Use of Smartphones

in BFHI Assessment in

Uganda

Onyango Gerald

IBFAN Uganda

Outline

– Background

– Objectives

– Findings

– Way Forward

Background

Baby Friendly Health Facility Initiative

– Is a global effort launched by WHO and UNICEF to implement practices that protect, promote and support breastfeeding

– Is a Quality Improvement (QI) and recognition program for maternity facilities that have created an optimal environment for appropriate infant feeding and mother-baby bonding.

Background

Internal Assessment

External Assessment

Re-Assessment

Self Assessment

BFHI Assessment Process

Background

SMARTPHONE

– A smartphone is a mobile phone with an advanced mobile operating system which combines features of a personal computer operating system with other features useful for mobile or handheld use

– Offer a hardware platform for various applications

– Data input or captured may be transmitted or shared in many ways (including SMS, MMS, USSD, Bluetooth, wireless Internet, or the exchange of physical memory cards)

– Where mobile connectivity is not available, data can be stored on the phone and transmitted later once a phone is within sufficient range of a cell tower

BackgroundINTRODUCTION

– With support from UNICEF, and the Ministry of Health, IBFAN Uganda is implementing a project whose aim is to “Empower Health Service Providers in 19 Districts of Uganda to give the best start in life to newborn babies”

– Districts of Focus are:

– Ibanda, Kiruhura, Kanungu, Lwengo, Kisoro, Rukungiri, Mitooma, Buhweju, Sheema, Pader, Lamwo, Nwoya, Gulu, Amuru, Agago, Gomba, Masaka, Kalungu and Butambala

– One of the expected outcomes was to conduct a baseline assessment on the current status of the Baby Friendly Health Facility Initiative (BFHI) in the above mentioned districts.

Assessment Objectives

– Assess efforts made by the Districts since the adoption of the BFHI package in Uganda

– Assess the capacity of the Health Facilities to implement and deliver BFHI results as per the Uganda 16 BFHI Requirements

– Identify community structures that can be avenues for supporting mothers/caretakers to optimally feed their infants and young children

– Assess community perception on maternity services provided in the health facilities

Methodology– Quantitative Data Collection

– Qualitative Data Collection– Focus Group Discussions

– Key Informant Interviews

– Health facilities offering maternity services targeted– Hospitals

– Health Centre IVs

– Health Centre IIIs

– All quantitative data collected was recorded on a smartphone using a questionnaire created using an open source application, Open Data Kit (ODK)

Why Use smartphone– Open Source software (ODK) available that

– Allows for Skip and Logic patterns

– Can be used where there is no mobile phone network (Offline)

– Easy compatibility with excel

– Smartphones provided rich media survey questions directly to respondents and helped guide the actions of ‘enumerators’ by presenting a user-friendly interface to help an enumerator input and transmit data in structured ways.

– Combined with the knowledge of well-trained supervisors and team leaders, mobile technology improved the quality of the data collected. The process of collecting and digitizing data right at the source made entry more efficient and cleaner, resulting in improved data quality

Findings

Efforts made by the Districts since the adoption of the BFHI package in Uganda

– There was a lack of awareness about the CODE and IYCF in some of the districts.

– Trainings on BFHI had been carried out in some districts. However, health workers who attend the trainings, more often than not, do not pass on the information gained to others

– Implementation of BFHI has been met with difficulties such as: lack of essential equipment and inadequate staffing in health facilities which hampered effective service delivery.

FindingsCapacity of Health Facilities to Implement BFHI

– Capacity to implement BFHI/IYCF in most of the districts assessed were generally low

– Although the IYCF policy guideline was disseminated in most Districts in Uganda, Key Informant interviews with majority of the district officials revealed lack of awareness and knowledge on the IYCF/BFHI policies, and CODE on the Regulation of Marketing of Breastmilk Substitutes (BMS).

– At the health facilities, majority of the health care staff were not trained in BFHI/IYCF

– Some facilities were using the old HMIS registers that do not capture some BFHI indicators

Findings

Community structures that can be avenues for supporting mothers/caretakers to optimally feed their infants and young children

– A few health facilities had mother support groups which are used as referral points to support mothers.

– However, there are other existing community structures/ groups (farmers’ groups, SACCOs, youth group, Mothers unions), which are spread out in communities, that health facilities ought to use to reach out to their members to widely sensitize community members IYCF

Findings

Community perception on maternity services provided in the health facilities of their vicinity

– Poor attitudes of health workers in some health facilities,

– Inadequate medical and maternity equipment,

– Health workers’ absenteeism and

– A belief that some health facilities do not have the capacity of providing maternity services to those communities which in turn make them shun from health facilities.

Way Forward

SMARTPHONE USAGE– Can be used in other aspects of BFHI implementation such as provision of Guidelines and

Protocols to Health workers

– CODE monitoring using the mobile data collection tools already available on the Code Implementation Centre Website

– Use during Self Appraisal, Internal Assessment, and External Assessment

– Mapping of BFHI Health Facilities

Way forwardTO THE DISTRICTS

– Build capacity of all health workers, in health facilities providing maternity services, to provide nutrition services and adequate IYCF information

– Orient district leadership on IYCF/BFHI policy guidelines and CODE

– Support District Nutrition Coordination Committees (DNCC) to conduct quarterly district review meetings to enable all district departments to be involved in IYCF

– Sensitize existing community structures such as SACCOs, family Support groups, farming groups, peer groups, mothers’ and fathers’ union, and youth groups to support mothers on optimal IYCF practices

– Promote and support community dialogues between health workers and the communities that they serve to improve the working relationship

Way ForwardHEALTH FACILITIES

– There’s need for on job mentorship on IYCF/BFHI for health workers using the quality improvement approach

– Health facilities should embrace use of the updated HMIS tools that capture more BFHI indicators

– Need to orient newly recruited staff on BFHI in all facilities through CMEs

– Health facility In-charges should ensure that health workers adhere to the duty rosters and provide timely services

– All health workers should be involved in the provision of IYCF/BFHI services

Thank You