Shahidullah: National Scaling Up of Helping Babies Breathe Initiatives in Bangladesh

7/28/2019 Shahidullah: National Scaling Up of Helping Babies Breathe Initiatives in Bangladesh

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National Scaling Up of Helping Babies Breathe Initiatives in

Bangladesh

Prof. Mohammad Shahidullah

Chairman Neonatology Department and Pro-Vice Chancellor,

Bangabandhu Sheikh Mujib Medical University (BSMMU)

Dhaka, Bangladesh


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Presentation Outline

Background National scale up strategy

Evaluation design

Results to date Quality improvement process

Plans for sustainability

Lessons learned


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Background:

Facts of Neonatal Health in Bangladesh

Delivery at health facility -29%

Delivery attended by a skilledprovider -32%

Neonatal death per year is79,000 *

Neonatal mortality rate:32/1000 live births

Neonatal deaths - 60% of all


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Causes of Newborn Mortality in Bangladesh

Data source: Bangladesh-specific mortality estimates (Liu et al. 2012).


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Background of National Scale-up of HBB in

Bangladesh

National Dissemination & Stakeholder Meeting Political leadership, commitment

2010 - HBB PilotStudy conducted

in Bangladesh

by BSMMU

Series of stakeholders consultation to

develop HBB Scale-up strategy

HBB

curriculum

Adaptation toincorporate

ENC and

translated in

Bangla


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National Scale-up PlanCapacity Building

Training on NB resuscitation including primary management of birth asphyxiaand basic ENC to all SBAs (from highest level service provider to communitylevel) of Bangladesh (public sector)

Equip all the facilities of public health sector and cSBAs with resuscitator(neonatal bag & mask with sucker)

Quality Assurance Supervision and monitoring of training

MIS system strengthening and evaluation of the HBB scale-up activities

Sustainability

Incorporate in National Health Sector Program

Incorporate HBB protocol in all relevant in-service and pre-servicecurriculum

Capacity building of the facilities for training & refreshers training

Routine refreshers training for retention of skills and utilization of the NBresuscitation capacity


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Background of National Scale-up of HBB in

Bangladesh


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MOH&FW (DGFP, DGHS)

Overall implementation TAX/VAT of offshore procurement

MCHIP/Save the Children Nationwide Implementation, supervision,

monitoring and Evaluation

Ensure Logistics

BSMMU Adaptation of training materials

Organize training in all level

Monitoring and supervision

UNICEF

Equipment for district implementingmaternal and NB projects,

Supervision and monitoring

ICDDRB Evaluation of HBB scale-up activities

HBB Scale-up Partners in Bangladesh

Funding Arrangement

MOH&FW (Cash and kind)

USAID through

MCHIP/Save the Children

UNICEF

Laerdal Foundation

through Save the Children


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2 days TOT in BSMMU Trainer return

and provide training to

district and upazila SBAs

Step-wise HBB scale-up plan

6 districts

TOT- Doctors from

Medical College Hosp (if any),District Hospital, District

Health and FP Office andUpazila Health Complexes

Each StepTotal 11 steps

7-8 batches

Medical College Hosp

30 doctors and 40 nurses District Hospital- 6-8 doctors and 10+ nurses

MCWC- all doctors and FWV

UHC- 5-7 Medical Officer and all Nurses

All FWVs and CSBAs

Training starts immediately after TOT


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Plan of System Evaluation of Scaling-up of HBB Interventionin Facility and Community Settings in Bangladesh

10


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Status of HBB Implementation - Training

Category ReceivedTraining

Percentage

Doctor 3570 23%

Nurse 4104 26%

Paramedics 3783 24%

CSBA 4080 26%

Total 15537 100%


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13

Training and equipping

Mannequin (NeoNatalie-Laerdal)

Resuscitator & Suction device

Use for trainingand refreshers

Kept in all facilities

from UHC and

above for refreshers

training

Provided to use for training

and refreshers

Provided to all

facilities &

CSBAs for newborn

resuscitation

.

Type ofFacilities

No.Facility

NeonatalieComplite

Bag & Muskwith Sucker

Medical

Colleges

Hospital

18 43 54

District

Hospital38 76 86

Maternal andChild Welfare

Center

40 80 80

Upazila Health

Complexes302 604 604

Union Health

and Family

Welfare Center

2372 - 2372

NGOs Facilities 69 70 123

Community

SBA- - 4380

Total 2839 873 7699


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Training and equipping

Action plan

for training andhanged in delivery sites of the

facilities

Flipchart- for training

and kept in facilities for

refreshers training

Learner Workbook-provided to all trainee


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Incorporation of HBB Protocol in DifferentCurriculum

HBB Scale-up plan have the component to incorporate theHBB protocol in all relevant pre-service and in-servicecurriculum.

