treasure of the state.

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We need the media to help raise awareness that though he is small, he matters to us culturally,

socially, financially and in every way imaginable.

We need the private sector to partner with government in building mothers’ hostels and

creating a place for the newborn in every single hospital in the country to keep them warm and

alive.

At the end of the day when all has been said and done, the real question is not: is this achievable, or is

this viable financially, or is this doable, or is it even ethical? The real question is: DO WE WANT TO DO

IT?”

CALL FOR SUPPORT

A number of stakeholders and newborn care champions called for support to accelerate quality health

care services for newborns in Ghana.

“… You may not have money, but we all have voices and we can speak on behalf of the newborn – on

the radio, on television... You may not have to give a mother money, but you can give your love, your

time and your commitment. Thousands and thousands of babies are said to be born dead when they

were actually born alive. Some of them were born too small, and they could not handle them. Ladies

and gentlemen, we can invest in innovations and research. Our partners have done a lot, but are we

going to continuously rely on partners? Each one of us is an advocate, we should all call for support

wherever we find ourselves, and if we are determined, together as a country we can help every

newborn survive and develop well. Together we can!”

Dr. Linda Vanotoo - Regional Director for Health, Greater Accra Region.

“… I am here to join the call, an urgent call to action. We must take opportunity whenever we have

the microphone to advocate for the newborn. I am taking it upon myself to do a monthly call to check

on the number of preterm babies surviving in my region and advocate for support in parliament. For

me I know there is hope, because in the era of HIV in Ghana, we all sat and worked together and HIV

prevalence dropped. I believe that if we could all come together and prevent Ebola from coming to

Ghana, I strongly believe that together we will be able to save our newborns. We can do it! I implore

all of you to contribute to support the newborn care programme. God bless you all.”

Honourable Mavis Ama Frimpong, Deputy Regional Minister for the Eastern Region and Newborn Care Ambassador

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KEYNOTE ADDRESS

The Honourable Minister for Health, Dr. Alex Segbefia, delivered the keynote

address. Also a proud father of a preterm child, his daughter was born at 28

weeks and for two weeks they thought they were going to lose her, his

daughter survived and has graduated in Law and Business and has started

working. “The topic of prematurity and low birth weight which we are

“… We need action now! We set dates and timelines and we don’t meet them, probably apart from

elections. We made so much noise about MDG 4 and 5, and 2015 is here and we did not achieve the

targets. I think we need to do something now especially those of us in civil society and the various

nongovernmental organisations (NGOs). We need to take the bull by the horn and do something

about newborn health. Maybe we need to politicize newborn health and get the media to put the

information out. We need to make noise, we need to demand. At the launch of the 10th anniversary of

the Women’s Manifesto last year, we said “Women demanding, still demanding,” and yes, we are still

demanding that something more should be done for the newborn. It is a partnership, it’s not just

about women - it’s about men and women. I want to agree with my colleague ambassador, that if we

could fight Ebola, then we can fight to put an end to needless deaths of newborns in Ghana.

Motherhood is beautiful, so let’s help to make it really beautiful.”

Gifty Anti, Chief Executive Officer-GDA Concepts, Host of “The Standpoint” on Ghana Television and

Newborn Care Ambassador

Colombia supports Kangaroo Mother Care implementation in Ghana

Kangaroo Mother Care (KMC) started in Colombia. “I believe that the KMC programme is about

showing love to mothers and babies”, she said, “and we have to strengthen that vision of love by

improving KMC for all preterm and low birth weight newborns.” In October 2014, she made a passing

visit to one of the MEBCI workshops organised by PATH in Accra, and a request was made for support

to expand KMC in Ghana. The Colombian government has approved a proposal to support the

implementation and expansion of KMC in Ghana. This includes sponsorship for an off-site three

month training in KMC for three health professionals from Ghana this year, and technical support for

the setting up of “centers of excellence” for KMC training and implementation in Ghana. The Ghana

Health Service and the Ministry of Health are grateful to the Government of Colombia for their

support and collaboration.

Claudia Turbay, Colombian Ambassador to Ghana

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discussing here today is very important because it can affect any of us in different ways. The theme for

this conference, “Born too soon, born too small, help us live!” is very appropriate and all of us present

here today should commit to nurture these small babies so that they live,” the Minister said.

Although Ghana has seen a decline in under five mortality and infant mortality, neonatal mortality has

remained stagnant. Ghana’s neonatal mortality rate of 29/1000 live births is a serious blot on our

development ethics, and we have to halt these preventable deaths because every life counts(7). He

assured us that child health has and will always remain on the list of priorities for the government. A

number of development partners and other stakeholders have shown commitment in working together

with government to achieve the goals and objectives of the Newborn strategy to improve newborn

survival and health in Ghana. Every newborn, every child and every pregnant woman in our community

has the right to live. He emphasized that, “it is our moral and ethical responsibility to ensure that

newborns survive because they represent the builders of the future of Ghana. It is therefore in our

interest that we invest in newborns because when we invest in our newborns we are investing in the

foundations for growth, development and progress for Ghana.”

TECHNICAL SESSION

The Technical Session of the Newborn Stakeholders Meeting took place from the afternoon of 28th July

to 30th July 2015.

Objectives of the session

1. Review programmes and achievements under the Newborn Strategy

2. Highlight evidence based interventions related to the care of the preterm and low birth weight

newborn along the continuum of care

3. Standardize KMC and set the stage for strengthening and scaling up KMC in Ghana

4. Share best practices and lessons learned from the above strategies and interventions related to

KMC and care of the preterm/low birth weight newborn

5. Develop annual national and regional action plans with timeframe and available resources for

accelerating KMC in Ghana

25

SESSION 1: PROGRAMMES AND ACHIEVEMENTS UNDER THE NEWBORN

STRATEGY

1. PROVEN INTERVENTIONS FOR IMPROVING THE QUALITY OF NEWBORN CARE

Dr. Hari Banskota from UNICEF presented some key proven interventions that can improve quality

of newborn care in line with the Every Newborn Action Plan.

The three main causes of newborn deaths all have effective and feasible interventions

(Table 1).

71% of newborn deaths are preventable and actionable now without intensive care.

Investing in quality care at birth results in a triple return, is highly cost effective and achieves

high impact results.

Table 1: Proven interventions targeting the major causes of newborn deaths

• Preterm birth • Antenatal corticosteroids, preterm labor management

• Essential newborn care + Kangaroo mother care

• Birth complications

(and intrapartum

stillbirths)

• Antenatal corticosteroids, preterm labor management

• Essential newborn care + Kangaroo mother care

• Neonatal infections • Essential newborn care especially early and exclusive

breastfeeding, handwashing, chlorhexidine where

appropriate

• Case management of neonatal sepsis with antibiotics

2. RESEARCH

A. EVIDENCE-BASED NEWBORN CARE IN GHANA: LESSONS FROM THE NAVRONGO HEALTH RESEARCH CENTRE - Dr. Cheryl Moyer (Director - GlobalREACH programme, University of Michigan) shared results from the Stillbirth and Neonatal Death Study (SANDS), on behalf of the Research Team.

Key findings

Stillbirth rate: 23/1000, Early neonatal mortality rate: 16/1000, Neonatal mortality rate:

24/1000(14)

Grandmothers are influential for infant feeding and other newborn care practices(15)

Community members know recommendations for breastfeeding and clean delivery, but

they do not always follow it(15, 16)

Maltreatment in facilities during labour and delivery is a barrier for care seeking(17, 18)

The community prefers traditional providers because they have a better understanding

and appreciation for local customs(19)

26

New Project at the Navrongo Research Center

PREMAND (Preventing maternal and neonatal deaths in Ghana) is a USAID-Ghana-

funded project that builds upon lessons from SANDS. It will focus on using social

autopsy and spatial visualization to foster locally relevant solutions for maternal and

neonatal deaths and near-misses.

B. GHANA EMBRACE IMPLEMENTATION RESEARCH: Dr. Abraham Hodgson, Director of Reasearch, Research Unit, Ghana Health Service (Member of Research Team)

In 2012, the Japanese government in conjunction with Ghana government launched the Ghana

EMBRACE Implementation Research (20) at three study sites: Health and Demographic Surveillance

System sites at Navrongo, Kintampo and Dodowa. EMBRACE simply means “Ensure Mothers and

Babies Regular Access to Care.” Sixty-seven percent (67%) of neonatal deaths can be prevented if

the Maternal Newborn and Child Health (MNCH) continuum of care process is completed. On the

contrary, the EMBRACE team prior to the study, identified a lot of breaks along the continuum of

care (CoC) for mothers and newborns, with only 8% of women completing the CoC process (Figure

4). The CoC includes pre pregnancy care, at least four antenatal visits, delivery assisted by skilled

birth attendants, postnatal care within 48 hours, at 7 days and 6 weeks.

The aim of EMBRACE project:

1. To develop a pathway to create feasible and sustainable packages of interventions to

improve MNCH outcomes and to test such packages in rural settings.

2. To disseminate the findings and lessons learnt to the wider global health community.

SANDS highlighted the gaps in understanding the important role of social and cultural factors that affect neonatal outcomes along the continuum of care.

“No intervention will reach its maximum potential for success without acknowledging and

accounting for regional, tribal, community, and familial differences in attitudes, beliefs,

norms, and cultural traditions surrounding pregnancy, delivery, and newborn care”

Dr. Cheryl Moyer

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Figure 4: Coverage of continuum of care related service indicators at the three study sites

Preliminary findings between October and December 2014

Very high potential of adoptability with over 5000 CoC cards distributed

Sharp increase in the number of women staying in the facility for 24

hours, and received postnatal care (PNC) within 48 hours of delivery

Comment from a mother: “When I properly follow the CoC card and do

good behavior, I can get a gold star. I want to get all gold stars”

3. QUALITY IMPROVEMENT (QI) INITIATIVES IN THE BRONG-AHAFO REGION: Dr. Paulina Appiah, Newborn focal person for Brong-Ahafo Region, Paediatrician, Sunyani Municipal Hospital)

Under the MEBCI project sponsored by PATH, a Rapid health facility assessment was

conducted in 2014 to serve as a baseline to monitor and evaluate project outcomes.

Achievements Currently, three newborn care areas have been created in three District hospitals,

adding on to the existing 7 within the Region

138 (27%) providers have received training in HBB, ECEB and IPC (see details in Table 3).

The facilities have also institutionalized practice sessions and drills in HBB and ECEB.

Facilities have provided sterile cot sheets for deliveries.

28

Challenges Despite these achievements there have been a few challenges such as late referrals from

Health centers and Maternity homes. Unfortunately, these facilities are not included in

the MEBCI training.

Difficulty in getting drugs and supplies for newborn care eg. Vitamin K1

Poor quality of newborn data being captured and erratic flow of funds for newborn care

in the region.

HBB training session in Brong-Ahafo Region

4. HOME BASED POSTNATAL CARE (HBPNC) IN THE UPPER EAST REGION: Rofina Asunu, Deputy Director of Nursing services, Upper East Region

In 2012 UNICEF supported the region to roll out newborn care activities with particular focus on

HBPNC. Frontline staff mostly Community Health Officers and Community Health Nurses were

trained in HBPNC. They were all provided with job aids and other logistics such as home visiting

booklets and bags, thermometers, spring weighing scales and many others.

A Community Health Officer conducting a HBPNC visit

29

Challenges

Inadequate transport and fuel

Inconsistent addresses

Lack of standard home visiting register

Weather conditions especially during rainy season hamper home visits

High staff attrition rates

Difficulty in sustaining volunteer enthusiasm

Harmful traditional beliefs and practices still persist

Successes PNC registration increased from 8,400 in 2013 to 11,900 in 2015

Number of babies visited increased from 2,500 in 2013 to 9,700 in 2015

Number of sick babies treated increased from 0 in 2013 to 33 in 2015

Number of mothers counseled increased from 2,500 in 2013 to 9,600 in 2015

SESSION 2: IMPLEMENTATION OF EVIDENCE BASED INTERVENTIONS

RELATED TO CARE OF PRETERM AND LOW BIRTH WEIGHT NEWBORN WITHIN

THE RMNCH STRATEGY


ANTEPARTUM AND INTRAPARTUM CARE – Dr. Michael Yeboah, Senior Obstetrician Gynaecologist,

KATH, Kumasi

Key points The obstetric care of the preterm fetus focuses on the prevention or delay of a preterm birth.

Of key importance is the identification of predisposing factors and their elimination.

Prediction of the risk of a preterm birth is possible, and those with significant risk can be

managed with cerclage or progesterone(21, 22).

In cases of threatened preterm birth, an attempt at aborting uterine contractions is essential so

that fetal health may be enhanced using steroids with or without magnesium sulphate(23, 24).

Delivery of preterm babies below 34 weeks is safer without vacuum extraction and safer with

caesarean section if it is a breech presentation(23).

30

Corticosteroids: With 95% universal coverage, 41% of preterm deaths would be prevented by

2025 and 444,000 babies would be saved(6).

ESSENTIAL AND EXTRA CARE FOR THE PRETERM AND LOW BIRTH WEIGHT NEWBORN – Dr. Mame Yaa

Nyarko, Senior Specialist Paediatrician, Princess Marie Louis Hospital, Accra

More than one in 10 of all babies born around the world are preterm. All newborns are vulnerable, but

preterm babies are much more vulnerable. According to the “Born Too Soon” report(3), with simple

measures such as providing warmth, preventing infections by hand washing, appropriate feeding

including exclusive breastfeeding and support for feeding, many preventable deaths among preterm and

LBW babies can be avoided. Kangaroo Mother Care though a simple intervention, is crucial for

improving preterm and low birth weight (LBW) outcomes and is also cost saving. Training health care

providers to identify danger signs early and refer to the next level for appropriate management will help

reduce long term complications among preterm and LBW babies.

LONG TERM CARE AND FOLLOW UP OF THE PRETERM BABY WITH COMPLICATIONS – Dr. Bola Ozoya,

Specialist Paediatrician, Korlebu Teaching Hospital (KBTH), Accra

A planned follow up programme is an integral part of the care of every preterm and LBW baby after

discharge from hospital. The objectives of the follow up programme (25, 26) are to

Conduct a comprehensive evaluation of the preterm baby and recognise the need for early

intervention

Identify and treat medical complications early

Identify neuro-developmental disability early and refer to appropriate specialists

Provide parental counseling and support

An effective follow up programme needs a multidisciplinary team of health care providers (Doctors,

Public health nurses, Nutritionists, Physiotherapists etc) with linkages to support groups such as KMC

support groups and breastfeeding support groups within the community(25, 26).

