CONTRIBUTION TO SYSTEM STRENGTHENING THROUGH THE BABY FRIENDLY HEALTH FACILITY INITIATIVE

A CASE OF KITGUM DISTRICT

Ministry of Health

Presentation outline

• Introduction

• Situation Analysis snap shot

• System strengthening

• Health system opportunities to implement BFHI

• Linkage of IMCI, EMNoC, IYCF and eMTCT to BFHI

• Current status of implementation

• What lies ahead?

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Introduction• Women and children play a crucial role in

development. Therefore;

– Investing more in women’s and children’s health is notonly the right thing to do;

• it also builds stable, peaceful and productive societies.

• Yet;– Every year 9.2 million children in the world die before

their fifth birthday, as do

– more than half a million pregnant women.Source: Lancet

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Situation is not any different in Uganda

• Child mortality

– Under five mortality rate is 90 per 1,000 live births

– Infant mortality rate is 54 per 1,000 live births

• Maternal health

– Maternal mortality ratio is 438 per 100,000 live births

– Contraceptive prevalence rate is only 30.0%

– Antenatal care coverage: four or more visits by any provider47.6%

– Unmet need for family planning 34.3%Source: UDHS 20115/02/2013 4

How about Kitgum District

• The morbidity rate among children is at 66.9%

• 70.1% of the mothers exclusively breastfed

• 15% of newborns are never breastfed

• 27.2% of children in Kitgum are fully immunized

• Full ANC (4 visits) attendances, 12%Source: EAMNCH Baseline Report, 2011

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Kitgum situation cont.….

• 97.7% of health workers have no capacity to implement BFHI

• 68.8% have not received any mentoring

• Health facilities have no IEC materials on IYFC

– 5 health facilities have not maternity registers

• Low staffing levels

– Only 4 general doctors in the district

• Only 2 functional theatresSource: BFHI Baseline Draft Report 20135/02/2013 6

What have we not done right?

– How much time and resources do we spendinnovating knew interventions and systems?

– And what are our perceptions to the currentsystems?

How about strengthening the health

systems just like we do for our own

“body systems”!

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System strengthening

• Access, coverage, quality, or efficiency of interventions forimproved maternal and child health outcomes can beachieved if;– Initiatives and strategies that improves one or more of the

functions of the health system

– Look at the mothers and child as one• Integration of BFHI, IMCI, EMNoC, eMTCT among others

• In Uganda;– health-system strengthening activities are encouraging,

however focus and clarity are critical.

– System strengthening is apriority in The National health policy.

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Why health system strengthening for BFHI

• BFHI is framework to improve othersinterventions for the mothers and child

• BFHI requirements are based on strengtheninghealth system positive practices for sustainabilityof programs

• Provided an opportunity

for the system to be

evaluated

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Health system opportunities to implement BFHI

At National level (Ministry of Health)– Basing on lessons learnt from past experience of

implementing BFH

– Technical officers from Nutrition, Child Health, andReproductive Health divisions

– National materials (Training packages, IEC andsupervisory tools)

– Cluster meetings (MCH and Nutrition)

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Opportunities cont.…At Kitgum district

– Committed district leadership

– Established Health facilities(1 Government hospital,1 Non-for-profit hospital, 1 HC IV, 8HC IIIs and 10 HC IIs.)

– Human resource despite the low staffing levels

– Partners (NGO and Local government support)

– Community linkages

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“Mother-baby friendly” facility

(BFHI)

Requirements 1, 2,

EMNoC

(Goal-oriented

ANC, delivery in

facility)

IMCI

Vitamin A,

immunization, CHC

IYCF

Exclusive breastfeed,

positioning and

attachment

eMTCT

HIV and Infant Feeding

Requirement 9,

13

Requirements

14, 15, 16

Requirements

4, 5, 6, 8, 9, 11

Requirements 12,

3, 4, 7

Linkage of IMCI, EMNoC, IYCF and eMTCT to BFHI

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Current status of implementation

Orientation of the district on BFHI

• MoH contribution

– Pledged support to the district and provided platform for consultation and guidance

• Kitgum district contribution

– District informed and committed

– Identified officials to guide implementation in the district

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Status cont.….

Baseline study in the district

– District role

• Coordinated study especially communicating to health facilities

• Validating the data collected

• Key system findings

– Inadequate capacity to implement BFHI, IMCI and EMNoC

– Irregular and poor quality supervision

– Lack of equipment especially for resuscitation

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Status cont.….

Capacity building for Health workers on BFHI

– Technically guided by MoH officials

– District Trainer facilitated some sessions

– Over 60 health workers

trained

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What Lies Ahead?Build capacity ofhealth workers in; IMCI;

(47.7% not trained)

⁻ Using ICATT

EMNoC(81.8% not trained)

⁻ Helping Babies Breathe⁻ 47.9% of HW offer resuscitation⁻ Only 25% can confidently offer the service

⁻ Babies born too soon⁻ Only the hospitals have Special care units

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WHAT LIES AHEAD?

• Follow up of the trainees

– Assess uses of knowledge attained and address gaps

– Review actions plans developed

• Mentoring and coaching

– Learning sessions based on QI principles

• Self-appraisals

– Monthly reporting to the district

– Trying out mHealth approaches

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What lies ahead cont.…..

• Internal Assessment of the Health Facilities– MoH evaluating status of implementation

• Addressing gaps from Internal Assessment– Strengthening positive practices to address the gaps

• Community support group activity evaluation– Strengthening community linkages for improve maternal and

child health

• External Assessment of the Health Facilities– Accrediting facilities mother-baby friendly centers

• Quality check for sustainability– Assessing level of integration and developing plans for

sustainability

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Thank you

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