Following curriculum already incorporated the HBB

protocol.1. MBBS Curriculum2. Diploma and Degree course of Nursing3. Midwifery Training Curriculum4. FWV training Curriculum5. Private Paramedics Training Curriculum6. CSBA Training Curriculum

Incorporated in Standard Operation Procedure for NewbornHealth Care in Primary and Secondary level facilities

In the process of incorporation in Maternal Health SOP


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National Level (DGHS, DGFP BSMMU and SC ) Joint monitoring visit and follow-up of divisional officials visit

Divisional Level Health and FP officials Usually 1 district/division in each phase, so feasible for divisional

level to organize monitoring visit

District Health and FP officials visit each batch as resourceperson

UHFPO/UFPO/RMO coordinate the training of theirupazila/facilities

MNCH, MNH, MNCS and MaMoni and other similar programproviding support for supervision and supervise in the projectarea

Standard checklist use for supervision and monitoring

Quality Improvement


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Quality Improvement (Cont.)

Supervision and monitoring of training 90% session are expected to be supervised/monitored by District

level DGHS and DGFP officials

83% sessions observed by district level Health/FP managers

50% sessions will be monitored /supervised by BSMMU officials Monitoring visits with checklist (219 out of 786 sessions) training- 28% of

sessions)

QA through direct observation of master trainers (159 out of 786 - 20% ofsessions)

15% sessions are expected to be supervised by national anddivisional level DGHS/DGFP official


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Quality Improvement- Refreshers training

StepsComplet

e

A. Prepares for birth

Identifies a helper

Prepares the area for delivery

Cleans hands

Prepares an area for ventilation

Checks equipments

B. Dries thoroughlyDries the baby thoroughly

Removes wet cloth

C. Clears airway and stimulates

reathing if baby is not crying*

Keeps warm

Positions head and clears airway

Stimulates breathing by rubbing the

ack

D. Ventilates with bag and mask if

aby is not breathing

Cuts cord and moves to area for

entilation

Apply the mask to make a firm seal

Starts ventilation within Golden

Minute

(started at _________ seconds)

Ventilates at 40 breaths/min (30-50

acceptable)

(_________breaths per minute)*

Looks for chest movement *

E. Improve ventilation if chest does

not move*

Head: reapply mask and reposition

head

Mouth: clear secretions and open the

mouth

Bag: squeezes the bag harder

Refreshers training introducedthrough routine system

SBA describe the experience ofresuscitation to others in themonthly meeting if any newbornwas resuscitated

1/3rd of SBAs practice with themanikins and bag & mask underobservation of their trainedsupervisor as a routine practice

The supervisors take brief testand record it in a card given

during training All SBA have to practice and

record his/her performance inthe record card by every 3rdmonth


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Plans for sustainability

HBB program incorporated in the Health Population Nutrition Sector

Development the Program (HPNSDP) 2011-2016 and its Operation Plans

(OP) of the MNC&AH (DGHS) and MCR&AH (DGFP)

Curriculums and Newborn SOP incorporated the protocol

Refreshers training introduced through routine system

Developing a video for refreshers training and distribution to all thefacilities are under way

Regular review meeting in directorates are going way.

MIS incorporation under process,

A Technical Sub-Committee on Finalization of Newborn Indicator havebeen formed and are working

DGFP is now piloting HBB related indicators

Surveillance activities are planned


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Lessons learned

Rapid scaling-up of an public health intervention becamepossible due to the-

Political Commitment

Systemic Cascade Approach

Technical Capacity

Partnership and

Fund Availability

Still the Challenges of HBB Scale-up are-

Retention of skill

Monitoring of implementation and outcome and linking with routine

system

Cleaning of the Equipment


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Sabina Yasmin with her baby who was

resuscitated with bag & mask on 23rd

November at Mohammadpur UHC.

Dr Subol Chandra Borman , RMOresuscitating a newborn baby at Jointapur

UHC on 7th December.

Shahidullah: National Scaling Up of Helping Babies Breathe Initiatives in Bangladesh

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