31

Dr. Bola Ozoya, first from the right, counseling parents of a preterm baby at

follow up

Every premature baby needs long term follow up care but this care must be individualized. “Babies born

too soon and too small certainly need our help to live to enable them attain their full potential and

enjoy their lives and make a positive contribution to society.” Dr. Bola Ozoya

PSYCHOSOCIAL SUPPORT FOR MOTHERS AND FAMILIES OF PRETERM AND LBW NEWBORNS - Dr.

Kwabena Kusi Mensah, Senior Resident, Department of Psychiatry-KATH

Studies have shown that continuous untreated depression is a high risk factor for preterm birth(27, 28).

When an infant is born prematurely a mother may not be as emotionally or physiologically prepared for

childbirth as she would have been had the pregnancy gone to term. The premature birth may represent

an interruption in the natural process of the mother's bonding with her child and could be more ego-

threatening to mothers. Research has shown that in the first week after birth parents of preterm infants

cried more, felt more helpless, were more worried about future pregnancies and their ability to cope,

and wanted to talk to hospital staff a lot more(29). Psychosocial support should start early in pregnancy

and must be provided at every stage of the continuum of care programme. Providing information,

answering questions from the family and providing avenues where specific challenges can be addressed

can provide relief to parents and boost their confidence(29). Parents will then be empowered to provide

optimal care, love and support for their preterm babies, and ensure that they survive and thrive.

“Sometimes a kind word to a distressed soul does more good for more people than all the medicine in

the world.” Dr. Kwabena Kusi Mensah

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SESSION 3: UNDERSTANDING KANGAROO MOTHER CARE: HISTORY,

DEFINITION, EVIDENCE AND PROGRAMMATIC APPROACHES


The session was chaired by Dr. Gyikua Plange-Rhule

GLOBAL HISTORY AND CONTEXT OF KMC - Dr. Goldy Mazia, Senior Newborn Health Advisor, PATH,

Washington

Kangaroo Mother Care (KMC) was initiated by Dr. Edgar Rey Sanabria in Bogota- Colombia in 1978 at a

time when there was a shortage of incubators in his hospital. KMC has become a more humanized and

less costly modality of care in both developed and developing countries(30). It has been taught globally

by the Colombian Kangaroo Foundation for the past 25 years and also by the Medical Research Council

Unit for Maternal and Infant Health Care Strategies, University of Pretoria, South Africa. WHO, USAID,

UNICEF, Save the Children, and countries such as South Africa are strongly contributing to dissemination

and scale-up.

In 1981, WHO started calling attention to the KMC programme in Bogota.

In 1996, the first international conference on KMC was held in Italy where the International KMC

Network was formed. Since then 9 additional international meetings have taken place to share

research and implementation experiences.

WHO endorsed KMC in 2003 confirming that KMC is more than an alternative to incubator care,

and has shown to be effective for thermal control, breastfeeding and bonding in all newborn

infants(31).

In May 2012, WHO published the “Born Too Soon” report that strongly recommended KMC as

one of the most effective ways to save preterm babies. The report cited a systematic review of

several randomized controlled trials that showed a significant reduction in neonatal mortality by

51% compared to incubator care among babies weighing less than 2000g(2, 3, 8, 9).

More recent evidence from a Cochrane Review in 2014 concluded that continuous KMC reduced

the risk of death among preterm babies by 40% at discharge or 40 weeks corrected age(32).

In October 2013, newborn experts and stakeholders met in Istanbul, Turkey to discuss how to

accelerate KMC implementation globally. Based on available evidence, the consensus reached

which was also backed by WHO stated that:

33

“KMC should be adopted and accelerated as STANDARD OF CARE

as an essential intervention for preterm newborns. We have

defined success as the increased and sustained action to achieve

50% coverage of KMC for premature babies at the national and

global levels by 2020 as part of an integrated reproductive,

maternal, newborn, and child health package(5).”

CURRENT KMC LANDSCAPE: DEFINITION AND EVIDENCE – Dr.

Naana Wireko-Brobby, Specialist Paediatrician, KATH

Kangaroo Mother Care is not only skin to skin contact between a mother and baby. KMC has three main

components: Kangaroo position (placing a baby in skin to skin contact in between the mother’s breast),

Kangaroo nutrition (exclusive breastfeeding and feeding expressed breastmilk) and Kangaroo follow up

(early discharge and follow up)(31, 33).

Preliminary evidence from studies in Colombia has shown better brain function among

adolescents born preterm that were managed with KMC(34).

A systematic review demonstrated a reduction in nosocomial infections and hospital stay, and an

increase in weight gain and exclusive breastfeeding among LBW newborns receiving KMC(32).

Study in Ghana reported that 70% of mothers said KMC was easy to practice, 72% said they

would recommend KMC to other mothers, 96% said it was beneficial to their babies and 99.5%

said continued to practice KMC at home(35).

Key definitions(31, 33)

Skin to skin contact

Skin to skin contact is

recommended for every baby. It is

simply placing a baby in skin to skin

contact with the mother

immediately after delivery for a

least one hour to ensure warmth and

early initiation of breastfeeding. It

is also recommended for

transporting sick newborns to a

health facility.

Kangaroo Mother Care (KMC)

KMC is the early, prolonged, and

continuous skin to skin contact

between mother (or substitute) and

baby, both in hospital and after early

discharge, with support for

positioning, feeding (ideally exclusive

breastfeeding), prevention and

management of infections and follow

up care. The duration for continuous

KMC should be at least 20 hours.

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PROGRAMMATIC APPROACHES TO KMC INTRODUCTION AND EXPANSION – Dr. Anne-Marie Bergh, Senior Research Officer, Medical Research Council Unit for Maternal and Infant Health Care Strategies, University of Pretoria, South Africa

KMC introduction in Ghana

KMC was introduced in Ghana in 2007 in Kumasi, and in 2008 KBTH also started implementing KMC.

UNICEF in 2008, introduced KMC in four regions in Ghana. In the same year, four doctors and nurses

from KBTH and KATH were sponsored by Saving Newborn Lives/Save the Children to attend a KMC

orientation workshop in South Africa. They returned as champions to establish their facilities as centres

of excellence. Despite the fact that KMC was introduced in Ghana eight years ago, KMC is still not well

known.

The reasons could have been due to lack of country ownership. Recommendations following

implementation were not taken up, there were no long-term plans for supportive supervision and

follow-up, drivers retired or left the service, changes in leadership at different levels of the health

system, and it is not clear how the final regional reports were disseminated or used.

All the same, KATH and KBTH have continued to provide KMC services to date, and two additional

facilities in Kumasi have also started implementing KMC.

Approaches to the introduction, expansion and scale-up of KMC There are four main approaches with two focus areas:

Intermittent KMC

Intermittent KMC refers to

recurrent but not continuous skin to

skin contact between mother and

baby for few hours in the day. It is

practiced when the mother is

unable or unwilling to practice

continuous KMC.

Post discharge KMC

Post discharge KMC is when the

mother and baby are discharged from

the facility because the baby is

feeding well, growing and stable, and

the mother or caregiver

demonstrates competency in caring

for the baby on her own. KMC is

continued at home with an agreed-

upon schedule for follow up visits at

the hospital, outreach clinic or at

home to monitor the health of the

baby.

35

• Pathways to implementation 1. “Big bang” or “staggered” approach (Table 4) 2. Pedestal approach

• Tools for programme planning, execution and evaluation 3. Stages of change approach 4. Systems approach

SESSION 4: KMC EXPERIENCES AND IMPLEMENTATION IN GHANA

The session was chaired by Dr. Kwasi Yeboah-Awudzi, Public Health Physician & Director - Kumasi

Metropolitan Health Directorate.

PERSPECTIVES FROM KORLEBU TEACHING HOSPITAL (KBTH), ACCRA by Dr. Joan Woode, Specialist

Paediatrician, KBTH

History

In 2008, one Paediatrician and nurse attended a KMC orientation training in South Africa

sponsored by Save the Children

KMC unit established in April 2008

Began as a 4-bed unit, expanded into an 8 bed KMC unit

Initiative was driven by a doctor, the Head of the Neonatal Intensive Care Unit (NICU)

There was buy-in from the Head of Department of Child Health and matron-in-charge of NICU at

the time and her deputy

Preparation towards implementation

Bottom-up approach

KMC guidelines were developed

Space identified at the NICU

Basic equipment such as weighing scales and thermometers were obtained from the NICU

“Knowledge of KMC does not imply there is a policy. A policy or the existence of KMC guidelines does not imply that it is implemented. Implementation of KMC

does not guarantee sustainability.” Anne-Marie Bergh

36

The nurse-in-charge surveyed the hospital from department to department and got beds,

mattresses and chairs for the KMC unit.

Bathing and toilet facilities available

There was no initial funding

A few staff were transferred from the NICU to man the KMC unit

Implementation of KMC

All babies less than 2.0kg and who are stable are eligible for KMC. There are three methods of

KMC practice at KBTH. Mothers use a special wrap to tie the baby in KMC position.

In-house continuous KMC: Mothers are admitted to the KMC unit for continuous KMC

Daytime KMC: Due to lack of space and beds, mothers practice KMC continuously until

evening, go home and return the following morning to continue KMC.

Intermittent KMC: KMC is done for several minutes or few hours at the NICU

Staffing: There are two dedicated nurses at the KMC unit responsible for the care of the mother

and baby. Doctors review the patients on a daily basis.

Discharge and follow up: Patients are discharged based on discharge criteria and enrolled into

the follow up programme.

Occurs at the NICU clinic, held once weekly

Special arrangements are made for babies discharged home small <1.2kg – early review

within a week on NICU

Ophthalmology review and hearing assessment are done for all preterm babies.

Those with complications are referred for specialist care

Challenges

High case load: preterm babies account for nearly 50% of admissions and one out of five are

very low birth weight

Lack of space (only 25% of babies <1.5kg do in-house continuous KMC)

Reluctance of mothers and families to practice day time continuous KMC due to the stress of

going in and out of hospital.

Successes

Between 2009 and 2014, 795 babies <1.5kg were admitted for continuous KMC – approximately

133 per year

37

Case fatality rate of 0.02%, more than 99% survived

Number of brought-in-dead preterms significantly reduced after KMC implementation

PERSPECTIVES FROM KOMFO ANOKYE TEACHING HOSPITAL (KATH), KUMASI by Mrs. Christiana

Acquah, Senior Nursing Officer, KATH.

History

KMC started in 2007 following a Neonatal emergency nursing training programme which

included a full day workshop on KMC for doctors, nurses and midwives in Kumasi.

The KMC workshop was facilitated by Karen Davy, a nurse practitioner from South Africa.

Programme was sponsored by the Millennium Cities Initiative (MCI), MASHAV (Israeli Centre for

International Cooperation, Ministry of Foreign Affairs) and Soroka Medical Center, Israel, in

collaboration with the Kumasi Metropolitan Health Directorate and KATH.

The initiative at KATH was driven by the nurse manager for the Mother and Baby Unit (MBU)

and a Paediatrician at the unit.

Preparation towards implementation

No available space for a KMC unit

No funding

Had to reorganise newborn care services at the MBU which has three wards.

Designated one ward solely for preterm and LBW newborns

Staffing: Pulled dedicated staff from within the MBU and assigned them to the LBW unit to run a

24 hour shift (2 nurses and 1 doctor per shift)

Developed guidelines for KMC


Moved all preterm and LBW newborns to the LBW unit in 2008

21 – Bed capacity, but with an average daily ward state of 40 babies

The LBW unit provides conventional care and intermittent KMC

Intermittent KMC is practiced for 1 – 2 hours twice a day (morning and afternoon)

Mothers use their own cloth to tie the baby in KMC position

Mothers sit in the corridor of the unit and practice KMC

38

Initially preterm LBW babies weighing ≥ 1.5 kg and

stable were transferred to Kumasi South and Suntreso

Government Hospitals for continuous KMC. But since

2012, the transfers have stopped because the two

facilities now admit many cases from their facility with

a lot of referrals.

Discharge and follow up:

LBW newborns weighing < 1.5 kg are followed

up on alternate days at MBU

LBW newborns weighing > 1.5 kg come for

weekly visits until they are between 2.5 kg

and 3.0 kg.

Follow up continues at the specialist clinic and care is individualised

Challenges

The set-up of the unit does not allow for continuous KMC

Continuous increase in the number of admissions out numbering the unit’s bed capacity for

mothers and babiesHigh case load with a nurse-patient ratio of 1:20

Mothers get tired easily – “I would love to do kangaroo more often but I can’t, I get tired of

sitting.” Comment by a mother

Bathing and toilet facilities not available

Successes

“It allows my baby to sleep well and feed more.” Comment by a mother

Paediatricians from KATH provided technical support for the initial training, set up and running

of the MBUs at Kumasi South and Suntreso Government hospitals. Currently the units are fully

functional with three permanent paediatricians and nursing staff.

Trained over 500 nurses and midwives in KMC with support from Millennium Cities Initiative and

Women’s Health to Wealth.

KATH management has finally and officially allocated more space in the hospital to the MBU and

part of this space will be used as a KMC ward.

39

PERSPECTIVES FROM A REGIONAL/DISTRICT HOSPITAL, KUMASI by Dr. Rita Fosu-Yeboah, Specialist

Paediatrician, Kumasi South Hospital, Kumasi and Abenaa Akuamoah-Boateng, former West Africa

Director for MCI, CEO of Women’s Health to Wealth.

“Every facility that delivers babies should have a dedicated space for newborn care and I think it is

unethical if you don’t have anything in place to take care of Newborn emergencies and Kanagaroo

Mother Care.” Abenaa Akuamoah-Boateng

History

KMC started in 2008 at the Regional hospital – Kumasi South Hospital (KSH) and in 2009 at one

of the District Hospitals – Suntreso Government Hospital (SGH) all in Kumasi.

This was after the Kumasi Neonatal emergency nursing care training in 2007.

A 10 member KMC steering committee was set up to champion KMC. Members were nurse-in

charges from various facilities within the Kumasi metropolis.

MASHAV – Israel built an MBU at SGH, and renovated a section of a Maternity block at KSH for

an MBU, between 2008 and 2009.

The objective was to help decongest the MBU at KATH and provide a unit for continuous KMC.

Preparing to implement

Series of meetings between the Ashanti Regional Health Directorate, Kumasi Metropolitan

Health Directorate and KATH to discuss operational and technical issues of the collaboration

Guidelines and protocols were developed by Paediatricians at KATH and Soroka Medical Center,

Israel.

Staffing: Nursing staff from the two hospitals were assigned to the MBU, and Paediatricians and

residents from KATH reviewed the patients on a daily basis

Basic equipments such as ventilation bags were provided my MASHAV and MCI, and hospital

supplies were procured by the facilities. Currently Women’s Health to Wealth is supporting the

facilities with newborn care training and equipment.


The MBU has three wards – a postnatal ward for mothers and their sick newborns, a special care

ward and a Kangaroo Mother Care ward.

40

KSH has 16 beds and 20 cots, SGH has 15 beds and 12 cots

KMC is practiced continuously

Discharge and Follow up: LBW babies come for alternate day visits until they weigh 2.0 kg, and

then weekly follow up visits at the MBU until they attain a weight of 2.5 - 3.0 kg. They are

referred to the Child Welfare Clinic to continue the follow up.

Challenges

Low awareness about the practice of KMC among mothers

Lack of catering services in facilities and a dedicated eating place

Inadequate laboratory services and inadequate supply of newborn drug formulations

Poor management of pain

especially among caesarean

section mothers

Lack of family support on

discharge

Lost to follow-up on

discharge

Rotation policy and transfer

of nurses has led to a

massive decrease in the

number of trained nurses –

only one of the initial staff

trained in 2007 is still on the MBU

Increased number of admissions with increasing LBW babies

Successes

KMC mothers have become peer educators on the ward

KSH has served as a KMC training centre for midwives and nurses from Ashanti and Brong-Ahafo

region

Over 80% of all LBW newborns admitted received KMC

41

Lessons

A good incentive for health care providers that has worked is consciously and regularly

recognizing, acknowledging and appreciating every team member

Providing facilitative and supportive supervision and timely feedback needed for action at

facility level is vital for quality newborn care

A PARENT’S EXPERIENCE WITH KMC by Mr. & Mrs. Sackey

“I am a mother from KBTH KMC unit. KMC has helped us a lot. Infact we have learnt a lot and KMC has

boost our confidence to take care of our baby, a 0.9 kg baby. The nurses and doctors were all available to

help us …” Mrs. Sackey (mother)

“… you can imagine, we leave our daughter at the NICU and go home. I could not sleep very well. When

we were told our baby was ready for full KMC we were so happy because we knew that our baby will

soon be discharged from hospital. And within one week we saw that her weight gain had improved. So

what you see today is the product of KMC – a healthy and good looking baby girl.”

Mr. Sackey (Father)

KEY OUTCOMES

1. Awareness about the care of preterm/LBW newborns and KMC created.

2. Executive forum broadcasted on National television and other television stations as a major

news item.

3. Call for support and investment in the preterm and LBW newborn successfully done

4. Progress of implementation of the Newborn Health Strategy between 2014 and 2015 reviewed

42

5. Evidence based interventions related to the care of the preterm/LBW newborn along the

continuum of care presented and discussed

6. KMC definition clarified, KMC components explained and programmatic approaches to KMC

implementation presented and discussed.

7. KMC implementation experiences shared and lessons learnt

8. Facilitators, barriers and possible solutions to KMC implementation discussed at Regional and

National levels

9. Key recommendations for KMC implementation developed, presented and discussed.

10. Regional action plans for care of the preterm/LBW newborn developed

11. National and Regional KMC implementation plans developed and discussed

43

ANNEX

ANNEX 1: Summary of progress with the Newborn Health Strategy

Table 2: SUMMARY OF PROGRESS BETWEEN 2014 AND 2015

STRATEGY PROGRESS and ACHIEVEMENTS

STRATEGY 1

Develop/update policies, guidelines,

standards and coordinating

mechanisms

National Sub-committee on Newborn

care strengthened

10 Regional Newborn focal persons

appointed

Training guidelines for Community-

Based-Agents developed

Integrated Management of Newborn

and Childhood Illness (IMNCI)

training modules updated

Helping Babies Breath(HBB) already

in use in-country and Essential Care

for Every Baby (ECEB) training

materials adapted

STRATEGY 2

Update Health Informationm

Management System/ District

Health Management Information

System (HIMS/DHIMS2) to include

key indicators

Newborn Indicators identified for

inclusion in District Health

Information Management System

(DHIMS2)

Delivery register revised to capture

data on quality of care

Newborn indicators included in list

for sector-wide

Scorecard for Reproductive

Maternal Newborn and Child Health

44

(RMNCH) developed

STRATEGY 3

Increase health financing for

newborn care

Resource mobilization on-going; new

partners including private sector and

international agencies

STRATEGY 4

Procurement, distribution and

maintenance of essential medicines,

devices and commodities

List of essential equipment for

various levels developed

Efforts to include Chlorhexidine in

Essential Medicines List and

declassify antenatal corticosteroids

Basic Resuscitation and other

equipments procured and distributed

to some regions

STRATEGY 5

Availability and equitable

distribution of key competent

health workers

Staff strength improving for

doctors, nurses, midwives but

inequities and heavy workloads still

exist

STRATEGY 6

Improve capacity of facility level

health workers

In-service training in progress (HBB,

ECEB, IPC) for various categories of

staff - midwives, nurses,

anaesthetists, doctors

Development of courses for

accreditation

STRATEGY 7 Modules for Community-based agents

finalized and in use

45

Build capacity of community health

workers to promote newborn health

Newborn section of Community-

based Health Planning and Services

(CHPS) curriculum strengthened

STRATEGY 8

Promote and institutionalize quality

improvement including supportive

supervision /mentoring

Newborn section included in peer

review tool for health facilities

Newborn issues included in national

integrated supervisory tool

Perinatal audit tool under

development

Development of draft maternal and

newborn care quality standards and

criteria

STRATEGY 9

Scale up a strengthened and

expanded mother-baby friendly

facility initiative (MBFFI)

MBFFI Model to be developed to

focus on quality improvement for

Newborn Care

STRATEGY 10

Strengthen advocacy,

communication, social mobilization

and community based interventions

Advocacy and communication

strategy developed

Newborn web-site developed and

being tested

STRATEGY 11

Strengthen links between facility

and community

Increase in home-based postnatal

care by Community Health

Officers/Community Health Nurses

from 39% (2013) to 58% (2014) in

46

Northern and Upper East Regions

STRATEGY 12

Strengthen Public Private

Partnerships

Some corporate agencies already on

board

Planning for a more targeted

approach

STRATEGY 13

Operationalise an effective plan

for monitoring and evaluation

Count every newborn:

Document the quality of care

Record achievement of the

goals and objectives

Strengthen the registration of

births and deaths

Newborn items included in peer

review tool

Health facility assessment tools

developed

Draft In-patient monitoring charts

developed

Delivery register updated

Annual National Newborn

stakeholders’ meeting

Collaboration with Births and Deaths

Registry

47

Table 3: Summary of Achievements in the Brong-Ahafo Region following the MEBCI training in HBB, ECEB and IPC in 2014

System Intervention areas Before intervention After intervention Challenges

HOSPITAL Provider knowledge and

skills in Essential Newborn

Care

37% of providers

trained in HBB

13% trained in cord

care, thermal care and

IPC

No facility newborn

champions

64% of providers trained in

HBB

40% trained in ECEB and IPC

7 Facility newborn

champions selected

Institutionalized practice

sessions and drills

Health centers and

maternity homes

not included in the

MEBCI training

Facility readiness to

provide essential newborn

care

Cot sheets (not sterile)

provided by mothers

for delivery

Single use suction

bulbs used several

times on different

babies

Inadequate ventilation

bags and masks

Babies separated from

mothers at birth, no

Sterile cot sheets for drying

every newborn provided by

facilities

Penguin suction bulbs,

ventilation bags and masks

provided to all facilities

trained

Continuous skin to skin

contact for 1 hour after

birth and delayed cord

clamping now routinely

Problems with

quality of newborn

data being captured

Difficulty in getting

drugs and supplies

for newborns eg.

Vitamin K1

Low coverage of

Kangaroo Mother

Care for

preterm/low birth

48

continuous skin to skin

contact, early cord

clamping

practiced weight newborns

Creation of newborn areas

in District hospitals

7 out of 19 facilities

had newborn areas

10 out of 19 facilities have

newborn areas

Erratic flow of funds

Lack of space for

newborn care areas

Inadequate staff

COMMUNITY Advocacy for newborn

care

3 newborn care

champions identified in

the community

Involvement of community

based volunteers, opinion

leaders and traditional birth

attendants

Late referrals from

the community

49

ANNEX 2: Regional Progress and Next steps with the Newborn Health Strategy

for 2015-2016 Volta Region:

o Established six (6) new Mother and Baby Units/Neonatal Units in selected districts.

o Next steps: Plan and scale up the establishment of neonatal units to all districts in the

region.

Upper East Region:

o Organised newborn advocacy programs twice weekly on radio, and established a

Newborn resource center at the Regional Hospital, and established Neonatal Intensive

Care Units with support from UNICEF and Government of Japan.

o Next steps: Strengthen partnerships and social networking to advocate for support for

newborn care.

Northern Region:

o Set up a Telemedicine center at Tamale Teaching Hospital to provide newborn care and

support to peripheral facilities. Achieved a significant reduction in neonatal mortality

with the establishment of Neonatal Intensive Care Units in the Region, supported by

UNICEF, Government of Japan and MTN Ghana Foundation.

o Next steps: Scale up the number of Neonatal Intensive Care Units in the region.

Eastern Region:

o Trained 30 Regional trainers in HBB, ECEB and Infection Prevention and Control (IPC)

under the Making Every Baby Count Initiative project.

o Next steps: Train all midwives and health workers who provide maternal and newborn

care in all district hospitals in the region.

Upper West Region:

o Procured newborn equipments for health facilities with funds from Japan International

Cooperation Agency (JICA).

o Next steps: Train midwives in essential newborn care. Build a mothers hostel using

internally generated funds and reimbursements from the National Health Insurance

Scheme.

Central Region:

o Instituted a routine system of motivating well performing staff with awards and

certificates.

50

o Next steps: Expand KMC in the Region.

Ashanti Region:

o Ten (10) trainers and 223 midwives/nurses trained in HBB and ECEB with support from

Women’s Health to Wealth (WHW).

o Next steps: Set up a Regional newborn committee, and train all midwives in district

hospitals in HBB, ECEB and IPC.

Brong-Ahafo Region:

o Trained 30 Regional trainers and 138 providers trained in HBB, ECEB and Infection

Prevention and Control (IPC) under the Making Every Baby Count Initiative project

Instituted quality improvement initiatives in 7 facilities – facilities provide sterile cot

sheets for drying every newborn at birth.

o Next steps: Scale up quality improvement initiatives to all district hospitals.

Western Region:

o With support from eni foundation, a new maternity block has been completed in one of

the districts. Vehicles, Equipments, Information Education and Communication

materials provided for maternal and newborn health activities. Built eight (8)

Community-based Health Planning Service compounds in selected districts.

o Next steps: Scale up maternal and newborn care interventions to other districts.

Greater Accra Region:

o GHS proposal for setting up a KMC center of excellence in the region for training health

care providers developed and approved. The Colombian government will support the

implementation and expansion of KMC in Ghana.

o Next steps: An off-site three month training in KMC for three health professionals, and

technical support for the setting up of “centers of excellence” for KMC training and

implementation in Ghana.

51

ANNEX 3: Programmatic Approaches to KMC implementation

Table 4: ADVANTAGES AND DISADVANTAGES OF THE ‘BIG-BANG’ APPROACH AND ‘STAGGERED’

APPROACH

ADVANTAGES

‘Big bang’ approach ‘Staggered’ approach

• Immediate coverage results

• Intensity and wider spread of messages –

can help with sustainability

• Implementers more mindful of importance

of success due to public awareness and

publicity

• Immediate benefit for more mothers and

babies

• Building of momentum and demand over time

increased ownership

• Costs spread out over a longer period

• Learning from implementation over time increased

sensitisation to the process and implementation

becomes easier

• Possibility of establishing centres of excellence

success breeds success

• Benchmarking and training at centres of excellence

with successful KMC programs

• Easier integration of KMC into newborn services

• Better control over quality of care

DISADVANTAGES

• If insufficient ownership, long-term sustainability

may be compromised

• More difficult to sustain momentum during

implementation ”dips”

• More difficult to integrate KMC into newborn

services

• Immediate cost is high

• Quality of care more difficult to achieve

• More qualified and experienced trainers needed

further increase in costs

• Quality of training may suffer where experienced

trainers are unavailable

• Could unravel in case of changes in drivers or trainers in

middle of process

• Longer time for intervention to be implemented

• Longer time for more mothers and babies to benefit

52

2. PEDESTAL APPROACH

‘Pedestal’ approach is often used when KMC can easily disappear or be forgotten. It is not equivalent to

a vertical programme. In this approach KMC is lifted out of the newborn care package for special

attention until well established, leading to a mindset change and a paradigm shift. The concept of the

KMC Steering committee serves as a pivotal point for success.

3. STAGES OF CHANGE APPROACH

The stages of change approach with progress markers was shown in figure 1, and figure 5 describes

the stages of change including coverage and quality of care.

Stakeholder

readiness

2. Commit to

implement

3. Prepare to

implement

4. Implement

5. Integrate into

routine

practice

6. Sustain new

practice

Get acquainted

1. Create awareness

STAGES OF CHANGE

Health-system

readiness

QUALITY

1. Indicators in HMIS

2. Standards for newborn

services accreditation*

3. Standards for quality

newborn care**

* Facility level ** Individual level HMIS = Health Management Information System

C

O

V

E

R

A

G

E

Bergh et al (2014) The implementation and scale up of facility-based kangaroo mother care in five Asian countries. Unpublished report, MCHIP/Save the Children

Figure 5: STAGES OF CHANGE, COVERAGE AND QUALITY OF CARE

53

4. SYSTEMS APPROACH

KMC services in health facilities are essential before further roll-out in the community. People have

different interpretations of what a KMC programme entails, but under the systems approach method, it

basically consists of four main activities and all four should be included in programme planning and

evaluation (see Annex 3, Table 5).

I. KMC practice (method/people)

II. KMC services (system)

III. KMC implementation

IV. KMC training

54

Table 5: Elements to include in KMC programme planning – examples

KMC practice

(people)

KMC services

(system)

KMC

implementation

KMC training

and orientation

Input How much KMC?

(Intermittent/Continuous)

Resources (human, financial,

equipment, infrastructure,

time)

Training

Resources Resources

Process How long KMC?

Barriers to practice

Policies & protocols

Record keeping & statistics

Day-to-day running

Design & intervention

Supportive supervision

Monitoring and evaluation

programme

Training strategies

Pedagogical approaches

Outcome Survival

Morbidity

Percentage of eligible infants

receiving KMC

Coverage

(institutions, population)

Number of people trained

Impact Long-term effects (e.g.

bonding, neurodevelopment)

Neonatal mortality & morbidity

rates, etc

Epidemiological indicators

(e.g. mortality, morbidity,

long-term health outcomes)

Use of knowledge and skills

Has a KMC program been

implemented?

KEY MESSAGES FOR KMC INTRODUCTION AND EXPANSION • THE PROCESS

Implementation paralysis – sometimes people don't know what to do with KMC and the process stalls

Remember Rome was not built in one day

KMC should be on many agendas (meetings, forums)

55

Piggy-back on other initiatives (e.g. Mother-Baby Friendly Facility Initiative, EMBRACE, Project Five’s Alive, MEBCI project)

One size may not fit all and there is a need to address contextual and sociocultural issues

• VALUES

Set minimum realistic and achievable norms and standards for KMC services

Accountability - (Monitoring and Evaluation indicators, perinatal audit, mortality and morbidity review meetings, mechanisms for

regular reporting)

Continuous quality improvement

Constraints are not an excuse for not implementing KMC

• QUALITY OF CARE

Strengthen the referral chain between different levels of care and resources needed for a well functioning network

Components of KMC - quality of KMC practice

Correct handling of small babies

Correct positioning of the baby on the mother/caregiver’s chest

Covering baby’s head

Appropriate feeding job aids for small babies

Follow-up and review systems that can work in low-resource settings

Multidisciplinary teamwork at all levels

Strong community-facility linkages

56

ANNEX 4: Key Recommendations for KMC implementation

by Dr. Priscilla Wobil, Senior Specialist Paediatrician-KATH

KMC is a programme consisting of three main components: Position (prolonged skin to skin contact),

Nutrition (breastmilk/exclusive breastfeeding) and Follow up (early discharge and follow up care). KMC

is part of the continuum of care for mothers and newborns. KMC requires a multidisciplinary team

approach, commitment, perseverance and a supportive environment at all levels.

NutritionPosition

Discharge and follow-up

Health care facility

Community

Family

Staff

Kangaroo Mother

Care

Figure 6: Kangaroo Mother Care components, courtesy Anne-Marie Bergh

RECOMMENDATIONS FOR NATIONAL LEVEL USING THE STAGES OF CHANGE APPROACH

Create awareness

Conduct a situation analysis on preterm/LBW newborns in Ghana and feasibility of

introducing KMC

Conduct a SWOT (strengths, weaknesses, opportunities and threats) analysis of KMC

implementation

Organise National level stakeholders meetings (already in progress)

57

Commit to implement

Organise National level stakeholders meeting (already in progress)

Put KMC as a permanent item on the agenda of key meetings

Develop next steps and action plans including budgeting

Plan a visit to a functional KMC site (in country or abroad)

Prepare to implement KMC

Review national policies and guidelines on care of the preterm/LBW newborn within the

newborn strategy

Draft and adapt a national policy for care of preterm and LBW babies including KMC

Develop or adapt competence based training materials

Identify implementation site and teams using a standard criteria

Identify and train trainers

Work with regions and partners on training plan

Plan and have working meetings with management at the Regional level to determine

road map and time frame for taking up KMC and discuss Regional action plans

Identify implementation site(s)/team(s) based on a set of criteria (centers of excellence)

Develop or adapt monitoring and evaluation plans, including hospital forms, charts and

registers

Plan and implement community mobilization and Behaviour Change Communication

plan – Develop or adapt materials for KMC education and promotion, strengthen

linkages, referrals & postnatal care

Implementing the KMC programme (see figure 7)

Integrate KMC into routine practice

Analyse practice, provide feedback and report findings, use findings to improve on

practice (Quality Improvement)

Provide supportive supervision, monitoring and evaluation of the KMC programme

Perinatal audits and performance review meetings should include newborn care and

KMC

Sustain the new practice

National ownership

58

Establish an accreditation system with KMC as a vital component for assessing newborn

care services

WHO?

WHAT?

WHEN?

WHERE?

HOW?Support for

implementation

Budget & resources

Workforce• Adequacy (provider-

patient ratio)

• Staff competency

• Job descriptions

• Staff attitudes

• Support for mother

Planning for infra-

structure• Space

• Equipment (e.g. beds,

chairs, wraps)

• Transport

• Referral system

• Follow-up facilities

Advocacy & training• Who should be trained?

• Stand-alone vs. integrated

• Training approach

• Coverage of training

Guidelines• National guidelines

• Minimum newborn care

standards

• Systems for KMC delivery

• M&E systems

• Facility protocols/SOPs

LEADERS

• Policy makers

• Government

• Partners/donors

• Administrators

• Managers

• Health workers

• Community

All levels of health system

• Stand-alone,

‘pedestal’ or

integrated?

• Pace of

implementation –

‘big bang’ or

‘staggered’?

End-user and community factors

• Socio-political-cultural issues

• Socio-economic factors

• Access to health facilities

• Awareness & acceptance

• Education & preparedness

• Family support

FOR WHOM?

Po

lit

ica

l w

ill

Bergh et al (2014) The implementation and scale up of facility-based kangaroo mother care in five Asian countries. Unpublished report, MCHIP/Save the Children

Figure 7: Support for KMC implementation

KEY RECOMMENDATIONS AT THE REGIONAL AND DISTRICT LEVEL

Create awareness

Prepare your region districts facilities for KMC implementation

Organise a meeting with stakeholders

Conduct a situation analysis of care of the preterm/LBW baby in the region

Conduct a SWOT analysis of KMC implementation

Plan and conduct a tour of some facilities

Commit to implement and expand KMC

Adopt the concept, evidence of decision to implement KMC

Identify potential champions for steering the process

59

Commit to support districts and facilities

Develop an action plan for the Region

Prepare to implement (passion & determination)

Collect baseline data on care of preterm/LBW newborns per facility

Prepare basic equipment and supplies for care of the preterm/LBW

Identify space for KMC, if there is no space, consider structural adaption or reorganization. Be

innovative!

Develop training plans – as part of newborn care training, learning on the job, visit functioning

KMC sites (centers of excellence), adapt and use KMC training materials approved by GHS and

MOH.

Develop or adapt KMC guidelines, registers and monitoring charts for documentation

Plan for community outreach

Strengthen referral networks and follow up systems – bring services closer to home

Implementing the KMC programme Note: Care for the preterm/LBW starts before pregnancy

Start with what you have

Infrastructure – facility, unit, ward…

Need skilled & committed staff – midwives, nurses, doctors, social workers, psychologists, others

Focus on the Mother, Baby and the Family and take their basic needs into account – feeding and

lodging facilities

Determine the type of KMC that can be practiced in the facility: continuous, intermittent or both

Decide of the model of KMC to be implemented at the various levels/facilities

Integrate KMC into routine practice Analyse practice, provide feedback and report findings, use findings to improve on practice

(Quality improvement initiatives)

Provide internal supportive supervision

Acknowledge and appreciate facility champions and providers

Sustain practice

Regional, district and facility ownership

60

ANNEX 5: Discussion Points

Cultural issues and traditional practices: Is anyone working with the traditionalists and “asram”

herbalists in Ghana? These are a group of highly influential people in the community. The Ghana

Health Service and partners should develop strategies to engage them. Herbalists and

traditional birth attendants are valuable community assets and finding new roles for them such

as providing support for women during labour and serving as a link between the facility and

community can be a vital tool for increasing access and utilisation of health services. On the

other hand, during focused antenatal care, health providers should aim at gaining the

confidence of mothers and take opportunity to counsel them on harmful traditional practices

that affect mothers and newborns.

Facility deliveries: One disincentive for mothers not wanting to deliver in health facilities is due

to the fact that some midwives demand toiletries and supplies from mothers when they come

to deliver. Participants appealed to the Ghana Health Service to make a strong statement to

condemn and stop this practice, ensure universal access to health care for all pregnant women

devoid of unwarranted financial hardships.

Funding for newborn care: Facilities cannot solely rely on the National Health Insurance Scheme

and Internally Generated Funds. They should actively and aggressively advocate for support

from the District Assemblies, opinion leaders, business organisations and members of

parliament. Regions were encouraged to be innovative in sourcing for funds for newborn care.

Staff attrition: The high staff attrition rate in the Northern regions of the country is a cause for

concern. The Ghana Health Service is already in talks with the Nursing and Midwifery Council on

this issue. It was proposed that government should provide incentives for staff working in these

regions in the form of future career progression and subspecialty training. In considering this

proposal, the Ghana Health Service would have to think about how to sustain this process in the

absence of support from partners.

Holistic care for the preterm/LBW newborn: Caring for a preterm baby is not only about KMC.

KMC actually brings all the various essential and extra newborn interventions together as a

package for the preterm LBW baby. Care of the preterm baby starts before pregnancy and

continues beyond the postnatal period. It is important for stakeholders to note that quality care

provided during the antenatal period, intrapartum period with skilled delivery, use of the

partograph, provision of basic resuscitation equipments to help a preterm baby breathe at birth

61

when necessary, skin to skin contact and all the other essential care interventions are vital for

their survival.

Feeding the preterm/LBW newborn: Health workers must be extremely cautious with formula

feeding and promote exclusive breastfeeding and expressed breastmilk for the preterm and

LBW newborn as much as possible. Some formula manufacturing companies are flouting the law

and not abiding by the International Code of Marketing of Breast-Milk Substitutes. Health

workers should acquaint themselves with the provisions of the Code and promote, protect and

support early and exclusive breastfeeding for every newborn.

Supportive environment for mothers: Sick newborns and preterm babies tend to be on

admission for several days and facility managers should provide lodging facilities for mothers

including feeding. These services must be included in the National Health Insurance Scheme.

Motivation and incentives for health workers: Motivation of staff is an important determinant

for quality of care. For facilities that are performing very well and achieving results, GHS and

MOH should develop innovative approaches such as awards, accreditation and recognition of

facilities and health workers during annual review meetings.

Professional associations: The Professional associations and Societies such as Paediatric Society

of Ghana and the Society of Obstetricians and Gynaecologists of Ghana should take this forum

beyond this meeting. The Paediatric Society of Ghana is already advocating for children and

newborns and they called for the Obstetricians to come on board.

KMC promotion: Facilities, Districts, Regions and National should take advantage of existing

programmes, activities and celebrations to advocate and promote KMC. A few examples cited

were World Prematurity day, World Breastfeeding week, National Child Health Promotion week,

KMC Awareness day (15th May), International day of the Midwife and Annual General and

Scientific Meetings of professional bodies and associations.

KMC training centers: KMC is like a mentorship programme. It is not learnt in the classroom per

se, health workers learn it by experiencing and practicing on a KMC ward. Training can be done

outside the country if funds are available. However, regions need to use existing training centers

within the country and send their teams to these centers for training in KMC. The training center

would have to develop a supervision plan and provide technical support for these teams to

establish KMC units in their facilities. The Essential Care for Small Babies’ curriculum is a new

training module that can be used for the classroom session, but the practical part would have to

be at the health facility.

62

Newborn indicators: KMC registers have to be developed for use at the facility level and KMC

indicators must be included in DHIMS2 to track progress, advocate for funding and facilitate

programme planning. At the global level, the Newborn and KMC Indicators working group is

developing a set of indicators that will be in the Every Newborn Action Plan. These indicators

when finalised, will be recommended for inclusion into the DHIMS2.

63

ANNEX 6: Summary of strengths and challenges with regard to KMC (and newborn care) implementation

identified in regional working groups Below is a summary of the themes that emerged from the regional working groups. For most issues there are strengths associated with each, but also

challenges. Not all regions may have mentioned all issues. The content of many of the themes relates to health service delivery and newborn care in general

and not only to KMC. (Compiled by Anne-Marie Bergh)

Table 6: Summary of strengths and challenges with regard to KMC (and newborn care) implementation identified in regional working groups

Building block

Theme / Issue Strengths Challenges Possible solution(s)/Remarks

1. Leadership and governance (enabling environment)

Support for the newborn cause and preterm and low birth weight newborns

• Leadership willingness and commitment in some regions (e.g. Regional Health Directorates)

• Experience of KMC and the provision of services in some regions/health facilities

• Weak commitment in some regions/facilities inter alia because newborn care and mortality is not a priority at all levels

• No experience in KMC in some regions/health facilities

• Buy-in from opinion and political leaders is essential

• Leaders at national, regional and district level are instrumental in

- policy formulation and implementation of KMC

- advocacy - mobilization of resources - capacity building - networking and liaison - monitoring and evaluation

• Identify and use leadership and other training opportunities and existing meeting structures to sensitise leaders on the importance of KMC within the newborn care context and how they could assist with putting policy into practice

• Identify new and use existing newborn champions to promote the cause of KMC and drive implementation at all levels

• Engage with development partners and traditional and community leaders on their potential contribution to health services and community mobilisation for KMC advocacy and implementation

Governance and system structures and organograms (e.g. regional and district health committees; sub-district, district and regional health management teams; Metropolitan, Municipal and District Assemblies [MMDAs])

• Already in place • Some regions have newborn committees

• Some structures not fully functional in some regions

• Management teams unfamiliar with KMC or little knowledge of the importance of KMC

• Roles with regard to the implementation and strengthening of KMC services not defined (KMC not included in job descriptions at different levels)

• No uniform reporting formats for KMC

Newborn focal persons • Regional focal persons appointed • They have potential to translate KMC policy

to practice at facility level

• Not clear how focal persons should operate within the regional and district teams with regard to KMC implementation and supervision

• No district focal persons or teams

Policies and strategy documents

• Existing • Putting policy into practice

Leadership training • On-going in some regions • Training in the implementation of KMC not

64

Building block


in the focus of the training • Revisit guidelines and job descriptions at all levels to ensure that KMC also features

• Get professional associations on board (e.g. Ghana Registered Nurses Association [GRNA], Ghana medical Association [GMA])

• Use existing structures (e.g. half year reviews) to further the cause of KMC through advocacy and regular feedback on progress with KMC implementation

• Use existing facility management teams to

- work out a plan for the implementation and strengthening of KMC services at facility level

- ensure adherence to protocols and guidelines

- advocate for and organise training in KMC - keep KMC as a fixed item on the agenda of

important meetings

• In the case of dysfunctional structures conduct a root cause analysis

• Engage with the owners and boards of private health care facilities for sensitisation of KMC

Committed traditional and community leaders

• Existence of structures (e.g. traditional councils and House of Chiefs)

• Unfamiliar with KMC

Development partners (e.g. Red Cross, UNICEF, Catholic Relief Services [CRS], UNFPA, Regional Coordinating Councils [RCCs], PATH, other NGOs)

• Partners involved in newborn care in all regions

• Existing structures that bring together partners (e.g. Coalition of NGOs in Health)

• Competing priorities

Public health care facilities • Existing health management teams for promoting KMC implementation and strengthening existing services (incl. medical superintendent, hospital administrators, nursing administrators, in charges)

• In some facilities persons in these positions have experience with KMC or are aware of the importance of KMC

• Low awareness among some facility managers on benefits of KMC to facilities and overall reduction in neonatal mortality → KMC not considered a priority

• In-facility newborn or KMC teams not functional, even where KMC services are provided

• Key staff positions not filled (e.g. paediatricians, O&G specialists)

• Unclear guidelines

Faith-based and other private health care facilities

• Existing regulatory agencies and boards for these facilities

• Unfamiliar with KMC

2. Health systems financing (enabling environment)

Leaders’ and managers’ views on the provision of KMC (priorities)

• Champions willing to support KMC financially

• KMC services perceived as capital intensive or poor return on investment (due to ignorance)

• Competing priorities

• See comments under Leadership building

block above

• Advocacy at all levels (regional, district and

sub-district) to create awareness of the

critical role of KMC in order to positively

inform budgetary allocation and to make

KMC a financed health activity

• Regular review of tariffs and use of IGF for

KMC implementation activities (e.g. at

Budget allocations from Government of Ghana (GOG)

• Budget support from GOG • Inadequate and sometimes erratic financial support for all services (making it difficult to institute new services)

• KMC competing with other budget needs • Lack of funding for newborn infrastructure

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Building block


Earmarked funds • MDG Acceleration Framework (MAF) facility level for feeding mothers, incentives

for staff, procuring cups and spoons)

• Encourage more people to enrol in the NHIS

• Explore different funding sources and write

proposals for setting up KMC services,

procurement of essential items for preterm

and low birth weight care, and capacity

building (e.g. sponsoring midwives to go for

training, benchmarking at other facilities

with KMC services, study tours)

• Explore public-private partnerships and

synergize donor efforts

• Investigate how NHIS reimburse for LBW

babies and KMC and advocate for changes to

ensure sufficient coverage

• Timely submission of claims and getting

NHIA to reimburse promptly are recommen-

dations that could contribute to the more

efficient institution of KMC services

• Monthly reports and enforcement of internal control of hospital funds with regular spot checks or routine auditing to inculcate accountability and ensure appropriate prioritisation of funds (incl. for KMC)

National Health Insurance Scheme (NHIS)

• NHIS does not adequately cover special situations in new born care (e.g. care for the LBW neonate and extended hospital stays, also for KMC)

• Delayed reimbursements by the National Health Insurance Authority (NHIA)

• Cutting of claims submitted

Internally generated funds (IGF) (insured & non-insured)

• Available • Can be used for specific projects

• Low tariffs • Poor documentation because of absence of

qualified staff • Misuse and misdirected use of facility IGF

and fraud

Partner sponsorship (donors, philanthropist societies/foundations)

• Sponsorship of training programmes that include KMC

• Lack of coordination amongst supporting partners

• Delay in release of donor funds

Private funding (incl. NGOs) • Donations available in some instances

Allocation of resources for KMC at facility level

• Little or no financial and human resources for KMC

3. Health workforce (supply)

Newborn care champions • Available at different levels in some regions (especially paediatric nurses)

• No recognised team for promoting KMC at regional level

• Absence of committees to steer newborn activities (incl. KMC) at different levels of the health system

• See also comments above under the Leadership building block

• Develop a human resources management plan, which includes provision for KMC services and a focus on staff retention

• Form or revitalise regional newborn care

steering committees or district / facility-

based KMC steering committees Staff availability • Facility level: paediatricians, O&G and other

specialists, medical doctors, physician • Mobility, turnover and attrition of staff with

KMC experience (e.g. transfers / study leave

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Building block


assistants / paediatric nurses, midwives, general nurses, and support staff available (more in some regions than others) – also quality improvement (QI) teams

• Community health officers, nurses, volunteers, community-based agents (CBAs)

and vacation / resignations / retirements) • Attrition of supervisors → weak supervision • Poor health worker : patient ratio → high

staff workload • Embargo on staff recruitment / employment

• Orientation and training (capacity building) at all levels:

- Use exiting training opportunities to reinforce KMC (e.g. Making Every Baby Count Initiative [MEBCI])

- Develop regional master training for KMC and/or newborn care

- More sharing of knowledge and skills acquired through training with other facilities in the same region

- Incorporate newborn care training (incl. KMC) into pre-service curricula

- Regular in-service training and on-the-job orientation and coaching

- Continuous departmental training by hands-on activities

• Provision, allocation and distribution of staff (to also cover KMC services):

- Existing training institutions to supply staff to be distributed to various levels

- Use training institutions and development partners for staff capacity building and retraining of critical staff, research and protocol development

- Devise more appropriate staff retention

Staff allocation • Frequent / Annual rotation of staff trained in newborn care or KMC

• Human resources not allocated for KMC at facility level

• Inequitable distribution of healthcare providers across levels (inter alia due to influential people)

Staff commitment (attitudes)

• Non-commitment of some staff • Staff apathy from weak teams • Refusal of some staff to be posted to remote

areas

Staff competency in KMC (and newborn care)

• KMC-trained health workforce already in place in pockets of some regions

• Majority of staff are untrained in KMC • Lack of critical staff mix (in newborn care) • Litigation

Training (general) • Existing training institutions (some specialised): universities, nurse and midwifery training schools)

• No KMC trainers in some regions

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Building block


Training (facility level) • Some facilities with regular in-service training in KMC

and management policies or plans to retain KMC-trained staff in newborn care

- Review internal rotation systems and retain trained staff at the MBU/NICU / KMC corners for at least a year

- Establish and implement staffing norms for KMC

- Assign roles to staff with regard to the provision of KMC services

- Consider task shifting - Sanction non-performing staff - Work on staff motivation

• Supervision and outreach:

- Specialists to embark on specialist outreach programmes supported by the trained paediatric nurses to serve as mentors, models and trainers

- Regular supervisory and supportive visits to provide mentorship

4. Essential medical products and technologies (supply)

Human resources, maintenance and supply chains

• Vibrant and functional regional medical stores, procurement teams / committees with plans and engineering units in some regions

• Partners who support with medical products and equipment

• Lack of well-trained, competent medical engineers to repair faulty equipment

• Practising KMC does not cost that much, but it is part of essential newborn care for which stocks, supplies and equipment have to be available – therefore a need to solicit funds

• Nurture a culture of sustainable preventive maintenance of equipment – regular monitoring and support visits

• Sustainable procurement plan for essential drugs, consumables and equipment for all facilities:

- Basic equipment for neonatal resuscitation

- Option of private medical stores that offer

Procurement of equipment and stock for all newborn care

• Availability of some supply of consumables (incl. paediatric formulations / vaccines / essential medicines, shea butter, spirits, chlorhexidine, chloramphenicol eye drops, Vit K) from Regional and District Medical Stores (RMS & DMS)

• One region: “Some facilities have more than enough of these supplies.”

• Availability of some equipment, linen and

• Unavailability or frequent stock-outs of essential medical products for newborns

• Expired or sub-standard drugs • Lengthy procurement procedure • Procurement of inappropriate or low-quality

and non-durable supplies and equipment • Lack of equipment for newborn

resuscitation in some facilities • Lack of other equipment: reclining chairs,

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Building block


smaller items (e.g. tape measures) (some through donor funding)

• Cold chain maintained

feeding utensils, thermometers, appropriate weighing scales

• Non-settlement of commitment to RMS by NHIA → high debts

quality services to clients

• Better management of stocks:

- Prioritize the purchase of essential drugs - RMS should stock adequate consumables - Schedule delivery of stocks - Redistribution of stock and equipment

between facilities with excesses and deprived facilities (to be done on supervisory visits)

- Safe storage rooms with fire extinguishers

• Other types of financial support: • More financial support from GOG • Vetting and debt retrieval committees

Storage of stock • Fire hazards in storage space

Private medical stores • Able to provide some of the consumables

Essential staff competencies

• Knowledge deficit in paediatric prescription • Inability of staff to operate or handle

equipment

5. Health service delivery (supply, quality)

Newborn staff and teams • Regional and lower-level newborn teams • Availability of willing and skilled staff to

provide quality care – different designations (see Health Workforce building block)

• Presence of trainable staff for KMC in facilities

• Referral enhanced by the existence of facilities and staff from primary health care to tertiary care levels

• Inadequately trained staff • Poor staff commitment to ensure KMC

practice • Low standard of nursing care practice

• See all the building blocks above – importance of quality service delivery for client satisfaction

• The opportunity is there to offer special care to the newborn

• Nurture an institutional culture promoting facility- and health worker ownership of KMC

• Health workforce:

- Prepare and motivate health workers at facility level for compulsory activities (incl. job descriptions and performance agreements)

- Staff capacity building in newborn care (incl. KMC and training in IPC), including

▫ on-the job training ▫ structured in-service courses and

Services available to support KMC

• Focused antenatal care (FANC), skilled delivery, PMTCT, BEmONC, CEmONC, home-based postnatal care

• Creation of newborn units in some facilities • Existence of emergency systems and quality

improvement teams • Public health units (vaccines for

immunisation)

• Non-functional QI teams • Inadequate documentation

Infrastructure (incl. space) • Ability to procure supplies • Resuscitation area in some facilities

• Inadequate infrastructure and deplorable state of existing ones (incl. broken-down

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Building block


• Space for KMC available in some facilities • Basic equipment available

vehicles) • Network and logistical challenges • Unreliable electricity supply → affects

preservation and quality of medicines and equipment.

• Use of substandard drugs • Lack of equipment • Lack of dedicated space to practice KMC • Inadequate health commodities (incl. KMC

kits)

refresher training

- Encourage staff commitment to best practices through regular departmental talks

- Implement effective monitoring and supportive supervision

- Additional staff?? (request from national level)

- Explore opportunities for safe task shifting - Consider a facility award system for good

KMC performance

• KMC guidelines should be available with a clear indication of the type of KMC service to be available at the various levels of care

• Infrastructural improvements:

- District assemblies to renovate and maintain existing structures and expand facilities

- Create a space for KMC (e.g. corners, bays or wards/units in various facilities)

- Every district facility should have alternate sources of power

- Lobby for donors and other stakeholders to support infrastructural improvements and provision of essential supplies

• Other quality issues:

- Effective logistics of management systems - Repositioning of TBAs as link agents to

skilled delivery

Protocols and guidelines • Presence of protocols for infection prevention and control

• Presence of referral guidelines • Existence of an essential medicines list

• Poor adherence to infection control measures at health facility level

• No clear-cut definitions related to KMC (e.g. continuous vs. Intermittent KMC, eligibility criteria for babies to receive KMC and for how long)

• No clear-cut written guidelines, policy and plans for KMC → threat to sustainability

• Lack of funds to disseminate guidelines / protocols

Supportive supervision • Weak supervision – no regular visits by people with the technical expertise to validate the practice of KMC at the peripheries

• Lack of vehicles for supervision

Provider-client relationships • Communication gap between service providers and care givers (mothers and relatives)

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Building block


6. Health information systems (quality)

Structures to manage data collection, management and analysis

• Existence of health information units at all levels

• Presence of primary collectors of data (midwives)

• Presence of trained health information officers at different levels

• Availability of biostatistician • Availability of network service to facilitate

data management

• Collect baseline data in the region, inter alia for neonatal indicators and about the state of KMC implementation in the various facilities, with a view to

- creating awareness of the problem - planning systematic implementation

• Document the process of KMC implementation and record improvements as a result of the implementation

• Develop and use of KMC indicators:

- Inclusion of KMC indicators in DHIMS - Indicators of KMC practice at facility level

with a regular reporting mechanism (e.g. monthly or quarterly) (number of enrolments, morbidities, successes etc.) – can be linked with DHIMS

- Use data with a view to (quality) improvement:

▫ monitoring and evaluation ▫ supervision ▫ planning and decision making ▫ sharing of best practice

• Data tools:

- Revisit tools and records related to the

Equipment and internet • No or inadequate computers • Unreliable network (inter alia due to

frequent power outages) → challenges with internet connectivity

District Health Information Management System (DHIMS)

• Existence of health information system (DHIMS 2) and other software to collate and utilise health data

• Availability of E-tracker

• Non-inclusion of KMC indicators in DHIMS • High workload for midwives

Health Administration Management System (HAMS)

• Existence of HAMS

Perinatal audit • Existence of perinatal audit teams • No standard perinatal mortality audit form

Data quality • Data quality audit • Poor data capturing and validation • Data discrepancies and inaccuracies • Closing DHIMS makes validation impossible

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Building block


Data tools • In some regions facilities with KMC wards have registers and assessment forms for babies whilst on admission and at discharge

• Registers for antenatal care, delivery and postnatal care

• Existence of a newborn register • Opportunity to design and print newborn

standard reporting format • Data capturing tools for home-based care

and KMC available • RMNCH score cards to monitor data inputs • Standard registers and e-register

• Too many registers and too many reporting forms and formats → parallel reporting

• General unavailability of KMC registers • Lack of registers and assessment forms in

some facilities practising KMC – where available, there is lack of uniformity

• Lack of standardised KMC reporting format • Service access and quality not guided by

existing data collection tools

capturing of newborn care information - Consider standardisation of data capturing

(e.g. records/registers/audit forms) and reporting tools (that will include KMC)

- Create a thematic area on KMC in the health facilities peer review checklist

• General improvements required:

- Data management → timely availability of data (also with regard to KMC indicators)

- Accuracy in data capturing - Availability of computers (incl. seeking

funding from donors or using IGF) - Lobby for alternative power resources

(e.g. solar systems)

Data generation and use • Stakeholders have access to DHIMS to monitor indicators and also inform decision-making

• Health facilities not monitoring themselves • Absence of data at facility level • Poor data generation and utilisation

7. Community ownership and participation (demand)

Community leadership and structures (general)

• Existing leadership structures (incl. Social Welfare, RCCs, Rural Health Collaborative [RHC])

• Cordial relationship between District and Municipal Health Directorate and the District and Municipal Coordinating Councils or authorities

• Commitment of chiefs, queen mothers, religious and other opinion leaders

• NGOs, civil organisations, media

• Running of parallel programmes • See also Leadership building block above • Integrate KMC with existing interventions

such as those aimed at improving community based newborn care practices

• Advocacy activities are essential for:

- Resource mobilisation - Service delivery

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Building block


Health leadership (health) • Well demarcated functional Community-Based Health Planning and Service (CHPS) zones with community health committees and compounds and health centres with staff ( midwives and community health workers)

• Presence of public health units • Presence of community-based champions

and newborn ambassadors • Community health nurses (CHNs),

community-based surveillance volunteers (CBSV)

• Traditional birth attendants (TBAs), traditional healers, herbalists, bone setters

• Lack of awareness of the critical role of KMC among local authorities

• Ineffective village health committees • Lack of collaboration between health

workers and community • High demands from volunteers and lack of

incentives → volunteer fatigue • Lack of intervention, protection and control

(IPC) measures • Inadequate communication between service

providers and community members (relatives) on their role in providing KMC (support to mothers and providers)

- Peace

• Target community leaders through grassroots advocacy for KMC and advocacy for peace

• Community sensitisation for KMC and involvement by means of

- working with traditional leaders and NGOs - community activities (e.g. durbars),

outreach and education - inclusion in activities of other health

campaigns (e.g. child survival week, breastfeeding week)

- the use of mass media (incl. local radio stations)

- the use of existing structures and opinion leader groups

- creation of local KMC community champions (e.g. using grandaunts)

- the use of open days within the GHS facilities to share the benefits of KMC with opinion leaders and the community

- community health workers going into the community to encourage KMC in homes

• Sensitise prospective mothers on the relevance of KMC from ANC through to lying in and at the MBU/NICU

• Find ways to address harmful advice and socio-cultural practices that can impact on the uptake of KMC and the survival of preterm and low birth weight babies

• Improve geographical accessibility to health services (and by implication KMC and newborn follow-up services)

• Revamp community structures and re-

Cultural beliefs and practices

• Myths, superstitions, cultural beliefs and practices that may be harmful or hinder the practice of KMC in the community

• Poor health systems / stakeholder interaction on negative cultural practices

• Poor health seeking behaviour • Inadequate knowledge on KMC

Community support • Mother-to-mother support groups (MTMSGs)

• Father-to-father support groups (FTFSG)

• Low community participation and poor community utilisation → dying spirit of volunteerism

• Lack of community support due to:

- lack of commitment toward the care of newborns

- insufficient sensitisation of the importance of KMC and how to practice it

Access to health services • Inability to pay for services in the health facility when not covered by NHIS

• Lack of transportation for follow-up visits for LBW and KMC babies (e.g. durable motor

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Building block


cycles) orientate health service delivery to enable community dialogue and promote community participation as much as possible, inter alia by rekindling the spirit of volunteerism

Contextual factors • Conflicts, flooding and fire – insecurity for outreach, etc.

• Chieftaincy and land disputes

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ANNEX 7: Regional KMC Implementation plans The Regional newborn focal persons, the Regional and District Health Management Teams and the Facility Heads will be responsible for implementing these

actions.

Table 7: Regional KMC implementation plans

REGION Immediate actions Actions within 3 months

Actions within 6 months

Actions within 1 months

Actions 1 year and beyond

Ashanti Region 1. Debrief Regional and District Health Management Team (RHMT/DHMT), Regional Coordinating Council (RCC).

2. Organise a Stakeholders‘ meeting

3. Conduct Baseline Data collection on preterm and LBW babies

4. Advocacy and awareness creation at all levels(District Assemblies, social /community groups)

5. Create a Regional committee for New-Born Care

1. Continue collection of baseline data.

2. Prepare and train health staff on KMC.

3. Continue with advocacy programmes.

4. Identify potential champions/ambassadors

5. Identify private partners/sponsors.

6. Identify logistics and support required (financial and material)

7. Identify existing structures to harness for KMC implementation.

8. Develop KMC/Newborn Care guidelines and protocols.

1. Continue with training and advocacy programmes.

2. Identify focal persons at all levels.

3. Start KMC implementation

4. Institute Referral guidelines for Newborn Care

1. Expansion of KMC programmes to other facilities

2. Organise Study Tours 3. Continuous training

and advocacy programmes

4. Monitoring and supervision

1. Annual performance reporting/review.

2. Award system for best working staff and facilities.

3. Structured in-service training programmes and refresher courses.

4. Work on inclusion of KMC in pre-service training.

5. Regular feedback on progress

Brong-Ahafo Region 1. Debrief RHMT members on Monday(3rd August)

2. Gather baseline information on low birth weight from DHIMS ( morbidity

1. Reach agreement among decision makers, opinion leaders and health workers to expand KMC services in region(use forum for

1. Resources for Roll out 4 other districts

2. Document the process for KMC implementation

3. Record improvement as a result of KMC

1. Roll out all district hospitals

2. Refresher training for facility newborn champion

3. Provide feedback on progress with

1. Analyse KMC activities

2. Institutional culture promoting facility- and health worker ownership of KMC

3. Support for essential

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and mortality) 3. Stakeholders to be

reached during half year review meeting on 13th August and to advocate for KMC

4. Use FM stations to create awareness of KMC in the region

5. Place KMC on weekly and monthly DHMT/RHMT/Hospital meetings

regional newborn champions)

2. Assess preparedness of 6 district hospitals

3. Send hospital providers to facilities in Kumasi practicing KMC for training

4. Use MEBCI training to sensitize providers

5. Adapt KMC guidelines from practicing facilities

6. Start with 4 facilities(intermittent) (1 reg hosp and 3 district hospital)

implementation 4. Supportive

supervision 5. Identify Role and

responsibilities of different partners

implementation of KMC

4. Regular assessment and quality of KMC related data

resources integrated into the health system functioning

4. Long term and sustained monitoring, evaluation and feedback on the expansion and provision of KMC services at all levels

Central Region 1. Collect information on local and international experience that can inform the expansion

2. Identify meetings and forums where KMC can be disseminated

3. Make KMC a permanent agenda item for regular reporting on progress

1. Collect baseline data for creating awareness of problem

2. Use baseline data for creating awareness of the problem

3. Use existing forums, meetings etc. across all levels for initial orientation in KMC

4. Stakeholders to be reached – orientation to get on board

5. Advocacy for KMC 6. Reach agreement

among decision makers, opinion leaders and health workers to expand KMC services in region

7. Spell out and solicit the commitment required from leaders

1. Capacity to support sustainable KMC services at all levels and forums for regular reporting on progress

2. Decide and plan an expansion programme with timelines (including how existing structures will be used and whether some temporary committee may be needed to get the ball rolling and oversee the initial implementation with a view to integrate within the overall newborn care activities)

3. Decide and plan on initial orientation and

1. Prepare and motivate of health workers at facility level for compulsory activities, including job descriptions and performance agreements

2. Other accountability measures for expansion and maintenance

1. Half year meetings and review

2. Monitoring and supervision trips

3. Feedbacks to lower levels

4. Periodic capacity building sessions (new and refresher)

5. Roll out to non-practicing facilities

6. Advocacy meetings 7. Resource mobilisation

from available sources

8. Orientation for new managers

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and managers at different levels in the region

8. Identify other commitments and support required (e.g. human resources, financial, capital/material

9. Dialogue and assess the flow of information between healthcare users, providers, and policy makers

10. Place KMC as a permanent agenda item on the identified meetings

11. Identify existing structures to harness for KMC implementation

12. Determine roles and responsibilities of different partners and role-players

13. Committed leadership across levels (identify and use ‘champions’)

14. Keep KMC as a permanent agenda item on the identified meetings and forums for regular reporting on progress

training and training models to use (integration with other training programmes, temporary stand-alone sessions, etc.)

4. Business plans for the expansion process and for the maintenance of quality of LBW/preterm services at all levels (including resource allocations from existing budgets)

5. Assess preparedness of individual healthcare facilities and health networks to implement KMC and sustain practice (including referrals and follow-up)

6. Adapt exiting newborn/LBW care guidelines to include KMC

Eastern Region 1. AWARENESS CREATION Debrief RHMT Identify

additional

1. AWARENESS CREATION THROUGH:

Maternal and neonatal

1. Identify sites for implementation-based on availability of infrastructure-space, human

1. Implement KMC practice in selected sites.

2. Monitoring and supportive

1. Scale it up to all facilities

2. ANC to integrate KMC promotion into FANC

3. Continue monitoring

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champions Create demand

for the service among 5 practising hospitals through satisfied clients and health workers

2. DEVELOP REGIONAL STRATEGY FOR KMC IMPLEMENTATION TO BE ENDORSED BY Regional Dir. Health Services. All hospitals to

earmark space for KMC

Whole site sensitisation of all staff

Plan to Identify and train staff

Plan how to start implementation

And Support supervision

mortality conferences

Regional half year review meeting

Advocacy at district and sub district levels with relevant stakeholders

resource and material resource.

2. Mobilise resources for training

3. Carry out trainings.

supervision. 3. Evaluate the

programme

Regional maternal and newborn stakeholders meeting

and support supervision

4. Evaluation of programme

Greater Accra Region 1. Debriefing of Regional Health Management Team (RHMT).

2. Advocacy for KMC through stakeholders meeting to create awareness on the problems of the preterm neonate. (quasi government hospitals, private facilities, regional coordinating council, district assemblies,

1. Continue collection of baseline data.

2. Continue with advocacy programmes by placing KMC as a permanent agenda item on identified meetings and forums (midwives association, obstetrics, paediatric society of Ghana, clinical meetings) for

1. Continue with advocacy by gaining committed leadership across levels ( identify and use ‘champions’ or focal persons at all levels and especially in facilities earmarked for KMC implementation).

2. Decisions on initial orientation and training models to use( integration with

1. Business plans for the expansion process and for the maintenance of quality of LBW/preterm services at all levels ( including resource allocations from existing budgets)

2. Assess preparedness of individual healthcare facilities and health networks

1. Continuous advocacy programs.

2. Structured in-service training programs and refresher courses.

3. Monitoring and supervision.

4. Regular feedback on progress.

5. Annual performance reporting/review

6. Work on inclusion of KMC in pre-service training.

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social /community groups).

3. Create a Regional committee for New-Born Care.

4. Collecting baseline data on the facilities already practising KMC

5. Identify the facilities that can offer KMC.

6. Identify existing structures to harness for KMC implementation

regular reporting on progress.

3. Spell out and solicit the commitment required from leaders and managers at different levels in the region

4. Identify other commitments and support required (e.g. human resources, financial, capital/material).

5. Develop KMC guidelines or adapt existing newborn/LBW care guidelines to include KMC

6. Dialogue and flow of information between healthcare users, providers, and policy makers

other training programmes, temporary stand-alone sessions.

3. Decisions on an expansion programme with timeliness.

4. Define roles and responsibilities of different partners and role-players.

5. Training (pre- and in-service)

to implement KMC and sustain practice ( including referrals and follow ups).

3. Prepare and motivate health workers at facility level for compulsory activities, including job descriptions and performance agreements.

4. Communicate clearly KMC guidelines, including referrals to primary health care facilities and systems for follow up of babies.

5. Expansion of KMC programs to other facilities

Northern Region 1. Debrifing with RHMT and Tamale Teaching Hospital (3-7 August)

1. Debrief RCC, DHMT at mid-year review Presentation at Tamale Teaching Hospital review meeting (September)

2. Sensitization of opinion leaders, media, health workers, identify champions for KMC and newborn ambassadors

3. Formation of regional and district steering committees

1. Orientation/training of health workers

2. Assessment of all health facilities for preparedness to implement KMC

3. Organise both pre/inservice training students and staff

4. Adopt, Develop and deploy data capturing tool for reporting on KMC

5. Creation of KMC corners in facilities and designating them

1. Carry out KMC at selected facilities and report on activities monthly

2. Provide all the necessary commodities for KMC in all facilities

3. Ensure LBW/preterms go through all components of KMC

4. Document all activities on KMC and report

5. Organise review meetings on KMC and share best practices

1. Institute effective mechanisms for referral of sick ones to NICU centres

2. Documentation of activities and monthly data validation

3. Organise integrated supportive supervision at all levels

4. Provide monthly feedback and response on changes, outcomes and impact of KMC to all levels

5. Organise

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as such 6. Institute an award system for high performing facilities/staff

7. Carry out quarterly monitoring/ supportive supervision to lower levels

refresher/training for old and new staff respectively

6. Scale-up KMC to other facilities

7. All components of KMC integrated into service at Pre-natal, antenatal through to Post-Natal

8. Monthly, quarterly and annual monitoring of KMC activities at all levels Provide continuous refresher and training on the job for old staff and new staff

9. Organise annual performance reviews on KMC

Upper East Region 1. Review facility data on prematurity and high neonatal deaths.

2. Use existing fora to advocate for new born care issues:

3. Debrief RDHS and RHMT on August 3rd, Half year review 2015, Training sessions on LSS

4. Maternal and new born care training for midwives physician assistants and general nurses and community health nurses and officers

5. Advocacy programmes on Radio

1. Organise a stakeholder meeting on new born care

2. Identify champions in the community

3. Capture data on use of antepartum steroids

4. On the job coaching on use of steroids for preterm babies. Identify space for KMC

5. Whip up Staff commitment in newborn care/KMC

6. On the job coaching on the management of premature babies including KMC

1. Refurbish facilities for New born Care

2. Provide logistics and equipment

3. Whip up Staff commitment in the management including KMC

4. Training of staff 5. study tour for best

practises 6. Scale up

implementation in other health facilities

7. Monitoring and supervision of new born care activities in the region

1. Perform and evaluation on the management of newborns/KMC in the region

2. Organise review meetings on newborn care/KMC

3. Monitoring and supervision of newborn care activities

1. Set up a resource center for newborn care/KMC

2. Scale up KMC in other hospitals

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6. Sensitize RCC 7. Assess equipment

and commodities available for management for new born care

8. Identify Regional KMC trainers

9. Regional newborn care steering committee

7. Community sensitization

Upper West Region 1. Debrief all stakeholders(RHMT, RCC, maternity ward in charges, paediatric nurses, medical doctors, physician assistants, politicians, opinion leaders, media, religious leaders)

2. Collect baseline data on KMC/NICU activities

3. Develop and disseminate a uniform reporting format and a standard check list for monitoring and evaluation

4. Revamp the existing KMC centres

5. Mobilization of resources for service delivery

6. Follow up of KMC facility graduates at community levels by community health officers

1. Community sensitization on KMC

2. Refresher training for TOTs

3. Lobby for funds to support KMC services

4. Training of facility and community health care providers

5. Dialogue with community leaders on negative cultural practices

6. Identify maternal and newborn champions

7. Develop and circulate protocols to all facilities

8. Appeal for funds/support for KMC mothers

9. Strengthen existing referral systems

1. Organise facilitative supervision

2. Restructure maternity wards ie creation of space for KMC

3. Lobby for specialist ( paediatricians, obstetricians etc)

4. Procure basic equipment/logistics for maternal and new born care

5. Procure paediatric formulations of drugs at regional medical stores

6. Identify nurses for training in paediatric courses

7. Advocate for upgrading of certificate paediatric training to diploma

1. Collect data on first years implementation for analysis and evaluation

2. Feedback to higher and lower levels

3. Sponsor some nurses and doctors for specialization in paediatrics

4. Ensure all health facilities are actively practicing KMC

1. Refresher training of staff

2. Yearly assessment of the KMC programme.

3. Introduce an award system for KMC

4. KMC included in staff assessment

5. 2 days dedicated for KMC during the child survival week

6. Annual launching of KMC day

7. Advocate for the construction of mothers hostels in the hospitals.

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7. KMC awareness creation at all levels

Volta region 1. Debriefing, sensitization and awareness creation among key stakeholders RHMT, Facility heads during Half Year Review meeting

2. Radio Discussions 3. Baseline assessment

of newborn indicators to be used in creating awareness

4. Reactivation of newborn committee at the regional level

1. Continue awareness creation: community leaders and opinion leaders, Faith based organizations, professional associations, antenatal care

2. Radio Discussions on KMC on all Radio Stations in the region

3. Prepare to train staff on KMC

1. Creation of Newborn care teams at all levels

2. Pilot KMC in the regional hospital and 3 other selected hospitals(North-Krachi, Central-Hohoe, South-Keta)

3. Training and orientation of staff on KMC (PATH, Systems for Health)

4. Institute referral guidelines for new born

5. Develop regional guidelines for new born deaths audits

6. Develop and disseminate guidelines on KMC

1. Analyse and disseminate results of KMC

2. Scale up implementation of KMC to other Hospitals in the region

3. Provide supportive supervision, mentoring etc.

4. Refresher Training

1. Integration and sustainability of KMC

2. Building capacity of data collectors

3. Quarterly Data Quality Audit

4. Creating a regular feedback system on KMC

5. Creation of thematic areas on KMC in the health facilities as a peer review checklist

6. Continue training of new staffs and champions on KMC

Western Region 1. Debrief Management - Sensitization during Half year review

2. Formation of regional steering committee

3. Sensitization of stakeholders and media

1. Region will facilitate the formation of steering committees and stakeholders at the district level

2. Facility assessment for KMC readiness

3. Development of regional KMC protocol, policy guideline, data collection tools

4. Train facility teams on KMC

5. Radio discussion on KMC

6. Identification of KMC champions

1. Implementation of KMC in selected facilities

2. Monitoring and supportive visits to KMC facilities

1. Evaluation of KMC facilities

2. Hold stakeholder meeting to share experience and successes.

3. Roll-out KMC throughout the region

1. Monitoring and supportive visits to KMC facilities

2. Review meeting on KMC implementation

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ANNEX 8: Agenda for the meeting

Born Too Soon, Born Too Small: Help Us Live! Accelerating Quality Health Care Services for preterm/low birth weight newborns in Ghana

Executive Forum

July 28, 2015

Objectives of Forum

Objectives of this forum:

1. To raise awareness about the importance of improving care for preterm and low birth weight babies so that they survive and thrive

2. To advocate for resources to improve the care of preterm and low birth weight newborns along the continuum of care

3. Review progress on the implementation of the Newborn Health Strategy 2014 – 2018

8:00 am - 8:30 am Registration

8:30 am - 9:00am Opening prayer Introduction of Chairperson – Chairperson of the Parliamentary select committee on Health Introduction of Participants Chairperson’s Opening remarks

9:00am – 9:15am Welcome Address Speaker: Director General, GHS

9:15am – 9:35am

What’s happening with the preterm/low birth weight newborn in Ghana? Speaker: Dr. Gyikua Plange-Rhule (Paediatrician/Snr. Lecturer/Lawyer - KATH/School of Medical Sciences)

9:35am – 9:55am Keynote address by the Minister of Health

9:55am – 10:10am Statement from Partners Speakers: UNICEF, WHO, USAID, PATH

10:10am –10:30am The Newborn Strategy: Progress so far Speaker: Dr. Isabella Sagoe-Moses (National Child Health Coordinator – GHS)

10:30am– 11:05am

Investing in Newborn Health: The Case for the Preterm and LBW baby & Call for support Speakers: Dr. Yaa Adoma Fokuo (Paediatrician-Dormaa-Ahenkro), Dr. Linda Vanotoo (Regional Director of Health-Greater Accra Region)

11:05am– 11:30am

Message from Newborn Champions:

Hon. Mavis Ama Frimpong, Deputy Regional Minister, Eastern Region

Dr. Gifty Anti, CEO of GDA Concepts and Hostess of “The Standpoint”

11:30am – 11:40am Statement by HE Ambassador to Columbia

11:40am -11:55am Open Forum

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11:55am– 12:00pm Vote of thanks Speaker: Mrs. Christiana Annoh

11:40 am – 12:10 pm COCOA BREAK/END

Introduction to the Technical Session Session 1 - The Newborn Strategy: Programmes and Achievements

Chairperson: Dr. Linda Vanotoo

12:10pm-12:20pm Objectives and agenda for the Newborn Stakeholders Meeting Speaker: Dr. Cynthia Bannerman

12:20pm -12:40pm Proven key interventions for improving quality of newborn care Speaker: Dr. Hari Banskota

12:40pm – 1:00pm Evidence-based newborn care in Ghana: lessons from a research institution Speaker: Dr. Cheryl Moyer

1:00pm – 1:20pm Discussion

1:20pm -2:20pm LUNCH

2:20pm – 3:50pm

Panel discussion: Newborn Health Strategy - Summary of Achievements at the district and regional level 2014-2015 (4 panelists) Panelists: Representatives from Upper East region (HBPNC), Brong-Ahafo region (QI), Health Reasearch Unit-GHS (Continuum of care), Eastern region (Community initiatives) 5 min per presentation

3:50pm – 4:00pm Wrap up

4:00pm Closing prayer: Patience Dapaah End of day 1

4th Annual Newborn Stakeholders’ Meeting

Born Too Soon, Born Too Small, Help Us Live! Technical session

29th to 30th July, 2015

Accra, Ghana

Objectives of meeting

o Highlight evidence based interventions related to the care of the preterm and low birth weight newborn

along the continuum of care

o Standardize KMC and set the stage for strengthening and scaling up KMC in Ghana

o Share best practices and lessons learned from the above strategies and interventions related to KMC and

care of the preterm/low birth weight newborn

84

o Develop annual national and regional action plans with timeframe and available resources for accelerating

KMC in Ghana

8:00 am – 8:30 am Registration

8:30 am – 8:35 am Opening prayer

Session 2: Implementation of evidence based interventions related to care of preterm and low birth weight newborns within RMNCH strategy Chairperson: Prof. Bamenla Goka

8:35 am – 8:55 am Antepartum and intrapartum care Speaker: Dr. Michael Yeboah (Obstetrician Gynaecologist-KATH)

8:55 am – 9:20 am Essential and extra care for the preterm and low birth weight newborn Speaker: Dr. Mame Yaa Nyarko (Paediatrician-Princess Marie Louis Hosp., Accra)

9:20 am – 9:40 am Long term care and follow up of the preterm baby with complications Speaker: Dr. Bola Ozoya (Paediatrician-KBTH)

9:40 am – 10:00 am Psychosocial support for mothers and families of preterm/LBW newborns Speaker: Dr. Kwabena Kusi-Mensah (Resident Psychiatrist-KATH)

10:00am –10:20 am Discussion

10:20am –10:40 am BREAK

Session 3: Understanding Kangaroo Mother Care: history, definition, evidence and programmatic approaches

Chairperson: Dr. Gyikua Plange-Rhule

10:40am - 11:00 am Context and History of KMC

Speaker: Dr. Goldy Mazia (PATH)

11:00am –11:20 am Current KMC landscape: definition and evidence

Speaker: Dr. Naana Wireko-Brobby (Paediatrician-KATH)

11:20am – 11:40pm Programmatic approaches to KMC introduction and expansion

Speaker: Dr. Anne-Marie Bergh (Medical Research Council Unit for Maternal and Infant

Health Care Strategies, South Africa)

11:40am – 12:00pm Discussion

Session 4: KMC experience and implementation in Ghana

Chairperson: Dr. Kwasi Yeboah-Awudzi

12:00pm – 12:15pm Facility based experiences in KMC implementation: perspectives from KBTH Speaker: Dr. Joan Woode (Paediatrician-KBTH)

12:15pm – 12:30pm Facility based experiences in KMC implementation: perspectives from KATH Speaker: Mrs. Christina Acquah (Senior Nursing Officer-KATH)

12:30pm – 12:50pm

Facility based experiences in KMC implementation: A Regional/District hospital’s perspective Speakers: Dr. Rita Fosu-Yeboah (Paediatrician-KSH) & Ms. Abenaa Akuamoa-Boateng (Director –Women’s Health to Wealth)

12:50pm – 1:00pm A parent’s experience with KMC Speakers: Mr. & Mrs. Sackey

13:00pm – 13:20pm Discussion

85

13:20pm – 14:20pm LUNCH

14:20pm – 14:35pm Introduction to group work Speaker: Dr. Anne-Marie Bergh

14:35pm – 15:45pm BREAK and Regional Group Work: Discuss bottlenecks, barriers and possible solutions for implementation of KMC in your respective regions

15:45pm – 16:45pm Presentations by 4 regions (Presentation: 10 min, Discussion: 5 min)

16:45pm Closing prayer END OF DAY 2

DAY 3 July 30, 2015

Session 5: Kangaroo Mother Care Implementation – key recommendations Chairperson: Dr. Anne-Marie Bergh

8:30 am -8:40 am Opening prayer

Video on KMC

8:40 am – 8:50 am Introduction to group work

Speaker: Dr. Anne-Marie Bergh

8:50am – 9:10am Key recommendations for KMC implementation in facilities

Speaker: Dr. Priscilla Wobil (Paediatrician-KATH)

9:10 am – 11:00am BREAK and Regional Group Work: Regional Group Work on Newborn Care action plans and KMC Implementation Plans

Session 6: Regional Newborn care action plans/KMC Implementation Plan Presentations Chairpersons: Dr. Abraham Hodgson, Dr. Edward Antwi

11:00am – 11:30pm National and Discussion – (10 minutes)

11:30pm – 12:00pm 2 Regions and Discussions - (10 minutes each)

12:00pm – 12:30pm 2 Regions and Discussions - (10 minutes each)

12:30 pm – 13:00 pm 2 Regions and Discussions - (10 minutes each)

13:00pm – 13:10pm Chairperson’s closing remarks

13:10pm – 13:15pm Closing prayer/END

13:15pm LUNCH

86

ANNEX 9: Participants list Speakers and Chairpersons

Hon. Alex Segbefia

Minister for Health, Ghana

Dr. Patrick Aboagye

Director Family Health Division, GHS

Dr. Victor Ngongala

UNICEF

Dr. Isabella Sagoe-Moses

National Child Health Coordinator

Dr. Hari Banskota

UNICEF

Dr. Gyikua Plange-Rhule

Paediatrician/Senior Lecturer/Lawyer

SMS-KNUST/KATH

Dr. Anne-Marie Bergh

MRC Unit, South Africa

Dr. Adoma Dwomo-Fokuo

Paediatrician-Dormaa Presbyterian

Hospital

Dr. Cheryl Moyer

University of Michigan/Navrongo

Health Research Centre

Dr. Cynthia Bannerman

Institutional Care Division, GHS

Prof. Bamenla Goka

Paediatrician, University of Ghana

Medical School/KBTH

Dr. Linda Vanotoo

Regional Director of Health Services-

Greater Accra Region

Dr. Mame Yaa Nyarko

Paediatrician, Princess Marie Louis

Hospital, Greater Accra Region

Dr. Yeboah-Awudzi

Kumasi Metropolitan Health

Director, Ashanti Region

Dr. Goldy Mazia

PATH

Dr. Rita Fosu-Yeboah

Paediatrician/Newborn Focal person-

Ashanti Region

Dr. Kwabena Kusi-Mensah

Chief Resident Psychiatrist, KATH

Dr. Paulina Appiah

Paediatrician/Newborn Coordinator,

Brong-Ahafo Region

Dr. Michael Yeboah

Obstetrician Gynaecologist, KATH

Dr. Joan Woode

Paediatrician, KBTH

Dr. Bola Ozoya

Paediatrician, KBTH

Mrs. Christina Acquah

Senior Nursing Officer, KATH

Dr. Abraham Hodgson

Director- Research Division, GHS

Dr. Naana Wireko-Brobby

Paediatrician, KATH

Dr. Priscilla Wobil

Paediatrician-KATH/National

Consultant for the Newborn

Stakeholder’s Meeting

Abenaa Akuamoah Boateng

CEO-Women’s Health to wealth

Dr. Edward Antwi

GHS Headquarters

Mr. & Mrs. Sackey

KMC Parents

Ministries

Tony Goodman Dr. Maureen Martey Pearl Akpene Sah

87

Ministry of Health Ministry of Health Ministry of Gender, Children and

Social Protection

Mary Mpeseh

National Development Planning

Commission

Eugenia Donkoh

National Development Planning

Commission

W. Okai

Department of Social Welfare, Accra

Partners

Suzanne Dawson

PATH

Josephine Agborson

UNICEF

Dr. Patience Cofie

PATH

Dr. Amanua Chinbuah

PATH

Magdalena Serpa

PATH

Salimatu Futa

USAID

Felicia Mahama

UNICEF

Monica Arach

UNICEF

Theodocia Ofosu-Appiah

UNICEF

Surani Abeyesekera

UNICEF

Ly Nguyen

CIFF

Giada Namer

Eni Foundation

Sora Kim

UNICEF

Gloria Obeng-Amoako

UNICEF

Evelyn Aryeetey

PATH

Nora Maresh

USAID

Offeibea Baddoo

UNICEF

Daniel Yayemain

UNICEF

Patience Dapaah

PATH

Williams Kwavah

PATH

Imran Ravji

UNICEF

Roseline Doe

WHO

Theresah B. Nobiya

Systems For Health

Hon. Mavis Frimpong

Deputy Minister - Eastern

Region/Newborn Ambassador

H.E. Claudia Turbay

Colombian Ambassador to Ghana

Elsie Nkrumah

eni Foundation

Gifty Anti

GDA Concepts/Newborn Ambassador

Erica Thomas

Jhpiego TZ

Kota Yoshifuji

JICA

Linda Weisert

CIFF

Theresa Babero

Systems for Health

Papa Coleman

Fidelity Bank

Agyekum Oti Enoch

JICA

Ghana Health Service - Headquarters

Dr. Gloria Quansah-Asare Gladys Brew Gladys S. Owusu

88

Deputy Director GHS Family Health Division – GHS Family Health Division-GHS

Dr. Rhoda Manu

Family Health Division – GHS

Emmanuel Ayire Adongo


Dr. Anthony Ofosu

GHS-PPME

Doris Amarteyfio


Eunice Sackey

Family Health Division-GHS

Dr. Samuel Kaba

GHS-Headquarters

Claudette Gogo

Family Health Division-GHS

Christiana Akuffo

GHS-Headquarters

Ebenezer Aman

GHS-Headquarters

Eleanor Sey

GHS-Headquarters

Beatrice Heymann

GHS-PPME

Fidel Leviel


Uzoma Tetteh

GHS-Headquarters

Ashanti Region

Rita Anafo

Public Health Nurse, GHS – Ashanti

Region

Beatrice Appah

Public Health Nurse, GHS –

Ashanti Region

Jennifer Marfo

Pharmacist, GHS - Ashanti Region

Dr. Alex Osei-Akoto

Paediatrician/Senior Lecturer

SMS-KNUST/KATH

Mary P. Bazaabon

Deputy Director of Nursing

Services, GHS-Ashanti Region

Dr. Alexis Nangbeifubah

Regional Director of Health Services,

Ashanti Region

Brong-Ahafo Region

Dr. Jacqueline G. Asibey

Paediatrician, Holy Family Hospital,

Brong-Ahafo Region

Dr. Joselyn Aware

Senior Medical Officer, Regional

Hospital-Sunyani, Brong-Ahafo

Region

Dr. Kofi Amo-Kodieh

Deputy Director of Clinical Care, Brong-

Ahafo Region

Central Region

Nancy Ekyem

Deputy Director of Health Services,

Central Region

Dr. Dzodiegbe Apetorgbor

Medical Superintendent, Central

Region

Dr. Kwaku Karikari

Deputy Director of Public Health,

Central Region

Margaret Forson

Deputy Director of Nursing Services

(PH), Central Region

Dr. Stephen Anyomi

Deputy Director of Clinical Care,

Central Region

Dr. Samuel Kwashie


Central Region

Eastern Region

89

Ellen D. Asare


(PH), Eastern Region

Margaret O. Adufu


Services (PH), Eastern Region

Nana Yaa Konadu

Deputy Newborn Coordinator, Eastern

Region

Dr. Brainard Asare


Eastern Region

Dr. Emmanuel Amoah

Paediatrician/Newborn Focal

person, Eastern Region

Dr. Charity Sarpong


Eastern Region


Dr. Juliana Ameh

Paediatrician/Medical Superintendent,

Lekma Hospital, Greater Accra Region

Sarah Amissah Bamfo



Dr. Nana Ama Adjabeng

Newborn Focal person, Greater Accra

Region

Comfort Kwegyir-Aggrey

Public Health Nurse, Greater Accra

Region

Dr. Hilary Andoh

Paediatrician, Ridge Regional

Hospital, Greater Accra Region

Northern Region

Denisia Agong


Northern Region

Abiba Amadu


Services (PH), Northern Region

Dr. Alhassan A. Mumin

Paediatrician, Tamale Teaching

Hospital, Northern Region

Sylvia P. Adzitey

Nurse, Tamale Teaching Hospital,

Northern Region

Dr. Sarkodie Jo


Northern Region

Billah Kombian

Deputy Director of Nursing Services,

Northern Region

Habiba Lawal

Nurse, Tamale Teaching Hospital,

Northern Region

Owusu Ansah Theophilus


Northern Region

Dr. Jacob Mahama


Northern Region

Upper West Region

Dr. Winfred Ofosu

Deputy Director of Public Health, Upper

West Region

Dr. Abdullai Forgor

Regional Director of Health

Services, Upper West Region

Sophia Nyireh


(PH), Upper West Region

Sumbu Theresa

Nurse, Upper West Region

Dr. Wodah-Seme

Medical Superintendent, Jirapa,

Upper West Region

Townson Ansah

Deputy Director Clinical Care, Upper

West Region

Volta Region

90

Robert Adabo

Deputy Director of Clinical Care, Volta

Region

Dr. Lord Mensah

Newborn Focal Person, Volta

Region

Perfect Titiati

Quality Improvement Coordinator,

Volta Region

Livingston Asem

Regional Health Nurse, Volta Region

Western Region

Sabina V. Bonney

GHS, Western Region

Isaac Kwarkye

GHS, Western Region

Dr. John Eghan

GHS, Western Region

Joyce K. Bagina

GHS, Western Region

Dr. Atsu Dodor

Deputy Director Clinical Care,

Western Region

Emmanuel Affelkum

GHS, Western Region

Upper East Region

Kwame Bimpeh

GHS, Upper East Region

Dr. Joseph Opare

Deputy Director Public Health,

Upper East Region

Dr. R. Atobra

Medical Superintendent, Upper East

Region

Rofina Asunu

Deputy Director of Nursing Services,

Upper East Region

Dr. Bogee Cullien

Medical Officer, Upper East

Region

Vida A. Abaseka

Community Health Officer, Upper East

Region

Quasi Government Hospitals

Dr. Marian Tetteh-Korboe

Paediatrician, Police Hospital, Accra

Dr. Nicholas Kyei, RCH

Coordinator, Military Hospital,

Accra

Media Groups

Ghana Broadcasting Corporation Radio Daily Guide The Punch

Junior Graphic Vanguard Public Agenda

Trend Africa Dep. News Ghanaian Times Ghana Television

TV3 Mercury FM Radio Gold

Public Agenda

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ANNEX 10: References 1. WHO, UNICEF. Every Newborn: an action plan to end preventable deaths. Geneva: World Health Organisation. 2014. 2. Lawn JE, Kinney MV, Belizan JM, Mason EM, McDougall L, Larson J, et al. Born too soon: accelerating actions for prevention and care of 15 million newborns born too soon. Reprod Health. 2013;10 Suppl 1:S6. 3. Lawn JE, Davidge R, Paul VK, von Xylander S, de Graft Johnson J, Costello A, et al. Born too soon: care for the preterm baby. Reprod Health. 2013;10 Suppl 1:S5. 4. Ministry of Health Ghana. Ghana National Newborn Health Strategy and Action Plan 2014-2018. Accra: Ministry of Health 2014. 5. Engmann C, Wall S, Darmstadt G, Valsangkar B, Claeson M. Consensus on kangaroo mother care acceleration. Lancet. 2013 Nov 30;382(9907):e26-27. 6. March of Dimes, PMNCH, Save the Children, WHO. Born Too Soon: the global action report on preterm births. Geneva: WHO 2012. 7. Ghana Statistical Service. Ghana Demographic Health Survey 2014. Accra 2015 [cited 21 August 2015]; Available from: http://www.statsghana.gov.gh/docfiles/publications/Ghana%20DHS%202014%20-%20KIR%20-%206%20April%202015.pdf. 8. Howson CP, Kinney MV, McDougall L, Lawn JE. Born too soon: preterm birth matters. Reprod Health. 2013;10 Suppl 1:S1. 9. Blencowe H, Cousens S, Chou D, Oestergaard M, Say L, Moller AB, et al. Born too soon: the global epidemiology of 15 million preterm births. Reprod Health. 2013;10 Suppl 1:S2. 10. Mamaye Evidence for Action. Factsheet on preterm birth in Ghana [website]. Accra: Mamaye; 2014 [cited 21 August 2015]; Available from: http://www.mamaye.org.gh/sites/default/files/evidence/GH%20preterm%20birth%202014%20factsheet.pdf. 11. Manu AT, C. Owusu-Agyei, S. Hill, Z. Kirkwood, B. Edmond, K. Bazzano, A. Adongo, P., editor. Final Report of the NEWHINTS Formative Research Intervention Development Workshop; 2007 21-23 February; Accra. 12. Yinger NV. Ransom E. Why invest in newborn health? Policy Perspectives on Newborn Health. Washington DC 2003. 13. Maternal Newborn and Child Health Network for Asia and the Pacific. Investing in maternal, newborn and child health: The case for Asia and the Pacific. Geneva: World Health Organisation; 2009 [cited 14 June 2015]. 14. Engmann C, Walega P, Aborigo RA, Adongo P, Moyer CA, Lavasani L, et al. Stillbirths and early neonatal mortality in rural Northern Ghana. Trop Med Int Health. 2012 Mar;17(3):272-282. 15. Moyer CA, Aborigo RA, Logonia G, Affah G, Rominski S, Adongo PB, et al. Clean delivery practices in rural northern Ghana: a qualitative study of community and provider knowledge, attitudes, and beliefs. BMC Pregnancy Childbirth. 2012;12:50. 16. Aborigo RA, Moyer CA, Rominski S, Adongo P, Williams J, Logonia G, et al. Infant nutrition in the first seven days of life in rural northern Ghana. BMC Pregnancy Childbirth. 2012;12:76. 17. Moyer CA, Adongo PB, Aborigo RA, Hodgson A, Engmann CM. 'They treat you like you are not a human being': maltreatment during labour and delivery in rural northern Ghana. Midwifery. 2014 Feb;30(2):262-268. 18. Aborigo RA, Moyer CA, Gupta M, Adongo PB, Williams J, Hodgson A, et al. Obstetric danger signs and factors affecting health seeking behaviour among the Kassena-Nankani of Northern Ghana: a qualitative study. African journal of reproductive health. 2014 Sep;18(3):78-86.

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http://www.statsghana.gov.gh/docfiles/publications/Ghana%20DHS%202014%20-%20KIR%20-%206%20April%202015.pdf

http://www.mamaye.org.gh/sites/default/files/evidence/GH%20preterm%20birth%202014%20factsheet.pdf

http://www.mamaye.org.gh/sites/default/files/evidence/GH%20preterm%20birth%202014%20factsheet.pdf

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19. Hill E, Hess R, Aborigo R, Adongo P, Hodgson A, Engmann C, et al. "I don't know anything about their culture": the disconnect between allopathic and traditional maternity care providers in rural northern Ghana. African Journal of Reproductive Health. 2014 Jun;18(2):36-45. 20. Kikuchi K, Ansah E, Hodgson A, Shibanuma A, Gyapong M, Owusu-Agyei S, et al. Ghana's Ensure Mothers and Babies Regular Access to Care (EMBRACE) program: study protocol for a cluster randomized controlled trial. Trials. 2015;16:22. 21. Romero R, Nicolaides K, Conde-Agudelo A, Tabor A, O'Brien JM, Cetingoz E, et al. Vaginal progesterone in women with an asymptomatic sonographic short cervix in the midtrimester decreases preterm delivery and neonatal morbidity: a systematic review and metaanalysis of individual patient data. Am J Obstet Gynecol. 2012 Feb;206(2):124 e121-119. 22. Conde-Agudelo A, Romero R, Nicolaides K, Chaiworapongsa T, O'Brien JM, Cetingoz E, et al. Vaginal progesterone vs. cervical cerclage for the prevention of preterm birth in women with a sonographic short cervix, previous preterm birth, and singleton gestation: a systematic review and indirect comparison metaanalysis. Am J Obstet Gynecol. 2013 Jan;208(1):42 e41-42 e18. 23. Chatterjee J, Gullam J, Vatish M, Thornton S. The management of preterm labour. Arch Dis Child Fetal Neonatal Ed. 2007 Mar;92(2):F88-93. 24. Mwansa-Kambafwile J, Cousens S, Hansen T, Lawn JE. Antenatal steroids in preterm labour for the prevention of neonatal deaths due to complications of preterm birth. Int J Epidemiol. 2010 Apr;39 Suppl 1:i122-133. 25. Wilson-Costello DE, Hack, M. Follow-up for High Risk Neonates. In: Fletcher J, Shreiner J, Davis RE., editor. Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant. 7th ed. St Louis, Missouri: Mosby Inc; 2002. p. 934-940. 26. Moddemann D, Shea S. The developmental paediatrician and neonatal follow-up. Paediatr Child Health. 2006 May;11(5):295. 27. Guo N, Bindt C, Te Bonle M, Appiah-Poku J, Tomori C, Hinz R, et al. Mental health related determinants of parenting stress among urban mothers of young children--results from a birth-cohort study in Ghana and Cote d'Ivoire. BMC Psychiatry. 2014;14:156. 28. Schappin R, Wijnroks L, Uniken Venema MM, Jongmans MJ. Rethinking stress in parents of preterm infants: a meta-analysis. PLoS One. 2013;8(2):e54992. 29. Younger JB, Kendell MJ, Pickler RH. Mastery of stress in mothers of preterm infants. J Soc Pediatr Nurs. 1997 Jan-Mar;2(1):29-35. 30. Tessier R. Kangaroo care: a different way of nurturing preterm babies (a Colombian-Canadian collaboration changing the world's thinking about preterm care). Canada: Canadian Institutes of Health Research; 2012 [cited 21 August 2015]; Available from: http://www.cihr-irsc.gc.ca/e/46094.html. 31. World Health Organisation. Kangaroo Mother Care: a practical guide. Geneva: Department of Reproductive Health and Research 2003. 32. Conde-Agudelo A, Diaz-Rossello JL. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. The Cochrane Database of Systematic Reviews. 2014;4:CD002771. 33. Maternal and Child Health Integrated Program. Kangaroo Mother Care Implementation Guide. Washington DC 2012. 34. Schneider C, Charpak N, Ruiz-Pelaez JG, Tessier R. Cerebral motor function in very premature-at-birth adolescents: a brain stimulation exploration of kangaroo mother care effects. Acta Paediatr. 2012 Oct;101(10):1045-1053. 35. Nguah SB, Wobil PN, Obeng R, Yakubu A, Kerber KJ, Lawn JE, et al. Perception and practice of Kangaroo Mother Care after discharge from hospital in Kumasi, Ghana: A longitudinal study. BMC Pregnancy Childbirth. 2011;11:99-107.

http://www.cihr-irsc.gc.ca/e/46094.html

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NATIONAL NEWBORN STAKEHOLDERS MEETING stakeholders... · 4 ACKNOWLEGMENTS The Ministry of Health and Ghana Health Service acknowledge the financial and technical support received